Pathological fracture of the tibia. The occurrence of a pathological fracture

Very great importance It has x-ray method research in the clinic of pathological fractures. A pathological fracture, in contrast to an ordinary traumatic one, is a violation of integrity that occurs in a bone that has already been changed by some previous pathological process and which is caused by a relatively minor injury or even by muscle tension alone, i.e., inappropriately weak external, manifesting itself outside the bone influence.

Synonyms for pathological fracture are the widely used designations - spontaneous, spontaneous fracture. These last terms should be abandoned as methodologically unacceptable: it is quite obvious that not a single fracture, like any natural phenomenon in general, can arise autochthonously, spontaneously, spontaneously, that is, from itself, without a specific external cause.

Most bone lesions can lead to this type of pathological disruption of bone integrity, and there is practical interest in the X-ray diagnosis of these fractures at the most various diseases is determined by the relative frequency and nature of both the underlying disease and the fracture complicating it.

The greatest predisposition to pathological fracture is created by destructive bone processes. But here it is necessary to emphasize that the phenomena of osteosclerosis, such as, for example, with marble disease, are no less capable of depriving the bone of its elasticity, strength and other mechanical properties. Both a decrease and an increase in the amount of mineral salts in the bone lead to its fragility. It would be better to call these bones not marble, but chalk - this would more accurately characterize their mechanical qualities. This will be discussed later.

Most common cause pathological fractures are fibrous osteodystrophy and bone neoplasms. From the group of fibrous osteodystrophies, at least 50-60% of all solitary cysts are complicated traumatic injuries. Bone fractures are slightly less common with fibrous bone dysplasia, both in single- and multi-bone forms. Fractures are also observed extremely often (up to 40-50%) in Recklinghausen's and Paget's diseases, while giant cell tumors account for about 15% of pathological fractures. As for tumors, malignant neoplasms are in first place, and metastatic, secondary tumors are much more likely to cause a fracture than primary tumors. Important property pathological fractures in metastatic tumors is their frequent multiplicity, especially with lesions of the vertebral bodies.

Particularly bone fractures occur with multiple metastases of myeloma, where fractures are observed in two thirds of all cases, less often with osteoclastic metastases of cancer and hypernephroma, and even less often with osteoplastic bone carcinosis. Osteoclastic bone sarcoma is almost 10 times more likely to break than the osteoplastic type. Among benign tumors chondromas strongly predominate. Almost as a rule, a bone breaks due to echinococcus. It is relatively rare to observe a fracture due to the usual common inflammatory diseases of the bones - osteomyelitis, tuberculosis and tertiary syphilis. A mandatory symptom is pathological fragility of bones with osteogenesis imperfecta and osteopsatirosis, fractures are almost always present in osteoarthropathy due to tabes spinal cord and syringomyelia. They also happen due to changes in the bones of a neurogenic nature after injuries nervous system. A kind of microscopic pathological fracture with osteochondropathy, almost always with childhood scurvy, often with congenital syphilis. But, contrary to popular belief, bones very rarely break during rickets and osteomalacia. Osteoporosis of any origin also rarely leads to a pathological fracture. Pathological fractures due to hemophilia have now become known. In essence, a fracture of a bone callus that has not yet strengthened is also pathological, that is, a local relapse of an ordinary traumatic fracture (refractura). As a matter of fact, pathological fractures should also include very peculiar ones, different from ordinary ones. traumatic fractures ankylosed and atrophied spine with ankylosing spondylitis. Fractures of various bone growths are equally pathological, for example, staples in disfiguring spondylosis or osteoarthrosis, marginal lips of saucer-shaped elevations in pseudarthrosis, calcaneal spurs or ulna etc. Relatively often we observe pathological fractures in atrophied bones near the joints with ankylosis of the latter, regardless of the cause of immobilization of the joints.

