Pathological 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. 

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.

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.

Everyone knows that whenever we get to hear the word fracture, then there is some kind of injury behind it. Falling generally on the ground does not cause a fracture, but in weakened bone (pathologic bone), it can lead to the fracture. 

Sometimes the bones become so much weak that a fracture can occur with no prominent event taking place. However, even after normal coughing, stepping out of the car or bending over can lead to a fracture when the bone is severely weakened.

Pathological Fracture Causes

A pathological fracture can be caused by two types of diseases. These include localized diseases and generalized diseases. These are as follows

LocalizedGeneralized
Infection (inflammatory diseases) Congenital disorders (Genetically) which means present by birth
Neoplastic means abnormal cell growth which include

1 - Benign Tumor (Non-cancerous) and
2 - Malignant (Cancerous)
Acquired (Which the patient acquire during his lifespan)
MiscellaneousMiscellaneous

Lets discuss about the Localized disease in details along with there examples

Infection (inflammatory diseases)It means where the disease has happened we'll get to see swelling and inflammation. Example include - Pyogenic Osteomyelitis (usually in chronic form)
Neoplastic means abnormal cell growth which include

1 - Benign Tumor (Non-cancerous) and
2 - Malignant (Cancerous)
Benign Tumor (Non-cancerous) - It cannot invade the surrounding tissue or cannot spread to other areas of the body, as cancer does. It include

1 - Chondroma (enchondroma)
2 - Giant Cell Tumor (Osteoclastoma)
3 - Haemangioma (spine)

Malignant (Cancerous) - Malignant tumors are composed of cells that multiply in uncontrolled ways and can spread locally or to distant areas. Malignant tumors are cancerous. They spread to distant areas through the bloodstream or lymphatic system. This spread is known as metastasis. It include

1 - Osteosarcoma  (osteogenic sarcoma)
2 - Ewing's Tumor
3 - Solitary Myeloma
4 - Metastatic carcinoma (They spread specially from lung, breast, prostate, thyroid or kidney)
5 - Metastatic Sarcoma (From primary in another bone)
Miscellaneous
1 - Simple bone cyst
2 - Monostotic fibrous dysplasia
3 - Eosinophilic granuloma
4 - Poliomyelitis

Now Lets discuss about generalized diseases of bone in details along with there examples

Congenital disorders (Genetically) which means present by birthOsteogenesis imperfecta
Acquired (Which the patient acquire during his lifespan)1 - Osteoporosis
2 - Osteomalacia
3 - Rickets
4 - Scurvey

Disseminated Tumors which include

1 - Multiple Myeloma (myelomatosis)

2 - Diffuse metastatic carcinoma
Miscellaneous1 - Paget's disease
2 - Polystotic fibrous dysplasia
3 - Gauher's disease

Lets discuss some of the examples of Localized and generalized diseases in details. The diseases that are discussed below are marked in bold in the above mentioned tables.

Metastatic Carcinoma

When a local or circumscribed lesion of bone is responsible for the pathological bone fracture, the most common cause is metastatic carcinoma. It usually spreads from the lungs, breast, prostate, thyroid, or kidney.

Such fractures occurs most frequently in the vertebral bodies (especially in the thoracic or lumbar region), in the proximal half of the femoral shaft, and in the proximal half of the humerus.

Bone Cyst

Another common cause is a bone cyst. It usually occurs in long bones.

Osteoporosis

Osteoporosis is a condition that weakens your bones, which makes bones more susceptible to breaking. This is a condition that occurs mainly in older age. Osteoporosis symptoms tend to be evident in the latter stage of this disease when the bones become weak.

If you’re not getting sufficient calcium and vitamin D in your diet to maintain the bone’s density, you’ll lose it. Osteoporosis chips away at your bone density. The bones may collapse and can lead to fracture, even if you’re careful. In most cases, pathologic fractures are the result of osteoporosis. 

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.

