PATHOLOGICAL

FRACTURE
Dr .JUSTINJOSE
Pathological fracture is the
fracture occuring in a bone
whose normal integrity
&strength has been
compromised by an invasive or
destructive process thereby
rendering it vulnerable to trivial
trauma
 Causes of pathological fractures
 GEN .BONE DISEASE
 Osteogenesis imperfecta
 Post menopausal osteoporosis

 Met.bone disese
 Myelomatosis

 Polyostotic fibrous dysplasia

 Pagets disease
 LOCAL BENIGN CONDITIONS
 C /c infection
 Solitary bone cyst
 Fibrous cortical defect
 Chondro myxoid fibroma
 aneurysmal bone cyst
 Chondroma
 Monostotic fibrous dysplasia
 Primary malig. tumours
 Chondrosarcom
 Osteo sarcoma
 Ewings tumour
 Metastatic tumours
 Ca breast
 Ca lung
 Ca thyroid; Ca kidney;Cacolon,Ca prostate
Pathological fracture at different age
groups
 0-5-age osteogenesis imperfecta, osteo
myelitis
 5-20ageosteo myelitis, simple bone cyst
,prim.bone malignancy
 20-50cystic lesion of bone
,malignancy,osteomalacia, g.c tumour
 After 50 osteoporosis multiple
myeloma,secondaries in bone
 HISTORY
 FRACTURES WHICH ARE
 SPONTANEOUS
 WITH MINIMAL TRAUMA

 UNUSUAL PATTERN
 OLD AGE

 H/O SEVERAL FRACTURES

 MALIGNANCY
 Achingor boring pain prior to fracture
 h/o fever &chills-osteo myelites
 h/o bowel or bladder incontinence,change of
bowel habits-g.i malignancy
 h/o gastrectomy,int.malabsorptionc/c
alcoholism,prolonged drug therapy-metabolic
bone disease
 PHYSICAL EXAMINATION
 Site of fractures
 General examination
 Cong. Dysplasia

 Fibrous dysplasia
 Cushings syndrome

 Pagets disease

 malignancy
 Investigations
 X-RAY
 DIAGNOSTIC CLUES
 Gen.osteopenia
 Periostel reaction
 Thinning of cortices
 Abnormal radio density
 Loosers line
 Calcification of small veins
 X-ray of other bones lungs ;urogen. Tract;chest;etc
 Multiple myeloma-punched out lesion
 Pagets disease-lesion areblastic lytic or mixed
although they may have a shaggy appearance
 Metastasis
 Osteoblastic-breast, prostate,
bladderca&lymphoma
 Osteolytic-lung,renal,thyroid, colon ca
 Sub periosteal bone resorption in phalanges-
hyper parathyroidism
 Bone scintigraphy-ares of increased
uptake(hot spots)-incresed blood
flow&incorporation of phosphate compound
in bone mineral phase
 But it is positive in infection, fractureor
arthrites
 Upper or lower G.I. radiographic studies in
addition to procto sigmoidoscopy
 Mammography, IVP
 N.M.R. studies,C.T , myelography
 ADDITIONAL INVESTIGATION
 BLOOD INVESTIGATION
 FULL BLOOD COUN
 ESR
 LFT
 S.Ca;Ph;&ALP Serum electrophoresis-
myeloma-90%myelom a shows monoclonal
spike
 PSA,PTH,CEA
OSTEOMA LOW S.CA LOW S.PH HIGH
LACIA S.ALP,
HIGH
UR.PH&HY
DROXY
PROLINE
HYPERPA HIGH S.CA LOW S.PH HIGH
RATHYROI S.ALP
DISM
PAGETS NL S.CA NL S. PH V.HIGHS.A
DISEASE LP&URINA
RY
HYDROXY
PROLINE
 Urine examination
 Hematuria
 Bence jones proteniuria
 24 HR URINARY HYDROXY PROLINE
 BIOPSY
 FINE NEEDLE
 CORE NEEDLE
 OPEN INCITIONAL
 General concepts in treatment of
path. fractures
 Loss of fixation
 Slower healing
 Optimization of patients medical status
inc.malnutrition, cardio pulmonary
compromise,d.m,&dehydration,should begin
immediately
 Introduction of methyl methacrylate bone
cement
 ,
 Reduction,immobilization,preservation of
function
 Choice of method-condition of bone &path.
Disorder
 Generalized bone disease
 Fracture heal well if properly immobilized
 Int. fixation is advisable
 Osteo malacia,hyperparathyroidism,renal osteo
dystrophy-syst. treatment
 Local benign condition
 Treatment same as simple fractures
 Heal well
 After bone has healed tumour dealt by
curettage &local excision
 Primary malig. Disease of bone

 Prognosis poor
 Pre op. chemo therapy followed by definitive
treatment
 Definitive treatment-limb salvage resection or
amputation
 Metastatic tumours
 Frequent cause
 Most common source-breast carcinoma
 Most common site-femur
 Fracture of long bone shaft –int fixation
 Fracture near bone end-excition &prosthetic
replacement
 Spinal fractures
 Operative stabilization
 Cauda equina syndrome-decompressed
 Primary tumour-investigated &treated