Pathological fracture
Updates to Article Attributes
Pathological fractures are fractures that occur in abnormal bone.
Terminology
The term pathological fracture is usually reserved for malignancies, either benign or malignant, although it has been used in the setting of osteomyelitis. It can be used in the setting of generalised metabolic bone disease (e.g. Paget disease, osteopetrosis), although the term insufficiency fracture is probably more correct 4.
Pathology
Location
The most common location for pathological fractures are 4:
- subtrochanteric femur
- humeral head and metaphyseal junction
- vertebral body
In addition, in adults patients, the avulsion of the femoral lesser trochanter should be considered a pathological fracture until proven otherwise 4.
Treatment and prognosis
Pathological fractures are feared by oncologists because they may cause immobilisation of their patients, especially when the spine or lower extremities are affected.
Practical points
A radiologist should mention the possibility of a pathological fracture if an osteolytic metastasis is seen. In principle, every osteolytic focus in the femoral neck or the spine is at risk of a pathological fracture.
Scoring systems have been developed to assess the fracture risk of bone metastases, the Mirels classification is the one that has gained most traction, although its poor sensitivity (35%) means that it is not without its controversy 5.
-<li><a href="/articles/vertebral-body">vertebral body</a></li>-</ul><p>In addition, in adults patients, the avulsion of the femoral lesser trochanter should be considered a pathological fracture until proven otherwise <sup>4</sup>.</p><h4>Treatment and prognosis</h4><p>Pathological fractures are feared by oncologists because they may cause immobilisation of their patients, especially when the spine or lower extremities are affected.</p><h4>Practical points</h4><p>A radiologist should mention the possibility of a pathological fracture if an osteolytic metastasis is seen. In principle, every osteolytic focus in the femoral neck or the spine is at risk of a pathological fracture.</p><p>Scoring systems have been developed to assess the fracture risk of bone metastases, the <a title="Pathological fracture risk (Mirel classification)" href="/articles/pathological-fracture-risk-mirels-classification-1">Mirels classification</a> is the one that has gained most traction, although its poor sensitivity (35%) means that it is not without its controversy <sup>5</sup>.</p>- +<li><a title="Vertebral body pathological fracture" href="/articles/vertebral-body-pathological-fracture">vertebral body</a></li>
- +</ul><p>In addition, in adults patients, the avulsion of the femoral lesser trochanter should be considered a pathological fracture until proven otherwise <sup>4</sup>.</p><h4>Treatment and prognosis</h4><p>Pathological fractures are feared by oncologists because they may cause immobilisation of their patients, especially when the spine or lower extremities are affected.</p><h4>Practical points</h4><p>A radiologist should mention the possibility of a pathological fracture if an osteolytic metastasis is seen. In principle, every osteolytic focus in the femoral neck or the spine is at risk of a pathological fracture.</p><p>Scoring systems have been developed to assess the fracture risk of bone metastases, the <a href="/articles/pathological-fracture-risk-mirels-classification-1">Mirels classification</a> is the one that has gained most traction, although its poor sensitivity (35%) means that it is not without its controversy <sup>5</sup>.</p>
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