Pathologic Fractures. H.T. Temple, MD Walter W. Virkus, MD Created March 2004; Revised December 2005, October 2008. Pathologic Fractures. Tumors primary secondary (metastatic) (most common) Metabolic osteoporosis (most common) Paget’s disease hyperparathyroidism.
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H.T. Temple, MD
Walter W. Virkus, MDCreated March 2004; Revised December 2005, October 2008
Intermediate grade chondrosarcoma
*fixation of primary bone tumors must not be performed until proper evaluation has been performed and the diagnosis has been established in order to prevent potential for spread of tumor.
Fracture through Pagetic
bone (arrow). Transverse fracture suggests pathologic bone.
Multiple brown tumors
in a patient with primary
Pathologic fracture through brown tumor (arrow)
Primary Site% metastasis to Bone
Destructive lesions in bone from
lung carcinoma (arrows)
In body pedicle junction
% Primary Tumor Identified
History and Physical 8%
Chest X-Ray 43%
Chest CT 15%
Abdominal CT 13%
% shaft destroyed Incidence Fx (%)
Harrington, K.D.: Clin. Orthop. 192: 222, 1985
1 2 3
Site upper limb lower limb peritrochanteric
Pain mild moderate functional
Lesion blastic mixed lytic
Size <1/3 1/3-2/3 >2/3
Score < 7 – no surgery
Score > 7 – prophylactic fixation
Mirels, H.: Clin. Orthop. 249: 256, 1989.
Gainor, B.J.: CORR 178: 297, 1983
PMMA no PMMA
Pain relief 97% 83%
Ambulation 95% 75%
Fixation failure 2 cases6 cases
Haberman, E.T: CORR, 169: 70, 1982
*pre operative embolization of renal cell mets should be done
Soft tissue mass
Pre-operative embolization can preventhemorrhage with intra-lesional surgery
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