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Pathological fractures

Pathological fractures. Pazourek L ., Rozkydal, Z. I.orthopaedic dpt ., St. Anna Hospital , Medical faculty , Brno. Features. Fracture in bone with pathological lesion decresing the stregth of bone Without trauma Minimal violence Normal traumatic mechanism.

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Pathological fractures

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  1. Pathologicalfractures Pazourek L., Rozkydal, Z. I.orthopaedicdpt., St. Anna Hospital, Medicalfaculty, Brno

  2. Features Fracture in bone withpathologicallesiondecresingthestregthof bone • Without trauma • Minimalviolence • Normaltraumaticmechanism

  3. Etiology • Metabolicdiseases • osteoporosis • osteomalacia, HPT • Locallesions bone metastasis, multiplemyeloma benigntumors malignanttumors • Congenitalanomalies osteogenesisimperfecta,.. • Otherentities Paget´sdiseaseof bone, fibrousdysplasia osteomyelitis osteonecrosis

  4. ♂ 53 let • Fr. by opening a bottle • i.m. osteosynthesis • Increasingswelling and mass in upperarm • X- rayrepeated no finding • backpainafter 3 months

  5. Metastasisofcarcinoma • After 4 monthsreferred to ourclinic • Exulceration • Th12 largeosteolyticlesion • Risk o paraplegia • Metastasisofcarcinomafromsmall cells

  6. ♂ 26 let • Fr. by driving a car • AO plate osteosynthesis • Afterwardsincreasingmass • X rayafter 3 months OSTEOSARCOMA HIGH-GRADE

  7. LEIOMYOSARCOMA G3 • Fall on stairs • Supracondylar fr. • Osteosynthesiswith a nail • Increasingpain and swelling • After 6 monthsremovalof metal a biopsy • Fracture not healed • Referred to ourclinic ♂ 42 let

  8. Bone metastasesofcarcinoma • Breast, prostate, kidney, lung, thyreoidgland • Assessmentofprognosis • Visceralor bone lesions, solitaryormultiplelesions • Type ofprimary tumor, staging • Timeoffirstoccurrence • Sensitivity to othertreatment • Comorbidities and generalcondition • Pathologicalfracturemakesalwaystheprognosisworse • Multidisciplinaryaccess

  9. Mirel´sscore

  10. TU-THA optimalsolution • Metastasisofclearcellsrenalcarcinoma (angiographywithembolisation)

  11. Conditionafterosteosynthesisforpathological fr. withmetastasisofrenal tumor, progresionofosteolyticlesion • No adjuvantchermotherapy Angiography + embolisation, resection TU THA

  12. METASTASIS ofthyroidcarcinoma ♂ 58 let • Totalthyroidectomia 7 years ago, radiotherapy and chemotherapy • X- rayosteosynthesis 2 years ago, no furthertreatment • No furthertreatmentforhumerallesion • No radiotherapy • Disarticulation in shoulder

  13. Total femur Metastasisofbreastcarcinoma, goodprognosis

  14. Dislocationof TU THA

  15. Proximal humeruHeadprosthesisReverse totalshoulderreplacement

  16. TU-TKA

  17. Metastasis in diaphyseal region • Femur and humerus • Types • i.m. nail • Resection + cement a osteosynthesis • Resection + intercalaryspacer • Resection + bone graft and osteosynthesis Radiotherapy in a case ofnonradicalsurgery

  18. i.m. nail • Tumor in situ • paliative surgery • wrongprognosis • Adjuvantradiotherapy

  19. Curretage + osteosynthesis + cement

  20. Resection + i.m. nail and cement

  21. Diaphysealspacer

  22. Primarymalignant bone tumors • Osteosarcoma, Ewingsa, chondrosarcoma • Pathologicalfracture • Worseprognosis • High risk ofdissemination • Lesschanceforlocalcontrol • Amputation ?

  23. Orthesis chemotherapy Resection bone graft plate ♂13 let boy By throwingof a ball High grade osteosarcoma

  24. ♀73 let, Dediferentiatedchondrosa G3 Pathol. fracture Amputation

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