REFERRAT

PATHOLOGIC FRACTURES

WAN MUHAMMAD MULKAN

030.12.277
 INTRODUCTION

• A pathological fracture (also called secondary fracture or spontaneous

fracture), fIrst named by Grunert in 1905

• A pathological fracture occurs without adequate trauma and is caused by

pre-existent pathological bone lesion. A bone fracture is a complete or
incomplete discontinuity of bone caused by a direct or indirect force.

• 5% of all fracture are pathological fractures due to local or systemic

diseases.

• Age-related fractures are projected to increase nationally from 2.1 million

in 2005 to over 3 million fractures in 2025, solely in the basis of growh in
the elderly population most at risk.
 ANATOMI

• Bones, from the viewpoint of their gross structure, are classified as :

1) long bones, or tubular bones (e.g. femur)
2) short bones or cuboidal bones (e.g. carpal bones), and
3) flat bones (e.g. scapula). Furthermore, each bone consists of dense cortical
bones (compacta) on the outside and a sponge-like arrangement of
trabecular bone (spongiosa) on the inside
• A long bone has two parts: the
diaphysis and the epiphysis.

• The diaphysis is the tubular shaft that

runs between the proximal and distal
ends of the bone

• The hollow region in the diaphysis is

called the medullary cavity

• The walls of the diaphysis are

composed of dense and hard compact
bone
• The medullary cavity has a delicate membranous lining called
the endoteum (end- = “inside”, oste- = “bone), where bone
growth, repair and remodeling occur.
• The outer surface of the bone is covered with a fibrous
membrane called the periosteum (per- = “around” or
“surrounding”)
• Mature long bone have 3 distinct zones : epiphyseal, metaphyis
and diaphysis.

• the epiphysis and metaphysis are separated by a fourth zone,

known as the epiphyseal plate, or physis
1. The zone of resting
cartilage

2. The zone of young

proliferating
cartilage

3. The zone of maturing

cartilage

4. The matrix of
calcifying cartilage
 Bone cells and tissue
• Bone certains a relative small number of cells entrenched in a
matrix of collagen fibers that provide a surface for inorganic
salt crystals to adhere.

• These salt crystals form when calcium phosphate and calcium

carbonate combine to create hydroxyapatite, which
incorporates other inorganic salts like magnesium hydroxide,
fluoride, and sulfate as it crystallizes, or calcifies, on the
collagen fibers
Cell type Function Location

Osteogenic Develop into osteoblast Deep layers of the periosteum and

cells the marrow

Osteoblasts Bone formation Growing portions of bone, including

periosteum and endosteum

Osteocytes Maintain mineral Entrapped in matrix

concentration of matrix

Osteoclasts Bone resorption Bone surfaces and at sites of old,

injured, or unneeded bone
 • Compact bone
is the denser,
stronger of the
two types of
bone tissue

• Compact bone is the denser, stronger of the two types of bone

tissue
• The microscopic structural unit of compact bone is called
an osteon, or Haversian system. Each osteon is composed of
concentric rings of calcified matrix called lamellae (singular =
lamella).
• spongy bone, also known as cancellous bone, contains osteocytes
housed in lacunae, but they are not arranged in concentric circles

• the spaces in some spongy bones contain red marrow, protected

by the trabeculae, where hematopoiesis occurs
• The biomechanical composition of bone is as follows: 30%
organic substances, 60% inorganic (mineral) substances and
10% water
 Metabolism of Calcium and
phosphorus
• The metabolisms of calcium (Ca) and phosphorus are so closely
interdependent that they are best considered together

• the normal plasma levels of both calcium and inorganic

phosphate (Pi) are regulated by three hormones, that is:
 the active metabolites of vitamin D (now considered to be
hormones rather than vitamins)
 parathyroid hormone (PTH)
 Calcitonin
 Calcium function :
• It controls internal
reguation

• It related cell membrane

permeability, nerve
excitability, muscle
contraction

• It control the hardness and

rigidity of bones
• As a physiological organ, bone is the resrvoir for 99% of the
total body calcium (1000 g) and 90% og the total body
phosphorus.
• Maintenance of a narrow normal range of total plasma calcium
is vital (9.0 to 10.4 mg/100 mL or 2.25 to 2.60 mM)
 DEFINITION

• A pathological fracture occurs without adequate trauma and is

caused by pre-existent pathological bone lesion.

