Pathological vertebral fracture causes. Pathological bone fractures

… accurate recognition of a pathological fracture is important, as its treatment differs significantly from that of a traumatic one.

Pathological bone fracture- this is a fracture that occurred under the influence of a slight traumatic force or even a physiological load on the bone, altered by some previous pathological process (inflammatory, infectious (for example, tuberculosis), dystrophic, dysplastic, tumor, etc.). That is, pathological fracture a bone is a fracture of a bone in the area of ​​its pathological reorganization.

Etiology. One of the leading places in the structure of causes leading to the development of weakness bone tissue, occupy tumors. Also the most common causes decrease in bone strength are tumors, dystrophic and dysplastic processes in it (osteoporosis, fibrous or cartilaginous dysplasia, dystrophic bone cyst, aneurysmal bone cyst, congenital bone fragility, osteolysis, etc.). Pathological fractures are also observed in neurogenic dystrophic processes, such as syringomyelia, dorsal tabes.

Clinic. Clinical manifestations of a pathological fracture are slightly less acute and pronounced compared to traumatic fractures, significant displacement of fragments are rare. Sometimes a pathological fracture is the first manifestation of a bone disease, about which neither the patient nor his relatives knew anything before this event. Main clinical signs that precede a pathological bone fracture against the background of metastases are spontaneous pain or pain under load, bone deformity. Accurate recognition of a pathological fracture is important, since its treatment differs significantly from traumatic, in addition, with each individual disease complicated by a violation of the integrity of the bone, special therapeutic measures are indicated.

Diagnostics. Diagnosis is carried out on the basis of complaints, traumatic anamnesis, as well as on the basis of clinical picture, radiological and laboratory methods research. From radiological methods of research along with the roentgenogram the scintigraphy is of great importance. Scanning can detect early metastases with an accuracy 4 times greater than with radiography. Angiography can only determine the general character traits malignant tumors. Laboratory studies in osteolytic lesions reveal hypercalcemia and hypercalciuria, as well as the release of hydroxypromine. In the case of an osteoplastic process, the value alkaline phosphatase increased, serum calcium levels decreased. Determination of the content of cyclic aminophosphatase can help in differentiating hypercalcemia caused by primary bone tumors and metastases. Despite this, laboratory data are not sufficiently specific in diagnosing bone metastases.

Treatment. In the treatment of pathological fractures, not only the complication, but also the underlying disease should be eliminated. Wherein medical tactics depends on a number of reasons: the nosological form, the nature of the pathological process, the stage of tumor development, the primary or secondary nature of the tumor process.

The purpose of surgery is to eliminate the pain syndrome, reduce the time inpatient treatment, transferring the patient to ambulatory treatment, facilitating patient care, promoting the implementation of other methods of treatment, the impact on the psycho-emotional state of the patient. Early activation prevents development trophic ulcers, thrombophlebitis and hypercalcemia.

In order to stabilize pathological fractures, surgical techniques must be individualized depending on the location, specific properties affected bone and involvement of adjacent soft tissue structures. The most common fractures of long bones are femoral and brachial bones that require stable intraosseous osteosynthesis. This fixation must withstand the load on the long bones. According to various authors, surgical fixation of fragments femur it is preferable if the patient can be operated on. Surgical treatment of pathological fractures against the background of oncological bone lesions serves to improve the patient's quality of life in the remaining period of time, and not to increase the patient's life expectancy (preference is given to arthroplasty).

Currently, surgical treatment of pathological fractures against the background of primary and secondary malignant processes in case of damage to the articular end, it involves arthroplasty, and in case of damage to the diaphyseal part of long bones, segmental resection using bone cement or bone grafting and fixation of bone fragments with external or internal metal structures, and can be used various methods transosseous osteosynthesis.

In case of pathological fractures against the background of benign tumors and tumor-like lesions, an active surgical tactics and perform bone resection in combination with osteosynthesis in the first days after its occurrence, without waiting for the possible fusion of fragments.

