Abstract
In general usually pathological fractures are caused by an inadequate trauma to the bone, which is impaired by the underlying disease. Pathologic fractures can be caused by a variety of local and systemic disorders. Aggressive neoplastic or pseudo tumor-like bone lesions present the second most common reason for pathologic fractures following osteoporosis. In this context the bony lesions can be divided into benign, primary malignant and secondary malignant tumorous lesions such as sarcoma and bone metastases respectively. Referring to the location of these bony lesions the humerus is considered as one of the most common localization of benign bone tumors as well as of sarcomas (osteosarcoma, chondrosarcoma, Ewing’s sarcoma). Several primary tumors metastasize primarily in the liver and lungs but also very often in the skeletal system. The most frequently affected locations are the spine and pelvis followed by proximal parts of humerus and femur. Concludingly, besides the spine and the femur the humerus is one of the most common localizations of pathologic tumor associated fractures [1]. The proximal humerus is particularly prone to pathologic fractures because of its long arm of lever, high rotational forces of the surrounding muscles and the mostly spongiform metaphyseal bone [2]. A profound knowledge on the different causes of pathologic fractures, on diagnostics and therapeutical options is necessary for a successful treatment of this heterogenic disorder. This book predominately deals with pathologic fractures of neoplastic genesis because of the high incidence of tumor associated pathologic fractures.
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References
Zeifang F, Sabo D, Ewerbeck V. Pathological fracture in primary malignant bone tumors. Chirurg. 2000;71(9):1121–5.
Capanna R, Campanacci DA. The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br. 2001;83(4):471–81.
Mutschler W, Wirbel R. Pathologische Frakturen. Unfallchirurg. 1997;100(6):410–29.
Maurer F, Ambacher T, Volkmann R, Weller S. Pathologic fractures: diagnostic and therapeutic considerations and results of treatment. Langenbecks Arch Chir. 1995;380(4):207–17.
Dietz P. Praxis der Kinder- und Jugentraumatologie. Berlin/Heidelberg: Springer; 2011.
Freyschmidt J. Pathological fractures from a pathological point of view. Trauma Berufskrankh. 2008;10 Suppl 2:165–6.
Krestan CR, Nemec U, Nemec S. Imaging of insufficiency fractures. Semin Musculoskelet Radiol. 2011;15(3):198–207. doi:10.1055/s-0031-1278420.
Kramer W, Gaebel G, Stuhldreyer G, Heitland W. Results of the treatment of pathologic fractures of long tubular bones. Unfallchirurgie. 1987;13(1):22–6.
Hardes J, Schultheiss M, Gosheger G, Schulte M. The juvenile bone cyst: treatment with continuous decompression using cannulated screws. Orthopade. 2009;38(3):256–62. doi:10.1007/s00132-009-1407-9.
Fuchs B, Valenzuela RG, Sim FH. Pathologic fracture as a complication in the treatment of Ewing’s sarcoma. Clin Orthop Relat Res. 2003;415:25–30. doi:10.1097/01.blo.0000093893.12372.9d.
Jaffe N, Spears R, Eftekhari F, Robertson R, Cangir A, Takaue Y, Carrasco H, Wallace S, Ayala A, Raymond K, et al. Pathologic fracture in osteosarcoma. Impact of chemotherapy on primary tumor and survival. Cancer. 1987;59(4):701–9.
Natarajan MV, Govardhan RH, Williams S, Raja Gopal TS. Limb salvage surgery for pathological fractures in osteosarcoma. Int Orthop. 2000;24(3):170–2.
Lodwick G, Wilson A, Farrell C, Virtama P, Dittrich F. Determining growth rates of focal lesions of bone from radiographs. Radiology. 1980;134(3):577–83.
Freyschmidt J. Die pathologische Fraktur aus Sicht des Radiologen. Trauma Berufskrankh. 2008;10:165–6.
Rechl H, Kirchhoff C, Wortler K, Lenze U, Toepfer A, von Eisenhart-Rothe R. Diagnosis of malignant bone and soft tissue tumors. Orthopade. 2011;40(10):931–41. doi:10.1007/s00132-011-1821-7; quiz 933–42.
von Eisenhart-Rothe R, Toepfer A, Salzmann M, Schauwecker J, Gollwitzer H, Rechl H. Primary malignant bone tumors. Orthopade. 2011;40(12):1121–42. doi:10.1007/s00132-011-1866-7.
Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986;204:9–24.
Grimer R. WHO classification of tumours of soft tissue and bone, vol. 5. 4th ed. Geneva: WHO Press; 2013.
Fletcher C, Unni K, Mertens F. World health organization classification of tumours: pathology and genetics of tumours of soft tissue and bone. Malignant fibrous histiocytoma of bone. Lyon: IARC Press; 2002.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69(1):106–14.
Gaston CL, Bhumbra R, Watanuki M, Abudu AT, Carter SR, Jeys LM, Tillman RM, Grimer RJ. Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours in bone? J Bone Joint Surg Br. 2011;93(12):1665–9. doi:10.1302/0301-620X.93B12.27663.
