Signs and Symptoms

What is an impending pathological fracture?

An impending pathological fracture refers to a bone with a tumor in it where the tumor has caused significant destruction of the bone and has placed it at risk of fracturing but has not completely fractured yet. Generally, tumors that erode the cortex of the bone place the bone at a higher risk of fracturing. Many patients will have pain especially with walking or using the extremity. It is important to identify these patients and fix their bone prophylactically to prevent the bone from completely breaking. The outcome is usually better and the surgery simpler with less potential complications when treated before the bone breaks as opposed to the bone breaking and the patient requiring urgent surgery. Patients may be undergoing chemotherapy and break their bones while their blood counts are low and when they are debilitated. Performing urgent surgery during these times could be more risky for a patient so the idea is to provide fixation before the bone actually breaks. Bone cement may be used to augment fixation and strengthen the bone. Radiation may also be used after fixation. In most instances, the tumor will be removed and scraped out of the bone then the fixation performed. Radiation may be indicated after surgery to kill any residual cells and prevent the tumor from coming back.