- this is a violation of the integrity of the bone in the area of ​​\u200b\u200bits pathological restructuring. It occurs as a result of a minor traumatic effect: a fall from a small height, a non-intense blow, or even ordinary muscle tension. The cause of development is osteoporosis, osteomyelitis, malignant and benign neoplasms of bone tissue and some other diseases. Clinical manifestations are usually blurred, pain, swelling, limitation of limb function can be observed. The diagnosis is established on the basis of radiography, MRI, CT, scintigraphy, biopsy and other studies. Treatment is often surgical.

The reasons

Most often, pathological fractures are complicated by bone neoplasms and fibrous osteodystrophies. According to statistics, a pathological violation of the integrity of the bone is observed in 50-60% of solitary cysts. A little less often traumatic injuries occur with fibrous dysplasia. With Paget's disease and Recklinghausen's disease, bones break in 40-50% of cases, with giant cell tumors - in 15% of cases.

Among tumor processes, malignant tumors occupy the first place in terms of the number of such complications, while pathological bone lesions are more often observed in metastatic processes and less often in primary tumors. Distinctive feature fractures with metastases is a multiplicity, especially pronounced in injuries of the vertebral bodies. Multiple myeloma metastases are complicated by fractures in 2-3 cases. Less often, pathological fractures are observed with metastases of hypernephroma and cancer, as well as with osteoplastic bone carcinosis. Bone damage is not uncommon in osteoclastic sarcomas. Among benign neoplasms fractures are most often complicated by chondromas.

Nowadays, due to the increase in life expectancy and the decrease in motor activity The "average" person in traumatology and orthopedics is becoming increasingly important pathological fractures in osteoporosis. Damage occurs more often in post-menopausal women. The integrity of the vertebrae, femoral neck, or radius. Multiple repeated compression fractures of the vertebrae cause the development of kyphosis. Fractures of the femoral neck cause disability, and in old age in 25-30% of cases end in death due to severe complications.

Fractures often occur with echinococcosis and quite rarely with tuberculosis, osteomyelitis and tertiary syphilis. Pathological fragility of bones is also observed in osteopsatirosis and osteogenesis imperfecta, osteoarthropathy in syringomyelia and spinal cord tabes and osteosclerosis of various origins. Bone changes due to neurogenic disorders cause pathological fractures with paresis and paralysis, both traumatic and non-traumatic.

Peculiar microfractures always occur with osteochondropathy and in most cases with congenital syphilis and childhood scurvy. Less commonly, bones break with osteomalacia and rickets, and very rarely with hemophilia. A pathological fracture can also be considered a violation of the integrity of the emerging callus i.e. recurrence of the traumatic fracture. Bone integrity is also often compromised in ankylosis, in which case the atrophied bone breaks in the vicinity of the joint. Many experts attribute fractures of an atrophied and ankylosed spine in Bechterew's disease to pathological injuries.

Symptoms of a pathological fracture

A distinctive feature of such injuries is the mild severity of symptoms compared with conventional traumatic fractures. There may be slight or moderate pain and mild swelling of the affected segment. In some cases, such fractures become the first manifestation of a pathological process in the bone in people who previously considered themselves healthy. Often enough pathological disorder bone integrity is preceded by bone deformities, vague spontaneous pain, or pain on exertion.

Significant displacement of fragments is very rare. Often there are compression lesions, bends, large cracks, depressions and fractures of tubular bones in the form of a telescope (transverse injuries in which the thinned cortical layer of one fragment moves over another bone fragment). Pathological mobility and crepitus in such injuries are absent, hemorrhage may be mild or not pronounced at all. All of the above complicates the diagnosis and causes late treatment of patients to doctors.

