Shaft femoral fracture secondary to osteopathic manipulation: Case report and medico-legal implication

Background: People increasingly look for osteopathic practitioners due to musculoskeletal conditions, particularly for low back pain. Serious complications such as femur fractures are rare, and often depend on bone fragility due to osteoporosis or neoplastic involvement. Case report: We present a 43-year-old woman who suffered a femur fracture following osteopath manipulation at the lumbar and right thigh for low back pain of recent onset. The osteopath did not document informed consent disclosure and personal clinical history collection. After hospitalisation, the patient underwent synthesis with femoral nailing. Further investigations found secondary pelvic and spinal bones lesions of a breast cancer, 12 years after the treatment and out of follow-up. Discussion: In Italy, the osteopath is a health professional aimed at maintaining well-being through external manipulation. The osteopath must then document in writting the informative process concerning the osteopathic method and the related risks, as well as the subject's consent. Meanwhile, a preliminary pathological history collection and objective examination must be performed to exclude pathological conditions, otherwise to be referred to a physician for further assessment and management. Conclusions: The osteopath, who usually works as a self-insured free-lance professional, is called to inform the patient of the risks associated with manipulation and of alternative options, and to plan the care pathway after proper clinical assessment of the subject, by anticipating the possibility of further investigation by a physician.