Nevertheless, full weight bearing stability cannot always be allowed and implant failure may occur. Sometimes, additional procedures like cerclage wiring may be required.
Cement augmentation increases the stability of fixation. There is a need for the use of long plates with multiple screws in order to achieve a strong bone-implant construct. Dependent upon the extent and location of the lesion but also dependent upon the general bone quality, stable fixation sometimes is difficult to achieve. This procedure may be useful when adjuvant treatment options like irradiation or chemotherapy are planned. The approach requires opening of the tumor site, which may be necessary in cases where the metastatic lesion needs to be resected for debulking purposes in order to decrease the local tumor volume. Unless percutaneous fixation techniques are used, plate osteosynthesis is more aggressive, requires larger incisions and is associated with a more extensive blood loss than intramedullary nailing. The technique is also applicable in fractures that result from metastatic disease. Fractures caused by malignant neoplasms require comprehensive diagnosis and treatment.Open reduction and plate fixation is an established option in the management of non-pathological fractures of long bones. If the fracture occurred because of a benign bone lesion, it is necessary to perform surgical treatment, and to correct the bone defect. These include: the degree of severity of the disease, the age of the patient, the patient’s general condition, secondary diseases and the localization of the pathological fracture. TreatmentĪll features of the development of pathological fractures should be considered, in order to choose conservative or surgical treatment tactics. It is imperative to identify the primary focus of the lesion. To identify the etiologic cause, a CT, MRI, blood test and biopsy should be performed. In most cases, the diagnosis can be made with an X-ray examination. The main symptoms are pain, swelling, deformity, and moving difficulty at the fracture area. If the disease progresses, the infection can penetrate the cerebrospinal fluid and further lead to infectious lesions of the brain and spinal cord, which ends in death in 60-80% of cases. If not diagnosed in time, it can lead to the development of paralysis of the upper and lower limbs. An abscess can form around the vertebrae. If the disease is not treated in time, it can lead to fractures. Mycobacterium tuberculosis, brucella, and other microorganisms can lead to infectious damage to the spine. It is also among the diseases that most often lead to pathological fractures. Incomplete osteogenesis (osteogenezis imperfectis) is a disease that is characterized by a tendency for bones to fracture due to collagen deficiency. Paget’s disease – in this disease, the bones are more brittle than usual. Hyperparathyroidism – it is decreased bone density, due to increased function of the parathyroid glands, which contribute to the leaching of calcium from the bones.ģ. Malignant tumors lead to fractured vertebrae Metabolic lesionsġ.Osteoporosis – it is a decrease in bone density and an increase in fragility due to age.Ģ.
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