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Pathological Fracture Care in Pune
We treat pathological fractures from metastases at Sancheti Hospital’s Ortho Onco Department with expert surgical care.
Overview
A pathologic fracture is a bone break that happens when a bone becomes severely weakened by disease, not from a typical injury or accident. Unlike regular fractures that occur from falls or trauma, these breaks can happen from simple daily activities like walking, coughing, or even gentle movements.
Pathologic fractures most commonly affect strong bones that don’t usually break easily, including:
- Vertebrae (spine bones)
- Pelvis
- Humerus (upper arm bone)
- Femur (thigh bone)
When these fractures occur due to cancer metastasis (cancer spreading to bones), they often indicate advanced stage disease. This can significantly impact a person’s quality of life and may be life-threatening, making quick diagnosis and proper treatment essential.
Symptoms
Pathologic fractures share many symptoms with regular bone breaks, but they’re often accompanied by signs of the underlying disease causing the bone weakness.
Common symptoms include:
- Pain at the fracture site (may be widespread in cases of bone metastasis)
- Swelling and tenderness around the affected area
- Difficulty or inability to move the injured body part
- Bruising or skin discoloration
- Visible deformity or unusual bumps
Additional serious symptoms may include:
- Neurological problems: Numbness, weakness, or tingling in arms or legs (especially with spinal fractures)
- Spinal cord compression: A medical emergency requiring immediate treatment
- Hypercalcemia: High calcium levels in blood causing confusion, heart problems, or kidney issues
Sometimes, weakened bones cause pain even before they actually break, signaling an “impending pathologic fracture” that needs immediate attention.
Causes
Pathologic fractures happen when disease processes weaken bone structure and strength. The main causes include:
Primary Causes
Osteoporosis is the most common cause, making bones weak and brittle. Many people don’t know they have osteoporosis until they experience a fracture, as it often has no obvious symptoms. Postmenopausal women and older adults face the highest risk.
Bone tumors are the second leading cause:
- Metastatic bone disease: Cancer cells spread from other organs (breast, lung, prostate, kidney, thyroid) to bones
- Primary bone sarcomas: Cancers that start directly in bone tissue
- Benign bone tumors: Non-cancerous growths that can still weaken bones
How Tumors Weaken Bones
Tumor cells damage bones through different mechanisms:
- Osteolytic lesions: Increase bone breakdown, creating weak spots
- Osteoblastic lesions: Cause disorganized bone formation that’s structurally weak
- Mixed lesions: Combine both processes (common in breast cancer)
Other Causes
- Bone infections (osteomyelitis)
- Metabolic bone diseases (Paget’s disease, osteomalacia)
- Inherited bone disorders
- Long-term steroid use
Risk Factors
Several factors increase the likelihood of developing pathologic fractures:
- Age and gender: Older adults, especially postmenopausal women, have higher osteoporosis risk
- Cancer diagnosis: Particularly breast cancer, lung, prostate, kidney, and thyroid cancers
- Bone lesions: Visible on imaging tests, indicating weakened bone structure
Widespread cancer: Advanced metastasis to multiple bones or organs
Diagnosis
Diagnosing pathologic fractures requires identifying both the bone break and its underlying cause through comprehensive evaluation.
Medical Assessment
- Detailed medical history and physical examination
- Review of symptoms and previous medical conditions
- Assessment of pain, swelling, and movement limitations
Imaging Tests
- X-rays: First step to identify fractures and suspicious bone lesions
- CT scans: Detailed cross-sectional images showing bone damage extent
- MRI: Excellent for viewing soft tissues, spinal cord, and tumor involvement
- Bone scans: Detect bone damage and activity throughout the skeleton
- PET scans: Highly sensitive for identifying malignant tumors
Laboratory Tests
- Blood tests checking calcium levels and tumor markers
- Complete blood count and metabolic panels
- Specific cancer markers (PSA, CEA) when appropriate
Biopsy
A biopsy is crucial for definitive diagnosis, especially when the cause is unknown. This involves taking a small tissue sample from the bone lesion for microscopic examination. The procedure must be performed by experienced specialists to avoid spreading tumor cells or complicating future treatments.
