What Is a Pathological Fracture?
Pathological fractures such as osteoporosis, various malnutrition, and endocrine factors can cause systemic osteoporosis, which is manifested by atrophy and thinning of the cortex, thinning of bone trabeculae, and reduced number. It mainly affects the spine, femoral neck, and metacarpal. Compression fractures of the chest and lumbar spine in the elderly, especially in postmenopausal women, are more common in fractures of the femoral neck, upper humerus, and lower radius. Paralysis of the limbs, long-term fixation, or chronic bed rest can cause local disuse osteoporosis and cause pathological fractures. Endocrine disorders Hyperparathyroidism caused by parathyroid adenoma or hyperplasia can lead to decalcification of bone and accumulation of osteoclasts, and bone trabecula is replaced by fibrous tissue. Although new bone is formed at this time, only slender woven bone or non-calcified bone-like tissue can be formed, and multiple pathological fractures are extremely likely to occur.
Pathological fracture
- Primary or metastatic tumors of bone are the most common cause of pathological fractures, especially osteolytic primary or metastatic bone tumors. Primary bone tumors such as multiple myeloma, giant cell tumor of bone, and osteolytic osteosarcoma; etc .; metastatic bone tumors such as metastatic kidney cancer, breast cancer, lung cancer, thyroid cancer, and neuroblastoma. Many primary and metastatic bone tumors are sometimes found after pathological fractures. Clinical manifestations include shock, soft tissue injury, and bleeding.
Introduction to pathological fractures
- Pathological fractures such as osteoporosis, various malnutrition, and endocrine factors can cause systemic osteoporosis, which is manifested by atrophy and thinning of the cortex, thinning of bone trabeculae, and reduced number. It mainly affects the spine, femoral neck, and metacarpal. Compression fractures of the chest and lumbar spine in the elderly, especially in postmenopausal women, are more common in fractures of the femoral neck, upper humerus, and lower radius. Paralysis of the limbs, long-term fixation, or chronic bed rest can cause local disuse osteoporosis and cause pathological fractures. Endocrine disorders Hyperparathyroidism caused by parathyroid adenoma or hyperplasia can lead to decalcification of bone and accumulation of osteoclasts, and bone trabecula is replaced by fibrous tissue. Although new bone is formed at this time, only slender woven bone or non-calcified bone-like tissue can be formed, and multiple pathological fractures are extremely likely to occur.
- There are many types of congenital bone disorders that can cause pathological fractures. For example, congenital osteogenesis imperfecta is an autosomal dominant hereditary disease that develops in fetuses or children. It is due to congenital mesenchymal developmental defects that it is difficult to differentiate into osteoblasts, and osteoblasts synthesize bone Type collagen fibrous disorders, so long bone cortex is thin, bone is thin and brittle, and multiple pathological fractures are prone to occur, so it is also called fragile bone syndrome. The newly formed epiphysis after fracture is cartilage or fibrous, and ossification is difficult to occur. In pathological fractures, the original lesions of the bone often make the fracture heal slowly, and there is almost no repair response. It often changes or complicates the histological image of the original bone lesion.
Causes of pathological fractures
Pathological fracture osteoporosis
- Older age, various malnutrition, and endocrine factors can cause systemic osteoporosis, manifested by atrophy and thinning of the cortex, thinning of the trabeculae and a decrease in number. It mainly affects the spine, femoral neck, and metacarpal. Chest and lumbar compression in the elderly, especially in postmenopausal women
- Pathological fracture
Endocrine disorders of pathological fractures
- Hyperparathyroidism caused by parathyroid adenoma or hyperplasia can lead to decalcification of bone and accumulation of osteoclasts, and bone trabecula is replaced by fibrous tissue. Although new bone is formed at this time, only slender woven bone or non-calcified bone-like tissue can be formed, and multiple pathological fractures are extremely likely to occur.
