Tumor-related pathologic fractures

Abstract

Pathologic fracture is most commonly caused by metastatic bone disease, which has become increasingly prevalent because advances in medical care have prolonged the survival of cancer patients long enough for bone metastasis to occur. Less common causes include primary bone tumors. Accurate diagnosis is a crucial determinant of treatment outcomes, since treating a pathologic fracture in the same manner as a traumatic fracture may result in reoperations and poorer outcomes. Therefore, thorough evaluation to identify the underlying pathology of the bone is necessary before initiating treatment. Management of pathologic fracture consists of conservative treatment, surgery, radiotherapy, and medical treatment. The goal of surgery is to restore patients’ ability to perform daily activities and to relieve pain. Surgical decisionmaking must consider disease factors, prognosis, as well as the location and size of the affected bone. Treating pathologic fracture is a challenge for orthopaedic surgeons, particularly those without subspecialty expertise in orthopaeadic oncology. When treatment limitations exist, referral to a hospital with a multidisciplinary team capable of providing comprehensive care is recommended.