Types
Pathologic fractures can be classified based on the bone damage pattern and timing:
By Bone Damage Type
- Osteolytic lesions: Bone breakdown and erosion
- Osteoblastic lesions: Abnormal bone formation
- Mixed lesions: Combination of both patterns
By Fracture Status
- Impending pathologic fracture: Bone severely weakened but not yet broken
- Established pathologic fracture: Bone already broken due to weakness
Treatment
Pathologic fracture treatment focuses on relieving symptoms, preventing cancer spread, and improving quality of life. A team approach involving oncologists, orthopedic surgeons, radiation specialists, and palliative care experts provides the best outcomes.
Non-Surgical Treatment
Pain management through medications and activity modification helps control discomfort and maintain function.
Radiation therapy effectively relieves pain and controls tumor growth, especially for radiosensitive cancers like breast cancer, prostate cancer, and lymphoma.
Bone modifying drugs like bisphosphonates and denosumab strengthen weakened bones, reduce pain, prevent future fractures, and manage hypercalcemia.
Vertebroplasty or kyphoplasty can stabilize spinal fractures by injecting bone cement into fractured vertebrae.
Systemic cancer treatments including chemotherapy, immunotherapy, and hormone therapy help control the underlying cancer throughout the body.
Surgical Treatment
Surgery may be necessary for high-risk impending fractures, established fractures, or when there’s spinal instability. The goal is to provide immediate stability and allow early movement.
Prophylactic fixation involves reinforcing weakened bones before they break, which generally has better outcomes than repairing already broken bones.
Internal fixation uses metal plates, screws, or rods to stabilize bones, often with bone cement for additional support.
Endoprosthesis replacement involves replacing extensively damaged bone sections with specialized implants, providing immediate structural integrity.
Limb salvage surgery aims to save affected limbs rather than requiring amputation through careful resection and reconstruction.
Rehabilitation
Rehabilitation is essential for recovery, especially after surgical intervention. The primary goal is early mobilization and functional restoration.
Key components include:
- Immediate mobilization: Early movement with assistive devices as tolerated
- Physical therapy: Structured programs to regain strength, flexibility, and range of motion
- Continued medical treatment: Ongoing chemotherapy, radiation therapy, and bone modifying drugs
- Blood clot prevention: Anticoagulation therapy when appropriate
The ultimate goal is achieving a painless, mobile, and functional limb that maintains the highest possible quality of life.
Complications
Pathologic fractures and their treatments can lead to various complications affecting both immediate recovery and long-term outcomes.
Fracture-Related Complications
- Persistent pain at the metastatic site
- Neurological impairment including spinal cord compression
- Hypercalcemia from bone breakdown
- Poor bone healing (malunion or nonunion)
Surgical Complications
- Hardware failure or reconstruction breakdown
- Infection requiring antibiotics or implant removal
- Wound healing problems
- Rare but serious cement-related complications
Systemic Complications
- Physical deconditioning from reduced mobility
- Blood clot formation
Skeletal-related events including new fractures
Prevention
Preventing pathologic fractures involves identifying and treating bone weakness before fractures occur.
Prophylactic Measures
Prophylactic fixation can prevent fractures in high-risk bones. Mirel’s score (a 4-12 point scale) helps assess fracture risk, with scores of 9 or higher indicating need for preventive surgery.
Early Detection and Treatment
For osteoporosis: Regular screenings, calcium and vitamin D supplements, bisphosphonates, and weight-bearing exercise can strengthen bones.
For bone tumors: Regular monitoring of cancer patients helps detect bone metastasis early, allowing prompt treatment before fractures occur.
Living With Pathologic Fractures
- Living with pathologic fractures often means managing complex, progressive disease, especially when caused by metastatic cancer. The focus shifts to optimizing quality of life for as long as possible.
- Multidisciplinary care involving oncologists, orthopedic surgeons, radiation oncologists, and palliative care teams ensures comprehensive management of both the fracture and underlying disease.
