In the Name of God

1. In the Name of God Dr. A. Borjian Isfahan University of Medical Science

2. Pathologic fracture

3. Benign tumors • Malignant primary tumors • Mtastatic tumors

4. Pathologic Fx: • A pathologic Fx is defined, Fx occur in Abnormal Bone • Bone lack of normal biomechanical and viscoelastic properties • Weakened bone predispose the patient to failure in normal activity or after minor trauma.

5. Pathologic fracture (Incidence): • Osteoprosis most common condition associated with pathologic Fx • 10 million American>50 have osteoprosis • 34 million have osteomalacia and at risk devalping osteoporosis • 1.5 million sustain P. Fx related to osteoprosis eah year

6. Classification: • Intrinsic:  Osteopenia of osteogensis imperfect & Replacement of Bone with tumor • Extrinsic: Lessen the inherent structural integrity of bone  Radiation or hole in bone • Localize  Bone cyst • Generalize  Osteopetrosis • Correctable  Rickets • Un correctable  Metastatic cancer • In normal bone  Vascular foramina

7. Classification: A: Correctable disease: • Renal osteodystrophy • Hyper parathyroidism • Osteomalacia • Disuse osteoprosis

8. Classification: B: Uncorrectable disease: • Osteogesis imperfecta • Polyostatic fibrous dysplasia • Postmonoposal osteoprosis • Paget disease • Osteo petrosis

9. Pathologic fracture: • Fx callus may not form normally • healing slowly • Increase incidence of nonunion & delay union

10. Diagnoses has been made on clinical finding • History • Physical examination • Xray • Laboratory finding • Often the history is most helpful

11. Evaluation of a pediatric patient • Age of patient • Location of the lesion • Epiphysis- metaphysis- diaphysis • What is the lesion doing to the bone • Zone of transition • Pathern of lesion • What is the bone doing to the lesion • Periosteal response • Lytic- blastic- calsified- osified- ground glass

12. Table 6-2

13. Table 6-3

14. Benign tumor

15. U.B.C: • Radiolucent centric fluid filled cystic • 70% proximal Humerus or femor, • 75% present with pathologic Fx, • if diameter of cyst 85% or more  pathologic Fx

16. Complication patho Fx: • Malunion • Growth arrest • Osteo necrosis • Collapse of articular surface

17. Treatment: • Undisplace Fx • Traction • Curtage & Bone graft (autograft or allograft) • Displace Fx or Unstable Fx • Internal fixation + curettage & bone graft

18. Classification for treatment of proximal femur:

23. Malignant tumors: • Osteosarcoma • Chondrosarcoma • lymphoma

24. lymphoma

26. Lymphoma • Primary or secondary • Sixth and seven decades • Male/female = 1.5/1 • Femor pelvic spine ribs

27. Lymphoma • Chief complain • Localized pain • Swelling • Nerve root or cord compression

28. lymphoma • X ray • Diaphysial • Illdefined • Bone distraction • Permeativeapperance • Ticking of cortex • Periosteal reaction rarely seen

29. Radiogarph can be normal • Bone scan • MRI

30. Staging • CBC • Serom chemistry • Bone scan • CT (chest abdomen pelvic) • Bone marrow biopsy

31. patology Patology?

32. Prognosis • Primary 55% 5-year survival • Secondary <25%

33. Treatment • Chemotherapy • Radiotherapy • surgury

34. Case 1

46. Case 2