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In the Name of God

In the Name of God. Dr. A. Borjian Isfahan University of Medical Science. Pathologic fracture. Benign tumors Malignant primary tumors Mtastatic tumors. Pathologic Fx :. A pathologic Fx is defined, Fx occur in Abnormal Bone

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In the Name of God

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  1. In the Name of God Dr. A. Borjian Isfahan University of Medical Science

  2. Pathologic fracture

  3. Benign tumors • Malignant primary tumors • Mtastatic tumors

  4. Pathologic Fx: • A pathologic Fx is defined, Fx occur in Abnormal Bone • Bone lack of normal biomechanical and viscoelastic properties • Weakened bone predispose the patient to failure in normal activity or after minor trauma.

  5. Pathologic fracture (Incidence): • Osteoprosis most common condition associated with pathologic Fx • 10 million American>50 have osteoprosis • 34 million have osteomalacia and at risk devalping osteoporosis • 1.5 million sustain P. Fx related to osteoprosis eah year

  6. Classification: • Intrinsic:  Osteopenia of osteogensis imperfect & Replacement of Bone with tumor • Extrinsic: Lessen the inherent structural integrity of bone  Radiation or hole in bone • Localize  Bone cyst • Generalize  Osteopetrosis • Correctable  Rickets • Un correctable  Metastatic cancer • In normal bone  Vascular foramina

  7. Classification: A: Correctable disease: • Renal osteodystrophy • Hyper parathyroidism • Osteomalacia • Disuse osteoprosis

  8. Classification: B: Uncorrectable disease: • Osteogesis imperfecta • Polyostatic fibrous dysplasia • Postmonoposal osteoprosis • Paget disease • Osteo petrosis

  9. Pathologic fracture: • Fx callus may not form normally • healing slowly • Increase incidence of nonunion & delay union

  10. Diagnoses has been made on clinical finding • History • Physical examination • Xray • Laboratory finding • Often the history is most helpful

  11. Evaluation of a pediatric patient • Age of patient • Location of the lesion • Epiphysis- metaphysis- diaphysis • What is the lesion doing to the bone • Zone of transition • Pathern of lesion • What is the bone doing to the lesion • Periosteal response • Lytic- blastic- calsified- osified- ground glass

  12. Table 6-2

  13. Table 6-3

  14. Benign tumor

  15. U.B.C: • Radiolucent centric fluid filled cystic • 70% proximal Humerus or femor, • 75% present with pathologic Fx, • if diameter of cyst 85% or more  pathologic Fx

  16. Complication patho Fx: • Malunion • Growth arrest • Osteo necrosis • Collapse of articular surface

  17. Treatment: • Undisplace Fx • Traction • Curtage & Bone graft (autograft or allograft) • Displace Fx or Unstable Fx • Internal fixation + curettage & bone graft

  18. Classification for treatment of proximal femur:

  19. Malignant tumors: • Osteosarcoma • Chondrosarcoma • lymphoma

  20. lymphoma

  21. Lymphoma • Primary or secondary • Sixth and seven decades • Male/female = 1.5/1 • Femor pelvic spine ribs

  22. Lymphoma • Chief complain • Localized pain • Swelling • Nerve root or cord compression

  23. lymphoma • X ray • Diaphysial • Illdefined • Bone distraction • Permeativeapperance • Ticking of cortex • Periosteal reaction rarely seen

  24. Radiogarph can be normal • Bone scan • MRI

  25. Staging • CBC • Serom chemistry • Bone scan • CT (chest abdomen pelvic) • Bone marrow biopsy

  26. patology Patology?

  27. Prognosis • Primary 55% 5-year survival • Secondary <25%

  28. Treatment • Chemotherapy • Radiotherapy • surgury

  29. Case 1

  30. Case 2

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