[Fractures due to primary tumors and tumor-like changes]

The incidence of pathological fractures resulting from primary bone tumors and tumor-like lesions and various treatment options for such fractures are discussed. In addition to the benign/malignant nature, site, and extent of the tumorous lesion, the patient's age and activity level have to be considered if optimal treatment is to be selected. The treatment is completely different for a pathological fracture resulting from a benign tumor or a tumor-like lesion than for a fracture resulting from a primary malignant bone tumor. As a rule, benign tumors and tumor-like lesions require wide curettage when a fracture occurs, until macroscopically normal bone is reached. The residual cavity is then filled with autogenous cancellous bone grafts. Other fractures, e.g. those resulting from solitary bone cysts, may be treated as if normal bone were concerned. On the other hand, the treatment of a pathological fracture resulting from a primary malignant bone tumor is subordinate to the management of the primary disease, which may be life-threatening. A pathological fracture means a poorer prognosis because of contamination of the surrounding tissues. The risk of local recurrence is high, so that in most cases wide or radical resection or amputation is required.