Diagnostics

The diagnosis is made taking into account complaints, a characteristic anamnesis (minor injury), examination data and additional methods examinations. The radiography is of the greatest importance. MRI and CT can also be used to more accurately assess the condition of the bones and surrounding soft tissues. When metastases are suspected, scintigraphy is of great importance, allowing four times more often than conventional radiography to detect metastatic lesions. If osteoporosis is suspected, densitometry is indicated. In some cases, the nature of the pathological process can only be established with the help of a biopsy.

Laboratory studies also have a certain diagnostic value. Osteolytic processes are characterized by the release of hydroxypromine, hypercalciuria and hypercalcemia. With osteoplastic lesions, there is a decrease in the level of calcium and an increase in the level of alkaline phosphatase in the blood serum. However, the test data in most cases are not specific and can only be considered as an additional diagnostic criterion.

Pathological fracture treatment

Therapeutic tactics is determined taking into account the underlying disease, as well as the location and nature of the damage. aim surgical intervention there may be a reduction in the duration of treatment in a hospital, the elimination of pain, simplification of patient care, early activation of the patient and improvement psycho-emotional state, as well as a decrease in the likelihood of complications: bedsores, thrombophlebitis, trophic ulcers, congestive pneumonia, hypercalcemia, etc.

The method of surgical intervention is chosen taking into account the characteristics of the pathological process. In benign tumors, resection of the affected area is performed (in some cases, with the replacement of the resulting defect with an allo- or homograft) in combination with external or intraosseous osteosynthesis. With oncological lesions, it is often not an increase in the duration that comes to the fore, but an improvement in the quality of life of the patient.

However, at successful treatment of the underlying disease, pathological fractures, which are a complication of malignant tumors, grow together quite successfully, which must also be taken into account when choosing surgical tactics. In case of damage to the joint or periarticular region, if possible, arthroplasty is carried out, in case of violation of the integrity of the diaphysis, segmental resection in combination with strengthening the damaged area with bone cement or replacing the defect with a graft. Fragments are fixed using nails, plates, pins, screws or by installing Ilizarov apparatus.

pathological fractures occur in children with diseases of the bones of the skeleton when exposed to a slight traumatic force. The cause of such fractures can be imperfect bone formation, fibrous and cartilaginous osteodysplasia, beriberi (rickets, scurvy), inflammatory diseases (osteomyelitis, tuberculosis), etc. Imperfect bone formation is congenital fragility of bones of unknown etiology. In this disease, fractures are possible with a slight force effect: in children early age- when swaddling), shifting them, in older children - when trying to sit down, stand up - etc. Fractures are accompanied by soreness, pathological mobility and deformity, swelling and crepitus. There are subperiosteal fractures and fractures with complete displacement. More often there are fractures of the lower extremities, then the upper and ribs.

Clinically, imperfect bone formation is manifested by the curvature of the limbs due to multiple repetitive fractures or fractures of the bones, muscle hypotrophy, the presence of blue sclera, sometimes "amber teeth" and hearing loss. With a congenital form, already in a newborn, attention is drawn to the curvature of the limbs with the deflection of the bones outwards or anteriorly. In the area of ​​fractures, dense callus is often palpated. The number of fractures in such "glass children" is significant. Despite the fragility of the bones, fractures quickly grow together, however, as a result of muscle hypotrophy, incomplete adaptation of bone fragments, and “elasticity” of the callus, bone deformities occur. The disease is characterized by softness and suppleness of the skull bones in young children, which is the cause of head deformity in older children (mainly in the anteroposterior direction).

On the radiograph, the bones appear delicate and thin, especially the thin cortical layer: the spongy substance is transparent and has a barely noticeable pattern. Fused fractures are clearly visible. Due to multiple fractures the limbs are deformed and shortened.

