A pathologic fracture occurs when a bone breaks in an area that was already weakened by another disease. When the bone is weakened by some underlying medical condition, the individual becomes more susceptible to fracture. Causes of weakened bone include osteoporosis, tumors, infection, and certain inherited bone disorders.
What are pathologic fractures and why do they occur?
Fractures through abnormal bone are called “pathological” fractures. Probably the most common cause of this is an underlying tumor, either benign or malignant. However, almost any underlying process of bone that weakens the bone can lead to a pathological fracture.
What is the most common cause of pathologic fractures?
- Osteoporosis: This is the most common cause of pathologic fractures in the elderly population.
- Metabolic bone disease: Osteomalacia and hyperparathyroidism may be present.
- Paget disease: This is present in 5% to 15% of the elderly population. ...
What are the four types of fracture?
- Transverse, where the break is straight across the bone in perpendicular fashion
- Longitudinal, where the break is along the long axis of the bone, somewhat down the middle
- Comminuted, where the bone is broken into more than two pieces
What are the symptoms of a fracture?
Symptoms of fractures include:
- Pain
- Difficulty moving the injured area
- Inability to bear weight on that part of the body
- Swelling and tenderness around the injury
- Bruising
- Numbness in the area of the broken bone
- Deformity The area may look abnormal or not the usual shape A limb may look out of place A part of the bone may puncture through the skin
Which is an example of a pathologic fracture?
A pathological fracture is one in which breaks in the bone were caused by an underlying disease. Examples of pathological fractures include those caused by cancer (see Figure 1), osteoporosis, or other bone diseases.
What is the most common pathological fracture?
The femoral neck and head are the most common locations for pathologic fracture because of the propensity for metastases to involve proximal bones and because of the stress of weight placed on this part of the femur.
What causes a pathologic fracture?
Pathologic fractures are frequently caused by tumors. Tumors may originate in the vertebrae, or may be the result of cancer that has spread from elsewhere in the body. The spread of cancer is called metastasis. The vertebrae are a common site for metastasis.
Can pathological fractures heal?
Recovery can take anywhere from a couple of weeks to several months, depending on the affected body part. If the fracture was caused by a condition that makes it hard for your bones to heal, you may need additional treatment, such as surgery.
What is the another name of pathological fracture?
Pathologic fractureOther namesInsufficiency fracturePathological fracture of the humerus in a patient with metastasis of renal cell carcinomaSpecialtyRheumatology1 more row
Where do pathological fractures occur?
Pathologic fractures most commonly occur in the proximal humerus and humeral shaft.
Is a pathological fracture considered traumatic?
A nontraumatic or pathological fracture is a break of a diseased or weakened bone without any identifiable trauma or following a minor injury that would not ordinarily break a healthy bone. A pathological fracture is classified to code 733.1x, with a fifth digit identifying the fracture site.
What is the most common pathologic fracture associated with osteoporosis?
Consistent with current clinical experience, the fractures rated most likely due to osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral fractures.
What is the difference between a traumatic fracture and a pathological fracture?
Examples of traumatic fractures include fractures resulting from a fall, blunt injury or a motor vehicle accident1. There are several types of traumatic fractures, which include transverse, oblique, spiral, angulated and displaced fractures. A pathological fracture results from a break of a diseased or weakened bone.
What type of pre existing condition might likely cause a pathologic fracture to occur?
Pathologic fractures develop because of some abnormal local condition that causes the bone to become weakened. The most common causes are tumors that metastasize to bone. Other causes are infection, cystic lesions of bone, and Paget's disease.
When does a broken bone need to be set in surgery?
Closed reduction is a procedure to set (reduce) a broken bone without cutting the skin open. The broken bone is put back in place, which allows it to grow back together. It works best when it is done as soon as possible after the bone breaks.
Can osteoarthritis cause a pathological fracture?
