Pathologic Fracture:

1. Latar Belakang
1.1 Definisi:
Fraktur tulang di akibatkan dari penyebab lain yang
menganggu integritas struktur tulang
Fraktur bise terjadi tiba-tiba (spontaneous) atau setelah .
(trivial injury)
1.2 Epidimeologi
1.3 Etiology
1.3.1 Penyakit tulang general
1. Ontogenesis Imperfecta
2. Post Menopausal osteoporosis
3. Metabolic bone disease
4. Myelomatosis
5. Polyostotic fibrous dysplasia
6. Pagets diease
1.3.2
1.
2.
3.
4.
5.
6.
7.

Kondisi local ginak

Chronic Infection
Solitary bone cyst
Fibrous cortical defect
Chondromyxoid fibroma
Aneurysmal bone cyst
Chrondroma
Monostotic Fibrous dysplasia

1.3.3
1.
2.
3.

Tumor Primer Ganas

Chondrosarcoma
Osteosarcoma
Ewings tumor

1.3.4 Metastasis
Carcinoma dari:
Payu darah (50-85%)
Prostat (50-70%)
Hodgkins (50-70%)
Paru-paru (30-50%)
Ginjal (30-50%)
Tyroid (40%)
Melanoma (30-40%)
Bladder (12-25%)
Mechanism of Metastasis:

Route of Metastasis: Contiguous or Hematogenous (more

common)
Release of cells from the primary tumor
Invasion of efferent lymphatic or vascular channels
Dissemination of cells
Endothelial attachment and invasion at distant site
Angiogenesis and tumor growth at distant site

Impending pathologic fractures

61% of all pathologic fractures occur in the femur
80% are peritrochanteric

Parrish and Murray, 1970

increasing pain with advancing cortical destruction of
lesions involving >50% of the shaft diameter
Beals, 1971
lesions >2.5 cm are at increased risk to fracture
Murray, 1974
increased fracture with destruction of > one-third of the
cortex, pain after radiotherapy
Fidler, 1981
% shaft destroyed
Incidence Fx (%)
0-25%
0%
25-50%
3.7%
50-75%
61%
>75%
79%
Patients with tumors destroying >50% of the diameter
of bone require prophylactic internal fixation
Harrington criteria
>50% of diameter of bone
>2.5 cm
pain after radiation
fracture of the lesser trochanter
Limitations:
o only for proximal femur
o doesnt account for tumor biology
Mirels Criteria