Pathologic fracture

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Pathologic fracture
Other namesInsufficiency fracture
Pathologische Fraktur bei Metastase Nierencell-Ca im Humerus.jpg
Pathological fracture of the humerus in a patient with metastasis of renal cell carcinoma
Specialty Rheumatology   OOjs UI icon edit-ltr-progressive.svg

A pathologic fracture is a bone fracture caused by weakness of the bone structure that leads to decrease mechanical resistance to normal mechanical loads. [1] This process is most commonly due to osteoporosis, but may also be due to other pathologies such as cancer, infection (such as osteomyelitis), inherited bone disorders, or a bone cyst. Only a small number of conditions are commonly responsible for pathological fractures, including osteoporosis, osteomalacia, Paget's disease, Osteitis, osteogenesis imperfecta, benign bone tumours and cysts, secondary malignant bone tumours and primary malignant bone tumours.

Contents

Fragility fracture is a type of pathologic fracture that occurs as a result of an injury that would be insufficient to cause fracture in a normal bone. [2] There are three fracture sites said to be typical of fragility fractures: vertebral fractures, fractures of the neck of the femur, and Colles fracture of the wrist. This definition arises because a normal human being ought to be able to fall from standing height without breaking any bones, and a fracture, therefore, suggests weakness of the skeleton.

Pathological fractures present as a chalkstick fracture in long bones, and appear as a transverse fractures nearly 90 degrees to the long axis of the bone. In a pathological compression fracture of a spinal vertebra fractures will commonly appear to collapse the entire body of vertebra.

Cause

Pathologic fractures in children and adolescents can result from a diverse array of disorders namely; metabolic, endocrine, neoplastic, infectious, immunologic, and genetic skeletal dysplasias. [ citation needed ]

Juvenile osteoporosis Blausen 0686 Osteoporosis 01.png
Juvenile osteoporosis

Miscellaneous causes

Diagnosis

In circumstances where other pathologies are excluded (for example, cancer), a pathologic fracture is diagnostic of osteoporosis irrespective of bone mineral density.[ citation needed ]

Management

Based on Mirel's score (if the score is more than 8), bone fixation should be done prophylactically. Fixation is done by internal fixation rather than conservatively, along with treatment of the underlying cause. [4]

Once a fracture has occurred, intramedullary fixation is the usual surgical management for certain long bones, such as the femur, tibia, and fibula. [5] For pathological fractures in the setting of metastatic disease where there is a need for postoperative radiation, a carbon fiber implant may be preferred due to its radiolucency, allowing better visualization of the affected area on x-ray imaging. [6]

Related Research Articles

<span class="mw-page-title-main">Osteoid</span> Unmineralized, organic portion of the bone matrix

In histology, osteoid is the unmineralized, organic portion of the bone matrix that forms prior to the maturation of bone tissue. Osteoblasts begin the process of forming bone tissue by secreting the osteoid as several specific proteins. When it becomes mineralized, the osteoid and its adjacent bone cells have developed into new bone tissue.

<span class="mw-page-title-main">Coxa vara</span> Deformity of the hip

Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It may be congenital and is commonly caused by injury, such as a fracture. It can also occur when the bone tissue in the neck of the femur is softer than normal, causing it to bend under the weight of the body. This may either be congenital or the result of a bone disorder. The most common cause of coxa vara is either congenital or developmental. Other common causes include metabolic bone diseases, post-Perthes deformity, osteomyelitis, and post traumatic. Shepherd's Crook deformity is a severe form of coxa vara where the proximal femur is severely deformed with a reduction in the neck shaft angle beyond 90 degrees. It is most commonly a sequela of osteogenesis imperfecta, Paget's disease, osteomyelitis, tumour and tumour-like conditions.

<span class="mw-page-title-main">Osteosclerosis</span> Condition in which bones are abnormally hardened, with elevated density

Osteosclerosis is a disorder that is characterized by abnormal hardening of bone and an elevation in bone density. It may predominantly affect the medullary portion and/or cortex of bone. Plain radiographs are a valuable tool for detecting and classifying osteosclerotic disorders. It can manifest in localized or generalized osteosclerosis. Localized osteosclerosis can be caused by Legg–Calvé–Perthes disease, sickle-cell disease and osteoarthritis among others. Osteosclerosis can be classified in accordance with the causative factor into acquired and hereditary.

<span class="mw-page-title-main">Osteopetrosis</span> Rare disease of the bones

Osteopetrosis, literally "stone bone", also known as marble bone disease or Albers-Schönberg disease, is an extremely rare inherited disorder whereby the bones harden, becoming denser, in contrast to more prevalent conditions like osteoporosis, in which the bones become less dense and more brittle, or osteomalacia, in which the bones soften. Osteopetrosis can cause bones to dissolve and break.

<span class="mw-page-title-main">Bisphosphonate</span> Pharmaceutical drugs for preventing bone loss

Bisphosphonates are a class of drugs that prevent the loss of bone density, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called bisphosphonates because they have two phosphonate groups. They are thus also called diphosphonates.

<span class="mw-page-title-main">Osteogenesis imperfecta</span> Group of genetic disorders

Osteogenesis imperfecta, colloquially known as brittle bone disease, is a group of genetic disorders that all result in bones that break easily. The range of symptoms—on the skeleton as well as on the body's other organs—may be mild to severe. Symptoms found in various types of OI include whites of the eye (sclerae) that are blue instead, short stature, loose joints, hearing loss, breathing problems and problems with the teeth. Potentially life-threatening complications, all of which become more common in more severe OI, include: tearing (dissection) of the major arteries, such as the aorta; pulmonary valve insufficiency secondary to distortion of the ribcage; and basilar invagination.