- Ongoing treatment typically includes continued cancer therapies, localized radiation therapy for pain control, and long-term bone modifying drugs to prevent future complications.
- Prognosis varies widely depending on the primary cancer type and stage. Breast cancer patients with bone metastasis may have longer survival times compared to those with lung cancer spread.
- Supportive care includes physical rehabilitation to maintain mobility and independence, plus psychosocial support to cope with disease challenges. Complementary therapies like yoga and meditation may help manage symptoms and improve overall well-being.
Key Takeaways
- Pathologic fractures result from bone weakness due to underlying disease, not typical trauma, commonly caused by osteoporosis or metastatic bone disease
- Early recognition of symptoms like pain, swelling, and reduced mobility is crucial, especially when neurological issues or hypercalcemia are present
- Comprehensive diagnosis requires physical examination, advanced imaging, and biopsy for definitive tissue diagnosis
- Treatment approaches are multidisciplinary, focusing on symptom management and quality of life improvement through radiation therapy, bone modifying drugs, and surgical intervention when appropriate
- Prophylactic fixation based on risk assessment tools like Mirel’s score can prevent fractures in high-risk patients
- Rehabilitation emphasizes early mobilization and functional restoration, supported by ongoing medical therapies
- Potential complications include hardware failure, infection, and skeletal-related events, highlighting the importance of comprehensive care
At Sancheti Hospital, we understand that pathologic fractures require specialized, compassionate care that addresses both the immediate fracture and the underlying condition causing bone weakness. Our multidisciplinary team of orthopedic surgeons, oncologists, and rehabilitation specialists work together to provide comprehensive treatment plans tailored to each patient’s unique needs.
We offer advanced diagnostic imaging, minimally invasive surgical techniques, and state-of-the-art rehabilitation programs to help patients achieve the best possible outcomes. Our hospital is equipped with modern facilities for prophylactic fixation, internal fixation, and endoprosthesis procedures, ensuring patients receive the most appropriate treatment for their specific condition.
We also provide ongoing support through our palliative care services, helping patients and families navigate the challenges of living with pathologic fractures while maintaining the highest possible quality of life.
Meet Our Ortho Onco Specialist
Patient Stories & Experiences
The pain in my left knee left me feeling helpless for years. After my treatment here, I can finally say I'm pain-free.
Vinita Singh
The nerves were swollen, and the body went numb. But thanks to Sancheti Hospital, I got a second life!
Parvati
I finally could walk again, a relief I've only felt after the hip pain surgery. I thank the doctors at Sancheti Hospital for their help.
Balaji Kharat
I'm a police officer, and I'm extremely thankful to Sancheti Hospital for treating my fracture without surgery.
Shantilal
My life has completely changed after the knee replacement surgery at Sancheti Hospital. It's like I can finally live again!
Kalpana Lepcha
The knee pain I've carried for years finally went away with the help of Sancheti Hospital.
Karuna
I can't believe that I get to finally live a normal and happy life, all thanks to the knee surgery I had at Sancheti Hospital.
Kishore Bhosle
Frequently Asked Questions
Can pathologic fractures be prevented?
Yes, especially when impending fractures are identified. Prevention strategies include prophylactic fixation (surgical reinforcement before breaking), managing osteoporosis with medications, and treating bone tumors early.
What role does surgery play in treating pathologic fractures?
Surgery aims to stabilize broken bones, relieve pain, and allow early movement. Techniques include internal fixation using rods or plates, or endoprosthesis replacement for extensive bone damage. The goal is immediate stability to improve quality of life.
What is Mirel's score?
Mirel’s score is a scoring system doctors use to assess impending pathologic fracture risk in long bones. It helps determine if prophylactic fixation is needed, with scores of 9 or higher indicating high fracture risk.
How do bone modifying drugs help manage pathologic fractures?
Bone modifying drugs like bisphosphonates and denosumab strengthen weakened bones, reduce pain, prevent future fractures, and manage complications like hypercalcemia. They’re essential for long-term treatment, especially in metastatic bone disease.
