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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).

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