With imperfect bone formation, the treatment of fractures is reduced mainly to careful reposition, reliable immobilization until complete consolidation. The terms of fixation of the fracture are somewhat lengthened, despite the fact that the formation of callus occurs quickly and at the usual age, but it is still long time remains “elastic”, as a result of which the possibility of deforming the limb with a fused fracture remains. Except local treatment fracture, general strengthening treatment is carried out: ultrasound irradiation, multivitamins, ergocalciferol (vitamin D), fish fat, calcium preparations, of hydrochloric acid with pepsin. It is advisable to prescribe the anabolic hormone methandrostenolone (nerobol), a hormone thyroid gland thyrocalcitonin intramuscularly. Treatment can also be outpatient settings in compliance with all the recommendations of the attending physicians of the hospital.

In case of frequently recurring fractures with severe and significant deformity of the extremities, surgical treatment is recommended, which mainly consists of corrective osteotomy, intramedullary osteosynthesis, and bone auto- or alloplasty to stimulate reparative bone tissue regeneration. In addition to imperfect bone formation, pathological fractures are observed in diseases that disrupt the normal anatomical structure of the bone.

A pathological fracture in most cases is the first symptom of a bone cyst and osteoblastoclastoma. As a result of a minor injury in the area of ​​the most frequent localization of the pathological focus: the proximal metaphysis of the humerus, the proximal and distal metaphyses of the femur and the proximal metaphysis of the tibia, pain occurs, moderate swelling and hemorrhage, and deformity are noted. There is a loss of function. Big displacement bone fragments, as a rule, are not observed; therefore, pathological mobility and crepitus are uncharacteristic of fractures in children with a bone cyst or osteoblastoclastoma. The diagnosis of a pathological fracture is established after an x-ray examination (Fig. 14.10).

Bone cyst formation is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on acute hemodynamic disorders in the bone that occur during aneurysmal or solitary cysts stretched over time.

Most solitary cysts are localized in the proximal tubular bones. The humerus (56%) and femur (23%) bones are most commonly affected. The destruction process develops slowly, asymptomatically and is manifested by a pathological fracture. Most aneurysmal cysts are localized in spongy bones with a rich arterial blood supply (vertebrae; pelvic bones; ends of bones that form knee-joint). All patients have a history of trauma. The first symptoms are mild pain, a feeling of discomfort, stiffness. Clinical and radiological manifestations of bone cysts require differential diagnosis solitary cysts with fibrous dysplasia, non-osteogenic fibroma, hyperparathyroidism, eosinophilic granuloma. Aneurysmal cysts must be distinguished from chondromyxoid fibroma, osteogenic sarcoma. Indications for conservative or surgical treatment depend on the phase of the pathological process, the extent of the lesion and the data of cystography, angiography, radioisotope research, biopsy, etc.

With a lack of vitamins D and C, pathological fragility of bones occurs. With rickets and scurvy in children younger age fractures are observed. A minor injury or awkward movement is enough for a child with rickets to have a fracture. Such fractures usually occur in the lower third of the femur and on the bones of the forearm. Often they are subperiosteal. Complaints of pain are insignificant, and the fracture is often visible; in such cases, only with the development of calluses and curvature of the limb, a former fracture is detected, which is confirmed by an x-ray.

Complete rachitic fractures grow slowly and require, along with reliable immobilization, vigorous anti-rachitic general treatment.

Changes in bones at a scurvy meet less often. With a lack of vitamin C in the second half of the first year of a child's life, rarely after a year, hemorrhages may occur in the epiphyseal line, which spread under the periosteum. Usually, hemorrhages occur in the region of the upper or lower end of the femur, upper end tibia, ribs and humerus. At the site of the hemorrhage, the bone beams are destroyed and the integrity of the bone is broken. Clinically, there is swelling in the area of ​​the limb, sharp pain during movement and palpation of the limb, thickening. Sometimes it is possible to palpate fluctuation under the muscles. Skin over the place most painful swelling tense and brilliant. The limb is in forced position. On the skin - small petechiae, the gums swell and become bluish in color, in the presence of teeth there is gingivitis. On the radiograph, a shadow is found around the diaphysis, which gives a hemorrhage, and sometimes the separation of the epiphysis from the metaphysis. The separation of the epiphysis, in addition, is determined on the radiograph by a change in the position of the ossification nucleus: the shadow of the ossification nucleus does not lie along the midline, but shifts away from the axis of the limb.

