Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Pathologic fracture (path fx)
Definitions
Fracture through abnormal osseous lesion
Tumor
Infection
Postsurgical
Metabolic
Congenital
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Chakarun CJ et al: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 33(1):197-211, 2013
Hechmati G et al: Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study. J Med Econ. 16(5):691-700, 2013
Probst S et al: Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan. Clin Nucl Med. 38(5):397-9, 2013
Steensma M et al: Trends in the surgical treatment of pathologic proximal femur fractures among musculoskeletal tumor society members. Clin Orthop Relat Res. 471(6):2000-6, 2013
Chan SS et al: Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features. AJR Am J Roentgenol. 194(6):1581-6, 2010
Kurup AN et al: Ablation of skeletal metastases: current status. J Vasc Interv Radiol. 21(8 Suppl):S242-50, 2010
Bosita RV et al: Avascular necrosis of lumbar facet joints associated with bilateral facet fractures. Spine J. 9(6):e1-4, 2009
Kim MS et al: Prognostic effect of pathologic fracture in localized osteosarcoma: a cohort/case controlled study at a single institute. J Surg Oncol. 100(3):233-9, 2009
Atesok K et al: Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol. 14(4):1493-8, 2007
Bramer JA et al: Do pathological fractures influence survival and local recurrence rate in bony sarcomas? Eur J Cancer. 43(13):1944-51, 2007
Deheshi BM et al: Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res. 459:96-104, 2007
Shenoy R et al: Tumours of the hand presenting as pathological fractures. Acta Orthop Belg. 73(2):192-5, 2007
Erly WK et al: The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol. 27(6):1183-8, 2006
James SL et al: Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 16(2):512-4, 2006
Papagelopoulos PJ et al: Advances and challenges in diagnosis and management of skeletal metastases. Orthopedics. 29(7):609-20; quiz 621-2, 2006
Snyder BD et al: Predicting fracture through benign skeletal lesions with quantitative computed tomography. J Bone Joint Surg Am. 88(1):55-70, 2006
Fayad LM et al: Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol. 185(4):915-24, 2005
Weber KL et al: An approach to the management of the patient with metastatic bone disease. Instr Course Lect. 53:663-76, 2004
Bacci G: Pathologic fracture in osteosarcoma. J Bone Joint Surg Am. 85-A(9):1848; author reply 1848-9, 2003
Frassica FJ et al: Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. (415 Suppl):S212-8, 2003
McVey MJ et al: Pathologic fracture of metacarpal enchondroma: case study and differential diagnosis. J Manipulative Physiol Ther. 25(5):340-4, 2002
Spuentrup E et al: Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol. 176(2):351-8, 2001
Wai EK et al: Pathologic fractures of the proximal femur secondary to benign bone tumors. Clin Orthop Relat Res. (393):279-86, 2001
Ablove RH et al: Early versus delayed treatment of enchondroma. Am J Orthop (Belle Mead NJ). 29(10):771-2, 2000
Natarajan MV et al: Limb salvage surgery for pathological fractures in osteosarcoma. Int Orthop. 24(3):170-2, 2000
Ishiguro N et al: The surgical treatment of a haemophilic pseudotumour in an extremity: a report of three cases with pathological fractures. Haemophilia. 4(2):126-31, 1998
Lingg GM et al: Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography. Eur J Radiol. 26(1):54-63, 1997
Hillemanns M et al: Malignant lymphoma. Skeletal Radiol. 25(1):73-5, 1996
Wall JE et al: Fractures in children treated with radiotherapy for soft tissue sarcoma. Orthopedics. 19(8):657-64, 1996
Dijstra S et al: Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg. 160(10):535-42, 1994
Townsend PW et al: Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol. 12(11):2345-50, 1994
Haentjens P et al: Evaluation of impending fractures and indications for prophylactic fixation of metastases in long bones. Review of the literature. Acta Orthop Belg. 59 Suppl 1:6-11, 1993
Rock MG: Metastatic lesions of the humerus and the upper extremity. Instr Course Lect. 41:329-33, 1992
Walker LG et al: Pathologic fracture of the proximal ulna through a bone graft donor site. J Hand Surg Am. 15(5):781-4, 1990
Bertin KC et al: Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease. J Bone Joint Surg Am. 66(5):770-3, 1984
