Pathological fracture

Definition and Epidemiology

• A pathological fracture is a break in a bone weakened by some other disease process, such as osteoporosis, cancer, or infection.
• Common in the elderly due to osteoporosis, and in patients with certain cancers (breast, prostate, lung, and multiple myeloma).
• Can occur with minimal or no trauma, often in bones that are typically resistant to fracture.

Pathophysiology

• Underlying disease processes lead to weakening of the bone structure.
• Osteoporosis: Decreased bone density and deterioration of bone tissue.
• Malignancy: Bone destruction due to primary bone tumors or metastases.
• Other causes: Infection (osteomyelitis), prolonged steroid use, and certain genetic bone disorders.

Clinical Features

• Sudden onset of pain at the site of the fracture, often with minimal or no history of trauma.
• Swelling, bruising, and deformity may be present.
• Reduced mobility or inability to bear weight.
• Systemic symptoms if related to underlying malignancy or infection.

Diagnosis

• Clinical assessment supported by imaging.
• X-rays are the first line; may show the fracture and signs of underlying bone pathology.
• MRI, CT, or bone scan for more detailed assessment, especially in suspected malignancy.
• Biopsy may be necessary to diagnose the underlying condition.

Management

• Treatment of the fracture itself, often requiring surgical intervention.
• Addressing the underlying disease is crucial.
  • Osteoporosis: Bisphosphonates, calcium, and vitamin D supplementation.
  • Malignancy: Oncological treatment as per the primary cancer.
  • Infection: Antibiotics and debridement.
• Rehabilitation for mobility and prevention of further fractures.

Complications

• Delayed healing due to the weakened bone structure.
• Increased risk of subsequent fractures.
• Potential for systemic complications from the underlying disease.

Prognosis

• Depends on the underlying cause of the fracture.
• Generally poorer in fractures due to malignancy compared to those due to osteoporosis.

Prevention

• Early detection and management of diseases that weaken bone.
• Regular monitoring and treatment for patients with known risk factors (e.g., osteoporosis, cancer).