Branstetter DG, Nelson SD, Manivel JC, Blay JY, Chawla S, Thomas DM, Jun S, Jacobs I. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res. 2012;18(16):4415–24. doi:10.1158/1078-0432.CCR-12-0578.
Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk Jr GR. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013;33(1):197–211. doi:10.1148/rg.331125089.
Thomas DM. RANKL, denosumab, and giant cell tumor of bone. Curr Opin Oncol. 2012;24(4):397–403. doi:10.1097/CCO.0b013e328354c129.
Freyschmidt JO, Ostertag H, Jundt G. Knochenutmoren mit Kiefertumoren: Klinik-Radiologie-Pathologie. Berlin/Heidelberg: Springer; 2010.
Hou HY, Wu K, Wang CT, Chang SM, Lin WH, Yang RS. Treatment of unicameral bone cyst: surgical technique. J Bone Joint Surg Am. 2011;93 Suppl 1:92–9. doi:10.2106/JBJS.J.01123.
Cho HS, Oh JH, Kim HS, Kang HG, Lee SH. Unicameral bone cysts: a comparison of injection of steroid and grafting with autologous bone marrow. J Bone Joint Surg Br. 2007;89(2):222–6. doi:10.1302/0301-620X.89B2.18116.
Donaldson S, Chundamala J, Yandow S, Wright JG. Treatment for unicameral bone cysts in long bones: an evidence based review. Orthop Rev (Pavia). 2010;2(1), e13. doi:10.4081/or.2010.e13.
Bramer JA, Abudu AA, Grimer RJ, Carter SR, Tillman RM. Do pathological fractures influence survival and local recurrence rate in bony sarcomas? Eur J Cancer. 2007;43(13):1944–51. doi:10.1016/j.ejca.2007.07.004.
Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabro T, Pala E, Mercuri M. Protocol of surgical treatment of long bone pathological fractures. Injury. 2010;41(11):1161–7. doi:10.1016/j.injury.2010.09.018.
Cho WH, Song WS, Jeon DG, Kong CB, Kim MS, Lee JA, Yoo JY, Kim JD, Lee SY. Differential presentations, clinical courses, and survivals of osteosarcomas of the proximal humerus over other extremity locations. Ann Surg Oncol. 2010;17(3):702–8. doi:10.1245/s10434-009-0825-6.
Ebeid W, Amin S, Abdelmegid A. Limb salvage management of pathologic fractures of primary malignant bone tumors. Cancer Control. 2005;12(1):57–61.
Bramer JA, van Linge JH, Grimer RJ, Scholten RJ. Prognostic factors in localized extremity osteosarcoma: a systematic review. Eur J Surg Oncol. 2009;35(10):1030–6. doi:10.1016/j.ejso.2009.01.011.
Pakos EE, Nearchou AD, Grimer RJ, Koumoullis HD, Abudu A, Bramer JA, Jeys LM, Franchi A, Scoccianti G, Campanacci D, Capanna R, Aparicio J, Tabone MD, Holzer G, Abdolvahab F, Funovics P, Dominkus M, Ilhan I, Berrak SG, Patino-Garcia A, Sierrasesumaga L, San-Julian M, Garraus M, Petrilli AS, Filho RJ, Macedo CR, Alves MT, Seiwerth S, Nagarajan R, Cripe TP, Ioannidis JP. Prognostic factors and outcomes for osteosarcoma: an international collaboration. Eur J Cancer. 2009;45(13):2367–75. doi:10.1016/j.ejca.2009.03.005.
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20(3):776–90.
Wunder JS, Paulian G, Huvos AG, Heller G, Meyers PA, Healey JH. The histological response to chemotherapy as a predictor of the oncological outcome of operative treatment of Ewing sarcoma. J Bone Joint Surg Am. 1998;80(7):1020–33.
Puri A, Shah M, Agarwal MG, Jambhekar NA, Basappa P. Chondrosarcoma of bone: does the size of the tumor, the presence of a pathologic fracture, or prior intervention have an impact on local control and survival? J Cancer Res Ther. 2009;5(1):14–9.
Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468(2):581–9. doi:10.1007/s11999-009-1056-7.
Parlier-Cuau C, Bousson V, Ogilvie CM, Lackman RD, Laredo JD. When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal. Eur J Radiol. 2011;77(1):6–12. doi:10.1016/j.ejrad.2010.06.051.
Kendell SD, Collins MS, Adkins MC, Sundaram M, Unni KK. Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula. Skeletal Radiol. 2004;33(8):458–66. doi:10.1007/s00256-004-0791-9.
Geirnaerdt MJ, Hermans J, Bloem JL, Kroon HM, Pope TL, Taminiau AH, Hogendoorn PC. Usefulness of radiography in differentiating enchondroma from central grade 1 chondrosarcoma. AJR Am J Roentgenol. 1997;169(4):1097–104. doi:10.2214/ajr.169.4.9308471.