Scurvy disease with bone lesions occurs with improper and malnutrition, directed artificial feeding. Sometimes children with bone disease due to beriberi C have a "well-fed" appearance; there are no signs of malnutrition, since the children have maintained their body weight, although they receive the same malnutrition.

Diagnosis is difficult when there is still no large hematoma and the child's complaints are vague. During this period, carers of the child note that touching him and shifting causes crying. With the appearance of swelling, sharp local pain, an increase in body temperature, an inflammatory process is suspected - epiphyseal osteomyelitis, phlegmon. An error in diagnosis leads to the fact that an incision is made to the patient, during which only a hemorrhage is detected, and after surgery, the true nature of the disease is revealed.

General treatment of beriberi C, proper nutrition, the creation of rest of the pronounced limb quickly improves the condition of the child. At inflammatory diseases bone tissue can be destroyed, which leads to a pathological fracture. Such diseases in children include osteomyelitis and tuberculosis. Significant destruction of bone tissue in osteomyelitis may be accompanied by a pathological fracture. They are most often observed in the lower metaphysis of the femur and in the region of its neck or in the upper third of the humerus. Bone altered by a pathological process may break under the influence of minor violence, often almost imperceptible. Therefore, this type of fracture is called spontaneous (spontaneous).

Recognition of a pathological fracture in osteomyelitis is not difficult. Often children begin to complain of increased pain in the limb. At complete fractures with displacement, pathological mobility, deformity and shortening of the limb are determined. Often a fracture is discovered by chance, during dressings. Clarifies the diagnosis x-ray examination. Pathological fractures in osteomyelitis are sometimes accompanied by exacerbation inflammatory process, with insufficient immobilization, deformities and shortening of the limb occur, in rare cases false joints are formed.

With tuberculous lesions, pathological fractures are possible not only due to bone destruction, but also as a result of the development dystrophic processes in the bones of the entire affected limb - osteoporosis and atrophy.

Traumatology and Orthopedics
Edited by corresponding member RAMS
Yu. G. Shaposhnikova

A pathological fracture appears as a result of a violation of the integrity of the bone at the site of its pathological restructuring. The occurrence of this type of injury occurs even from minor damage or impact. Often they are caused by the presence of various bone diseases and tissues around them. The most common sites of pathological fractures are: spine, femoral neck, ribs, humerus, hands.

pathological fracture

There are many reasons that contribute to the occurrence of pathological fractures, but the main one is the formation of tumors on the bone. Innovations are:

  • benign;
  • malignant.

Benign tumors, developing on the bones for a long time, may not manifest themselves. Their main symptom is minor pain. The most common formations are:

  • osteoblastoma;

Malignant tumors often cause changes in bone and cartilage tissues creating metastases in them. Metastases very quickly disperse throughout the body and affect internal organs causing inflammation in them. They can provoke several fractures in one bone. The main types of malignant tumors are:

  • chordoma;
  • giant cell tumor of the bone;

Tumors often damage the tubular bones, they are primary and secondary. Primary tumors are very rare, and children are the main contingent of this tumor. Secondary, they are also called metastatic, on the contrary, they prevail in the elderly, and the percentage of their occurrence is much higher than the primary ones.

Diseases

Pathological fracture can also provoke various diseases, the main of which are:

  • echinococcosis;
  • syphilis;
  • osteopsathyrosis;
  • imperfect osteogenesis;

Symptoms

Pathological fracture of the bone is accompanied by very weak severe symptoms the course of the disease. This is due to the fact that it occurs at the slightest injury, after which it is impossible to immediately determine the presence of a fracture.

At first, the disease causes minor pain, which may be accompanied by swelling of the soft tissues. It is these signs that may indicate the presence of a pathological fracture of the bone. Unpleasant manifestations of the disease can occur with loads, even minor ones.

