OVERVIEW

What is a pathological fracture?

A pathological fracture is a type of bone fracture, but its cause is relatively unique. It is usually not caused by severe traumatic injury but rather by various factors that weaken the bone structure, making it unable to support body weight, leading to the fracture.

Common causes of bone structure damage include: osteoporosis, osteomalacia (bones softening due to various reasons), bone tumors, bone infections, and other specific bone diseases (such as Paget's disease, osteogenesis imperfecta), etc.

The symptoms of pathological fractures are largely similar to those of ordinary fractures, including localized pain, swelling, bruising or bleeding in some areas, and deformity in cases of long bone fractures.

Additionally, some pathological fractures are caused by bone tumors, and the growth of tumors may lead to visible lumps.

Are pathological fractures common?

They are not uncommon. Among them, pathological fractures caused by osteoporosis are the most common.

SYMPTOMS

What are the common manifestations of pathological fractures?

The symptoms are basically the same as those of ordinary fractures, and it is generally difficult to distinguish between ordinary fractures and pathological fractures based solely on symptoms. Clinical manifestations include:

• Pain: Localized pain at the fracture site is one of the most common clinical manifestations of pathological fractures. It can often be triggered by minor or even no external force.

• Swelling, deformity, bruising, etc.: In pathological fractures of the limbs, if there is significant displacement of the fracture, rupture of local blood vessels, or bleeding, symptoms such as limb swelling, deformity, and bruising may occur.

• Special manifestations: In patients with pathological fractures, tumor tissue may extensively destroy the bone structure at the fracture site. Subsequently, this tumor tissue may proliferate and enlarge. At a certain stage of development, a localized mass may appear before the fracture occurs.

CAUSES

What are the common causes of pathological fractures?

• Osteoporosis: This is currently the most common cause of pathological fractures. Many fractures in the elderly, such as vertebral fractures, hip fractures, and wrist fractures, are often pathological fractures caused by osteoporosis.

• Tumors: Including benign bone tumors, malignant tumors, and metastatic tumors. Metastatic tumors most commonly originate from breast cancer, prostate cancer, lung cancer, thyroid cancer, and kidney cancer. Pathological fractures caused by tumors are currently a challenging clinical issue to treat.

• Osteomalacia: This condition is relatively rare. Osteomalacia means the bones are softer and less dense than normal bones, making them more prone to fractures. The main cause is vitamin D deficiency. In addition to pathological fractures, osteomalacia may also cause other atypical symptoms, such as muscle weakness and pain in weight-bearing joints (mainly the hips).

• Bone infections: Usually caused by bacteria or fungi. Patients with bone infections often exhibit infection-related symptoms in addition to fractures, such as localized redness, swelling, and systemic chills.

• Other rare bone diseases: Such as Paget's disease and osteogenesis imperfecta. These conditions can weaken bone strength, impair support function, and increase the risk of fractures.

DIAGNOSIS

How to Determine Pathological Fractures?

Diagnosing pathological fractures relies on the "clinical triad"—medical history, physical examination, and auxiliary tests.

• Medical history: Includes whether the patient has a history of tumors, recent physical condition, past skeletal development issues, or symptoms of fractures such as pain, swelling, deformity, and limited mobility.

• Physical examination: The doctor will conduct a thorough examination. The painful area may exhibit obvious tenderness, and displaced fractures may show angular deformities. Bone crepitus may be felt during the exam. For cases where tumors have destroyed bone and caused local tumor growth, a mass may be palpable at the fracture site.

• Auxiliary tests: Based on the patient's condition, the doctor may order tests such as imaging, pathological examinations, and hematological tests to confirm the diagnosis.

What Imaging Tests Are Needed for Diagnosing Pathological Fractures?

Imaging tests include X-rays, CT scans, and MRI, each with advantages and disadvantages.

• X-rays: Their strength lies in "definitive confirmation." If a fracture appears on an X-ray, it can generally be confirmed, and the cause of the pathological fracture can be roughly inferred. However, X-rays poorly display bone structure, surrounding "soft tissues" (ligaments, tendons, etc.), and cannot accurately assess bone destruction or identify certain special pathological fractures.

