Professional Documents
Culture Documents
Pathologic Fractures
Tumors
primary
secondary (metastatic) (most common)
Metabolic
osteoporosis (most common)
Pagets disease
hyperparathyroidism
Pathologic Fractures
Benign Tumors
Fractures more common in benign tumors
(vs malignant tumors)
most asymptomatic prior to fracture
antecedent nocturnal/rest symptoms rare
most common in children
humerus
femur
unicameral bone cyst, NOF, fibrous dysplasia,
eosinophilic granuloma
Fractures through benign tumors
Adenoma
Polyostotic disease
Mixed
Mental status changes radiodense
and
Abdominal pain radiolucent
lesions
Nephrolithiasis
Polyostotic disease
mixed radiolucent/radiodense
Multiple brown tumors
in a patient with primary
hyperparathyroidism
Hyperparathyroidism
May be secondary to renal
failure
secondary
tertiary
Treatment
parathyroid adenectomy
ORIF for fracture
correct calcium
Diaphyseal lesion
Good bone stock
Histology sensitive to
chemo/radiation
Impending fractures
Poor prosthetic options
Indications For Replacement
Periarticular disease
Fracture after radiation
Failed fixation
Renal cell ca
Pathologic Fracture Treatment
Periarticular fractures, especially around the hip
are more appropriately treated with arthroplasty
Periacetabular fractures
protrusio shell,
cement, arthroplasty
saddle prosthesis
Structural
allograft-prosthesis
composite
Cement
PMMA no PMMA
Pain relief 97% 83%
Permeative lysis
Post-op intercalary
allograft
Thank You