Pathological Fracture

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.