Naturally, every disease that affects certain age Some skeletal elements are preferred over others, and are also characterized by a favorite location of pathological fracture. For example, a pathological fracture of the proximal metaphysis of the humerus in school age speaks almost certainly in favor of a solitary cyst, the same fracture in a middle-aged man indicates myeloma, a pathological fracture of the middle diaphysis of a long tubular bone of the lower limb in an old man makes one think first of all about Paget’s disease, etc. Much more often than all other bones it breaks in under pathological conditions, the thigh, then in descending order of frequency are followed by the tibia, shoulder, clavicle, ribs, phalanges, etc. The vertebral body is especially often subject to pathological compression fractures.

Pathological fractures give a much higher percentage of all kinds of complications than ordinary violations of the integrity of the bone. In most cases, the healing process also occurs effectively in pathological fractures, and the underlying disease does not prevent the onset of consolidation. Even with fractures due to soil malignant tumors not so rare if successful modern treatment of the underlying disease, the formation of callus must be observed.

Accurate recognition of a pathological fracture is extremely important, since the treatment of an ordinary traumatic and pathological fracture differs significantly from each other, and, in addition, with each a separate disease, complicated by a violation of the integrity of the bone, special therapeutic measures are indicated. IN clinical picture either signs of the underlying disease or signs of a fracture come to the fore, and accurate diagnosis without x-rays is usually difficult. Each of the symptoms of a fracture - pain, limitation of function, displacement of fragments, hemorrhage, crepitus - can be only very mildly expressed or even completely absent. X-ray diagnosis is simple and reliable; along with signs of a fracture, symptoms of the underlying lesion are also detected. X-ray examination, therefore, provides an opportunity not only to establish the fact of a fracture and its details, but also to find out the nature of the main process, its distribution, the degree of bone destruction, etc. In addition, and this is especially important, it is not uncommon for a fracture to serve as the first manifestation the underlying disease, which was hidden before the x-ray examination, and the radiologist unexpectedly and for the first time discovers the true nature of the disease due to the fracture.

In some cases, a surprise in the X-ray room is that in the case of an unidentified fracture, the underlying disease, for example, a cyst or Paget's disease, and, on the contrary, in the case of an already clinically recognized underlying disease, it is the pathological fracture that has complicated this disease. This is especially true for cyst-like bone destruction with so-called fractures in the form of spyglass, when a thinned cortical cylinder moves at the site of a transverse fracture onto the end of another fragment and is thus fixed. Often they don’t give any clinical symptom and large cracks, bends and depressions pathological bones. In every questionable clinical case, the radiologist must think about the possibility of a pathological fracture, because mistaking such a fracture for an ordinary traumatic one means making a grave mistake.

Pathological fractures occur in children with diseases of the skeletal bones when exposed to minor traumatic forces. The cause of such fractures can be imperfect bone formation, fibrous and cartilaginous osteodysplasia, vitamin deficiency (rickets, scurvy), inflammatory diseases (osteomyelitis, tuberculosis), etc. Imperfect bone formation is congenital fragility of bones unknown etiology. With this disease, fractures are possible with minor force: in children early age- when swaddling) shifting them, in older children - when trying to sit down, stand up, etc. Fractures are accompanied by pain, pathological mobility and deformation, swelling and crepitus. Subperiosteal fractures and fractures with complete displacement occur. Fractures occur more often lower limbs, then the upper and ribs.

Clinically, imperfect bone formation is manifested by curvature of the limbs due to multiple repeated fractures or bone fractures, muscle wasting, and the presence blue sclera, sometimes “amber teeth” and decreased hearing. At congenital form Already in a newborn, attention is drawn to the curvature of the limbs with the deflection of the bones outward or anteriorly. In the area of fractures, dense bone callus is often palpated. The number of fractures in such “glass children” can be significant. Despite the fragility of the bones, fractures quickly heal, but as a result of muscle wasting, incomplete adaptation of bone fragments, and the “elasticity” of the callus, bone deformations occur. The disease is characterized by softness and pliability of the skull bones in young children, which causes head deformation in older children (mainly in the anteroposterior direction).