Osteoarthritis does not cause bone loss or fractures. On the contrary, it is associated with increased bone density and abnormal growths (osteophytes) due to the deficiency in bone resorption.
What is the difference between a traumatic fracture and a pathological fracture?
Examples of traumatic fractures include fractures resulting from a fall, blunt injury or a motor vehicle accident1. There are several types of traumatic fractures, which include transverse, oblique, spiral, angulated and displaced fractures. A pathological fracture results from a break of a diseased or weakened bone.
How can you tell the difference between a pathological fracture?
Whereas stress fractures occur in normal or metabolically weakened bones, pathologic fractures occur at the site of a bone tumor. Unfortunately, stress fractures may share imaging features with pathologic fractures on plain radiography, and therefore other modalities are commonly utilized to distinguish these entities.
What type of fracture is considered traumatic?
A traumatic fracture occurs when significant or extreme force is applied to a bone. Examples include broken bones caused by impacts from a fall or car accident, and those caused by forceful overextension, such as a twisting injury that may cause an ankle fracture. Traumatic fractures may be nondisplaced or displaced.
What is pathological facture?
Listen to pronunciation. (PA-thuh-LAH-jik FRAK-sher) A broken bone caused by disease, often by the spread of cancer to the bone.
What is pathologic fracture?
Understanding Pathologic Fractures. A fracture is a break in your bone. A break is called a pathologic fracture when force or impact didn’t cause the break to happen. Instead, an underlying disease leaves your bones weak and brittle. You may move wrong or shift your body weight in a way that puts pressure on weak bones.
How does a pathological fracture affect your health?
You can lessen the impact a pathological fracture has on your health by: Getting durable bone implants that allow you to keep using that part of your body with less stress to the area. When you fracture a bone, it leaves you with less mobility.
What happens if a tumor grows near your bones?
Tumors – If tumors grow near your bones or originate from your bones, they can cause pathologic fractures. The added pressure of tumors placing weight on your bones may be too much. Osteoporosis – This condition occurs primarily in older adulthood.
What happens if you have a fracture?
If fractures go untreated, they may cause swelling, bruising, and pain. In some cases, they lead to skeletal deformities or changes in how you are able to sit, stand, or sleep . The constant pain of a pathologic fracture may also leave you irritable and disinterested in things you used to enjoy doing.
Why is it important to stay active after a fracture?
This is especially important as you age because staying active helps maintain your cardiovascular health.
Can you reverse bone damage?
Treatments for Pathologic Fractures. You can’t reverse bone damage, but you can slow it down. Talk to your doctor about your symptoms and how they impact your quality of life. After determining the severity of your condition, your doctor can put together a treatment plan.
Can weak bones cause fractures?
If you have a chronic health condition, it may have negative effects on the density of your bones. With weak bones, there's a higher chance that fractures can happen, even without any impact to your bones.
What is pathologic fracture?
A pathologic fracture occurs when a bone breaks in an area that was already weakened by another disease. When the bone is weakened by some underlying medical condition, the individual becomes more susceptible to fracture. Causes of weakened bone include osteoporosis, tumors, infection, and certain inherited bone disorders.
Why is a fracture called a pathologic fracture?
The reason a fracture is called pathologic is that the bone was weakened even before an injury occurred. Sometimes pathologic fractures are obvious, and other times it is not as clear that there was a problem preceding the injury.
What to do if a fracture is pathological?
If the fracture is pathological in nature, your doctor will also want to treat the underlying cause of the bone break to help prevent it from happening again. Treatment of a pathologic fracture is highly dependent on the cause of the weakened bone.
How to tell if a fracture is severe?
Your healthcare provider may recommend an X-ray to determine whether a bone is broken.
How to tell if a bone is broken?
Your physician may recommend an X-ray to determine whether a bone is broken. . .
What tests can be done to determine if a bone is a tumor?