Osteomalacia

A lack of vitamin D usually causes Osteomalacia. It helps your body in absorbing calcium. Calcium plays a vital role in maintaining bone health, and when you’re not getting enough calcium, your bones begin to become weaker. This can make them more vulnerable to fracture.

The most common way to treat Osteomalacia is by changing your diet, sitting in morning sunlight (between 7 am to 10 am), or taking vitamin D supplements.

Rickets

Rickets is the weakening or softening of bones in children due to lack of prolonged vitamin D. In adults. It is called Osteomalacia. Adults may also suffer a similar condition as discussed above.

Osteomyelitis

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.

Paget’s Disease

Paget’s disease of the bone is a rare condition that results in an unusual bone structure.

Poliomyelitis & Bone cysts 

Other conditions like poliomyelitis may also lead to loss of bone density. There may be fluid-filled holes in the bone known as bone cysts which may make the bone weaker.

Congenital disorders 

Congenital disorders like osteogenesis imperfecta, also known as brittle bone disease, can also lead to pathological fractures due to soft and imperfect bones formed at birth which break easily.

Pathological Fracture Diagnosis

Some basic views in shaping the diagnosis of pathological fracture. As you don’t know what is going underneath the skin when you suffer an injury.

It can be challenging to determine whether the bone fracture is causing the pain. In case if the bone fracture is causing the pain, then what type of bone break it is. Consult your doctor for an evaluation to find out. 

The symptoms of any fracture may include pain that ranges from mild to severe or a limb that looks out of place, swelling, tenderness, tingling or numbness, or difficulty in moving the limb. Your doctor may order some radiological tests, which include

  • X-ray – To determine whether the bone is broken. It will also give your doctor a clear picture of the break.
  • They may also order MRI scans, bone scan or CT scan to get a better look.

If you’re unsure about what caused the fracture, your doctor could request additional tests to determine whether there is an underlying pathology or disease. Other tests could include:

  • Laboratory tests are often used to determine calcium and vitamin D levels in the blood or complete blood counts.
  • 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. 

How can you tell if the fracture is caused by pathology or not?

  • The most important thing to remember is that anyone who experiences a fracture without an injury or significant trauma could be suspected of having a pathological fracture.
  • If the patient tells from the front to the doctor that he had suffered or passed from a disease or disorder before the fracture. Then the doctor easily gets to know that the bone got weakened due to that disease or disorder, and the patient has suffered the fracture due to trivial trauma.
  • If the patient is already coming to the doctor with pre-diagnosed cancer or some type of disease. And due to that disease patient’s bones have become weakened, and fracture has taken place. Then it becomes straightforward for the doctor to make the diagnosis of pathological fracture.

Pathological Fracture Treatment

After a fracture, the first thing that doctors recommend for its treatment is to rest and wear a cast or splint. If surgery is not needed, then after performing close reduction of the bone, a cast or splint is given to wear for immobilization and stabilization.

Sometimes you’ll require surgery. Nowadays, Internal fixation is the chosen method for the treatment of pathological fractures. Internal fixation involves use of screws, rods, and plates to provide stability to the fracture site. It is mainly performed in the cases of bone cysts and tumors. Resection of the bone, i.e., removal of the diseased part of the bone, is also performed in some cases.

Let’s talk about the union of the fracture sites.

The fusion of the pathological fracture largely depends upon the nature of the underlying disease of the bone.

           Conditions       Union
In case of generalized diseases of bone such as Paget's disease, osteogenesis imperfecta, or acquired disorders of bone-like Osteoporosis, Osteomalacia, Rickets The fracture may be expected to unite, often in about normal time, but sometimes the union happens more slower than normal.
A fracture that occurs at the site of Benign tumor or Bone cyst They will also generally unite, but there could be some delay.
If a fracture is caused by the weakening of a bone due to an infection (Osteomyelitis).The process of union is seriously delayed or could fail completely until the infection is removed.
A fracture that occur at the site of Malignant tumor.The fracture often remains ununited, but the union may be possible sometimes after the treatment.

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