The investigation and management of suspected malignant pathological fractures: A review for the general orthopaedic surgeon

• Published in: Injury Vol. 46; no. 10; pp. 1891 - 1899
• Main Authors: Bryson, D.J, Wicks, L, Ashford, R.U
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2015
• Subjects: Blood Investigations; Bone Cements; Bone Neoplasms - diagnosis; Bone Neoplasms - secondary; Bone Neoplasms - surgery; Cementation - methods; Early Detection of Cancer; Fracture Fixation, Internal - methods; Fractures, Spontaneous - diagnostic imaging; Fractures, Spontaneous - etiology; Fractures, Spontaneous - surgery; Humans; Multiple Myeloma - complications; Multiple Myeloma - diagnostic imaging; Multiple Myeloma - surgery; Orthopedics; Pathological fracture; Practice Guidelines as Topic; Radiological Investigation; Skeletal Metastases; Surgeons; Surgical management; Skeletal Metastases; Surgical management; Radiological Investigation; Pathological fracture; Blood Investigations
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2015.07.028

Abstract The management of malignant pathological fractures necessitates careful diagnostic work-up, pre-operative investigation, planning and multidisciplinary input from specialists in the fields of radiology, pathology, oncology, trauma and orthopaedics. Malignant and non-malignant conditions including metabolic disorders, benign tumours and pharmacological therapies can be implicated. The majority of patients who present with suspected pathological fractures will be managed by general orthopaedic and trauma surgeons rather than specialists in orthopaedic oncology. Skeletal metastases can result in considerable morbidity and predispose to pathological fractures. With advances in the medical management of malignancy, life expectancy in cancer patients is increasing, leading to an increasing risk of skeletal metastasis and the potential for pathological fractures. Conventional modes of trauma fixation for pathological fractures may not be appropriate. The aim of this review is to outline diagnostic and management strategies for patients who present with a long bone fracture that is potentially pathological in nature.