Laboratory tests, including blood count analysis and calcium levels. Imaging tests, including bone scans and MRIs. Bone biopsy , in which a sample of the bone is obtained, either at the time of fracture repair or before—this test can be helpful when a tumor or infection is suspected as a cause.
How to treat a fractured bone?
To treat the fracture, itself, you may need to wear a cast or splint. Sometimes you might need surgery to put in plates, pins, or screws to keep the bone in place. You may need to rest for a certain period of time and avoid doing certain activities that stress the area of the fracture.
What is a Pathological Fracture (Pathological Fracture Definition)?
The word “pathological” means caused by a disease, and the word “fracture” means a break in the continuity of the bone. A pathological fracture occurs when the bone breaks in an area by a small trivial force or even casually that was already weakened by some other disease.
What causes pathological fractures?
A pathological fracture can be caused by two types of diseases. These include localized diseases and generalized diseases. These are as follows
How many women fracture their bones?
It affects females more than men. Based on the National Osteoporosis Foundation, 50% of women and up to 25% of men will fracture a bone during their lifespan due to osteoporosis.
Why does a broken bone break easily?
Due to some other disease, the bone gets weakened, then after the application of a small trivial force, the bone gets a break. However, a fracture is considered pathologic when the bone becomes weakened even before an injury has taken place. Compared to the normal bone, the weakened bone can not tolerate that much stress and resistance. That’s why it gets broken easily.
What is bone biopsy?
Bone biopsy is a process in which a sample of bone is obtained either before or at the time of fracture repair. This test is helpful in checking for infections, tumors, or both. In other words, when infection or tumor is suspected as a cause.
What causes a weakened bone?
There are numerous causes of weakened bone which include osteoporosis, tumor, infection, etc. However, these are only a few causes. Some many other conditions and diseases can lead to pathological bone fractures.
What is osteomyelitis caused by?
Osteomyelitis can be described as an infection in the bone. It is caused by a bacterial or fungal infection that spreads to adjacent bones. In rare instances, osteomyelitis can lead to a pathological fracture.
Why are pathologic fractures important?
The incidence of pathologic fractures is rising, primarily due to improved diagnosis and treatment of metastatic disease leading to prolonged survival . Therefore, diagnosis of the causative pathology is of paramount importance in the successful treatment of a pathologic fracture and is a prerequisite for proceeding with surgical intervention. Pathologic fractures occur through areas of weakened bone attributed to either primary malignant lesions, benign lesions, metastasis, or underlying metabolic abnormalities, with the common factor being altered skeletal biomechanics secondary to pathologic bone.
What causes neoplastic pathologic fractures?
The majority of neoplastic pathologic fractures are caused secondary to metastatic disease rather than primary bone tumors. In a patient 40 years of age or older, the likelihood that a pathologic fracture through an unknown lesion that is metastatic is 500 times more common than the likelihood of it being a primary bone sarcoma.[1] There are five recognized carcinomas that most frequently metastasize to bone, including lung, breast, thyroid, renal, and prostate. The most common sites for skeletal metastasis include the spine, proximal femur, and pelvis. [2][3] Primary bone sarcomas occur far less frequently, though disregarding the possibility that a pathologic fracture through a solitary bone lesion could be the first evidence of a primary sarcoma could lead to catastrophic consequences, including loss of life or limb.
What is the most important imaging modality for pathologic fractures?
Radiological analysis of pathologic fractures begins with orthogonal radiographs of the fracture site and the involved bone in its entirety. A plain radiograph is the single most important imaging modality and provides the most information about a pathologic lesion. There are a number of aggressive features suggestive of a pathologic lesion that may be identified on X-ray, which include: lesion diameter > 5 cm, cortical interruption, periosteal reaction, and associated pathologic fracture. A chest radiograph should also be obtained. Computed tomography (CT) of the chest, abdomen, and pelvis with oral and intravenous contrast should be obtained for staging purposes. Whole-body bone scintigraphy should also be obtained. Bone scans are particularly useful for identifying osteoblastic activity. If laboratory analysis has confirmed the diagnosis of multiple myeloma, a skeletal survey may be obtained in lieu of a bone scan, which might fail to identify the degree of osteolysis present in other sites. This comprehensive strategy is the gold standard and is successful in identifying the origin of the lesion in 85% of cases. [10]
What is an impending fracture?
