Pathological fractures occur in connection with. What is a pathological bone fracture

The cause of a pathological fracture of the vertebra is destructive bone processes. various etiologies. The peculiarity of such injuries is that the bone breaks under normal household loads or minimal external influence. This can happen when bending over, lifting a small load, coughing, walking for a long time, or patting a person on the back.

An accurate diagnosis is made after instrumental examination. Often, the only way to defeat an ailment is with the help of surgical intervention.

Most often, spinal injuries of any localization are caused by osteoporosis, which is characterized by accelerated demineralization and delayed osteosynthesis. Pathological fractures of the vertebral bodies can lead to various diseases accompanied by bone resorption or gross metabolic disorders, including in the elements of the skeleton.

The destruction of the vertebrae occurs for the following reasons:

metastases malignant tumors different localization;
the formation of cysts, hemangiomas in the thickness of the bone;
benign neoplasms of cartilage tissue;
hyperfunction of the thyroid gland;
osteomyelitis of various etiologies, including those caused by tuberculosis, syphilis;
helminthiases (echinococcosis);
long-term use of various drugs;
congenital disorders of bone formation;
severe beriberi, especially lack of vitamin D;
blood diseases;
anomalies in the structure of the spine.

Usually, bone damage associated with osteoporosis occurs in older people, against the background of sexual hypofunction.

Damage localization

Various vertebral segments are subject to pathological fractures, but the lower thoracic region and the lower back are more often damaged, as they experience maximum load in the process of life. The largest percentage of bone fractures refers to the compression variety. The occurrence of a compression fracture of the spine indicates a complication of osteoporosis that has reached a critical stage. At this stage of the disease, such injuries occur in every fifth patient.

A characteristic sign of a fracture is a decrease in the height of the vertebral body, detected on x-rays. It is this symptom that is the basis for determining the degree of damage. In the first degree, the vertebra decreases in height by 35%, in the second, its height becomes 2 times less, and in advanced stages, its decrease exceeds 50%.

The anterior parts of the vertebral body are more vulnerable. They are destroyed faster than the posterior sections, so gradually the vertebra becomes wedge-shaped.

Signs of pathology

Manifestations of a vertebral body fracture: pain in the area of the spine where the damage is localized, limitation of the volume of active and passive movements in the affected vertebral region.

On examination, it is revealed: swelling of the skin, sometimes - subcutaneous hemorrhages in the area of injury.

Feature: the pain syndrome does not respond well to the action of painkillers and anti-inflammatory drugs, although it often has a moderate aching character. It can last 1-2 months, gradually decreasing and turning into a constant feeling of discomfort in the back. This leads to the patient's neuroticism, sleep disturbance, irritability.

If the fracture involves the spinal canal and the spinal cord is damaged, it is considered complicated. The displacement of bone fragments makes the clinic brighter, as there is pressure on Bone marrow and nerve roots. This leads to severe neurological disorders, the nature of which is determined by the level of damage.

Specific symptoms that help to establish the localization of the injury:

Cervical - pain in the neck, radiating to the back of the head. With pressure from bone fragments on the spinal cord, headaches, dizziness, tinnitus, hiccups, and difficulty swallowing are disturbing. Respiratory and cardiac arrest, gross motor disorders are possible.
The thoracic region - pain in the interscapular region, on examination, a sharp muscle tension, spinal deformity, possibly a reflex tension of the abdominal muscles. Complicated form leads to violations respiratory function, sensitivity and physiological functions, paralysis of the limbs, loss of consciousness.
Lumbar region - due to pain, the patient tends to not move and lie on his back. When nerve structures are compressed, disorders develop pelvic organs, paralysis of the legs.
Sacrococcygeal region - severe pain radiating to the buttocks, legs and rectum.

Ways to detect damage to the spine

The doctor pays special attention to the circumstances of the injury. It is important to establish the cause of increased bone fragility.

The patient is being examined. If there is a history of previous fractures of the vertebral bodies or a long course of osteoporosis, kyphosis is formed, often with a lateral curvature. In addition to spinal deformity, it is possible to detect hematomas and edema in the affected area.

The traumatologist reveals pain on palpation, which is aggravated by the patient's attempts to stand up or turn around. The volume of passive movements is also sharply limited due to severe pain.

When a neurological deficit appears, a consultation of the appropriate specialist is required, who will prescribe the necessary treatment.

Laboratory methods:

complete blood count - moderate inflammatory changes including leukocytosis, increase in ESR, manifestations of anemia are possible;
biochemical blood test - fluctuations in calcium levels, an increase alkaline phosphatase, changes in protein fractions;
urinalysis - the presence of calcium and metabolites of collagen, which is part of the bone skeleton.

AT urgently radiography is performed. With its help, not only the localization of the injury and its severity, but also the presence of bone resorption, which served as possible cause damage. The diagnosis of a fracture is often made on the basis of callus.

For neuroimaging and damage assessment not only bone tissue, but also spinal cord perform magnetic resonance imaging. Clarify the location of the fracture and the degree of destruction of the vertebrae will allow computed tomography.