<span class="mw-page-title-main">Hip fracture</span> Broken bone in hip joint region

A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.

Bone pain is pain coming from a bone, and is caused by damaging stimuli. It occurs as a result of a wide range of diseases or physical conditions or both, and may severely impair the quality of life.

<span class="mw-page-title-main">Collagen, type I, alpha 1</span> Mammalian protein found in humans

Collagen, type I, alpha 1, also known as alpha-1 type I collagen, is a protein that in humans is encoded by the COL1A1 gene. COL1A1 encodes the major component of type I collagen, the fibrillar collagen found in most connective tissues, including cartilage.

An osteochondrodysplasia, or skeletal dysplasia, is a disorder of the development of bone and cartilage. Osteochondrodysplasias are rare diseases. About 1 in 5,000 babies are born with some type of skeletal dysplasia. Nonetheless, if taken collectively, genetic skeletal dysplasias or osteochondrodysplasias comprise a recognizable group of genetically determined disorders with generalized skeletal affection. These disorders lead to disproportionate short stature and bone abnormalities, particularly in the arms, legs, and spine. Skeletal dysplasia can result in marked functional limitation and even mortality.

<span class="mw-page-title-main">Dentin dysplasia</span> Medical condition

Dentin dysplasia (DD) is a rare genetic developmental disorder affecting dentine production of the teeth, commonly exhibiting an autosomal dominant inheritance that causes malformation of the root. It affects both primary and permanent dentitions in approximately 1 in every 100,000 patients. It is characterized by the presence of normal enamel but atypical dentin with abnormal pulpal morphology. Witkop in 1972 classified DD into two types which are Type I (DD-1) is the radicular type, and type II (DD-2) is the coronal type. DD-1 has been further divided into 4 different subtypes (DD-1a,1b,1c,1d) based on the radiographic features.

<span class="mw-page-title-main">Vertebral compression fracture</span> Medical condition

A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakening of the vertebra. This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from metastatic or primary tumors, or infection. In healthy patients, it is most often seen in individuals suffering extreme vertical shocks, such as ejecting from an ejection seat. Seen in lateral views in plain x-ray films, compression fractures of the spine characteristically appear as wedge deformities, with greater loss of height anteriorly than posteriorly and intact pedicles in the anteroposterior view.

Bone disease refers to the medical conditions which affect the bone.

A pseudofracture, also called a Looser zone, is a diagnostic finding in osteomalacia. Pseudofracture also rarely occurs in Paget's disease of bone, hyperparathyroidism, renal osteodystrophy, osteogenesis imperfecta, fibrous dysplasia, and hypophosphatasia. Looser zones are named after Emil Looser, a Swiss physician.

Mirels' score is a tool useful in the management of bone tumors, by identifying those patients who would benefit from prophylactic fixation if they have a high enough risk of pathological fracture.

The following outline is provided as an overview of and topical guide to trauma and orthopaedics:

<span class="mw-page-title-main">Index of trauma and orthopaedics articles</span>

Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.

<span class="mw-page-title-main">Tibia shaft fracture</span> Medical condition

Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia. Due to the location of the tibia, it is frequently injured. Thus it is the most commonly fractured long bone in the body.

<span class="mw-page-title-main">Calvarial doughnut lesions-bone fragility syndrome</span> Medical condition

Calvarial doughnut lesions-bone fragility syndrome, also known as familial calvarial doughnut lesions, is a rare autosomal dominant genetic disorder characterized by mild to moderate fragility of the bones accompanied with calvarial doughnut lesions.

References

  1. Salehi, Sana; Abedi, Aidin; Gross, Jordan S.; Gholamrezanezhad, Ali (2019-06-22). "Prayer's fracture: rare cases of knee insufficiency fracture in non-weight-bearing femoral condyle". Clinical Imaging. 58: 80–83. doi:10.1016/j.clinimag.2019.06.013. ISSN   0899-7071. PMID   31279988. S2CID   195830673.
  2. Vanasse, Alain; Dagenais, Pierre; Niyonsenga, Théophile; Grégoire, Jean-Pierre; Courteau, Josiane; Hemiari, Abbas (2005). "Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec". BMC Musculoskeletal Disorders. 6 (1): 33. doi: 10.1186/1471-2474-6-33 . ISSN   1471-2474. PMC   1187894 . PMID   15969760.
  3. Maheswari. Essential Orthopedics (3 ed.). Jaypee Publications. p. 4.
  4. Mirels H (October 2003). "Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. 1989". Clin. Orthop. Relat. Res. (415 Suppl): S4–13. doi:10.1097/01.blo.0000093045.56370.dd. PMID   14600587. S2CID   43255503.
  5. Hogan WB, Bluman EM. Brostrom-Gould procedure for lateral ankle instability. J Med Insight. 2024;2024(23). doi:10.24296/jomi/23.
  6. Rizk PA, Werenski JO, Lozano-Calderon SA. Carbon fiber implant for fixation of a pathologic subtrochanteric fracture. J Med Insight. 2024;2024(443). doi:10.24296/jomi/443.