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Pathologic Fractures

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Fractures in the Elderly

Part of the book series: Aging Medicine ((AGME))

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Abstract

Pathologic fractures occur in areas of bone weakened by a variety of processes; however, the term is most often meant to describe fractures occurring in the setting of a neoplastic process, which will be the focus of this chapter. In the geriatric population, the overwhelming majority of pathologic fractures are the result of metastatic lesions from a primary carcinoma elsewhere in the body. Any elderly patient presenting with a bony lesion should be worked up in a standard fashion to identify the etiology. The workup is initiated with a thorough history and physical examination, and then appropriate laboratory and diagnostic tests are combined with both basic (plain film radiography) and advanced imaging; this approach leads to an accurate diagnosis in approximately 85% of cases. The remainder of cases require a biopsy for diagnosis. A multidisciplinary approach to management is paramount to optimize outcomes. Referral to an orthopedic surgeon, usually one who specialized in musculoskeletal tumors (orthopedic oncologist), is often necessary to determine if surgical management is warranted for prophylactic or palliative treatment of impending or pathologic fractures. Surgical management is aimed at providing pain relief and improving a patient’s function and quality of life. Surgical constructs should be stable for the duration of a patient’s remaining lifetime and allow for early ambulation and rehabilitation. As with all surgeries, but even more imperative in a population with a limited life expectancy and often with complex medical comorbidities, the multidisciplinary team should do everything possible to limit and avoid postoperative complications or need for revision surgical procedures.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Russell N. Stitzlein

  2. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Kristy L. Weber

Authors
  1. Russell N. Stitzlein
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  2. Kristy L. Weber
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Correspondence to Russell N. Stitzlein .

Editor information

Editors and Affiliations

  1. Chair, Geriatric Medicine and Gerontology, Robert and Arlene Kogod Professor of Geriatric Medicine, Department of Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA

    Robert J. Pignolo

  2. Co-Director, Orthopaedic Trauma & Fracture Reconstruction, Advisory Dean, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Jaimo Ahn

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Stitzlein, R.N., Weber, K.L. (2018). Pathologic Fractures. In: Pignolo, R., Ahn, J. (eds) Fractures in the Elderly. Aging Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-72228-3_2

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  • DOI: https://doi.org/10.1007/978-3-319-72228-3_2

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-72226-9

  • Online ISBN: 978-3-319-72228-3

  • eBook Packages: MedicineMedicine (R0)

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