title: The investigation and management of suspected malignant pathological fractures: a review for the general orthopaedic surgeon.
abstract: The management of malignant pathological fractures necessitates careful diagnostic work-up, pre-operative investigation, planning and multidisciplinary input from specialists in the fields of radiology, pathology, oncology, trauma and orthopaedics. Malignant and non-malignant conditions including metabolic disorders, benign tumours and pharmacological therapies can be implicated. The majority of patients who present with suspected pathological fractures will be managed by general orthopaedic and trauma surgeons rather than specialists in orthopaedic oncology. Skeletal metastases can result in considerable morbidity and predispose to pathological fractures. With advances in the medical management of malignancy, life expectancy in cancer patients is increasing, leading to an increasing risk of skeletal metastasis and the potential for pathological fractures. Conventional modes of trauma fixation for pathological fractures may not be appropriate. The aim of this review is to outline diagnostic and management strategies for patients who present with a long bone fracture that is potentially pathological in nature.
authors.affiliation: Department of Orthopaedics, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK. Electronic address: davidjbryson@hotmail.com.
authors.forename: D J
authors.initials: DJ
authors.lastname: Bryson
authors.affiliation: Leicester Orthopaedics, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK. Electronic address: laurence.wicks@uhl-tr.nhs.uk.
authors.forename: L
authors.initials: L
authors.lastname: Wicks
authors.affiliation: East Midlands Sarcoma Service, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK; Academic Orthopaedics, Trauma & Sports Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK. Electronic address: robert.ashford@uhl-nhs.uk.
authors.forename: R U
authors.initials: RU
authors.lastname: Ashford
mesh_terms: D001843:Bone Cements; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D002484:Cementation / Q000379:methods*; D055088:Early Detection of Cancer; D005593:Fracture Fixation, Internal / Q000379:methods; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D009101:Multiple Myeloma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D009985:Orthopedics; D017410:Practice Guidelines as Topic; D066231:Surgeons
chemical_list: D001843:Bone Cements
keywords: Blood Investigations; Pathological fracture; Radiological Investigation; Skeletal Metastases; Surgical management