Pathological fractures

Pathological fractures

When abnormal bone fails under normal load this is referred to as a pathological fracture. Depending on the cause of the pathological fracture the bone may not heal and consideration should be given to a load-bearing device not load-sharing. If involving the joint surface or close to the joint surface, the a ff ected area may be excised en bloc and a joint replacement performed. The bone may be weakened by a primary bone tumour, secondary metastatic deposits, haematological malignancy (myeloma, lymphoma, leukaemia), osteomyelitis and meta bolic bone disease (osteomalacia, Paget’s disease, osteoporosis). A pathological fracture should be suspected if the history is not consistent with the severity of the injury . The patient may give a history of low-energy injury that normally w not cause a fracture. If a pathological fracture is suspected, the cause should be actively sought. Where a primary bone tumour is suspected, treatment should be planned to prevent disseminating the disease (see Chapter 42 ). In patients with metastatic bone disease, the primary source should be sought if multiple metastatic deposits are identified. If life expectancy is poor, then stabilisation with a load-bearing device may be considered. If an isolated metastasis is identified Sir James Paget , 1814–1899, surgeon, St Bartholomew’s Hospital, London, UK. more aggressive curative approach may be taken with en bloc excision of the primary and the isolated secondary de posit. If a metastatic deposit is identified prior to fracture, pro - phylactic fixation should be considered if impending fracture is likely . Prophylactic stabilisation with a load-bearing device is once again advocated. If life expectancy is good and the deposit periarticular, an en bloc e xcision and joint arthroplasty may be considered to optimise return to near normal function as soon as possible. Pathological fractures

When abnormal bone fails under normal load this is referred to as a pathological fracture. Depending on the cause of the pathological fracture the bone may not heal and consideration should be given to a load-bearing device not load-sharing. If involving the joint surface or close to the joint surface, the a ff ected area may be excised en bloc and a joint replacement performed. The bone may be weakened by a primary bone tumour, secondary metastatic deposits, haematological malignancy (myeloma, lymphoma, leukaemia), osteomyelitis and meta bolic bone disease (osteomalacia, Paget’s disease, osteoporosis). A pathological fracture should be suspected if the history is not consistent with the severity of the injury . The patient may give a history of low-energy injury that normally w not cause a fracture. If a pathological fracture is suspected, the cause should be actively sought. Where a primary bone tumour is suspected, treatment should be planned to prevent disseminating the disease (see Chapter 42 ). In patients with metastatic bone disease, the primary source should be sought if multiple metastatic deposits are identified. If life expectancy is poor, then stabilisation with a load-bearing device may be considered. If an isolated metastasis is identified Sir James Paget , 1814–1899, surgeon, St Bartholomew’s Hospital, London, UK. more aggressive curative approach may be taken with en bloc excision of the primary and the isolated secondary de posit. If a metastatic deposit is identified prior to fracture, pro - phylactic fixation should be considered if impending fracture is likely . Prophylactic stabilisation with a load-bearing device is once again advocated. If life expectancy is good and the deposit periarticular, an en bloc e xcision and joint arthroplasty may be considered to optimise return to near normal function as soon as possible. Pathological fractures

When abnormal bone fails under normal load this is referred to as a pathological fracture. Depending on the cause of the pathological fracture the bone may not heal and consideration should be given to a load-bearing device not load-sharing. If involving the joint surface or close to the joint surface, the a ff ected area may be excised en bloc and a joint replacement performed. The bone may be weakened by a primary bone tumour, secondary metastatic deposits, haematological malignancy (myeloma, lymphoma, leukaemia), osteomyelitis and meta bolic bone disease (osteomalacia, Paget’s disease, osteoporosis). A pathological fracture should be suspected if the history is not consistent with the severity of the injury . The patient may give a history of low-energy injury that normally w not cause a fracture. If a pathological fracture is suspected, the cause should be actively sought. Where a primary bone tumour is suspected, treatment should be planned to prevent disseminating the disease (see Chapter 42 ). In patients with metastatic bone disease, the primary source should be sought if multiple metastatic deposits are identified. If life expectancy is poor, then stabilisation with a load-bearing device may be considered. If an isolated metastasis is identified Sir James Paget , 1814–1899, surgeon, St Bartholomew’s Hospital, London, UK. more aggressive curative approach may be taken with en bloc excision of the primary and the isolated secondary de posit. If a metastatic deposit is identified prior to fracture, pro - phylactic fixation should be considered if impending fracture is likely . Prophylactic stabilisation with a load-bearing device is once again advocated. If life expectancy is good and the deposit periarticular, an en bloc e xcision and joint arthroplasty may be considered to optimise return to near normal function as soon as possible.