It is a fracture occurring in a bone weakened by some localized or generalized bony or systemic disease.
In such cases the bone fractures follow a trivial trauma or even occur spontaneously. On questioning, many patients admit of pain or discomfort in or around the affected bone for some time before the fracture.
Most common generalized / systemic cause.: osteoporosis Most common local cause - metastases to the bone
Localized Bone Disease
Osteloytic form of syphilitic infections
Chondroma, giant cell tumor, hemangimma
Primary : Osteosarcoma, Ewings sarcoma, solitary myeloma
In males : Lungs, prostate, kidney
In females : Breast, lungs, genitals, thyroid
Simple bone cyst (2'd most common cause)
Aneurysmal bone cyst
Monoostotic fibrous dysplasia
Bone atrophy and brittleness secondary to poliomyelitis, tabes dorsalis, irradiation etc.
Generalised Bone Disease
Acquired diffuse bone rarefaction
Diffuse metastatic carcinoma.
Polyosteotic fibrous dysplasia
Histiocytosis X Gaucher's disease Hand - schuller Christian disease
Lumbar and thoracic vertebrae
Fracture neck femur
Proximal femur / humerus
Relation to Age
Congenital bone disease
Infective bone disease
Adult and middle age Bone cyst
History of minimal trauma / spontaneous onset
H/o etiological condition / preexisting discomfort
Age of patient
Characteristic radiological features of etiology at fracture site or in other bones e.g. "moth eaten appearance" in multiple myeloma "soap bubble appearance" in giant cell tumor.
Diagnosis and simultaneous treatment of underlying cause if possible, should be aimed.
Assessment of the capacity of the fracture to unite based on underlying disease and thereby decide the protocol of management.
Fracture in generalised / metabolic bone diseases are expected to unite with prolonged conventional methods of treatment
Fracture at site of bone cyst / benign / primary bone malignancy also unites after treatment of tumor per se but is delayed.
Fracture in osteomyelitis bone requires continuous plaster or splint immobilization with systemic antibiotics and local measures to control infection. Still they may - fail to unite in some cases.
Fracture in metastatic bone lesions often fail to unite and aggressive therapy is primarily directed to such lessions.
Aims of treatment
Improve functional capacity and mobility
Facilitate nursing care
Conservative management : Splints / fraction
Use of methylmethacrylate bone cement
Prophylactic internal fixation and prophylactic joint replacement
Radiotherapy and chemotherapy