Pathological fractures of bones occur when. Treatment of pathological fractures

pathological fracture- this is a bone fracture, which occurred from the impact of an insignificant force or from a physiological load, on a bone altered by some pathological previous process. It can be inflammatory, dystrophic, tumor, dysplastic, infectious, etc. processes. The occurrence of pathological fractures mainly falls on the areas of pathological bone remodeling.

How are so-called pathological fractures treated?

In order to prescribe the correct treatment for the patient, specialists conduct a thorough diagnosis of the disease in the patient. in a variety of ways. Treatment of pathological bone fractures There are medical and surgical. Medical treatment is the application antibacterial agents and other chemotherapy drugs, vitamin D preparations. Surgical treatment depends on the underlying disease, on its nature, on the prevalence pathological process.

In general, the treatment of fractures of this type practically does not differ much from the treatment of ordinary fractures. But, as a rule, with pathological fractures, the periods of immobilization are lengthened. Orthopedic devices are used whenever possible for pathological fractures. special methods. For example, the Shevtsov-Matsukatov apparatus, the Ilizarov apparatus. These devices allow you to keep the patient's capacity even if the consolidation is very slow.

The most important for the treatment of pathological fractures is the identification of the cause of the painful restructuring of the bone, its elimination. For example, when oncological diseases, undoubtedly, the task of getting rid of the tumor comes to the fore (by surgery, with the help of radiation, chemotherapy, or a combination of these methods). In pathological fractures caused by osteomyelitis, antibiotics are prescribed to the patient. Surgery is necessary for a bone abscess. If the reason this disease osteoporosis needs treatment metabolic disorders tissues (bone) with the help of drugs that improve the microarchitectonics of bones and mineral composition bones.

aim surgical treatment is the elimination of the pain syndrome, the reduction of the duration of treatment in the hospital, the transfer of the patient to ambulatory treatment. Also, the impact on the mental and emotional condition patient, promoting the use of other methods of treatment, facilitating patient care. Early activation possibility of formation of hypercalcemia, trophic ulcers and thrombophlebitis prevents.

In order to stabilize pathological fractures, surgical methods of treatment should be selected individually for each patient, depending on the specific qualities of the affected bone, the involvement of soft tissue structures and localization.

Among the various injuries of long bones, in most cases, fractures of the humerus and femur, and they require stable permanent intraosseous osteosynthesis. The load on the long bones must be resisted by such fixation. Against the background of an oncological bone lesion, surgical treatment of a pathological fracture serves, one might say, to improve the patient's quality of life in the remaining time period, but not to increase the patient's life expectancy.

Surgical treatment of these fractures that occurred against the background malignant processes, both primary and secondary, with damage to the articular end currently involves arthroplasty. If the diaphyseal part of long bones is affected, then segmental resection is used using bone grafting or bone cement and fixation of bone fragments. Fixation is carried out internally or externally. metal structures, and can be used different techniques transosseous osteosynthesis.

With these fractures that have arisen against the background of tumor-like lesions and benign tumors, it is necessary to adhere to surgical active tactics and carry out bone resection, combined with osteosynthesis in the very first days after the fracture appears, without waiting for the fragments to grow together.

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 long time may not show themselves. The main symptoms are 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. Main types malignant tumors there is:

  • 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

A 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

It is a modern and informative method of studying 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. Just to determine the density bone tissue and use this type of research. 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 lower extremities and 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.

Occurs when there is a violation normal structure vertebral bone tissue and its destruction due to various diseases. Such fractures very often occur spontaneously, "out of the blue", i.e. the traumatic factor is still present, but its strength can be very small.

Causes and mechanism of occurrence

In the vast majority of cases pathological fractures of the spine represent compression fractures that can occur even with minor loads on the vertebral body, when the pathologically altered bone tissue cannot withstand even such a minimal load.

