Category Archives: Orthopaedics

Pathologic fracture: When the bone breaks without trauma!

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Bone fractures are most commonly occur after a trauma. But one wonders how bone can break or fracture without or with trivial trauma. Common sense may suggest that a fragile or weak bone can break easily, and that is true and the underlying reason or pathophysiology of pathologic fracture. Pathologic fracture, or the bone fractures without or with minimal traumas, has been known since 19th century.(1) It is caused by weakness in the bone structure, commonly occur due to osteoporosis. (2-3) But it also could be due to other pathologies such as cancers, infections such as osteomyelitis or bone infection, bone cysts, osteomalacia (soft bone) or paget’s disease, or even osteopetrosis (hard bone). (4-11) These fractures could be cause of a wide arrays of infections from venereal diseases, to tuberculosis, and even salmonella, (5-8) or cancers such as leukemia of childhood (9), or a cause of cancer treatment such as radiation. (10) It could also occur in a wide age range from infants and children to adults, and not only in elderly who are more common to have osteoporosis. (11-12) Pathologic fracture could also occur in many bones of the body from long bones of upper and lower extremities, to the hip and vertebrae and a small bone such as lower jaw or mandible. (13)  

 Osteoporosis, known commonly appearing in old age, specially in women has also been known for long that can occur at an earlier due to treatment with corticosteroids, used often for arthritic conditions. (14-15) This is while corticosteroids are paradoxically used also in the treatment and prevention of osteoporotic fractures. (16-17) Although pathologic fractures, specially occur in long bones and in elderly with osteoporosis in the hips, it can also occurs elsewhere including vertebral bones that is again paradoxically corticosteroids are reported to be used for its treatment and prevention. (18-19) Unrecognized such pathologic fractures of the vertebra have also been reported by radiologists without any such reports by the treating physicians in cancer patients, that partly could be due to the cancers and partly due to non-corticosteroid treatments of cancers. (20)

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