Pathological fracture cancer8/18/2023 A chest radiograph should also be obtained. There are a number of aggressive features suggestive of a pathologic lesion that may be identified on X-ray, which include: lesion diameter > 5 cm, cortical interruption, periosteal reaction, and associated pathologic fracture. A plain radiograph is the single most important imaging modality and provides the most information about a pathologic lesion. Radiological analysis of pathologic fractures begins with orthogonal radiographs of the fracture site and the involved bone in its entirety. Pregnancy tests should also be obtained in women of child-bearing age prior to imaging. If Bence-Jones proteins are present, multiple myeloma is likely the diagnosis. If hematuria is present, renal cell or uroepithelial carcinoma should be considered. For example, a urinalysis may provide some insight into the primary pathology. Laboratory abnormalities may exist secondary to malignancy and may elucidate the source of malignancy. Disease-specific markers, including prostate-specific antigen (PSA) and carcinoembryonic antigen (CEA), etc., may also be considered. Laboratory analysis should include a complete blood count, comprehensive metabolic panel (with special attention to serum calcium and alkaline phosphatase), prothrombin/INR, activated partial thromboplastin, erythrocyte sedimentation rate, urinalysis, urinary protein electrophoresis, and serum protein electrophoresis. © 2014 Royal Australasian College of Surgeons.When a pathologic fracture is identified through a lesion of unknown origin, a comprehensive workup must be conducted to identify the etiology and stage of the disease. We propose that these variables are scrutinized by the treating orthopaedic team preoperatively to help guide management and provide patients and their families with a realistic expectation of functional outcome and survival time.īone fractures neoplasm metastasis neoplasms pathologic processes prognosis spontaneous. Overall, the prognosis following pathological fracture is extremely poor. There is a statistically significant correlation between patient survival and primary cancer type, spinal metastatic burden and functional performance score. The median time between diagnosis of cancer to pathological fracture was 8.3 months, while the median survival post-fracture was 3.3 months. The variables of interest include primary cancer, fracture site, method of fixation, use of cement augmentation, appendicular metastatic load, spinal metastatic load, presence of visceral metastases, patient co-morbidities and functional scoring before and after the fracture has occurred. Retrospective clinical audit of 72 patients from the Orthopaedic Unit at Fremantle Hospital in Western Australia. ![]() This study investigates the variables affecting prognosis in patients suffering pathological fractures. Although several studies look into prognosis following the development of metastatic lesions, few look into the prognosis after the fracture itself. They are frequently a marker of end-stage cancer and the end of functional independence. Pathological fractures are a significant and often devastating event in the progression of metastatic bone disease.
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