Pathological fracture, this time I will discuss the pathological fracture. What is the purpose of pathological fracture? Pathological fracture a bone breaks Pls Occurs in an area That Is Weakened by another disease process. Causes of Weakened bone include tumors, infection, and Certain inherited bone disorders. There are dozens of diseases and conditions That can lead to a pathologic fracture.
Prevention is important for a variety of reasons, not the least of which is the avoidance of pain and decreased mobility. However, for those who may be at increased risk, taking a proactive approach to reduce the likelihood of a pathological fracture occurring also translates to fewer surgical interventions and lengthy hospital stays. Regular screening for patients who present one of the previously mentioned risk factors is recommended, particularly if there is reason to suspect skeletal lesions.
In assessing the local site of a pathological fracture:
- Ensure that the skin is intact and that there is no evidence of distal neurovascular impairment. Open pathologic fractures and pathologic fractures with neurovascular impairment are rare because these are generally not high-energy injuries.
- Evaluate the stability of the fracture.
- Determine the extent of physiological impairment caused by the injury. Evidence of articular involvement should be evaluated, especially in pathologic fractures occurring through aggressive or malignant primary tumor, which commonly effect the epiphyseal-metaphyseal portion of the bone. As a result, they more commonly affect the joint than metastatic pathologic fractures.
- Complete a general examination in older patients. If there is no known primary malignancy elsewhere, the common sites of tumors that metastasize to bone should be evaluated (thyroid, breast, lungs, kidney and prostate). Evidence of widespread metastases should be assessed by examining for hepatic or splenic enlargement, CNS signs, and changes of pulmonary osteoarthropathy.
In discussing investigations of pathological fractures, it is also necessary to describe management goals since in many cases, biopsy of the pathological fracture is combined with stabilization of the fracture. However, appropriate investigation should precede surgery.
- Order routine blood work, including complete blood count, erythro sedimentation rate, (CBC, ESR, Ca2+, PO4, alkaline phosphatase, serum immune electrophoresis, and PSA) if there is no known primary cancer in an adult patient.
- Obtain liver function and coagulation tests in a patient expected to have surgery.
- Obtain a total body bone scan to identify wide spread bony metastases if there is no known primary cancer and the patient is not confined to traction as a result of an unstable lower extremity fracture
- Order chest CT, mammogram, and abdominal ultrasound or CT as appropriate to evaluate the patient for an occult primary cancer. If the patient is known to have metastatic bony disease, routine and flexion/extension views of the cervical spine are necessary prior to intubation.
- Obtain plain radiographs. The interpretation of the radiographic features of the underlying lesion that caused the fracture is critical to the diagnosis of the condition and planning of further management.
- Order MRI or CT imaging of the local site of fracture for patients without a known cancer diagnosis, especially if the fracture has occurred through a solitary bony lesion. Imaging may demonstrate a soft tissue mass or matrix formation that suggests that the lesion is likely a primary aggressive or malignant tumor.
Treatment varies with each individual. In some cases, chemotherapy or radiation may be necessary to reduce tumors. Patients who experience a pathological fracture due to bone metastases associated with breast cancer are often treated with bisphosphonates. Surgery may also be indicated. For instance, some patients may benefit from prophylactic fixation of the fracture site with bone cement and rods, while others may receive an artificial prosthesis to replace defective bone.