The state of the bone marrow canal and its contents can be assessed using myelography.

X-ray densitometry will help determine the degree of demineralization. She is in without fail performed in case of suspected osteoporosis, especially in the elderly.

To detect bone metastases, scintigraphy is used - the introduction of radioactive isotopes.

Treatment strategy

If a vertebral fracture is suspected, relatives or others should immediately call Ambulance for urgent delivery of a person to the department of traumatology and orthopedics. Proper transport on a rigid stretcher with the utmost care and secure fixation the affected spine. It is advisable to pre-administer an anesthetic drug.

The therapy is complex, including drug exposure, physiotherapy, and, if necessary, the active assistance of orthopedists and neurosurgeons.

As a rule, strict immobilization is applied - bed rest using an orthopedic bed, corsets, including the Shants collar for fractures cervical spine. With the destruction of several vertebrae or the presence of complications, skeletal traction is performed.

The main task of a specialist in identifying a pathological fracture is to establish the underlying disease that provoked such dangerous injury. After all, therapy should be aimed specifically at the etiology of increased bone fragility.

If the injury was due to osteoporosis, hospital doctors will urgently prescribe treatment that is simultaneously aimed at healing the injury and stopping further bone destruction. Emergency treatment is especially needed when neurological disorders to help a person avoid serious threats to health and life.

Medical impact

Conservative treatment may be independent method or apply as additional measure in preparation for surgery and rehabilitation period after her. When choosing a method of therapy, the degree of destruction of the vertebra, the age of the patient, the presence of concomitant diseases, the prevalence of the process are taken into account.

A necessary component of treatment is the use medicines. To relieve pain and reduce concomitant inflammation, drugs of the following groups are used:

non-steroidal anti-inflammatory drugs;
anesthetics;
glucocorticosteroid hormones in a short course;
infusion therapy (Hemodez, Reopoliglyukin) - to normalize blood rheology and blood supply to the affected vertebral region;
vascular preparations - to improve microcirculation in bone tissue;
antioxidants - to interrupt the process of oxidative stress.

The patient should be warned about the need for active and prolonged treatment.

Surgery

Surgical methods of exposure play a leading role. Usually this is a necessary measure, especially when bones are affected by oncological etiology.

If more than half of the vertebral body is destroyed, it is removed. Also, the operation is indicated when conservative measures fail, when bone fragments affect the intervertebral foramen and nerve root, which leads to neurological symptoms.

Then vertebroplasty is performed to restore the strength of the vertebra and fix it: special cement or bone autograft is used. There is a stabilization of the affected department, the vertebra itself becomes higher and stronger, the patient's rehabilitation is accelerated. The method is considered safe and effective.

Reconstructive intervention is used - implantation of metal implants or strengthening of bones with the help of plates, pins.

How is rehabilitation going?

AT recovery period The following healing methods are used:

Physiotherapy - electrophoresis with anti-inflammatory solutions, vascular funds, calcium-containing preparations. Pulsed electrotherapy is also used. At the stage of healing of fractures, magnetotherapy and heat treatment with the use of healing mud are effective.
Therapeutic physical training - in the minimum allowable volume is carried out even at the stage of immobilization. it good prevention formation of bedsores, an incentive to restore muscle tone and joint function.
A gentle massage to relax the muscles and improve the blood supply to the affected tissues.

After discharge from the hospital, the patient receives long-term courses of calcium-containing drugs, chondroprotectors, vitamin-mineral complexes. It is necessary to regularly follow the prescribed course physiotherapy exercises With gradual increase loads in consultation with the supervising doctor.

Specialists will teach you how to do self-massage, it is also a good help in the process of rehabilitation at home. The help of a psychotherapist and the appointment of antidepressants are often required.

The patient must understand that after suffering a compression fracture of the vertebra, you need to change your lifestyle and diet. The diet should be enriched with minerals, easily digestible proteins, vitamins. It is important to give up bad habits.

Negative consequences

Pathological fractures of the vertebral bodies can permanently confine a person to bed and make him deeply disabled. At the same time, bedsores, chronic heart failure, and congestive pneumonia develop.

Other complications are the following problems:

Instability of the affected spine, which leads to a permanent limitation of its mobility and functionality.
neurological disorders. Their nature depends on the location of the fracture and is caused by damage to the bone fragments of the spinal cord and nerve roots extending from it. Motor and sensory disturbances, malfunctions are often observed vegetative system problems with urination and defecation.
Decrease in height, change in posture and gait.
Violation physiological state neighboring vertebrae and their gradual deformation.

Measures to prevent pathological fractures

It is necessary to undergo an annual medical examination, including laboratory and instrumental methods of examination. This is especially true for the elderly, who are most susceptible to osteoporosis. Examination of doctors of different profiles will help diagnose various deviations in the state of health and begin timely treatment.

To avoid fractures caused by osteoporosis, you need to adjust the diet, maintain an active and healthy lifestyle life, take vitamins enriched with calcium and other minerals.

Answers on questions

Is a favorable outcome of a pathological vertebral fracture possible?