Pathological fracture bone development disorder
- There are many types of congenital bone disorders that can cause pathological fractures. For example, congenital osteogenesis imperfecta is an autosomal dominant hereditary disease that develops in fetuses or children. It is due to congenital mesenchymal developmental defects that it is difficult to differentiate into osteoblasts, and osteoblasts synthesize bone Type collagen fibrous disorders, so long bone cortex is thin, bone is thin and brittle, and multiple pathological fractures are prone to occur, so it is also called fragile bone syndrome. The newly formed epiphysis after fracture is cartilage or fibrous, and ossification is difficult to occur.
Pathological fracture symptoms and signs
- Shock, soft tissue injury, bleeding, fracture.
Pathological fracture diagnosis
Pathological fracture ask about injury
- Including the cause, time, place of injury, body position at the time of the injury, and where to land first. If there is a wound or bleeding, you should also ask whether the wound has been treated, whether the tourniquet has been used, and the tourniquet time.
Comprehensive physical examination of pathological fractures
- Pay attention to shock, soft tissue injury, bleeding, check wound size, shape, depth and contamination
- Pathological fracture
X X-ray examination of pathological fracture
- In addition to normal and lateral X-rays, special postures should be taken according to the injury, such as the open position (upper cervical spine injury), dynamic lateral position (cervical spine), axial position (scaphoid, calcaneus, etc.) and Tangent position (patella). For complex pelvic fractures or suspected intravertebral fractures, tomography or CT should be performed as appropriate.
Pathological fracture complications
- 1. Shock caused by severe trauma, pathological fracture caused by major bleeding or damage to important organs.
- 2. Fat embolism syndrome occurs in adults due to excessive tension of the hematoma in the medullary cavity at the pathological fracture, the bone marrow is destroyed, and fat droplets enter the ruptured sinuses, which can cause pulmonary and cerebral fat embolism. It is also believed to be Due to the stress effects of trauma, the chylomicrons in normal blood lose the emulsification stability, combine into fat globules with a diameter of 10-20 vm and become emboli, blocking pulmonary capillaries. At the same time, when the pulmonary perfusion is poor, the alveolar ridge cells produce lipase, which hydrolyzes the shaped fat droplets in fat emboli into glycerol and free fatty acids, releases catecholamines, damages the capillary wall, and leaks protein-rich fluid to the lung Pulmonary hemorrhage, atelectasis, and hypoxemia occur in the lung and alveoli, clinically, respiratory dysfunction occurs, and cyanosis and chest radiographs have extensive pulmonary consolidation. Arterial hypoxia can cause irritability, lethargy, and even coma and death.
- 3. Important internal organ damage:
- a. Rupture of liver and spleen: Severe damage to the lower chest wall, in addition to causing pathological fractures of the ribs, may also cause left
- Pathological fracture
- b. Lung injury: In the pathological fracture of ribs, the pathological fracture end can damage the intercostal blood vessels and lung tissues, and pneumothorax, hemothorax or pneumothorax can occur, causing severe breathing difficulties.
- c, bladder and urethral damage: caused by pathological fracture of the pelvis, causing lower abdomen, perineal pain, swelling, and hematuria and dysuria caused by extravasation of the urine.
- d. Rectal injury: It can be caused by pathological fracture of the zygomatic coccyx. Lower abdominal pain and intrarectal bleeding occurred.
- 4. Important surrounding tissue damage:
- a. Important vascular injury: Common pathological fracture of the femoral condyle, the distal pathological fracture end can cause iliac artery injury. Anterior or posterior tibial arterial injury of pathological fracture of the upper tibial segment, straight pathological fracture of the humeral condyle, and lateral pathological fracture end are prone to cause brachial artery injury.
- b. Peripheral nerve injury: Especially in the part where the nerve is closely adjacent to the bone, such as the junction of the middle and lower 1/3 of the bone, it is easy to damage the rocking nerve that is close to the humerus. Pathological fractures of the fibula neck can easily cause damage to the common peroneal nerve.
