Pathological fractures |
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PATHOLOGICAL FRACTURES
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.
Causes
Most common generalized / systemic cause.: osteoporosis Most common local cause - metastases to the bone Localized Bone Disease
Infective
Pyogenic osteomyelitis Tuberculosis Osteloytic form of syphilitic infections
Neoplastic Benign : Chondroma, giant cell tumor, hemangimma
Malignant: Primary : Osteosarcoma, Ewings sarcoma, solitary myeloma Secondary (Metastatic) In males : Lungs, prostate, kidney In females : Breast, lungs, genitals, thyroid
Miscellaneous
Simple bone cyst (2'd most common cause) Aneurysmal bone cyst Monoostotic fibrous dysplasia Eosinophilic grannuloma Bone atrophy and brittleness secondary to poliomyelitis, tabes dorsalis, irradiation etc.
Generalised Bone Disease
Hereditary disorders Osteogenesis imperfecta Dyschondroplasia
Osteopetrosis Acquired diffuse bone rarefaction Senile osteoporosis Osteomalacia Parathyroid osteodystrophy Rickets Scurvy Uremia
Disseminated malignancy Multiple myeloma Diffuse metastatic carcinoma.
Miscellaneous Pagets disease Polyosteotic fibrous dysplasia Histiocytosis X Gaucher's disease Hand - schuller Christian disease
Common sites
Osteoporosis Lumbar and thoracic vertebrae Fracture neck femur CoIles' fracture
Metastasis Vertebrae Proximal femur / humerus Bone cyst Long bones Relation to Age
Young children Congenital bone disease Infective bone disease Adult and middle age Bone cyst Infections
Malignancy Old age Osteoporosis Malignancy
Diagnosis
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.
Management General principles 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
Relieve pain Improve functional capacity and mobility Facilitate nursing care Modalities
Conservative management : Splints / fraction Internal fixation Use of methylmethacrylate bone cement Prophylactic internal fixation and prophylactic joint replacement Radiotherapy and chemotherapy |