Pathological fracture of the spine can occur in diseases thyroid gland accompanied by over-education parathyroid hormone (hyperparathyroidism), which causes demyelination of bone tissue. Such fractures are also possible in various malignant neoplasms, both in cases where the tumor process initially occurs in the bone tissue, and in metastasis. Another reason is osteomyelitis - a purulent-necrotic process that occurs both in the bone tissue itself and in the bone marrow, as well as in the surrounding tissues. Osteomyelitis often occurs in children, as well as after arthroplasty, any bone damage complicated by infection (most often Staphylococcus aureus). The cause of such fractures can also be an abscess that has developed in a bone injury as a result of an injury. However, the most common cause is osteoporosis, in which the metabolism of bone tissue is disturbed, which causes a decrease in its density, changes in structure and microarchitectonics, and this, in turn, leads to increased bone fragility and their tendency to pathological fractures.

Clinical manifestations pathological fracture of the spine

Clinical signs pathological fracture of the spine practically do not differ from the “usual” ones and their only difference is the insignificant force of the traumatic effect in pathological fractures, which is why they often go unnoticed and undiagnosed.

Due to a compression fracture of the vertebral body, it is deformed with a decrease in height, while the spine is deformed towards the damaged vertebral body and kyphosis occurs, which, in turn, can lead to damage to adjacent vertebrae, i.e. kyphosis may progress.

Compression fractures of the vertebral bodies, incl. and in pathological fractures are often accompanied by lesions spinal cord and its roots, which leads to the appearance characteristic symptoms in the form of pain, sensory disturbances, paresis, dysfunction of the pelvic organs.

Diagnosis is confirmed by X-ray or MRI.

Treatment pathological fractures of the spine

The ability of bone tissue to restore its structure, incl. and bone tissue of the vertebrae various diseases, which are the cause pathological fracture of the spine, is noticeably reduced, therefore, in the treatment of such fractures, it is necessary to eliminate or minimize the impact of factors that caused pathological changes in the bone tissue. Those. First of all, it is necessary to treat the underlying disease that caused such fractures.

Conservative treatment pathological fractures of the spine is in strict bed rest and fixation of the affected spine, however, the process of treating such fractures due to changes in the structure of the bone tissue caused by these slow consolidation of fractures can be quite lengthy, therefore, various methods are used. orthopedic constructions(corsets, collars), allowing to a greater or lesser extent to maintain the patient's capacity.

If a conservative treatment turned out to be ineffective, and in some cases, immediately after the injury, surgical treatment is used. Surgical treatment is also used to prevent subsequent deformation of the damaged vertebra and adjacent vertebrae. For this purpose, the installation of metal structures can be used, which are fixed in the vertebral body and fix the damaged segment of the spine, creating prerequisites for the fracture to heal and compensating for the lost support function spinal column. Currently, vertebroplasty is being used more and more actively - the introduction of special bone cement into the vertebral body, which strengthens the vertebral body. Another option for surgical treatment is kyphoplasty, the introduction of an air balloon into the vertebral body, which inflates under pressure and restores the lost height of the vertebra; after that, the air cavity is filled with cement.

The advantage of kyphoplasty is the ability to correct the deformity of both the vertebra itself and the spinal column as a whole, as well as the possibility of safer introduction of cement into an already prepared cavity.

A pathological fracture of the spine is a process localized in one or more vertebrae of any part of the spinal column, which is not preceded by the fact mechanical injury. That is this disease not preceded by blows about hard surfaces or collision with them, falling from a height, etc. A pathological fracture of the spine occurs spontaneously, it would seem, against the background of perfect health bone tissue of the body.

With this disease, there is tissue destruction of the vertebral body, that is, its direct destruction. Destruction affects both bone part vertebrae, and the periosteum (the tissue lining the outside of the body, all the processes and openings of the vertebra and containing all the vessels that feed the vertebra and innervating small branches of the nerves).

Most often, this pathological process is localized in places that take on the most most loads of the whole post. These places are the lumbosacral region and to a lesser extent thoracic region spine. Other areas are more rare, but also quite likely to become sites of pathological fractures.