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Pathologic fracture (path fx)
Definitions
Fracture through abnormal osseous lesion
Tumor
Infection
Postsurgical
Metabolic
Congenital
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Chakarun CJ et al: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 33(1):197-211, 2013
Hechmati G et al: Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study. J Med Econ. 16(5):691-700, 2013
Probst S et al: Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan. Clin Nucl Med. 38(5):397-9, 2013
Steensma M et al: Trends in the surgical treatment of pathologic proximal femur fractures among musculoskeletal tumor society members. Clin Orthop Relat Res. 471(6):2000-6, 2013
Chan SS et al: Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features. AJR Am J Roentgenol. 194(6):1581-6, 2010
Kurup AN et al: Ablation of skeletal metastases: current status. J Vasc Interv Radiol. 21(8 Suppl):S242-50, 2010
Bosita RV et al: Avascular necrosis of lumbar facet joints associated with bilateral facet fractures. Spine J. 9(6):e1-4, 2009
Kim MS et al: Prognostic effect of pathologic fracture in localized osteosarcoma: a cohort/case controlled study at a single institute. J Surg Oncol. 100(3):233-9, 2009
Atesok K et al: Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol. 14(4):1493-8, 2007
Bramer JA et al: Do pathological fractures influence survival and local recurrence rate in bony sarcomas? Eur J Cancer. 43(13):1944-51, 2007
Deheshi BM et al: Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res. 459:96-104, 2007
Shenoy R et al: Tumours of the hand presenting as pathological fractures. Acta Orthop Belg. 73(2):192-5, 2007
Erly WK et al: The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol. 27(6):1183-8, 2006
James SL et al: Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 16(2):512-4, 2006
Papagelopoulos PJ et al: Advances and challenges in diagnosis and management of skeletal metastases. Orthopedics. 29(7):609-20; quiz 621-2, 2006
Snyder BD et al: Predicting fracture through benign skeletal lesions with quantitative computed tomography. J Bone Joint Surg Am. 88(1):55-70, 2006
Fayad LM et al: Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol. 185(4):915-24, 2005
Weber KL et al: An approach to the management of the patient with metastatic bone disease. Instr Course Lect. 53:663-76, 2004
Bacci G: Pathologic fracture in osteosarcoma. J Bone Joint Surg Am. 85-A(9):1848; author reply 1848-9, 2003
Frassica FJ et al: Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. (415 Suppl):S212-8, 2003
McVey MJ et al: Pathologic fracture of metacarpal enchondroma: case study and differential diagnosis. J Manipulative Physiol Ther. 25(5):340-4, 2002
Spuentrup E et al: Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol. 176(2):351-8, 2001
Wai EK et al: Pathologic fractures of the proximal femur secondary to benign bone tumors. Clin Orthop Relat Res. (393):279-86, 2001
Ablove RH et al: Early versus delayed treatment of enchondroma. Am J Orthop (Belle Mead NJ). 29(10):771-2, 2000
Natarajan MV et al: Limb salvage surgery for pathological fractures in osteosarcoma. Int Orthop. 24(3):170-2, 2000
Ishiguro N et al: The surgical treatment of a haemophilic pseudotumour in an extremity: a report of three cases with pathological fractures. Haemophilia. 4(2):126-31, 1998
Lingg GM et al: Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography. Eur J Radiol. 26(1):54-63, 1997
Hillemanns M et al: Malignant lymphoma. Skeletal Radiol. 25(1):73-5, 1996
Wall JE et al: Fractures in children treated with radiotherapy for soft tissue sarcoma. Orthopedics. 19(8):657-64, 1996
Dijstra S et al: Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg. 160(10):535-42, 1994
Townsend PW et al: Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol. 12(11):2345-50, 1994
Haentjens P et al: Evaluation of impending fractures and indications for prophylactic fixation of metastases in long bones. Review of the literature. Acta Orthop Belg. 59 Suppl 1:6-11, 1993
Rock MG: Metastatic lesions of the humerus and the upper extremity. Instr Course Lect. 41:329-33, 1992
Walker LG et al: Pathologic fracture of the proximal ulna through a bone graft donor site. J Hand Surg Am. 15(5):781-4, 1990
Bertin KC et al: Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease. J Bone Joint Surg Am. 66(5):770-3, 1984
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