An impending fracture is a biomechanically weakened area of bone that has a propensity to fracture with far less force than would be required for the normal bone to fracture due to the pathophysiology of the underlying lesion. For instance, normal weight-bearing through a pathologic lesion could tip the scales towards a pathologic fracture due to the biomechanical fragility of the surrounding bony architecture. Impending fractures may require prophylactic fixation, meaning surgical intervention in the form of internal fixation prior to a fracture event as a means of augmenting inherently weak bone and preventing future failure.
What is the treatment for a fracture?
Treatment algorithms exist for both impending fractures and pathologic fractures and generally involve operative fixation combined with chemotherapy and /or radiotherapy.
What are osteolytic lesions?
Osteolytic lesions of bone occur secondary to tumor-induced activation of osteoclasts by upregulation of RANK ligand. [7] Osteoblastic lesions occur secondary to endothelin 1, which is secreted by the tumor.[8] Pathologic fractures occur through these lesions due to altered biomechanics. For example, a lytic lesion or open-section defect might produce a stress concentration that cannot withstand normal or low-demand activity. [9]
When a pathologic fracture is identified through a lesion of unknown origin, a comprehensive workup must be?
When a pathologic fracture is identified through a lesion of unknown origin, a comprehensive workup must be conducted to identify the etiology and stage of the disease.
What is pathologic fracture?
A pathologic fracture is a break in a bone that is caused by an underlying disease. At the Spine Hospital at the Neurological Institute of New York, we specialize in pathologic fractures of vertebrae, or bones of the spine.
What is the best treatment for a pathologic fracture?
For the most part, nonoperative treatments are recommended for less severe pathologic fractures. These include taking pain medications, limiting physical activity, and wearing a brace. The brace helps support the back and prevents bending forward, which removes pressure from the fractured vertebrae.
What is the most common cause of fractures in older women?
Pathologic fractures are also frequently caused by osteoporosis. Osteoporosis is a condition of weak and brittle bones that is most common in older women.
Why do bones break?
For the most part, bones need a reason to break–for example, a significant trauma. However, some pathologies (diseases) weaken the bones of the spine. Forces as slight as the weight of the body or a minor trauma that would otherwise be tolerated can cause a fracture in the diseased bone.
What is neurological impairment?
neurological impairment–such as numbness and/or weakness in the arms or legs (if the fracture has affected the spinal cord and/or nerves in the spine)
What is nuclear bone scan?
Nuclear bone scan: a diagnostic procedure in which a radioactive substance is injected into the body to measure activity in the bones. (The amount of radiation is small–less than the radiation in half of one CT scan.) This scan helps identify damaged bones.
When is pathologic fracture less common?
Pathologic fracture is less common when the metastatic deposits promote an osteoblastic response within the host bone.
What causes pathologic fractures in children?
Pathologic fractures occur in diseased bone, and, in children, such fractures are caused by a spectrum of conditions different from those in adults. Children’s diseases frequently associated with pathologic fractures include noncancerous benign bone tumors and congenital or genetic abnormalities affecting the skeleton. Polyostotic disease with fractures affecting the immature skeleton is often caused by osteomyelitis, histiocytosis, vascular neoplasms, and metastasis (neuroblastoma and Wilms tumor). Rarely, sarcomas may initially manifest as fractures, and these patients require special consideration in their treatment approach. In contrast, causes of pathologic fractures in the adult skeleton, especially in individuals older than 40 years, include malignancies such as myeloma, metastatic carcinoma, lymphoma, and, rarely, sarcomas of the bone. Occasionally, giant cell tumors and enchondromas are identified. Elderly individuals frequently are seen with pathologic fractures from osteoporosis or Paget disease, in addition to metastasis (Table 4-1 ).
