Spontaneous fractures in the differential diagnosis of fractures in children.

A four-year-old male with cerebral palsy and spasticity, as a result of a non-accidental head injury sustained when he was two years old, died of pneumonia. Postmortem full body X-rays revealed fractures of varying ages of the left humerus and both femora, tibiae, and fibulae. This led to a thorough investigation of the case by the Office of the Chief Medical Examiner. Child abuse, accidents, metabolic bone disorders, other primary or secondary diseases of the bones, and pathological fractures were ruled out. The final diagnosis was spontaneous fractures secondary to osteopenia. The term spontaneous fractures is used to define fractures that occur without any known external cause, especially in cerebral palsy patients with spasticity.