pathological fracture
Introduction
Introduction to pathological fracture Primary or metastatic tumors of the bone are the most common cause of pathological fractures, especially osteolytic primary or metastatic bone tumors. Primary bone tumors such as multiple myeloma, giant cell tumor of bone and osteolytic osteosarcoma are metastatic bone tumors such as metastatic kidney cancer, breast cancer, lung cancer, thyroid cancer and neuroblastoma. Many primary and metastatic bone tumors are sometimes found after pathological fractures. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock, coma
Cause
Pathological fracture cause
1. Osteoporosis
Old age, various malnutrition and endocrine factors can cause systemic osteoporosis, which is characterized by atrophy of the cortical bone, thinning of the trabecular bone, and a decrease in the number. Mainly affect the vertebrae, femoral neck, metacarpal and so on. In the elderly, especially in postmenopausal women, chest and lumbar vertebrae compression pathological fractures, femoral neck, upper humerus and lower humerus fractures are more common. Limb paralysis, long-term fixation or prolonged bed rest can cause local disuse of osteoporosis and fracture.
2, endocrine disorders
Hyperparathyroidism caused by parathyroid adenoma or hyperplasia can lead to decalcification of bone and accumulation of a large number of osteoclasts, which are replaced by fibrous tissue. At this time, although new bone formation is formed, only slender woven bone or non-calcified bone-like tissue can be formed, and multiple pathological fractures are prone to occur.
3, bone developmental disorders
There are a variety of congenital bone disorders of this type that can cause pathological fractures. For example, congenital osteogenesis imperfecta, an autosomal dominant hereditary disease, occurs in the fetus or childhood, due to defects in congenital mesenchymal development, difficult to differentiate into osteoblasts, and osteoblasts in the bone matrix Type I collagen fiber is a disorder, so the long bone cortex is very thin, the bone is thin and brittle, and it is prone to multiple pathological fractures, so it is also called fragile bone syndrome. The newly formed osteophytes after fracture are cartilage, or fibrous, and ossification is difficult to occur.
Prevention
Pathological fracture prevention
Eat more foods that contain more calcium and avoid fractures.
Complication
Pathological fracture complications Complications, shock, coma
1, shock severe trauma, pathological fracture caused by massive bleeding or important organ damage.
2, fat congestion syndrome occurs in adults, due to pathological fractures in the medullary hematoma tension is too large, bone marrow is destroyed, fat drops into the ruptured sinus, can cause lung and brain fat embolism, others think it is Due to the stress of the wound, the chylomicrons in the normal blood lose the emulsion stability, and are combined into a fat globule having a diameter of 10-20 vm to become an embolus, which blocks the pulmonary capillaries. At the same time, when the lung is poorly perfused, the alveolar sputum cells produce lipase, which hydrolyzes the plastic fat droplets in the fat embolus into glycerol and free fatty acids, releases the catecholamine, damages the capillary wall, and causes the protein-rich liquid to leak into the lungs. In the lungs and alveoli, pulmonary hemorrhage, atelectasis and hypoxemia occur, and respiratory insufficiency occurs in the clinic. The cyanosis and chest radiographs have extensive lung consolidation. Arterial hypoxemia can cause irritability, lethargy, and even coma and death.
3. Important internal organ damage:
a, liver, spleen rupture: severe lower chest wall injury, in addition to causing pathological fractures of the ribs, may also cause rupture of the left side of the pathological fracture side of the spleen or right side of the liver, leading to shock.
b. Lung injury: When the rib is pathologically fractured, the pathological fracture end may cause damage to the intercostal blood vessels and lung tissue, and pneumothorax, hemothorax or blood pneumothorax may occur, causing severe breathing difficulties.
c, bladder and urethral injury: caused by pathological fracture of the pelvis, causing lower abdominal pain, perineal pain, swelling and hematuria, dysuria caused by extravasation of urine.
d, rectal injury: can be caused by pathological fracture of the appendix. There is pain in the lower abdomen and bleeding in the rectum.
4. Important surrounding tissue damage:
a, important vascular injury: a common pathological fracture of the femoral condyle, distal pathological fracture can cause radial artery injury. Injury of the anterior or posterior tibial artery in the upper segment of the humerus, the pathological fracture of the humerus and the lateral pathological fracture may cause brachial artery injury.
b. Peripheral nerve damage: especially in the areas where the nerve is closely adjacent to the bone, such as the middle and lower 1/3 of the bone, it is easy to damage the radial nerve that is close to the tibia. Pathological fractures of the humerus neck are prone to damage to the common peroneal nerve.
c. Spinal cord injury: a serious complication of pathological fracture and dislocation of the spine, more common in the cervical spine and thoracolumbar segment. There are many paraplegia below the injury plane. Although there are many studies on the regeneration of spinal cord injury, no breakthrough has been made. Paraplegia caused by spinal cord injury can lead to lifelong disability.
5. Osteofascial compartment syndrome is a series of early syndromes caused by acute ischemia of the fascia muscles and nerves formed by bone, interosseous membrane, intramuscular septum and deep fascia. Most commonly seen in the forearm volar and calf, often caused by hematoma and tissue edema of traumatic pathological fractures, the volume of the indoor contents is increased or over-tightened, and local pressure forces the volume of the femoral compartment to be effective, resulting in increased pressure in the compartment. As a result, when the pressure reaches a certain level (the forearm 8.7 kPa (65 mmHg) calf 7.3 kPa (55 mmHg) can close the arteries supplying the muscles, forming a vicious circle of ischemia-edema-study blood, depending on the degree of ischemia
a, near the ischemic muscle contracture - early ischemic, timely treatment to restore blood supply, may occur or only a small amount of muscle necrosis, may not affect limb function.
b. Ischemic tendon contraction - incomplete ischemia with a shorter or more severe period of time, restoring most muscle necrosis after blood supply. The formation of contracture deformity seriously affects the function of the affected limb.
c, gangrene - extensive, long-term complete ischemia, a large number of muscle gangrene, often need amputation, if a large number of toxins into the blood circulation, can also cause shock, arrhythmia and acute renal failure.
Symptom
Pathological fracture symptoms Common symptoms Shock soft tissue swelling Soft tissue infection internal bleeding
Shock, soft tissue injury, bleeding, fracture.
Examine
Pathological fracture examination
1, comprehensive physical examination
Pay attention to the presence or absence of shock, soft tissue injury, bleeding, examination of wound size, shape, depth and pathological fractures. There are no bone ends exposed, with or without nerves, blood vessels, craniocerebral, visceral injuries and other parts of the fracture. Serious injuries must be made quickly.
2, X-ray inspection
In addition to the positive and lateral X-ray, the special body phase should be photographed according to the injury, such as the opening position (upper cervical vertebra injury), the dynamic lateral position (cervical vertebra), the axial position (scaphoid, calcaneus, etc.) and Tangential position (tibia) and so on. Complicated pelvic fractures or suspected intraspinal fractures should be performed on a slice or CT examination as appropriate.
Diagnosis
Diagnosis and diagnosis of pathological fracture
Ask about the injury
Including the cause of the injury, the time, the location, the body posture at the time of injury and the first place, if there is a wound or bleeding, you should also ask about the wound treatment, whether the tourniquet has been used and the time of the tourniquet.