What percentage of pathologic fractures require surgery?
Approximately 10% to 30% of pathologic fractures that occur in long bones where a metastatic lesion is present require surgical intervention. Clinically, the outcome for patients with a pathologic fracture resulting from a bone metastasis after surgical repair is comparable to that of patients sustaining a traumatic fracture. 152-154 Prognosis is generally poor if hypercalcemia is present and if parenteral narcotics are required to control pain from other sites of bone metastases. In such cases, the decision for surgical intervention should be based on the severity of the symptoms associated with the fracture. 152 As shown in Figure 39-2, postoperative radiation is often given after surgical fixation of a pathologic fracture to reduce the risk of progressive disease in the bone that could lead to instability of the internal fixation. 157
How long does it take to recover from a pathologic fracture?
Indications for surgical intervention of pathologic fracture or impending fracture include an expected survival duration of more than 6 weeks, the ability to accomplish internal stability of the fracture site, and the absence of coexistent conditions that would preclude early mobilization (e.g., metastasis involving weight-bearing bones and lytic lesions more than 2 or 3 cm in size or metastases that destroy more than 50% of the cortex). 152-156 It is unclear whether osteolytic metastases are more likely to lead to fracture than are osteoblastic lesions because osteoblastic lesions, by definition, have an osteolytic component that facilitates the formation of new bone.
What causes a fracture in the skeleton?
In contrast, causes of pathologic fractures in the adult skeleton, especially in individuals older than 40 years, include malignancies such as myeloma, metastatic carcinoma, lymphoma, and, rarely, sarcomas of the bone. Occasionally, giant cell tumors and enchondromas are identified.
What fracture is on a femur?
Lateral radiograph of the femur in a child with open growth plates shows an oblique fracture through the proximal end of the distal diaphysis. The fracture extends through an OSA that has produced endosteal cortical thinning as well as faint medullary mineralization .
What is a close up view of a fracture?
Close-up view shows a fracture through an ill-defined OSA involving the femoral shaft. Poorly organized mineralized tissue is seen around the fracture site and within the femur . The mineralized tissue does not show the layered structure that would be expected from simple callus.
What Is A Pathologic Spinal Fracture?
Spinal vertebrae can fracture for a number of different reasons. If you’re involved in a car accident or you fall off a ladder, acute trauma may be the root cause of your spinal fracture. However, if more innocuous actions lead to the development of a fracture, it may have a pathological reason behind it. In today’s blog, we take a closer look at pathologic spinal fractures, and we explain how to best treat them.
What does it mean when you say a spinal fracture is pathologic?
Pathologic means to be related with a pathology, or disease, and fracture means that there is a break in the bone. In other words, your spinal fracture occurred in part because of an underlying health condition.
What are the two most common underlying conditions that contribute to pathological spinal fractures?
But what kind of health conditions could contribute to a pathological spinal fracture? The two most common underlying conditions that contribute to pathological spinal fractures are tumors and osteoporosis. In rarer cases, pathologic fractures can be caused by the presence of an infection and bone-weakening conditions like osteomalacia and Paget’s disease.
Can you have a vertebral fracture without surgery?
Once the pathology is understood, treatment will focus on both the fracture and the underlying cause. The good news is that most vertebral fractures heal just fine without surgery, so rest, painkillers, activity restriction and some physical therapy will likely be in your future.
Can a spine fracture be diagnosed with x-rays?
Spinal fractures are easy enough to diagnose with x-rays and a comprehensive physical exam, but understanding the pathology behind it will be a little more difficult. Additional imaging or blood tests may be conducted to look for the presence of a tumor or infection, and your doctor will test to see if a bone-weakening condition is present. Once the pathology is understood, treatment will focus on both the fracture and the underlying cause.