Have you ever heard of a pathologic fracture? Unlike typical bone breaks caused by acute trauma, these fractures occur when a bone weakened by disease breaks under everyday stress. You may be surprised to learn that pathologic fractures can happen during everyday activities like walking or rolling over in bed. In this article, you'll discover what makes pathologic fractures unique, explore the underlying conditions that lead to them, and learn about diagnostic methods and treatment options available to address this serious medical issue.
A pathologic fracture is caused by disease or a disease process that weakens bone structure. They do not occur with the usual acute trauma or excessive force that results in acute fractures and can take place with minimal or no apparent injury. Pathologic fractures can often be a sign of a more serious underlying health problem.
These pathologic fractures may be caused by several disorders affecting the strength and integrity of bones, including:
Symptoms include sudden pain, swelling, and loss of function or motion of the involved area. There may even be an audible cracking sound when the bone breaks. Diagnosis is based on the following:
Many diseased states can significantly weaken bones. Osteoporosis is a disease in which mass and density are reduced, and quality is impaired; it is the most common cause of pathologic fractures. Other disorders, such as osteomalacia due to a deficiency of vitamin D, also serve to weaken bones and increase fracture risk.
Malignancies of the bones, whether primary bone malignancies or metastatic lesions from other parts of the body, may cause erosion of the bone tissue, creating spots that are susceptible to fracture.
Chronic bone infections, such as osteomyelitis, and inflammatory disorders, including rheumatoid arthritis, may compromise bone quality over time and increase fracture risk.
Conditions that disrupt normal bone metabolism, such as hyperparathyroidism or Paget's disease, can lead to abnormal bone structure and increased fracture risk.
Pathologic fractures typically present with acute and severe pain at the site of the fracture. The pain may be exacerbated by motion or weight bearing. You may observe swelling or tenderness over the involved area, and a visible deformity or bruising may occur in the affected limb. Unlike the other forms of fractures, the pain originating from a pathologic fracture can be gradual, weeks or even months, before an actual fracture occurs.
Pathologic fractures are typically associated with sharp and intense pain at the fracture site. Motion or weight bearing may exacerbate the pain.
Systemic symptoms can depend on the underlying condition that caused the pathologic fracture. These include unexplained weight loss, generalized fatigue, or even night sweats. Other signs of malignancy causing the fracture include chronic coughing, changes in bowel habits, and strange lumps and masses elsewhere in the body.
Healthcare providers always begin their review of patients suspected of a pathological fracture with an adequate clinical examination. The detailed history covers risk factors like cancer, osteoporosis, and metabolic disorders. Your doctor may also do a physical exam to look for tenderness at the site of the fracture, swelling in the area of the fracture, or poor movement of the part.
Radiological imaging helps diagnose pathological fractures. X-rays can be the principal initial imagery modality, which may reveal fracture patterns and some underlying bone abnormality. Magnetic resonance imaging can be performed for further detail. Advanced imaging techniques can show fine details about the bone lesions and details about the surrounding soft tissues.
Blood tests and other investigations help recognize the underlying factors causing pathologic fractures. These may include:
A bone biopsy may be indicated in selected cases to confirm the nature of bone lesions and their diagnosis. It entails removing a small sample of bone tissue, which is examined under the microscope to distinguish benign bones from malignant ones.
Generally, pathologic fractures are initially treated by treating the underlined condition. Your doctor can prescribe certain drugs that stabilize and strengthen bones, such as bisphosphonates, which might be used in cases of osteoporosis, or hormonal therapy, which may come in handy in cases of cancers dealing with hormonal imbalances. Pain control is essential, of course, and your care team might recommend a mix of over-the-counter pain relievers and prescription medication to help keep you comfortable as you heal.
Surgery may sometimes be required to stabilize the fracture, preventing additional injury. Surgical techniques may vary but can include internal fixation using steel rods or plates to hold the bone in its proper setting and even joint replacement in severe injuries. Your orthopedic surgeon will decide the best course of action depending on the fracture's severity, the injury's location, and your overall health.
The prevention of pathologic fractures is multifold. It would prevent a weakness that may lead to a fracture since regular bone density scans would be done. It would help if you also worked out your general lifestyle: eat proper food with calcium and vitamin D and do weight-bearing exercises, strengthening bones and improving balance, hence decreasing the chances of falls. If you're at high risk, your doctor might suggest using assistive devices or home modification changes to make it a safer environment.
Conclusion Pathologic fractures are essential for both the patient and the provider. Since these fractures are caused by an underlying medical condition weakening the bones, their treatments are specific. Suppose one has a concern regarding their bones or risks having pathological fractures. In that case, it is best to consult with the healthcare provider to develop an appropriate plan of prevention and treatment that fits one's needs.
