Pathologic Fracture Discussion
A pathologic fracture occurs through a weakened area of bone, typically
from a bone tumor. Bone tumors may be benign or malignant, and
differentiation may be difficult. Statistically, most bone tumors are
benign. If the tumor does prove to be malignant, major resection or
amputation with or without adjuvant therapy may be required. Malignant bone
tumors may spread uncontrollably and result in death. Benign tumors may be
locally aggressive and can recur even after surgical removal, at times
requiring amputation for local control. The most exact diagnostic technique
is biopsy to obtain tissue for pathologic examination. Any bone tumor may
weaken the bone and result in pathologic fracture. Unfortunately, because
of the healing process, needle biopsy of a pathologic fracture may be
difficult to distinguish from osteogenic sarcoma, and MRI of a recent
fracture may not be able to differentiate between fracture hematoma and
extraosseous bone involvement. Treatment options include observation with
additional xrays or MRI scans taken at regular intervals to monitor any
progressive change, further bone scans or biopsy. Unless there is strong
evidence of an aggressive malignant tumor or uncontrollable mechanical
instability, pathologic fractures are allowed to heal before proceeding
with definitive excision.
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