Pathological fractures of the extremities

Abstract

Pathological fractures of the appendicular skeleton due to tumours are relatively uncommon. Patients who are older than 50 years are most likely to have a metastasis, while patients who are younger than 20 are more likely to have a primary bone neoplasm.

In all fractures, but especially those that present after minimal trauma, one should have a high index of suspicion that the fracture might be pathological. Correct diagnosis prior to treatment is essential and we have constructed a protocol for this. In the assessment of these tumours a multidisciplinary assessment with radiologist, pathologist, oncologist and orthopaedic surgeon, is essential. The patient will require both oncological and surgical treatment. The aims of surgical treatment are firstly to stabilize the fracture with a construct that will outlive the patient and second to improve the patient’s mobility and to relieve pain.

Advances in oncological treatment have prolonged the survival of patients with primary and metastatic bone disease. This puts increasing strains on the surgical construct, therefore the choice of surgical reconstruction needs to be carefully considered. We outline the assessment of a patient who presents with a pathological fracture in three phases and describe a treatment protocol.