Pathological Fracture

• What is a pathological fracture?

  Break in bone integrity that occurs secondary to an underlying disease process (rather than due to trauma)
• What predisposes you to a pathological fracture?

  Osteoporosis

  Osteomalacia

  Paget's disease

  Malignancies (primary bone tumours, metastatic carcinoma, multiple myeloma)

  RA

  Iatrogenic factors (corticosteroid, radiation)

  Infection (TB, osteomyelitis)

  Endocrine (hyperparathyroidism, hypogonadism)
• What are the most frequent sites of pathological fracture?

  Vertebrae

  Hip

  Wrist

  BUT can occur in any bone
• How can you classify pathological fractures?

  Location

  Cause (malignant/benign)

  Nature of fracture (complete/incomplete)
• What are the signs & symptoms of pathological fractures?

  Pain at site

  Limited ROM

  Functional impairment

  Possible nerve compression symptoms (numbness, tingling, weakness)

  Fever

  Night sweats

  Fatigue

  Unexplained weight loss
• What are the Inx for pathological fractures?

  Obs

  Full Hx & examination

  Urine electrophoresis (for myeloma)

  Bloods (FBC, ESR/CRP, bone profile, LFTs, PSA, serum electrophoresis (for myeloma))

  XR of affected joint

  MRI (for possible spinal cord compression)

  CT

  PET

  DEXA scan

  Tissue biopsy
• What is the management of pathological fractures?

  Analgesia

  Stabilisation of fracture

  Treat underlying cause

  Physio & OT input

  Regular follow up
• What are the potential complications of pathological fractures?

  Immediate

  • haemorrhage
  • infection
  • fat embolism syndrome (associated with long bone fractures)

  Long-term

  • malignant transformation
  • non-union or malunion of fractures (due to compromised bone integrity & vascularity)
  • functional impairment
  • morbidity of underlying disease