Your 12-year-old son is walking to school and trips as he’s crossing the street. He jumps up, hoping that nobody saw his graceful nose-dive, and continues on his way. Your 78-year-old father trips over the hose while watering his garden, and is unable to get back up. One sustains a bruised ego and the other a fractured femur. Why is such a benign fall resulting in a fracture?
A pathological fracture occurs as the result of an underlying disease — as opposed to direct physical trauma or impact. In fact, most pathological fractures occur from low-energy injuries that wouldn’t ordinarily lead to a broken bone in most people. A significant loss in bone density due to the development of osteoporosis is most frequently to blame. Osteoporosis affects 55 percent of people aged 50 and above, and 80 percent of those are women. However, there are many other conditions that can lead to a pathological fracture.
Medicare considers every fracture a traumatic fracture, unless told otherwise. Essentially, unless documented, they don’t differentiate the etiologies of the fractures of a young man skateboarding into a parked car, and the older woman who hears a “pop” as she’s walking upstairs.
What is the takeaway? If your patient’s “trauma” wouldn’t fracture a healthy bone, and you suspect that it may be pathological, please include that information in your progress note!