With this type of fracture, there is no hemorrhage, or its presence is not visible during the initial examination. This is due to the fact that it is internal.

A callus sometimes occurs in the area of ​​the fracture, which can be felt on palpation. Very often, the presence of cracks, bends, indentations can turn into a fracture in case of any damage.

Such symptoms do not make it possible to quickly diagnose a pathological fracture, as they cause a late visit to a medical institution.

Diagnostics

For correct and accurate diagnosis you need to go through a series of procedures. At first, the doctor collects an anamnesis, that is, information about the patient, his complaints and internal sensations. There is also an examination of places that cause discomfort. Unfortunately, after collecting information and listening to complaints, it is impossible to accurately diagnose this species fracture. Therefore, an instrumental examination is prescribed.

For this, it is widely used following methods, which will help to study the condition of the bones:

    • radiography;
    • CT scan;
    • scintigraphy;
    • biopsy;
  • blood analysis.

Radiography

A very widely used examination method in traumatology and orthopedics. With the help of x-rays, the doctor can accurately determine the condition of the bone, exact location fracture, identify pathological neoplasms and very correctly diagnose and prescribe the right course of treatment. The bone has a very dense structure, and on the x-ray you can see all the changes on it. The procedure is not required special training. The main thing is to clearly and correctly follow the instructions of the laboratory assistant who conducts the x-ray in order to get a high-quality image. In 10-15 minutes after the procedure, the film with the image will be ready.

Apply this method prohibited during pregnancy, and the presence of severe internal bleeding.

Magnetic resonance therapy

This is a study using magnetic fields, high frequency pulses and computer system, which allows you to assess the condition of not only bone tissue, but also the soft tissues surrounding it. With the help of MRI, it is possible to accurately distinguish healthy tissue from a diseased one in which pathological changes. When performing therapy, there is no irradiation of the body. The results of the examination can be considered to the smallest detail, they can be saved on a computer, various electronic media and printed out at the right time for you. This method is considered more effective than radiography and ultrasound.

CT scan

This is a modern and informative method for studying the skeletal system. This method allows you to see the neoplasms that have arisen on the bone and determine what it is. These formations can be tumors, cysts and various bone lesions.
At the end of the procedure, the patient receives a series of images taken from different angles. Also, the photo is processed on a computer, as a result of which the image is voluminous and three-dimensional.

Scintigraphy

This diagnostic method allows you to determine the presence of pathological processes in the bone. For his providence use medical preparations. The main and huge advantage of this technique is the ability to detect abnormal processes on the bones at the initial stage of their appearance. The procedure for performing therapy is that the patient is injected with a special radioactive substance, which is very clearly visible during scintigraphy.

Densitometry

It is known that one of the main reasons for which a pathological fracture can occur is the presence of a disease - osteoporosis. This disease washes useful material from bone. It is to determine the density of bone tissue that this type of study is used. By the amount of calcium in them, you can determine their density, and the risk of fracture. To plots causing discomfort affect the flow x-rays and with the help of the device fix their intensity. Strong and dense bone does not allow deep penetration of the rays. Often, densitometric examinations are performed on the bones of the lower extremities and the spine.

Biopsy

It is known that neoplasms are malignant and benign. It is to determine what kind of tumor belongs to and conduct a biopsy. This research method is the most accurate. For research, a small piece of the affected tissue is taken, which is then examined under a microscope, and cytological and histological examinations are carried out.
In addition to all these methods, a blood test is prescribed to determine the level of calcium, vitamin D, and will also help determine the presence of an inflammatory process in the body.

Treatment

The main goal of treatment is to renew and strengthen the bone structure. The way to get rid of the disease depends on the type of disease that provoked the occurrence of a pathological fracture, as well as the location and size of the bone lesion. In addition, the age of the patient plays an important role, the older he is, the more difficult the processes of tissue regeneration are. The following therapies are used:

  • local;
  • restorative;
  • surgical.