On an x-ray, the bones appear delicate and thin, especially the thin cortical layer: the spongy substance is transparent and has a barely noticeable pattern. Healed fractures are clearly visible. Due to multiple fractures limbs are deformed and shortened.

With imperfect bone formation, treatment of fractures is reduced mainly to careful reposition, reliable immobilization until complete consolidation. The time frame for fixation of a fracture is somewhat lengthened, despite the fact that the formation of callus occurs quickly and in normal age periods, but it remains “elastic” for a long time, as a result of which the possibility of deformation of the limb remains when the fracture heals. Except local treatment fracture, general strengthening treatment is carried out: ultrasound irradiation, multivitamins, ergocalciferol (vitamin D), fish fat, calcium supplements, of hydrochloric acid with pepsin. It is advisable to prescribe the anabolic hormone methandrostenolone (Nerobol), a hormone thyroid gland thyrocalcitonin intramuscularly. Treatment can also be carried out in outpatient setting in compliance with all recommendations of the attending physicians at the hospital.

For frequently recurring fractures with severe and significant deformation of the limbs, surgical treatment is recommended, which consists mainly of corrective osteotomy, intramedullary osteosynthesis and bone auto- or alloplasty to stimulate reparative regeneration bone tissue. In addition to imperfect bone formation, pathological fractures are observed in diseases that disrupt the normal anatomical structure of the bone.

A pathological fracture is in most cases the first symptom of a bone cyst and osteoblastoclastoma. As a result of minor trauma in the area of the most common localization of the pathological focus: the proximal metaphysis of the humerus, the proximal and distal metaphysis of the femur and the proximal metaphysis of the tibia, pain occurs, moderate swelling and hemorrhage, and deformity are noted. There is loss of function. Large offset bone fragments, as a rule, are not observed; therefore, pathological mobility and crepitus are not typical for fractures in children with the presence of a bone cyst or osteoblastoclastoma. The diagnosis of a pathological fracture is established after x-ray examination (Fig. 14.10).

The formation of a bone cyst is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on the hemodynamic disturbances in the bone that acutely occur with aneurysmal or prolonged solitary cysts.

Most solitary cysts are localized in the proximal parts of the long bones. The humerus (56%) and femur (23%) bones are most often affected. The destruction process develops slowly, asymptomatically and is manifested by a pathological fracture. Most aneurysmal cysts are localized in spongy bones with a rich arterial blood supply (vertebrae; pelvic bones; ends of bones forming knee-joint). All patients had a history of trauma. The first symptoms are slight pain, feeling of discomfort, stiffness. Clinical and radiological manifestations of bone cysts require differential diagnosis solitary cysts with fibrous dysplasia, non-osteogenic fibroma, hyperparathyroidism, eosinophilic granuloma. Aneurysmal cysts must be distinguished from chondromyxoid fibroma, osteosarcoma. Indications for conservative or surgical treatment phase dependent pathological process, the extent of the lesion and the data of cystography, angiography, radioisotope research, biopsies, etc.

With a lack of vitamins D and C, pathological bone fragility occurs. With rickets and scurvy in young children, fractures are observed. A minor injury or awkward movement is enough for a child suffering from rickets to have a fracture. Such fractures usually occur in lower third femur and on the bones of the forearm. They are often subperiosteal. Complaints of pain are minor, and the fracture is often visible; in such cases, only with the development of a callus and curvature of the limb is a former fracture revealed, which is confirmed by an x-ray.

Complete rachitic fractures heal slowly and require, along with reliable immobilization, vigorous antirachitic general treatment.

