What is a pathological fracture?
THE pathological fractures These are particular bone fractures because they do not result from violent trauma, but from a prior weakening of the bone related to an illness. They can occur following a minor impact, or even during a routine daily activity. Their occurrence should always lead to a thorough medical evaluationbecause they often reveal an underlying pathology requiring specific treatment.
They correspond to a bone fracture on abnormal bone tissueUnlike a traumatic fracture, where a healthy bone gives way under the effect of a significant force, a pathological fracture occurs because the bone has lost its strength.
It may appear:
- without identifiable trauma
- after a fall from a low height,
- during a normal effort such as walking, standing up or carrying a light object.
Pathological fractures primarily involve:
- elderly people,
- patients with bone diseases,
- people suffering from cancers with bone involvement.
What are the main causes of pathological fractures?
Pathological fractures are always linked to a structural damage to the boneThe most frequent causes are as follows.
Osteoporosis
Osteoporosis is the most frequent cause of pathological fracture. It is characterized by a decrease in bone density and quality, making the bone more fragile. Osteoporotic fractures mainly affect:
- vertebrae (compression fractures),
- the femoral neck,
- the wrist.
Bone cancers and metastases
Many cancers can weaken the bone:
- primary bone cancers,
- bone metastases originating from breast, prostate, lung or kidney cancers,
- malignant blood disorders such as multiple myeloma.
In these situations, the fracture may be the first telltale sign of the disease.
Bone and metabolic diseases
Certain chronic diseases alter bone structure:
- osteomalacia (mineralization defect),
- endocrine diseases (hyperparathyroidism),
- bone infections,
- rare genetic diseases affecting bone.
Most frequent locations
Pathological fractures occur preferentially at the level of:
- of the vertebrae,
- of femur (especially proximal),
- of basin,
- of the coasts,
- of thehumerus.
These locations are particularly at risk because they are subjected to significant mechanical stresses.
Symptoms: how to recognize a pathological fracture?
The symptoms may be less spectacular than in a traumatic fracture, which explains diagnostic delays.
The most frequent signs are:
- progressive bone pain, sometimes old,
- pain appearing without impact or after minimal exertion
- persistent paineven when resting or at night,
- progressive decrease in mobility,
- loss of height or chronic back pain in case of vertebral fracture,
- deformation or shortening of a limb in advanced forms.
In patients with cancer or known osteoporosis, any unusual bone pain should be considered a warning signal.
When should you seek emergency medical attention?
A prompt medical consultation is essential in the following situations:
- Intense bone pain without obvious trauma
- persistent pain despite rest and painkillers.
- sudden inability to walk or use a limb,
- appearance of a deformation or subsidence,
- fracture occurring in a person with cancer,
- rapid worsening of known bone pain.
In older adults, a pathological fracture may go unnoticed. Any fall, even a minor one, associated with prolonged pain should prompt a medical consultation.
How is the diagnosis made?
The diagnosis is based on several complementary steps.
Clinical examination
The doctor assesses:
- the location and intensity of the pain,
- mobility,
- the patient's general condition,
- Medical history (osteoporosis, cancer, treatments).
Medical imaging
- X-ray : first examination, allowing visualization of the fracture.
- Scanner : useful for analyzing bone structure and stability.
- MRI : essential for detecting early bone lesions or tumors.
- Bone scintigraphy : sometimes used to look for multiple lesions.
Etiological assessment
In the case of a pathological fracture, it is essential to determine the cause:
- biological assessment,
- bone densitometry,
- Oncological examinations if necessary.
Care and treatment
The treatment of a pathological fracture relies on a dual approach : treat the fracture and treat the underlying disease.
Fracture treatment
Depending on the location and severity:
- immobilization by splint or cast,
- orthopedic surgery (nails, plates, prostheses),
- Preventive stabilization to avoid a complete fracture.
Treating the cause
- treatment of osteoporosis (calcium, vitamin D, specific treatments),
- cancer care in the event of cancer,
- treatment of metabolic or infectious diseases.
Rehabilitation
Functional rehabilitation is essential for:
- restore mobility,
- prevent loss of independence,
- reduce the risk of further fractures.
Functional consequences and long-term follow-up after a pathological fracture
Beyond the fracture itself, a pathological fracture can have significant repercussions on quality of life, particularly in the elderly or those with chronic illnesses. Its impact often extends beyond the acute event and requires a prolonged medical follow-up.
Impact on mobility and autonomy
Pathological fractures frequently affect key areas of the skeleton, such as the femur or vertebrae. They can lead to:
- a temporary or permanent loss of mobility,
- difficulty walking or standing up,
- a partial or total dependence for everyday tasks.
In elderly patients, these functional limitations increase the risk of loss of autonomyrepeated falls and prolonged hospitalizations.
Importance of regular medical follow-up
After a pathological fracture, follow-up is not limited to bone healing. It includes:
- monitoring the disease responsible for bone fragility,
- the assessment of the risk of new fractures,
- adapting long-term treatments,
- monitoring rehabilitation and functional recovery.
Coordinated follow-up between the attending physician, specialist and rehabilitation professionals is essential to limit relapses.
Prevention of pathological fractures
Prevention is based on:
- screening and treatment of osteoporosis,
- monitoring of cancer patients,
- fall prevention,
- maintaining muscle strength and balance,
- a diet adapted to bone health.
Conclusion
Pathological fractures are fractures that reveal a underlying bone fragilityTheir occurrence should always lead to a complete medical evaluationbecause they can be the first sign of a serious illness. Early recognition of symptoms, prompt consultation, and appropriate treatment are essential to limit complications and preserve quality of life.
