[Pathologic fractures: diagnostic and therapeutic considerations and results of treatment]

Compared with bone fractures caused by trauma, pathologic fractures due to diseased bone are rare events. A pathologic fracture is one that occurs without adequate trauma and is caused by a benign or malignant bone lesion. Diagnosis of the basic disease is important for the subsequent therapy. In cases of benign bone lesions the aim of treatment is total osseus healing with complete restoration of function. In malignant pathologic fractures surgery is an essential part of the overall oncologic treatment design. In most cases it is combined with adjuvant therapy. Various surgical procedures are available for fractures at different sites and depending on whether the operation is performed with curative or palliative intent. In cases of progressive neoplastic disease stabilization is necessary to attenuate pain and to maintain mobility. Between 1983 and 1993 we treated 131 patients with 143 pathologic fractures. Conservative therapy was possible in 10 cases, while 133 fractures had to be treated surgically. Most fractures were caused by skeletal metastasis (61), solitary bone cysts (19), osteoporosis (17) and plasmocytoma (16). The most frequent localizations of pathologic fractures were humerus and femur. The favoured methods of surgical stabilization were endoprosthesis and reinforced osteosynthesis. Most fractures appeared in adolescent patients up to the age of 19 and in adults between the 5th and the 7th decade, and 57.3% of the fractures were caused by a primary or secondary malignant tumour lesion. Surgical treatment was performed in all but 1 case of malignant pathologic fractures. Of 74 patients, with malignant bone lesions 6 (8.1%), are still alive. For 68 patients who died after stabilization, the average survival time was 11.6 months; individual survival time depended on the kind of the tumour present. In 55 patients with fractures in the area of benign bone lesions complete healing was achieved, in 9 cases with conservative therapy. The rate of recurrence for solitary bone cysts treated by curettage or segment resection was 23.5%. Compared with the recurrence rates published by other authors this is a very good result.