Local treatment consists in fixing the damaged bone until it is completely renewed. Fix the bone with plaster cast, special Ilizarov apparatus or Shevtsov-Matsukatov apparatus. In addition to this, the use of restorative means, such as:

  • ultrasonic irradiation;
  • hormonal drugs.

In most cases, apply surgical method elimination of the disease, since neoplasms that have arisen on the bone and around often require removal. Malignant tumors are capable of metastasizing and severely damage the bone and surrounding joints. To avoid the rapid spread of metastases in the body, doctors remove the damaged joint and part of the bone. Instead, he gets a prosthesis. This process is called arthroplasty.

Unfortunately, there are no special preventive measures leading to pathological fracture. The only solution to this problem is its timely detection, on early stages development.

Main symptoms:

  • Pain at the fracture site
  • Limb curvature
  • Swelling in the affected area
  • Callus formation

Pathological fracture - characterized by a violation of the integrity of the bone, which occurs due to the occurrence of metabolic or destructive processes. hallmark from an ordinary fracture is that which develops against the background of a minor traumatic factor.

The main reason for the development of this condition is the formation of neoplasms different nature in bone tissue. In addition, there are quite a few wide range disease leading to this disease.

Compared to traumatic fractures, pathological ones do not have such a pronounced clinical picture. The basis of the symptoms is a slight, slight swelling of the affected segment, and a significant displacement is extremely rare.

The correct diagnosis can only be made on the basis of instrumental examinations patient. Treatment of pathology very often involves a surgical operation.

The International Classification of Diseases identifies several values ​​for the disease, which differ depending on what served as the etiological factor. Thus, the ICD-10 code will be - M 80-M 84.4.

Etiology

Pathological fractures in children and adults in all cases are preceded by serious illness which negatively affects the condition of the bone tissue. However, quite often similar condition is the first sign of a disease.

Thus, most often such a manifestation develops against the background of:

  • formation of malignant or benign neoplasms of bones. In about 50% of cases, this is due to the appearance of solitary cysts;
  • the course of fibrous osteodystrophy or;
  • development or Recklinghausen's syndrome - while pathological bone fractures are diagnosed in 40% of cases;
  • the appearance of malignant giant cell neoplasms. It is noteworthy that such a violation often appears due to the metastatic process several times less often in primary cancer. A feature of fractures during metastasis is their multiplicity, often in patients during instrumental diagnostics, up to three foci of violation of the integrity of a particular bone are detected simultaneously;
  • osteoplastic bone carcinosis;
  • is the most common form benign formations, complicated by pathological fractures;
  • - while the main risk group is made up of female representatives in postmenopausal age category. Often there is a fracture of the femoral neck, radius and vertebrae. This can lead not only to disability, but also to cause lethal outcome;
  • the development of such ailments as;
  • callus formation;
  • the course of osteopsatirosis and osteogenesis imperfecta;
  • a wide range osteoarthropathy;
  • neurogenic disorders;
  • abscesses - this is one of the most common sources of pathological fractures of the spine;
  • and tertiary - against this background, there is often a violation of the integrity of the leg bone.

Several times less often, such bone fractures are caused by the following ailments:

  • congenital syphilis;
  • children's;

Due to the course of one of the above diseases, a provocateur of a fracture can be:

  • falling from a small height;
  • swipe;
  • excessive muscle tension.

Classification

Specialists from the field of orthopedics or traumatology distinguish several types of pathological fracture in children and adults. The most commonly used classifications are:

  • according to the integrity of the skin - are divided into open and closed;
  • depending on the involvement of the joint - there are intra-articular and extra-articular;
  • according to the severity of the course - they can be complete and incomplete.

Depending on the form, such a complication of many ailments exists in the following forms:

  • helical;
  • oblique;
  • longitudinal;
  • transverse;
  • splintered;
  • wedge-shaped;
  • hammered;
  • compression fracture spine is the most common.

