Pathological Fracture

Define pathological fracture:

Pathological fracture is a term used to refer to loss of continuity in the substance of a bone (= 'fracture')

when the bone itself is either abnormal or diseased (pathological fracture).

The expressions 'pathological fracture' and 'pathologic fracture' have the same meaning.

A simpler definition of a pathological (or pathologic) fracture is:

"A pathologic(al) fracture is a broken bone resulting from disease leading to weakness of the bone."

The above simple answer to the question "what is a pathological fracture?" might be easier for non-specialists to remember but is less accurate, the expression 'broken bone' being a simplification of the various different types of fractures, including e.g. incomplete fractures such as hairline fractures.

The expression 'broken bone' is generally understood and widely used by non-medical personnel but is not a formal orthopedic term. The stricter definition at the top of the page is therefore more accurate.

In summary:

The word fracture refers to damage 'loss of continuity' to bone(s). When used on its own the word pathology generally refers to diseases or disease processes. Pathological fractures are damaged bones that are also affected by an abnormality or disease, of which there are several possibilities - listed in the following table.

Pathological processes that can lead to a pathological fracture
or whose presence causes fractures of affected bones to be classified as "pathological fractures"
:

Cause (pathology)

Description of pathological process

1.

Osteitis

Osteitis is a general term used to refer to inflammation of bone.
It is also part of certain terms/names used to refer to some specific conditions e.g. Von Recklinghausen's disease of bone (also known as osteitis fibrosa cystica).

2.

Osteogenesis imperfecta

Osteogenesis imperfecta is a hereditary disorder that is usually diagnosed in infancy or childhood (but sometimes not until later in life) in which fragile bones lead to symptoms including:

  • Bowing of long bones, e.g. in the legs
  • Bone deformities
  • Stunted growth
  • Pathological fractures.
3.

Osteomalacia / Rickets

Osteomalacia is a condition affecting bones and muscle in adults. In children who are still growing the same condition is known as rickets. Symptoms include bones becoming soft and prone to pain and fractures due to insufficient or defective bone mineralisation, i.e. the bones are not sufficiently hardened by minerals containing calcium and phosphate. Causes include:

  • Severe and prolonged deficiency of vitamin D - which regulates the bone-building process and the body's use of calcium and phosphate to form strong, hard bones.
  • Insufficient sunlight on the skin - which leads to deficiency of vitamin D because vitamin D is made in the body by the action of sunlight on the skin. Lack of sunlight on the skin is the main reason that people get vitamin D deficiency and osteomalacia.
  • Some medical conditions and some medicines increase risk of vitamin D deficiency and consequent osteomalacia.
  • Some rare inherited conditions affect bone mineralisation and cause osteomalacia.
  • Aluminium poisoning (also rare).
4.

Osteoporosis

Osteoporosis is the most common cause of pathological fracture.
It generally involves failure of bone tissue formation or maintenance - resulting in bones having a translucent appearance on X-Ray images.

Osteoporosis can occur following or due to:

  • Reduced hormone levels - associated with age, esp. menopause.
  • Lack of use of affected bone(s) e.g. due to injury
  • Complication or after-effect of rheumatoid arthritis
  • Deficiency of vitamin C
5.

Paget's disease

Paget's disease is a chronic bone disorder involving breakdown and formation of bone tissue that can result in weakened bones, pain, mis-shapen bones, bone fractures, and arthritis in the joints near the affected bones. It usually affects local areas only, e.g. just one or a few bones, as opposed to all the bones in the body. Severity varies from person to person. Conventional medication is available.

It has been claimed (no reference found) that chalkstick fractures are common in cases of Paget's disease.

6.

Primary malignant bone tumours

There are several types of primary malignant bone tumours, e.g.

  • malignant change in an osteoclastoma
  • osteogenic sarcoma
  • chondrosarcoma
  • fibrosarcoma
  • Ewing's tumour
7.

Secondary malignant bone tumours

The most common malignant bone tumour is the metastatic deposit, that is a tumour that has metastasized (moved, or spread) from another part of the body, e.g. from an adjacent organ within the body. Secondary tumours found in bone tissue may, for example, occur from primary growths in the lung, breast or kidney.

8.

Simple bone tumours and cysts
e.g. enchondromata and unicameral bone cysts

  • Benign (non-cancerous) cartilaginous tumours called enchondromata are sometimes the cause of pathological fractures. They occur most commonly in the bones of the hands or feet, i.e. the metacarpals, metatarsals and phalanges.
  • Unicameral (simple) bone cysts are benign cavities within a bone that are filled with straw-colored fluid. They occur in one location in one bone, usually in people under 20 years old. In children aged 5 - 15 years, a unicameral bone cyst is one of the most common causes of pathological fracture e.g. in the upper arm or upper-leg. There is no known cause. Little is known about the development of unicameral bone cysts.

How do these pathological processes lead to pathological fractures ?

The mechanisms by which the bone conditions and diseases listed above can lead to a pathological fracture or fractures vary. In some cases the pathological process causes sufficient weakening of the structure and tissues of the bone that fracture(s) may occur either spontaneously or as a result of only slight injury e.g. an impact sustained in the course of normal day-to-day activities.

How is a pathological fracture identified or diagnosed ?

When the bone condition (pathology) is already known to the person and his/her medical practitioners, the pathological nature of the fracture may be expected and confirmed by medical imaging.

When the existence of a bone condition (pathology) is not known to the patient or medical practitioner, a bone fracture resulting from a seemingly trivial event or injury may be an initial cause for concern. In any case the medical images, e.g. X-rays, may provide the first clear evidence of a pre-existing bone pathology and may lead to further tests and/or treatment.

This is the end of this page about pathological fractures.

See also types of fractures, types of joints and skeletal disorders.







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