![]() ![]() Histology varies based upon the source of the primary malignancy. For example, a lytic lesion or open-section defect might produce a stress concentration that cannot withstand normal or low-demand activity. Pathologic fractures occur through these lesions due to altered biomechanics. Osteoblastic lesions occur secondary to endothelin 1, which is secreted by the tumor. Osteolytic lesions of bone occur secondary to tumor-induced activation of osteoclasts by upregulation of RANK ligand. Primary soft tissue and bone sarcomas are far less common, affecting roughly 13,000 and 3,600 people in the U.S., respectively. Approximately 8% of these patients will sustain a pathologic fracture, based on a retrospective analysis by Higinbotham on 1,800 patients with metastatic cancer to bone. Metastatic disease of the bone will affect approximately 5% of these patients, varying based on cancer type, with the cost of healthcare being nearly 13 billion dollars. EpidemiologyĪpproximately 1.7 million people are diagnosed with cancer each year in the United States. Primary bone sarcomas occur far less frequently, though disregarding the possibility that a pathologic fracture through a solitary bone lesion could be the first evidence of a primary sarcoma could lead to catastrophic consequences, including loss of life or limb. The most common sites for skeletal metastasis include the spine, proximal femur, and pelvis. There are five recognized carcinomas that most frequently metastasize to bone, including lung, breast, thyroid, renal, and prostate. In a patient 40 years of age or older, the likelihood that a pathologic fracture through an unknown lesion that is metastatic is 500 times more common than the likelihood of it being a primary bone sarcoma. The majority of neoplastic pathologic fractures are caused secondary to metastatic disease rather than primary bone tumors. Pathologic fractures occur through areas of weakened bone attributed to either primary malignant lesions, benign lesions, metastasis, or underlying metabolic abnormalities, with the common factor being altered skeletal biomechanics secondary to pathologic bone. Therefore, diagnosis of the causative pathology is of paramount importance in the successful treatment of a pathologic fracture and is a prerequisite for proceeding with surgical intervention. The incidence of pathologic fractures is rising, primarily due to improved diagnosis and treatment of metastatic disease leading to prolonged survival. ![]() Pathologic fractures represent a growing concern in the field of musculoskeletal oncology. Explain the importance of collaboration and communication amongst the interprofessional team to improve outcomes for patients affected by pathologic fractures.Summarize the surgical approach to fixation for pathologic fractures based on anatomic location and healing potential.Outline the approach to the staging workup for the causative lesion resulting in a pathologic fracture.Review the common symptoms and physical exam findings associated with pathologic fractures.This activity reviews the evaluation and treatment of pathologic fractures and highlights the role of the interprofessional team in managing patients with this condition. Therefore, proper diagnosis, staging, and treatment of pathologic fractures are essential to improve patient outcomes. Pathologic fractures occur secondary to altered skeletal physiology and mechanics in the setting of a benign or malignant lesion. ![]()
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