A favorable prognosis is provided timely appeal, competent transportation to the hospital, combination therapy and careful implementation of medical recommendations after discharge.

How to distinguish vertebral fractures in oncology from injuries caused by osteoporosis?

Metastases are often multiple, affecting the vertebrae various departments. Osteoporosis causes fractures of the most loaded segments of the spine.

Who heals?

First aid is provided by a doctor who came to the call. With an unexpressed pain syndrome, the patient can suffer a fracture in the legs, considering pain as a manifestation of osteochondrosis or fatigue. But a prolonged malaise will force him to turn to a local therapist who will prescribe everything necessary examinations and consultations of narrow specialists, including a neurologist, oncologist and rheumatologist, endocrinologist.

What parts of the spine are more likely to undergo surgery?

It depends on the degree of destruction of the elements of the spine, but according to medical statistics, patients with fractures in the lumbar region are more often operated on.

Conclusion

The occurrence of a pathological fracture of the vertebra has a different etiology. Often the reason is advanced stage osteoporosis, or progressive bone demineralization. A fracture worsens the patient's condition, sometimes leading to disability. To prevent such serious complications, it is important to treat the underlying disease in a timely manner.

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. Fractures are more common lower extremities, then top 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), the thyroid hormone 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 limbs, it is recommended surgical treatment, which consists mainly in 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.

pathological fracture in most cases, it 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).

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 of 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 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. These fractures usually occur in the lower third 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 the patient is made an incision, during which only hemorrhage is detected, and after surgical intervention revealed the true nature of the disease.

General treatment of beriberi C, proper nutrition, the creation of rest of the pronounced limb quickly improves the condition of the child. In 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 an exacerbation of the 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 of dystrophic processes in the bones of the entire affected limb - osteoporosis and atrophy.

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

- 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 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 violation of the integrity of the emerging callus, that is, a recurrence of a traumatic fracture, can also be considered a pathological 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.

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. The purpose of surgical intervention may be to reduce the duration of treatment in a hospital, to eliminate pain syndrome, facilitating patient care, early activation of the patient and improvement of his psycho-emotional state, as well as reducing 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.

At the same time, with successful treatment of the underlying disease, pathological fractures, which are a complication of malignant tumors, grow together quite successfully, which should 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.

What are pathological fractures

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.

Pathogenesis (what happens?) during pathological fractures

Imperfect bone formation is a congenital fragility of bones of unknown etiology. In this disease, fractures are possible with a slight force impact: in young children - when swaddling), shifting them, in older children - when trying to sit down, stand up, etc. Fractures are accompanied by pain, 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.

Symptoms of pathological fractures

Clinically, imperfect bone formation is manifested by the curvature of the limbs due to multiple repeated fractures or fractures of bones, muscle wasting, 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),

Diagnosis of pathological fractures

Treatment of pathological fractures

With imperfect bone formation, the treatment of fractures is reduced mainly to careful reposition, reliable immobilization until complete consolidation. The terms of fracture fixation are somewhat lengthened, despite the fact that the formation of callus occurs quickly and at normal age, but it remains “elastic” for a long time, as a result of which the possibility of deforming the limb with a fused fracture remains.

In addition to local treatment of a fracture, general strengthening treatment is carried out: ultrasonic irradiation, multivitamins, ergocalciferol (vitamin D), fish oil, calcium preparations, hydrochloric acid with pepsin. It is advisable to prescribe the anabolic hormone methandrostenolone (nerobol), the thyroid hormone thyrocalcitonin intramuscularly. Treatment can also be carried out on an outpatient basis 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. Large displacement of bone fragments, as a rule, is 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 X-ray examination.

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 the bones that form the 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 of 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, fractures are observed in young children. 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, the upper end of the tibia, in the 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. The skin over the site of the most painful swelling is tense and shiny. The limb is in a 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, improper 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.

The general treatment of beriberi C, proper nutrition, the creation of rest for a pronounced limb quickly improve the child's condition.

In 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. With 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 of X-ray examination.

Pathological fractures in osteomyelitis are sometimes accompanied by an exacerbation of the inflammatory process, with insufficient immobilization, deformities and shortening of the limb occur, and in rare cases, false joints are formed.

Which doctors should you contact if you have Pathological fractures

Traumatologist
Rheumatologist

… 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, a pathological bone fracture is a bone fracture in the zone of its pathological restructuring.

Etiology. One of the leading places in the structure of causes leading to the development of bone tissue weakness is occupied by 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, for example, with syringomyelia, dorsal tabes.

Clinic. Clinical manifestations of a pathological fracture are somewhat 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 osteoplastic process, the value of alkaline phosphatase is increased, the level of calcium in the serum is lowered. 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, facilitating other treatments, impact on psycho-emotional state sick. Early activation prevents development trophic ulcers, thrombophlebitis and hypercalcemia.

To stabilize pathological fractures, surgical methods should be individualized depending on the localization, 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 femoral fragments is preferable if the patient can be operated on. Surgery pathological fractures against the background of oncological bone lesions serves to improve the quality of life of the patient in the remaining period of time, and not to increase the life expectancy of the patient (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.