Causes of the disease

The causes of this pathological process are very numerous. Such a fracture of the spine may be the result of the following pathological and physiological conditions:

  • thyroid disease and/or parathyroid glands (hyperthyroidism, hypothyroidism, autoimmune thyroiditis, nodular goiter, solitary and multiple brushes and malignant neoplasms of these organs. With all these diseases, a violation of the metabolism of calcium and its salts in the bones is possible)
  • Malignant neoplasms of bones with localization in the spine.
  • Metastases malignant neoplasms into the spine of other organs (this is most often observed on late stages breast oncology, prostate, central or peripheral lung cancer, malignant diseases blood).
  • Osteomyelitis of the bones of the spine(this is inflammatory process involving bone tissue and Bone marrow, which further leads to purulent-necrotic fusion of these structures with the formation of sequesters containing detritus).
  • Bowel disease(diseases that result in impaired absorption of calcium and vitamins in various departments intestines).
  • Age-related changes in the body.
  • Changes in a woman's body during pregnancy and lactation.

Despite the presence of an abundance of conditions that can cause a pathological fracture of the spine, the immediate root cause is always only one factor. And this factor is a decrease in bone density, that is, osteoporosis. Physiological osteoporosis can be during pregnancy and period breastfeeding, as well as in the second half of life (mainly also women).

Symptoms

The main symptom of a pathological fracture of the vertebrae is discomfort at the fracture site. Most of the time these feelings are acute pain, even sometimes unbearable, forcing the patient to rush about and grab onto sore spot in search of a location that relieves pain (usually this is observed in oncological diseases).

With osteomyelitis, the pain is also very sharp, but its intensity is lower than in the previous case, there may often be visible defects on the skin with a characteristic discharge from this defect. In other cases, the pain may not be so strong and sharp.

It is worth noting that the pain syndrome occurs immediately at the moment of violation of the integrity of the periosteum, since it is in its thickness that the supply vessels and sensitive nerve endings pass.

Often there are general symptoms associated with impaired calcium metabolism in the body. These include:

  • General weakness.
  • Malaise.
  • Drowsiness or, conversely, increased excitability.
  • fatigue.
  • Feeling of lack of sleep.
  • Sensation of interruption in the work of the heart.

May also be observed:

  • Various paresis.
  • radicular syndromes.
  • Dysfunction of the pelvic organs.
  • Stiffness of movements.

Diagnostics

The main method for diagnosing a pathological fracture of the spine is radiography. X-rays performed in two projections (direct and lateral). Usually the most informative is the combination of radiographs of a particular section of the spine, giving clinical symptoms, and a sighting image of any several vertebrae (in which, according to palpation examination and anamnestic data, there is most likely a focus of bone tissue destruction). In addition, research is being carried out venous blood for calcium content.

To clarify the diagnosis in doubtful and complex cases, computed tomography or magnetic resonance imaging of the spine is provided. This study is mandatory in cancer patients to clarify the stage and extent of the tumor process.

Treatment of a pathological fracture of the spine

The treatment of this condition involves the primary treatment of the underlying disease, but the impact directly on the bone tissue that has undergone resorption is also an integral part of therapy. Surgery is almost always required.

Currently widely used various ways vertebroplasty. Vertebroplasty with special bone cement is one of the newest, simplest and safest methods.

Perfectly complements surgical operation medical correction of the disease, involving the adoption various drugs calcium (Sea Calcium, Calcemin Advance, etc.). In some cases, it is advisable to wear special supporting corsets.

- 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 usually erased, pain, swelling, limitation of limb function may 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 lethal outcome 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 to the usual ones. 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. Highest value has radiography. MRI and CT can also be used to more accurately assess the condition of the bones and surrounding soft tissues. If metastases are suspected great importance acquires scintigraphy, which allows 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.

certain diagnostic value have and laboratory research. Osteolytic processes are characterized by the release of hydroxypromine, hypercalciuria and hypercalcemia. In osteoplastic lesions, there is a decrease in the level of calcium and an increase in the level alkaline phosphatase in 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 of his psycho-emotional state, as well as a decrease in the likelihood of complications: bedsores, thrombophlebitis, trophic ulcers, congestive pneumonia, hypercalcemia, etc.

Method surgical intervention are selected taking into account the characteristics of the pathological process. At benign tumors resection of the affected area is performed (in some cases, with the replacement of the formed defect with an allo- or homograft) in combination with extraosseous 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.

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