- c. Spinal cord injury: It is a serious complication of pathological fracture and dislocation of the spine, which is more common in the cervical spine and thoracolumbar. Paraplegia appears below the injury level. Although there are many studies on spinal cord injury regeneration, no breakthrough has been achieved. Paraplegia caused by spinal cord injury can lead to lifelong disability.
- 5, osteofascial compartment syndrome is a series of early syndromes caused by acute ischemia of fascia and nerves in the osteofascial compartment formed by bone, interstitial membrane, muscle space and deep fascia. It is most common in the volar side of the forearm and the lower leg. Hematoma and tissue edema of traumatic pathological fractures often increase the volume of the contents in the room, or tighten it tightly. Cause, when the pressure reaches a certain level (forearm 8.7kPa (65mmHg) calf 7.3kPa (55mmHg) can close the arteries supplying muscles, forming a vicious cycle of ischemia-edema-learning blood, resulting in different degrees of ischemia
- a. On the verge of ischemic muscle contracture-in the early stage of ischemia, after timely treatment and restoration of blood supply, minimal or no muscle necrosis may occur, and limb function may not be affected.
- b. Ischemic muscle contractureshorter or heavier incomplete ischemia, most muscle necrosis after blood supply is restored. The formation of contracture deformities seriously affects the function of the affected limb.
- c. Gangreneextensive ischemia over a long period of time, a large number of muscle gangrene, often amputation. If a large amount of toxins enter the blood circulation, it can also cause shock, arrhythmia, and acute renal failure.
Pathological fracture treatment plan
- 1. Identify the cause. For those who have a clear etiology such as hyperparathyroidism, osteoporosis, and can be treated, the original etiology should be treated.
- 2. For patients with local benign tumors, tumor resection (or curettage) and bone grafting are feasible. For patients with a wide range of tumors, excision is required, and repair surgery is considered as appropriate.
- 3. For those caused by malignant tumors, if there is no metastasis throughout the body, extensive or radical surgery may be performed as appropriate according to the nature, course, stage, and general and local conditions of the tumor. For patients with systemic metastases, consider using drugs or radiation therapy, and locally
- Pathological fracture
- 4, due to osteogenesis imperfecta, deformity osteitis and other diseases caused by local non-surgical treatment. If surgical treatment is performed, the difficulties caused by the abnormal structure of the bone itself and the deformity of the entire limb should be fully considered.
- 5. X-ray examination In addition to the positive and lateral X-rays, special postures should be taken according to the injury, such as the open position (upper cervical spine injury), dynamic lateral position (cervical spine), axial position (scaphoid, Calcaneus, etc.) and tangent position (patella). For complex pelvic fractures or suspected intravertebral fractures, tomography or CT should be performed as appropriate. The influencing factors causing various displacements are:
- a. The nature, magnitude and direction of external violence.
- b. Muscle pull, different pathological fracture sites, due to different starting and ending points of muscle. Muscle pulls cause displacement in different directions.
- c. The stretching of the limb weight of the pathological fracture can cause the pathological fracture to separate and shift.
- d. Improper handling or treatment.
- Pathological fractures are often caused by more severe trauma. In some complicated injuries, sometimes the pathological fracture itself is not important. What is important is that the pathological fracture is accompanied by or caused damage to important tissues or important organs, which often causes severe systemic reactions and even endangers the patient's life. Some complications that occur during the treatment of pathological fractures will seriously affect the treatment of pathological fractures. Special attention should be paid to their prevention and timely and correct treatment.
Precautions for pathological fractures
- 1. Priority should be given to life-threatening complications (shock, major bleeding, fat embolism, etc.) and visceral injuries (cranium, chest, abdomen, pelvis, etc.). Fractures should be treated after the condition is stable, but the fractures should be temporarily fixed.
- 2. Open fractures should be debrided promptly and thoroughly, and antibiotics should be used as appropriate to prevent infection, and tetanus antiviral serum injection should be given at the same time.
- 3. Strive for early reduction and fixation after fracture.