Learning objectives
Illustrate in a case-based format a standardize approach to identify a pathological fracture,
described the underlying osseous mass lesion with emphasis on associated pertinent positive and negative findings reaching to providing a differential and final diagnosis.
Demonstrate by multiple imaging modalities the radiological findings seen in pathological fractures with underlying bone tumors,
from the benign to the malignant and from auntminnie to the challenging.
Background
Apathologic fractureis defined as bone fracture caused by a disease process that led to weakness of the bone structure.
Teaching pearls for pathological fractures with underlying tumor in adults:
In adults a localized lesion is worrying for malignancy.
The most common causes are metastasis and multiple myeloma.
Most common tumors that metastasize to bones are: Prostate,breast,kidney,thyroid and lung.
Teaching pearls for pathological fractures in children:
Etiology can be variable and includes metabolic diseases,
infection and tumors.
Pathological fractures through a malignant primary bone malignancy are...
Imaging findings OR Procedure Details
Pathological fractures' can be grouped into 3 major groups:
1.
Fractures related to underlying benign appearing/non-aggressive primary bone tumor.
2.
Fractures related to underlying malignant/aggressive primary bone tumor.
Table below shows a representative etiology of primary bone tumors that could cause pathological fractures.
Tumor type
Benign
Malignant
Bone-forming
Osteoblastoma (case reports)
Osteosarcoma
Cartilage-forming
Enchondroma
Chondrosarcoma
Small,
Round Blue cell
NA
Ewing sarcoma,
Multiple myeloma.
Others
Aneurysmal bone cyst
Simple cyst
Fibrous dysplasia
Langerhans cell histiocytosis
Giant cell tumor
3.
Fractures related to a known or...
Conclusion
Pathological fractures are not infrequently encountered in clinical practice and familiarity with this entity is crucial for appropriate management.
Imaging plays an important role in identifying the underlying pathology and helps differentiate a neoplastic pathological fracture from other types of pathological fractures like osteoporosis and from traumatic fractures,
nevertheless,
clinical data is inevitable for proper diagnosis.
References
Medical Definition of pathological fracture Available at https://www.merriam- wbster.com/medical/pathological%20fracture,
(accessed 12 April,
2018)
Vanasse,
Alain et al."Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec".
BMC Musculoskeletal Disorders.
6 (1).
doi:10.1186/1471-2474-6-33.
ISSN1471-2474 Available at https://en.wikipedia.org/wiki/Pathologic_fracture(accessed 12 April,
2018)
Pathologic Fracture.
E.
David Weinberg,
M.D.
February 1931 Radiology,
16,
282-287 and www.Statdx.com available at http://www.learningradiology.com/archives2013/COW%20543-Pathologic%20Fracture/pathfxcorrect.html
Mirels Classification for Risk of Pathological Fracture available at http://roentgenrayreader.blogspot.qa/2012/01/mirels-classification-for-risk-of_12.html,
(accessed 12 April,
2018) C.
B.
R.
De...
Personal Information
Dr.
Alaa Abdulsattar Al-Taie
Associate Consultant Musculoskeletal Radiologist.
M.B.Ch.B,
CABMS-RAD,
Musculoskeletal Radiology Clinical Fellowship.
Hamad Medical Corporation.
Doha,
Qatar.
Email:
[email protected]
Dr.
Abeer Hamed Marioud
Associate Consultant Musculoskeletal Radiologist.
MBBCh,
MSc,
CABMS-RAD,
Musculoskeletal Radiology Clinical Fellowship.
Hamad Medical Corporation.
Doha,
Qatar.
Email:
[email protected]
Dr.
Rawy Saif Alasaly
Radiology resident.
Hamad General Hospital,
Hamad Medical Corporation.
Doha,
Qatar.
Dr.
Zeyad Tareq Jaleel
Emergency radiologist.
M.B.Ch.B,
CABMS-RAD.
Hamad Medical Corporation.
Doha,
Qatar.
Email:
[email protected]