• CT scans: CT can be considered an upgraded version of X-rays, providing more comprehensive and clearer bone images, but with higher radiation exposure. Its drawbacks are similar to X-rays.

• MRI: More sensitive, radiation-free, and capable of revealing bone interior conditions. For metastatic tumors, it can assess the extent of bone destruction, preliminarily determine tumor nature, and evaluate relationships with surrounding muscles, tendons, blood vessels, and nerves.

A simple analogy:

X-rays are like 2D photos, unable to show the full 3D structure of bones but useful for general appearance assessment.

CT scans resemble 3D bone models, providing a clearer structural view but may not be as convenient for overall appearance evaluation.

MRI can reveal both bone conditions and internal bone details.

Generally, all three tests are recommended for pathological fracture patients to evaluate the cause comprehensively and guide treatment.

Other imaging methods, such as bone ECT, PET-CT, and PET-MRI, are valuable for challenging cases and assessing systemic tumor metastasis. However, these tests are expensive and not widely available.

Why Is a Pathological Examination Necessary for Suspected Pathological Fractures?

Pathological fractures are often difficult to diagnose through imaging alone, requiring bone tissue samples for definitive identification.

Currently, two main methods are used to obtain samples: needle biopsy and excisional biopsy.

Needle biopsy involves inserting a thin needle through the skin to extract tissue, while excisional biopsy involves surgically removing part or all of the specimen for pathological examination.

Why Are Blood Tests Needed for Suspected Pathological Fractures?

Certain hematological indicators—such as calcium levels, bone turnover markers, tumor markers, complete blood count, and blood cultures—can help identify causes like osteoporosis, tumors, or infections.

TREATMENT

Which department should I visit for a pathological fracture?

Pathological fractures usually require treatment in the orthopedics department.

What are the treatment goals for pathological fractures?

The main goals of treating pathological fractures are: pain relief, restoration of limb function, improvement of the patient's quality of life, and extension of survival time based on these objectives.

What are the treatment options for pathological fractures?

Pathological fractures can have many causes, and the treatment methods usually vary depending on the underlying cause. Factors such as age, the patient's general condition, expected survival time, location of the pathological fracture, and the extent of surrounding tumor involvement can all influence the treatment plan, making it difficult to establish a universally applicable approach.

Doctors generally follow these basic principles:

• Before selecting a treatment plan, the cause of the pathological fracture must first be identified.

• For pathological fractures that do not affect bone healing capacity, conservative treatment is usually adopted, primarily involving immobilization of the fracture site, pain reduction, and promotion of healing. For fractures that impair bone healing ability, surgical intervention is often necessary, mainly involving resection of proliferative soft tissue tumors at the fracture site, followed by bone reconstruction, internal fixation with plates, or joint replacement.

• Depending on the specific cause of the pathological fracture, additional treatments such as radiotherapy, osteoclast inhibitors (bisphosphonates, denosumab), chemotherapy, glucocorticoid therapy, immunotherapy, or targeted therapy may also be considered.

DIET & LIFESTYLE

Do patients with pathological fractures need dietary restrictions?

Whether dietary restrictions are necessary depends on the underlying disease causing the pathological fracture.
You can search for related diseases in this App to learn more details.

Do pathological fractures require regular follow-up examinations?

Yes, patients should follow the doctor's instructions and attend regular outpatient follow-ups to monitor fracture healing.

PREVENTION

Can Pathological Fractures Be Prevented?

Pathological fractures are difficult to effectively prevent. However, the following measures may help:

• Maintain regular exercise to preserve muscle and bone strength.

• Ensure a balanced diet to avoid calcium deficiency; engage in moderate outdoor activities to prevent vitamin D deficiency.

• Promptly treat diseases that may lead to pathological fractures.

• Avoid high-intensity activities.

• Attend regular health check-ups to detect potential underlying conditions early.

• Seek medical attention promptly if unexplained pain occurs.