Less common are changes in the bones with scurvy. With a lack of vitamin C in the second half of the first year of a child’s life, rarely after a year, hemorrhages may occur in the area of the epiphyseal line, which spread under the periosteum. Typically, hemorrhages occur in the area of the upper or lower end of the femur, the upper end of the tibia, ribs and humerus. At the site of hemorrhage, the bone beams are destroyed and the integrity of the bone is compromised. Clinically, swelling in the limb area, severe pain when moving and palpating the limb, and thickening are noted. Sometimes it is possible to palpate fluctuations under the muscles. The skin over the area of the most painful swelling is tense and shiny. The limb is in a forced position. There are small petechiae on the skin, the gums swell and become bluish in color, and gingivitis occurs in the presence of teeth. The radiograph reveals a shadow around the diaphysis, which is caused by hemorrhage, and sometimes separation of the epiphysis from the metaphysis. The separation of the epiphysis is, in addition, determined on an x-ray by a change in the position of the ossification nucleus: the shadow of the ossification nucleus does not lie along the midline, but shifts away from the axis of the limb.

The disease scurvy with bone damage occurs with improper and inadequate nutrition, artificial feeding. Sometimes children with bone damage caused by vitamin C deficiency have a “well-fed” appearance; There are no signs of malnutrition, since the children have maintained their body weight, although they receive monotonous, inadequate nutrition.

Diagnosis is difficult when there is not yet a large hematoma and the child’s complaints are vague. During this period, caregivers note that touching and moving the child causes crying. When swelling, sharp local pain, or increased body temperature appear, a suspicion of inflammatory process- epiphyseal osteomyelitis, phlegmon. An error in diagnosis leads to the fact that the patient is given an incision, during which only hemorrhage is detected, and after surgery the true nature of the disease is revealed.

General treatment of vitamin C deficiency, proper nutrition, creating rest for a pronounced limb quickly improves the child’s condition. Inflammatory diseases can destroy bone tissue, leading to a pathological fracture. Such diseases in children include osteomyelitis and tuberculosis. Significant destruction of bone tissue in osteomyelitis may be accompanied by a pathological fracture. They are most often observed in the lower metaphysis of the femur and in the area of its neck or in the upper third of the humerus. A bone altered by a pathological process can break under the influence of minor violence, often almost imperceptible. Therefore, fractures of this nature are called spontaneous (spontaneous).

Recognizing a pathological fracture in osteomyelitis is not difficult. Often children begin to complain of increased pain in the limb. In case of complete fractures with displacement, pathological mobility, deformation and shortening of the limb are determined. Often a fracture is discovered by chance, during dressings. Clarifies the diagnosis X-ray examination. Pathological fractures in osteomyelitis are sometimes accompanied by an exacerbation of the inflammatory process; with insufficient immobilization, deformities and shortening of the limb occur, in in rare cases false joints are formed.

With tuberculosis, pathological fractures are possible not only due to bone destruction, but also as a result of the development dystrophic processes in the bones of the entire affected limb - osteoporosis and atrophy.

Traumatology and orthopedics
Edited by corresponding member. RAMS
Yu. G. Shaposhnikova

A pathological fracture is a bone fracture that occurred from the influence of a slight force or from a physiological load on a bone that was changed by some pathological previous process. These can be inflammatory, dystrophic, tumor, dysplastic, infectious, etc. processes. The occurrence of pathological fractures mainly occurs in areas of pathological bone restructuring.

How are so-called pathological fractures treated?

To prescribe the correct treatment for a patient, specialists conduct a thorough diagnosis of the patient’s disease in a variety of ways. Treatment of pathological bone fractures It can be medicinal or surgical. Drug treatment- this is an application antibacterial agents and other chemotherapy drugs, vitamin D preparations. Surgical treatment depends on the underlying disease, its nature, and the extent of the pathological process.

In general, the treatment of fractures of this type is practically no different from the treatment of ordinary fractures. But, as a rule, with pathological fractures, the immobilization period is extended. Whenever possible, orthopedic devices are used for pathological fractures. special methods. For example, the Shevtsov-Matsukatov apparatus, the Ilizarov apparatus. These devices make it possible to maintain the patient’s capacity even if consolidation is very slow.

