Pathological Fracture Flashcards
Define pathological fracture
Fracture that occur in diseased or compromised bone tissue.
Provoked by an innocuous trauma that does not normally result in fracture, particularly in younger individuals.
What is the various aetiology of a pathological fracture?
Tumour - commonly metastatic or primary
Metabolic disorders - osteoporosis or hyperparathyroidism or hypogonadism
Bone disease - Pagets disease
Infection - TB or osteomyelitits
What are the typical signs and symptoms of a pathological fracture?
Vary based on site and underlying condition
Localised pain - may be severe or out of proportion to the injury
An unexpected fracture after minor trauma
Deformity at the fracture site
Impaired function of the affected limb
What are the key investigations for a pathological fracture?
Radiographic evaluation - fracture and associated bony abnormalities
Bone scans - detect metabolic abnormalities and tumours
Lab tests - serum calcium, phosphate, PTH and ALP to diagnose metabolic diseases
Biopsy - for tumour diagnosis
What is the key management of a pathological fracture?
Treatment of the underlying disease (pharma and non-pharma)
Fracture repair - immobilisation, surgery, physio etc appropriate to location and nature of the fracture
What cancers can lead to a pathological fracture?
Primary = osteosarcoma, ewings sarcoma, chondrosarcoma
Metastatic = commonly from breast, lung, prostate kidney, thyroid cancer
Multiple myeloma - lytic bone lesions inc fracture risk
What iatrogenic factors can lead to pathological fractures?
Corticosteroid use - long term decreased bone density and increased fracture risk
Radiation therapy - can cause local osteopenia or osteonecrosis
What bloods are important to do when investigating pathological fractures?
Blood tests - FBC, ESR, CRP, Calcium, phosphate, alkaline phosphatase, LFTs, prostate specific antigen for men, may require serum and urine electrophoresis if suspect multiple myeloma.
What are some immediate complications of a pathological fracture?
Haemorrhage - common complication due to disrupted blood vessels at the fracture site. Rapid loss = hypovolemia
Infection - osteomyelitis
Fat embolism syndrome - long bone fractures, resp distress, altered mental status and petechial rash.
What are some potential long term complication of a pathological fracture?
Malignant transformation - if secondary to benign bone lesions
Non-union or malunion - due to compromised bone integrity and vascularity
Impaired function - mobility and quality of life affected
Morbidity - underlying pathology if not managed.
