Pathologic Fracture

Breast Cancer in Bone

In this patient with breast cancer, the cancer has spread to the bone (metastasized).  When tumors form within the bone, the normal structure and support of the bone can be altered.  Normal bone strength can be diminished by the tumor replacing the normal bone structure.  This process can weaken the bone and make it more susceptible to fracture.

You can see the bone at the top of the femur (thigh bone) on the left side of the image looks thinner than on the right side of the image. It looks less whitish on the image because there is less bone structure where the breast cancer had spread. The cause of the weakened bone is the breast cancer invading the bone.

Often if the tumor is detected at this stage, an orthopedic surgeon will operate on the patient to help stabilize and support the bone with a metal rod. In this patient, however, she did not have surgery. Therefore the bone was weakened by the tumor, and the likelihood of fracturing the bone, even without any significant injury, is high.

Pathologic Hip Fracture

Because of the weakened bone seen on the previous x-ray, this patient sustained a pathologic fracture of the femur (thigh bone) just below the hip joint. After cancer had weakened the bone in this patient, the weight of her body was eventually too much to support. Now the bone had been fractured, and surgery needs to be performed.

A pathologic fracture occurs when the bone is weakened by some condition (cancer, infection, and osteoporosis are just some causes of pathologic fracture).

Pathologic Fracture Treatment

This patient with metastatic breast cancer to bone had a pathologic fracture of the upper femur (thigh bone). Because of the weakened and fractured bone, surgery is needed to realign and hold the bones in position.

A metal rod and screws are used to hold the bone ends in the proper position. This will allow this patient to begin moving again soon after the surgical procedure. While the tumor is still in the bone, and still requires additional treatment from the oncologist, the patient will be able to begin moving and can focus her treatment on the cancer and not the bone problem.

As described earlier, often a surgeon will recommend stabilizing these areas of tumor infiltration of bone prior to the occurrence of a pathologic fracture. Because the risk of fracture is so high, many surgeons prefer to stabilize before an injury occurs. Furthermore, when a fracture occurs, there is associated soft-tissue damage that can cause pain, weakness, and functional limitations--avoiding those complications is a goal of prophylactic stabilization.

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