The most important thing for the treatment of pathological fractures is to identify the cause of painful bone restructuring and its elimination. For example, in the case of cancer, the task of getting rid of the tumor (by surgery, radiation, chemotherapy, or a combination of these methods) undoubtedly comes to the fore. For pathological fractures caused by osteomyelitis, the patient is prescribed antibiotics. Surgery is necessary for bone abscess. If the cause of this disease is osteoporosis, then treatment is needed metabolic disorders tissues (bone) with the help of drugs that improve the microarchitecture of bones and mineral composition bones.

The purpose of surgical treatment is to eliminate pain, reduce the length of treatment in hospital, transfer the patient to ambulatory treatment. Also the impact on mental and emotional condition patient, promoting the use of other treatment methods, facilitating patient care. Early activation may cause hypercalcemia, trophic ulcers and prevents thrombophlebitis.

In order to stabilize pathological fractures, surgical methods Treatments should be selected individually for each patient, depending on the specific qualities of the affected bone, the involvement of soft tissue structures and location.

Among various damages long bones in most cases, fractures of the humerus and femur are observed, and they require stable permanent intraosseous osteosynthesis. The load on the long bones must be resisted by such fixation. Against the background of cancer bone lesion surgery A pathological fracture serves, one might say, to improve the patient’s quality of life in the remaining time period, but not to increase the patient’s life expectancy.

Surgical treatment of these fractures that occurred against the background of malignant processes, both primary and secondary, with damage to the articular end currently involves endoprosthetics. If the diaphysis of long bones is affected, then segmental resection is used using bone grafting, or bone cement and fixation of bone fragments. Fixation is carried out with internal or external metal structures, and can be used different techniques transosseous osteosynthesis.

For these fractures that occur against the background of tumor-like lesions and benign tumors, it is necessary to adhere to active surgical tactics and perform bone resection, combined with osteosynthesis, in the very first days after the fracture occurs, without waiting for the fragments to heal.

Pathological fracture of the spine is a process localized in one or more vertebrae of any part spinal column, which is not preceded by the fact of mechanical injury. That is this disease are not preceded by impacts on hard surfaces or collisions with them, falls from a height, etc. A pathological fracture of the spine occurs spontaneously, seemingly against the background perfect health bone tissue of the body.

With this disease there is destruction of vertebral body tissue, that is, its direct destruction. The destruction affects both the bony part of the vertebra and the periosteum (the tissue lining the outside of the body, all the processes and openings of the vertebra and containing all the vessels that supply the vertebra and innervate the small branches of the nerves).

Most often, this pathological process is localized in places that take on the largest part of the load of the entire column. These places are the lumbosacral region and to a lesser extent thoracic region spine. Other areas are more rare, but may also well become sites of pathological fractures.

Causes of the disease

The causes of this pathological process are very numerous. Such a spinal fracture can be a consequence of the following pathological and physiological conditions:

Diseases of the thyroid and/or parathyroid glands (hyperthyroidism, hypothyroidism, autoimmune thyroiditis, nodular goiter, solitary and multiple hands and malignant neoplasms of these organs. With all these diseases, a disturbance in the metabolism of calcium and its salts in the bones is possible)
Malignant neoplasms of bones with localization in the spine.
Metastases of malignant neoplasms into the spine of other organs (this is most often observed in late stages breast oncology, prostate gland, central or peripheral cancer lungs, malignant diseases blood).
Osteomyelitis of the spinal bones(this is an inflammatory process involving bone tissue and Bone marrow, which subsequently leads to purulent-necrotic melting of these structures with the formation of sequesters containing detritus).
Intestinal diseases(diseases that result in impaired absorption of calcium and vitamins in various departments intestines).
Age-related changes in the body.
Changes in a woman's body during pregnancy and lactation.

Despite the presence of an abundance of conditions that can cause a pathological fracture of the spine, the immediate root cause is always only one factor. And this factor is a decrease in bone density, that is, osteoporosis. Physiological osteoporosis can occur during pregnancy and period breastfeeding, as well as in the second half of life (mainly also women).

