Pathologic fractures in children
Eduardo J Ortiz1, Marc H Isler, Jorge E Navia
1Department of Orthopaedic Surgery, Musculoskeletal Oncology Unit, Fundación Hospital Alcorcon, Madrid, Spain. ejortiz@fhalcorcon.es
Insights
Fractures through pediatric bone tumors vary in treatment needs. Nonossifying fibromas heal without surgery, while unicameral bone cysts and aneurysmal bone cysts often require surgical intervention for optimal outcomes.
Area of Science:
- Pediatric Orthopedics
- Skeletal Oncology
- Pediatric Traumatology
Background:
- Pathologic fractures in children present unique challenges.
- Management strategies require tailored approaches based on lesion type.
Purpose of the Study:
- To establish management guidelines for pediatric pathologic fractures.
- To analyze outcomes based on bone tumor histology and location.
Main Methods:
- Retrospective review of prospective databases from three referral centers (1987-2002).
- Inclusion criteria: pathologic fractures in patients under 14 years.
- Analysis of 105 patients with various bone lesions.
Main Results:
- Nonossifying fibroma fractures achieved union with nonoperative treatment.
- Unicameral bone cysts and aneurysmal bone cysts often necessitated surgical intervention.
- Proximal femoral lesions were prone to malunion without surgical fixation.
- Malignant lesions required initial nonoperative management followed by neoadjuvant and definitive therapy.
Conclusions:
- Treatment for pediatric pathologic fractures should be individualized.
- Nonossifying fibromas have excellent prognoses with conservative management.
- Surgical intervention is frequently required for unicameral bone cysts, aneurysmal bone cysts, and malignant tumors to ensure fracture healing and prevent complications.
Abstract:
Fractures through bone tumors are often difficult to treat. We reviewed our combined experience with this problem in children, as well as the existing literature, to formulate management guidelines. For this study, prospective databases (1987 to 2002) from three referral centers were screened for pathologic fractures occurring under the age of 14 years. One hundred five patients presented with fracture through unicameral bone cyst, nonossifying fibroma, fibrous dysplasia, aneurysmal bone cyst and osteosarcoma. Seventeen patients were excluded. The most common primary locations were the proximal humerus and proximal femur. Pathologic fracture through nonossifying fibroma had the best outcome; union occurred with nonsurgical treatment in all cases. Unicameral bone cyst required surgical treatment to avoid persistence of the cyst and refracture. However fracture healing was predictable without surgical treatment. Proximal femoral lesions tended to heal in malunion if not fixed surgically. Aneurysmal bone cyst required surgical treatment for the lesion to heal and to allow the fracture to heal as well. Percutaneous sclerotherapy may be the treatment of choice for many of these lesions. Fibrous dysplasia allows fracture healing with nonoperative therapy. Progressive deformity requires followup and surgical correction. Malignant lesions presenting a pathologic fracture are best managed by initial nonoperative therapy during investigation and neoadjuvant therapy when possible, followed by definitive treatment.
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