Symptoms

Main clinical manifestation such a pathology in both a child and an adult is the curvature of the upper or lower limb. This distortion may be due to:

  • recurring fractures;
  • crack formation;
  • muscular hypotrophy.

Additional signs may include:

  • slight or moderate pain syndrome, the localization of which will differ depending on which bone was affected by the pathology. For example, with a fracture of the collarbone, pain will be localized in the upper part chest, damage to the femur will lead to pain in the leg, lameness when walking is less common. It is extremely rare that there is a violation of the integrity of the bones of the skull, but even in such serious cases pain sensations in their maximum severity will resemble;
  • mild swelling problem area;
  • formation of bone marrow.

During the diagnosis, significant displacement and hemorrhage are rarely detected. The most frequently observed symptoms are:

  • compression lesions;
  • the appearance of bends and large cracks;
  • indentation or fracture of tubular bones.

The above factors, as well as the lack of pathological mobility, lead to the fact that patients seek qualified help late.

In some cases, such symptoms can be supplemented by clinical signs of the disease that could provoke a pathological fracture of the collarbone, femoral neck, lower leg, rib or spine.

Diagnostics

If symptoms occur, a traumatologist should be consulted, however, further diagnostic measures can also be performed by an orthopedist or oncologist.

Establishing the correct diagnosis is based on the implementation of a wide range of instrumental examinations, but not the last place in the diagnosis is occupied by such medical manipulations:

  • familiarization with the medical history and life history of the patient - to identify chronic illness, which could serve as a provocateur of a pathological fracture of the vertebra or a violation of the integrity of the bone of any other localization;
  • the implementation of a thorough physical examination, which consists in palpation of the problem area. During this process, the clinician monitors the patient's response;
  • conducting a detailed survey of the patient - to determine the severity of the main symptoms and possible presence additional signs.

the greatest diagnostic value, among laboratory research, has a general clinical blood test. Since a pathological fracture of the hip, rib, collarbone or other bone sometimes acts as the first symptom of a particular pathology, this diagnostic measure will help to find out what kind of negative process is taking place in the patient's body.

Instrumental diagnostics includes:

  • radiography - the procedure has highest value in determining the cause of development similar pathology;
  • CT and MRI - is performed to obtain an accurate picture of the problem area and assess the condition of the bone, which will also help to establish the shape of a pathological fracture of the femoral neck or rib, collarbone or lower leg, spine or skull;
  • scintigraphy - make it possible to detect the presence of metastases;
  • densitometry - the procedure is indicated for suspected osteoporosis;
  • biopsy - sometimes it makes it possible to establish the nature of the provocative disease that caused the appearance of a fracture of the clavicle or any other localization.

Treatment

Fracture Therapy Scheme pathological always surgical and aimed at achieving the following goals:

  • cupping pain;
  • facilitating care for victims of pathology;
  • early recovery working capacity;
  • improvement of the psycho-emotional state of the patient;
  • prevention of complications.

Tactics surgical treatment pathological fractures is dictated by the etiological factor. With formations of a benign nature, a complete excision of the affected area is shown, and in cases with malignant tumors Chemotherapy and radiation therapy come to the fore.

In other cases, refer to:

  • endoprosthetics;
  • strengthening the affected segment with bone cement;
  • replacement of the defect with a graft;
  • fixation of bone fragments with nails, plates, pins, screws or the Ilizarov apparatus.

Prevention and prognosis

specific preventive measures, warning the formation of a pathological fracture of the clavicle, femur, tibia or any other bone does not exist. It is only necessary a few times a year to have a complete examination in medical institution with a visit to all specialists. This will make it possible either to identify the course of the pathological process, or to early stage diagnose such a disease.

As for the prognosis, it is often favorable - pathological fractures heal safely. However, do not forget about the development of complications of the provocative disease.

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