Symptoms

The main symptom of a pathological vertebral fracture is discomfort at the fracture site. Most often these sensations are of the nature acute pain, even sometimes unbearable, forcing the patient to rush around and grab the sore spot in search of a location that will relieve pain syndrome(this is usually observed when oncological diseases).

With osteomyelitis, the pain is also very sharp, but its intensity is lower than in the previous case; there may often be visible defects on the skin with a characteristic discharge from this defect. In other cases, the pain may not be so strong and sharp.

It is worth noting that the pain syndrome occurs immediately at the moment of violation of the integrity of the periosteum, since it is in its thickness that feeding vessels and sensitive nerve endings pass.

There are often general symptoms associated with impaired calcium metabolism in the body. These include:

General weakness.
Malaise.
Drowsiness or, conversely, increased excitability.
Fatigue.
Feeling of lack of sleep.
Feeling of heart failure.

May also be observed:

Various paresis.
Radicular syndromes.
Dysfunction of the pelvic organs.
Stiffness of movements.

Diagnostics

The main method for diagnosing a pathological fracture of the spine is radiography. X-rays are taken in two projections (frontal and lateral). Usually the most informative is a combination of an x-ray of a specific part of the spine, giving clinical symptoms, and a targeted image of any several vertebrae (in which, according to palpation examination and anamnestic data, the focus of bone tissue destruction is most likely located). In addition, research is being conducted venous blood for calcium content.

To clarify the diagnosis in doubtful and difficult cases will be foreseen CT scan or magnetic resonance imaging of the spine. This study is mandatory in cancer patients to clarify the stage and extent of the tumor process.

Treatment of pathological fracture of the spine

Treatment of this condition involves primary treatment of the underlying disease, but direct action on bone tissue that has undergone resorption is also an integral part of therapy. Almost always required surgery.

Currently widely used various ways vertebroplasty. Vertebroplasty using special bone cement is one of the newest, simplest and safest methods.

Perfectly complements surgery drug correction of the disease, which involves taking various calcium supplements (Marine Calcium, Calcemin Advance, etc.). In some cases, it is advisable to wear special support corsets.

Almost every adult has encountered pathological fractures in one way or another - either from their own sad experience, or from the example of relatives and friends. And now we ourselves begin to say: “The most important thing is not to break your hip in old age and not to lie bedridden” or “I, like many women of my age (over 50 years old), broke my wrist.” Alas, along with vertebral fractures, a fracture of the femoral neck and distal epiphysis radius Indeed, they are among the most common pathological fractures. However, the good news is that these injuries are now preventable in many cases.

Pathological fracture: an idea of the problem and its symptoms

A pathological fracture is a violation of the integrity of the bone at the site of its pathological restructuring. Most often, a pathological fracture occurs “out of the blue” - that is, in the case when the force of the impact (from a bruise or fall) is clearly insufficient to damage healthy bone tissue. At the same time, a typical story about an injury looks something like this: “Well, I didn’t seem to hit it hard, but I broke my arm.” Or: “Every year in winter I fall 1-2 times, like all people. But this year I seemed to fall quite lightly and get a fracture out of the blue.”

In this case, the clinical signs of a pathological fracture completely coincide with those of ordinary fractures. In fact, the only distinguishing feature of this injury is that a pathological fracture most often occurs with minor trauma. Therefore, patients often seek medical care too late, without even realizing that they may have a fracture.

Pathological fractures of the spine (which in the vast majority of cases are compression fractures localized in the vertebral body) are especially often “overlooked.” The easiest way for a non-medic to imagine the essence of this damage is to draw an analogy between the spongy bone of a vertebra and a slice fresh bread. If you squeeze the bread with your fingers, the crumb will crumple - the vertebral body also “crumples” when compression fracture. The healing of this injury will be somewhat similar to restoring the shape of bread that is not too “bruised”, only very extended over time.