• A bone fracture is a complete or incomplete discontinuity of

bone caused by a direct or indirect force.
 EPIDEMIOLOGY

• A pathological fracture is one that occurs in bone tissue that is

pathological, weak and remodeled, with altered or reduced
mechanical and viscoelastic properties.

• 5% of all fracture are pathological fractures due to local or

systemic diseases.

• Age-related fractures are projected to increase nationally

from 2.1 million in 2005 to over 3 million fractures in 2025,
solely in the basis of growh in the elderly population most at
risk.
 GIT disorders and
fragility
Drugs IBD

Osteom Infection
alacia

ETIOLOGY
Endocrinopathies Non-malignant
haematological

Uncommon diseases of bone

Malignancies and connective tissue

Rheumatology
diseases
 CLINICAL FEATURES

• Pathologic fractures don’t always have symptoms.

Numbness,
tingling or
Bruising, weakness
tenderness and
Mild to severe swelling
pain
DIAGNOSIS AND INVESTIGATION

systemic skeletal disease

characterized by low bone
mass and micro-architectural
deterioration of bone tissue,
OSTEOPOROSIS leading to enhanced bone
fragility and a consequent
increase in fracture risk
Risk Age, sex and race
Factors
Family history
Reproductive factors
Hypogonadal states
Life style and physical activity
History of low trauma
Medication
 Clinically Diagnosis

• bone pain other sites, loss of both standing and sitting height,
and reduction in physical performance, including respiratory
function.

• The patient with advanced osteoporosis usually looks frail amd

exhibits an abnormal degree of dorsal kyphosis (the so-called
dowager;s hump).
Clinically Diagnosis
 Radiographic diagnosis
1. BONE MINERAL DENCITY (BMD)
2. Radiography
 The most frequent
primary sources for
metastatic carcinoma
in bone are breast,
prostate, lung,
Metastatic carcinoma is common, as kidney, thyroid,
evidenced by the post-mortem bladder, and colon
evidence that at least 25% of all (in that order).
patiets who have died from
carcinoma have one or more
metastases in bone

Metastatic tumors of bone

 Presentation

• Most symptomatic patients with metastatic bone disease

present with pain that is mechanical in nature, worse at night,
and unresponsive to anti-inflammatory medications and
narcotics.

• Neurological complaints may be the presenting symptoms

especially in cases of spinal metastases with associated nerve
root or spinal cord compression
 .One should look for
lytic, blastic, or
mixed lesions

• Computed tomography (CT) is the study of choice when looking

for bone detail and cortical destruction, but is not as sensitive
at assessing marrow replacement
• MRI on the other hand is very sensitive to early marrow
replacement and can locate metastases prior to their
appearance on radiographs and CT, but is not as helpful for
bony anatomy.
 Common clinical
manifestations are diffuse
bone and joint pain, bone
tenderness, muscle weakness
particularly proximal
myopathy, waddling gait,
muscle cramps, spasms,
tingling and numbness and in
severe cases single or
multiple fractures
Is a generalized disease of adult bone
characterized by a failure of calcium salts to be
deposited promptly in newly formed organic
bone matrix (osteoid)
 • Vit. D deficiency
and resistance
• Hypophosphatemic
• CKD

Etiology • RTA
• Mineralization
inhibitors
• Hypophosphatasia
• Inadequate calcium
intake
 TREATMENT

• Depending on the location of the fracture, it may require pins,

plates, or screws to hold the bone in place while healing

• If the fracture is caused by conditions that make it difficult for

the bone to heal, it may need additional treatment, such as
surgery.
 PROGNOSIS

• Most pathological fractures will united, because the rate of

bone deposition in fracture healing is usually more rapid than
the rate of bone resorption of the underlying pathological
process.
 CONCLUSION

• Pathologic fractures occur without adequate trauma and are caused by

pre-existing pathological bone lesions.

• Many causes that can cause pathological fractures include tumor metastation
to bone, osteoporosis, osteomalacia and vitamin D deficiency. less obvious
symptoms such as mild to severe pain in bone fractures, redness, swelling etc

• In some cases, it may be hard to tell the difference between symptoms of a

pathologic fracture and those of the underlying condition affecting your
bones.

• Treating pathologic fractures depends on the underlying conditions.