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Handbook of Fractures TP > Pathologic Fractures > Flashcards

Pathologic Fractures Flashcards

1
Q

pathologic fracture definition

A

occurs when normal integrity and strength of bone have been compromised by invasive or destructive processes

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2
Q

causes of pathologic fractures (7)

A

neoplasm, necrosis, metabolic disease, disuse, infection, osteoporosis, iatrogenic

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3
Q

are fractures more common in benign or malignant tumors?

A

benign

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4
Q

most common locations of pathologic fractures secondary to benign tumors in children (2)

A

humerus, femur

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5
Q

most common benign tumors associated with pathologic fractures in children (4)

A

unicameral bone cyst, non-ossifying fibroma, fibrous dysplasia, eosinophilic granuloma

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6
Q

primary malignant tumors associated with pathologic fractures (6)

A

osteosarcoma, ewing sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, etc

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7
Q

suspect a primary tumor in younger patients with aggressive-appearing lesions (3 characteristics)

A

poorly defined margins (wide zone of transition), matrix production, periosteal reaction

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8
Q

do benign or malignant tumors have antecedent pain before fracture

A

more often malignant

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9
Q

mechanism of injury in pathologic fractures

A

may be result of minimal trauma or normal activity

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10
Q

clinical history eliciting suspicion for pathologic fracture (5)

A

normal activity or minimal trauma, excessive pain at the site of fracture prior to injury, patients with known primary malignant disease or metabolic disease, history of multiple fractures, risk factors (smoking/environmental exposure to carcinogens)

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11
Q

additional physical exam (3)

A

adjacent peripheral lymph nodes, check for masses, other painful areas for impending fractures

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12
Q

laboratory evaluation (8)

A

cbc w diff, red blood cell indices, and peripheral smear; esr; chem panel; ua; stool guaiac; spep/upep; 24-hr urine hydroxyproline; specific tests

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13
Q

most specific laboratory tests for suspected pathologic fracture (4)

A

thyroid function tests, carcinoembryonic antigen, parathyroid hormone, prostate-specific antigen

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14
Q

abnormal lab finding in osteoporosis

A

none

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15
Q

abnormal lab finding(s) in osteomalacia

A

low urine calcium

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16
Q

abnormal lab finding(s) in hyperparathyroidism (1+/-2)

A

high urine calcium +/- high serum calcium/low serum phosphorus

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17
Q

abnormal lab finding(s) in renal osteodystrophy (3)

A

low serum calcium, high serum phosphorus, high serum alkaline phosphatase

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18
Q

abnormal lab finding(s) in paget disease (2)

A

very high serum alkaline phosphatase, urine hydroxyproline

19
Q

abnormal lab finding(s) in myeloma (1)

A

urine protein (spep/upep) bence-jones proteins

20
Q

percent bone loss detectable by standard x-ray

A

> 30%

21
Q

radiographs evaluating for pathologic fractures (5)

A

chest radiograph, bone scan, ct, mri, pet scan

22
Q

prevalence of paget disease in the elderly population

A

5% to 15%

23
Q

primary malignant tumors metastasizing to bone

A

blt kosher pickle (breast, lung, thyroid, kidney, prostate)

24
Q

most common locations of pathologic fractures associated with metastatic disease (5)

A

spine, ribs, pelvis, femur, humerus

25
Q

basis of springfield classification of pathologic fractures

A

pattern of bone invasion (systemic vs localized)

26
Q

correctable disorders associated with pathologic fractures (5)

A

osteomalacia, disuse osteoporosis, hyperparathyroidism, renal osteodystrophy, steroid-induced osteoporosis

27
Q

initial treatment of pathologic fracture (3)

A

standard fracture care, evaluation of underlying pathologic process, optimization of medical condition

28
Q

goals of operative management of pathologic fracture (4)

A

prevention of disuse osteopenia, mechanical support for weakened or fractured bone to permit the patient to perform daily activities, pain relief, decreased length and cost of hospitalization

29
Q

standard of care for most pathologic fractures

A

internal fixation with or without cement augmentation

30
Q

what may be considered for impending pathologic fractures in periarticular locations or for failed attempts of internal fixation

A

resection and prosthetic reconstruction

31
Q

most common complication in treatment of pathologic fractures

A

loss of fixation

32
Q

contraindications to surgical management of pathologic fractures (3)

A

medical clearance, mental obtundation precluding need for pain relief (srsly?), life expectancy <1 month (controversial)

33
Q

what percentage of pathologic fracture patients will be alive after 1 year

A

75%

34
Q

average survival time for pathologic fractures (obviously varies by primary diagnosis)

A

~21 months

35
Q

solitary lesions with pathologic fractures require ______

A

biopsy

36
Q

role of radiation and chemotherapy in treatment of pathologic fractures (3)

A

palliate symptoms, diminish lesion size, prevent advancement of lesion

37
Q

treatment of pathologic femoral neck fracture in the absence of acetabular involvement

A

hemiarthroplasty

38
Q

treatment of pathologic femoral shaft fractures

A

intramedullary nailing

39
Q

indications for prophylactic fixation (Harrington) (4)

A

cortical bone destruction >50%, proximal femoral lesion >2.5cm, pathologic avulsion of the lesser trochanter, persistent pain following irradiation

40
Q

Mirel’s score cutoff for prophylactic internal fixation

A

8

41
Q

treatment of painful pathologic spine fracture, but no neurologic loss, or loss of height

A

radiation therapy

42
Q

treatment of pathologic spine fractures caused by osteoporosis, myeloma, metastatic carcinoma

A

percutaneous cement placement in the vertebral body

43
Q

concern with percutaneous cement placement in vertebral body for pathologic spine fractures

A

leakage into canal and adjacent veins

44
Q

treatment of pathologic spine fracture with neurological loss

A

spinal decompression and fusion with internal fixation anteriorly or posteriorly

Handbook of Fractures TP (6 decks)

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