Despite the fundamental ability of the vertebral body to restore its structure with relatively minor damage, any fracture of the spine (including compression) is very dangerous. If the height of a vertebra is violated, the spine becomes deformed (kyphosis occurs), which contributes to damage to other vertebrae and the progression of kyphosis. In the case of compression accompanying the injury nerve endings, pain, paresis (numbness, “pins and needles”) and muscle weakness occur in the corresponding innervation zone.

With a pathological fracture, when interviewing the patient, in some cases it is possible to identify a history of complaints of pain and discomfort in the area where the fracture subsequently occurred.

The final diagnosis of a pathological fracture can be confirmed (or refuted) by radiography or computed resonance tomography.

Pathological fracture: causes

The causes of pathological fractures are conditions leading to the destruction of bone tissue. Thus, demineralization of bone tissue is promoted by excessive formation of the parathyroid hormone (parathyroid hormone), which occurs in hyperparathyroidism, including those caused by parathyroid adenoma.

Another cause of a pathological fracture is a tumor lesion of the bone. If there is a primary tumor or metastasis in the bone tissue malignant neoplasm, its structure changes, the bone becomes more fragile, and with the slightest damage in the affected area a pathological fracture occurs. That is why, if you suspect an oncological process, you need to start diagnostic measures, in particular, prescribe taking a biopsy of bone tissue from the damaged area.

Osteomyelitis - another cause of pathological fractures - is most often found in children, as well as in the area of endoprosthetics, comparison of bone fragments, as well as bone injuries of any origin, complicated by infection (in the vast majority of cases - Staphylococcus aureus). The most typical localization of osteomyelitis is the bones of the leg, femur and brachial bone, upper jaw, vertebrae. Pathological fractures also occur, caused by a bone abscess that develops as a result of trauma.

Finally, the most common cause of pathological fractures is osteoporosis.

Fractures due to osteoporosis

Osteoporosis is a widespread pathology that occurs, on average, in every third woman and every fifth man over 50 years of age. We can say that the world is experiencing an epidemic of osteoporosis in people in the second half of life! What is this terrible disease?

Osteoporosis is a metabolic bone disease in which bone mass decreases and bone structure changes such that the bones become more fragile and therefore more prone to pathological fractures. In the vast majority of cases, osteoporosis is spoken of in connection with menopausal changes. female body. This connection is understandable: during fertile (i.e. childbearing) age, female sex hormones (estrogens) maintain bone strength, and with changes associated with menopause hormonal levels the amount of estrogen decreases and bones become especially fragile. Although osteoporosis is also not uncommon in older men. This is why pathological fractures are much more common in older people.

Osteoporosis is confirmed by bone densitometry (primarily bone mineral density) and biochemical markers of osteoporosis. Most often, blood tests are performed for osteocalcin, bone alkaline phosphatase, acid phosphatase, pyridinoline, collagen degradation products, procollagen peptides. Sometimes some of these markers are detected in urine.

But a study such as radiography, which is mandatory for any fracture, cannot always help in diagnosing osteoporosis: x-ray its signs are visible only when at least 30% of bone mass is lost.

That's why experienced doctors often they begin to suspect osteoporosis (and, as a consequence, a pathological fracture) not so much based on the changes in the affected bone recorded on x-rays, but rather based on the location of the fracture. Thus, the most typical location of pathological fractures in osteoporosis is the distal epiphysis of the radius (Collis fracture), femoral neck, and vertebrae. At the same time, fractures in osteoporosis tend to become “cascading”: the first fracture increases the risk of the second by 2 times, the second fracture increases the risk of the third by 5 times, and so on.

Actually, a fracture in a person over 50 years of age should, in principle, raise suspicion regarding the pathological nature of the damage. In this regard, it is necessary to clarify whether the force of the fall (impact) was adequate to the injury received and to find out whether the patient had other fractures in the past. last years whether she (he) was examined for osteoporosis or received anti-osteoporosis drugs. After all, it is at this age that the clinic of osteoporosis makes itself felt, which without treatment will only get worse over time.