Murphey MD, Flemming DJ, Boyea SR, Bojescul JA, Sweet DE, Temple HT. Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics. 1998;18(5):1213–37; quiz 1215–44.
Hoffman R, Benz EJ, Furie B, Shattil SJ. Hematology: basic principles and practice. Philadelphia: Churchill Livingstone/Elsevier; 2009.
Pingali SR, Haddad RY, Saad A. Current concepts of clinical management of multiple myeloma. Dis Mon. 2012;58(4):195–207. doi:10.1016/j.disamonth.2012.01.006.
Greenspan A. Skelettradiologie: Orthop√§die, Traumatologie, Rheumatologie, Onkologie. München/Jena: Elsevier/Urban & Fischer; 2007.
Bohm P, Huber J. The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg. 2002;84(4):521–9.
Kivioja AH, Karaharju EO, Elomaa I, Bohling TO. Surgical treatment of myeloma of bone. Eur J Cancer. 1992;28A(11):1865–9.
Katzer A, Meenen NM, Grabbe F, Rueger JM. Surgery of skeletal metastases. Arch Orthop Trauma Surg. 2002;122(5):251–8. doi:10.1007/s00402-001-0359-2.
Abrams HL. Skeletal metastases in carcinoma. Radiology. 1950;55(4):534–8.
Braun S. Operative Therapie und Prognose bei Patienten mit skelettären Karzinommetastasen. München: Ludwig-Maximilians-Universität München; 2004.
Layer G. Skelettmetastasen. In: Stäbler AF, Freyschmidt J, editors. Handbuch diagnostische Radiologie, Muskuloskelettales System 2. Berlin: Springer; 2005. p. 329.
Piccioli A, Maccauro G, Rossi B, Scaramuzzo L, Frenos F, Capanna R. Surgical treatment of pathologic fractures of humerus. Injury. 2010;41(11):1112–6. doi:10.1016/j.injury.2010.08.015.
Hardes JG, Gosheger G. The pathologic fracture from the viewpoint of the orthopaedic specialist and trauma surgeon. Trauma Berufskrankh. 2008;10 Suppl 2:167–74.
Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res. 2001;393:264–71.
Gollwitzer H, Toepfer A, Gerdesmeyer L, Gradinger R. Tumors and tumor-like lesions of the foot and ankle: diagnosis and treatment. In: Saxena A, editor. Special procedures in foot and ankle surgery. New York: Springer; 2013. doi:10.1007/978-1-4471-4103-7.
Further Reading
Schulz T, Prietzel T, Kluge R, Schneider JP, Tannapfel A, Kahn T. Efficient diagnosis of pathological fractures. Rontgenpraxis. 2006;56(3):75–92.
Goudarzi YM, Sautmann F. Pathological fractures in childhood and adolescence in benign and semi-malignant bone tumors and tumorous and inflammatory bone changes. Aktuelle Traumatol. 1987;17(2):73–9.
Jacofsky DJ, Haidukewych GJ. Management of pathologic fractures of the proximal femur: state of the art. J Orthop Trauma. 2004;18(7):459–69.
Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clinical Orthop Relat Res. (249):256–64.
Franzius C, Daldrup-Link HE, Sciuk J, Rummeny EJ, Bielack S, Jurgens H, Schober O. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol. 2001;12(4):479–86.
Franzius C, Sciuk J, Daldrup-Link HE, Jurgens H, Schober O. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med. 2000;27(9):1305–11.
Yanagawa T, Shinozaki T, Iizuka Y, Takagishi K, Watanabe H. Role of 2-deoxy-2-[F-18] fluoro-D-glucose positron emission tomography in the management of bone and soft-tissue metastases. J Bone Joint Surg Br. 2010;92(3):419–23. doi:10.1302/0301-620x.92b3.23131.
Campanacci M. Bone and soft tissue tumors: clinical features, imaging, pathology and treatment. 2nd ed. Wien: Springer; 1999.
Campanacci DA, Scoccianti G, Franchi A, Roselli G, Beltrami G, Ippolito M, Caff G, Frenos F, Capanna R. Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol. 2013;14(2):101–7. doi:10.1007/s10195-013-0230-6.
Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer. 1977;40(2):818–31.
Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999;81(3):326–38.
Harousseau JL. Ten years of improvement in the management of multiple myeloma: 2000-2010. Clin Lymphoma Myeloma Leuk. 2010;10(6):424–42. doi:10.3816/CLML.2010.n.076.
Anderson JT, Erickson JM, Thompson Jr RC, Chao EY. Pathologic femoral shaft fractures comparing fixation techniques using cement. Clin Orthop Relat Res. 1978;131:273–8.
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Toepfer, A., Lenze, U., Pohlig, F., von Eisenhart-Rothe, R. (2015). Pathological Fracture of the Humerus. In: Biberthaler, P., Kirchhoff, C., Waddell, J. (eds) Fractures of the Proximal Humerus. Strategies in Fracture Treatments. Springer, Cham. https://doi.org/10.1007/978-3-319-20300-3_19
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DOI: https://doi.org/10.1007/978-3-319-20300-3_19
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