47 Pathological fracture
Fig. 47.1A This radiograph demonstrates a fracture through an aggressive lesion in the distal femoral diaphysis. This is a pathological fracture through a lytic metastasis.
Background
Please read the sections on benign versus aggressive lesions (Chapter 49) and bone metastases (Chapter 53).
This is a scenario that often causes confusion, hence its inclusion in this book.
A pathological fracture occurs in a bone that is weakened by a pathological process. This is usually a tumour, which may be a primary or secondary, but can also be infection. The process need not necessarily be a malignant or aggressive one – benign lytic lesions of bone can also fracture.
This condition might be expected to present to an orthopaedic or A&E doctor but many of the processes that weaken bone can occur on a medical ward too.
Also be aware that preventative measures can be taken to prevent fractures of bones with lytic metastases – consider an orthopaedic opinion before the bone breaks, particularly if it is a weight-bearing one.