It is also important to note the fact that pathological fractures, which occur quite easily against the background of osteoporosis, heal poorly. Speaking in “medical language,” a distinctive feature of pathological fractures is their poor consolidation, which often leads to disability in patients. And this is understandable: until the factor that caused the pathological restructuring of the bone is eliminated, restoration of its structure during healing of the damage is also extremely difficult. In addition, prolonged immobilization of patients with pathological fractures leads to the development of complications, including fatal ones ( congestive pneumonia, PE (thromboembolism pulmonary artery), bedsores, thrombophlebitis, etc.).

For this reason, a doctor who diagnoses a fracture in an elderly patient is obliged to prescribe an adequate examination that can identify osteoporosis: only eliminating the influence of the cause of a pathological fracture can achieve not only successful treatment injury, but also to prevent its complications. And, of course, serve as hope for the prevention of subsequent pathological fractures!

Treatment of pathological fractures - general principles

Treatment of pathological fractures in general is practically no different from the treatment of conventional ones. However, as a rule, the periods of immobilization for pathological fractures are extended. Therefore, in case of pathological fractures, whenever possible, special orthopedic methods are used (for example, the Ilizarov apparatus, the Shevtsov-Matsukatov apparatus), which make it possible to maintain a person’s capacity even if the consolidation is very slow.

What is most important in the treatment of pathological fractures is identifying the cause of painful bone remodeling and its elimination. So, with cancer, of course, the issue of eliminating the tumor (by surgery, chemotherapy, radiation, or a combination of these methods) comes to the fore. For pathological fractures caused by osteomyelitis, antibiotics are necessary. In some cases, surgery may be required (for example, with a bone abscess).

Well, if the cause of the pathological fracture is osteoporosis, it is necessary to treat metabolic disorders of bone tissue with the help of drugs that improve the mineral composition and microarchitecture (specific “structure”) of bones.

Bonviva for the prevention of pathological fractures in osteoporosis

The dangers of osteoporosis have been known for so long that many popular media have not ignored this topic. In particular, widest distribution received information about the leading role of calcium in the prevention of pathological fractures.

However, the authors of most of these materials lose sight of the fact that the pathological changes in bone tissue that occur during osteoporosis are caused not so much by calcium deficiency in the body, but by the inability of the bones to absorb and retain it. Therefore, it is impossible to cope with osteoporosis with calcium supplements alone: you also need special means, which will act only in bone tissue, helping to restore its structure and increase mineralization. Otherwise, it is almost impossible to prevent the pathological restructuring of bones. Therefore, at present, drugs from the group of bisphosphonates, powerful modulators of bone metabolism that can suppress resorption (“resorption”) of bone tissue, for which special cells—osteoclasts—are “responsible,” are of the greatest interest among anti-osteoporosis drugs.

One of the most studied (and, most importantly, clinically tested) drugs in this group is ibandronic acid. It is on this basis active substance Bonviva was created - a modern, highly effective tablet drug that is well tolerated and designed to enhance the mineralization of bone tissue and reduce the risk of pathological fractures.

It is noteworthy that Bonviva is recognized as the “gold standard” for the treatment of osteoporosis, not only due to its highest effectiveness, but also due to its ease of use: for the prevention and treatment of osteoporosis, including those complicated by pathological fractures, the drug is taken 1 tablet (150 mg) 1 time per day. month.

The exceptional convenience of using Bonviva significantly increases patient adherence to treatment: in other words, they do not stop therapy because they are tired of complying with all the requirements for the regularity and frequency of taking the medication (which, alas, is not uncommon). Well, adherence to treatment is a very important criterion for the success of treatment for osteoporosis, since anti-osteoporosis drugs must be taken for years. Thus, after 3 years of regular use, Bonviva reduces the likelihood of a fracture by more than 50%.