+ Models MEDLEG-244; No. of Pages 3 Please cite this article in press as: Durão C, et al. Hip fracture in the unattended elderly — a solitary and agonizing death: A forensic case. La revue de médecine légale (2017), https://doi.org/10.1016/j.medleg.2017.10.041 CASE REPORT Hip fracture in the unattended elderly — a solitary and agonizing death: A forensic case C. Durão a,b, * , F. Pedrosa b , F. Curate c , E. Cunha c a Trauma and orthopaedics department, hospital Vila Franca de Xira, Lisbon, Portugal b National institute of legal medicine and forensic sciences, Lisbon, Portugal c Laboratory of forensic anthropology, department of life sciences, university of Coimbra, Coimbra, Portugal KEYWORDS Osteoporotic fractures; Hip fracture; Elderly neglect; Unattended elderly Summary Proximal femur fractures in the elderly are associated with high morbidity and mortality. This case concerns to a forensic case of an unassisted elderly found dead in his residence. The body was already decomposing and was found lying on the ground near the overturned furniture, reminiscent of a crime scene. The autopsy revealed that the cause of death was related to a trochanteric fracture. Falls in the elderly cannot be ignored, and measures to prevent them should be adopted. This paper alerts for the deadly complications of fracture amongst older adults that live alone and raises awareness to the correct completion of death certificates that usually ignore and underreport hip fractures. Published by Elsevier Masson SAS. Introduction The demographic profile of the Portuguese population was radically transformed in the past 50 years, with a substantial increase of elderly (> 65 years) individuals — from 9.7% of the population in 1970 to 20.3% in 2014 [1]. Although the full magnitude of elderly neglect is still undetermined [2], the abandonment of older adults in Portugal is a major social concern [3]. The geriatric community in Portugal faces increased helplessness when compared to individuals from the same age group in other European countries, including lower retirement pensions, higher risk of poverty and unem- ployment, lower levels of education, and substandard access to healthcare, long-term care services or transporta- tion [2—4]. Also, comorbidities associated with older age, such as diabetes, atherosclerosis and osteoporosis, play a great role in the alarming condition of vulnerability that affects a sizeable number of Portuguese older adults. Hip fractures prevail as an important public health concern, due to the associated burden of disability and excess mortality [5—7], being particularly momentous in the unat- tended or the poverty-stricken elderly. The aim of this case report is to present a fracture of the proximal femur that probably elicited the death of an older adult male living alone. Case report In this work, we present a forensic case of an individual who was autopsied. It concerns debilitated 87-year-old man, La revue de médecine légale (2017) xxx, xxx—xxx * Corresponding author at: Hospital Vila Franca Xira, Estrada Nacional no. 1, Povos, 2600-009 Vila Franca de Xira, Lisboa, Portugal. E-mail address: drcarlosdurao@hotmail.com (C. Durão). Available online at ScienceDirect www.sciencedirect.com https://doi.org/10.1016/j.medleg.2017.10.041 1878-6529/Published by Elsevier Masson SAS.