Pathological fracture of 1 vertebra treatment. Pathological fractures of the spine

What are pathological fractures

Pathological fractures occur in children with diseases of the skeletal bones when exposed to minor traumatic forces. The cause of such fractures may be imperfect bone formation, fibrous and cartilaginous osteodysplasia, vitamin deficiency (rickets, scurvy), inflammatory diseases (osteomyelitis, tuberculosis), etc.

Pathogenesis (what happens?) during pathological fractures

Imperfect bone formation - 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.

Symptoms of Pathological Fractures

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, “elasticity” callus bone deformities 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),

Diagnosis of pathological fractures

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.

Treatment of Pathological Fractures

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 longer, despite the fact that the formation of callus occurs quickly and in normal age periods, but it is still long time remains “elastic”, resulting in the possibility of deformation of the limb during a healed fracture.

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 thyrocalcytonin 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 most frequent localization pathological focus: proximal metaphysis humerus, proximal and distal metaphyses of the femur and 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 made after an X-ray examination.

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 tubular 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 and osteogenic sarcoma.

Indications for conservative or surgical treatment depend on the phase of the 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. For rickets and scurvy in children younger age 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, and increased body temperature appear, an inflammatory process is suspected - 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.

At inflammatory diseases Bone tissue may be destroyed, 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. Bone, modified 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. X-ray examination clarifies the diagnosis.

Pathological fractures in osteomyelitis sometimes accompany exacerbation 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.

Which doctors should you contact if you have pathological fractures?

Traumatologist
Rheumatologist

The human body is complete system where everything is interconnected. Any disease, if it acquires chronic form and lasts for a long time, will ultimately adversely affect the strength of our bones and joints.

In particular severe forms– serious dysfunction pelvic organs, loss of sensation in the lower extremities, paralysis of the legs.

In the coccyx and sacrum

Acute pain radiates to the legs, buttocks, and lumbar region and intensifies when walking, defecating, or changing position.

Thus, the symptoms of pathological fractures of the spine are not fundamentally different from ordinary fractures. A specific difference is the minimal force of traumatic impact in pathological fractures. It is for this reason that they can go unnoticed for a long time and are diagnosed only after a visit to the doctor.

Diagnostics

Staging final diagnosis is based on the results of numerous medical procedures, laboratory and instrumental examinations.

MRI equipment

On initial stage The doctor studies the patient's medical history and anamnesis in order to identify any chronic disease, which became the root cause of the pathological fracture.

Among all laboratory research in this case, the most informative would be general analysis blood. Based on the data obtained as a result of this analysis, we can draw a conclusion about what negative process is occurring in the body.

Instrumental diagnosis of pathological fractures includes:

X-ray (will determine the location of the fracture and its severity).
Computed tomography and magnetic resonance imaging (allows you to examine the structure of the vertebrae and assess damage to soft tissues).
Scintigraphy and contrast myelography (detects the presence of metastases).
Densitometry (indicated for suspected osteoporosis).
Biopsy.

Treatment

Treatment will be aimed primarily at correcting the disease that caused the injury. Therapy can be conservative and surgical.

Conservative therapy

Treatment consists of following the pastel regime, using fixing devices and drug therapy. At a fracture cervical spine use orthopedic Shants collar, for fractures of other parts of the spine, bandages and corsets are indicated. The patient requires a hard bed with an adjustable backrest. In particular difficult cases apply skeletal traction with load.

Shants collar

The process of treating pathological fractures using methods conservative therapy can take a long time due to the reduced ability of bone tissue to restore its structure.

If conservative treatment does not bring the desired result, then after it, and most often immediately after the injury, surgical treatment is prescribed.

Surgery

Method selection tactics surgical treatment determined depending on the factor that provoked the disease. Surgical treatment prevents further deformation of the damaged vertebra and adjacent vertebrae using the following procedures:

Endoprosthetics.
Vertebroplasty (strengthening the vertebral body with special bone cement).
Kyphoplasty (introduction of an air balloon into the vertebral body and filling its cavity with bone cement in order to restore the lost height of the vertebra).
Replacement of a deformed vertebra with a graft.
Fixation of the damaged segment of the spine using special devices(nails, pins, screws, plates or Ilizarov apparatus).

Surgical treatment of pathological compression fracture Spine surgery is primarily aimed at restoring its height using vertebroplasty and kyphoplasty.

In case of a complicated compression fracture, open surgery in order to remove parts of the vertebra that are compressing the spinal cord and nerve roots, then vertebral segment They are fixed with a special metal structure and the vertebral body is filled with bone cement.

Treatment tactics for patients with spinal tumors will be somewhat different. For benign formations, carry out complete removal affected area, in the case of malignant neoplasms they use radiation therapy and chemotherapy.

Indications for surgical treatment of a pathological fracture of the spine with metastases are: intense pain, development neurological disorders, significant destruction bone structure vertebrae

Considering the complexity of this operation and the risks involved, it should be performed only if it can significantly improve the patient’s condition.

Rehabilitation

The rehabilitation period after a pathological fracture of the spine lasts about one year. Throughout later life It is necessary to undergo routine medical examinations and observe certain restrictions on workload.

An important role in rehabilitation is played by the treatment of the underlying disease that led to the injury.

The complex of rehabilitation procedures includes:

physiotherapy;
physical therapy (physical therapy);
massage;
balanced diet.

Physiotherapy

Prescribed from the first days after injury and are necessary to reduce swelling, reduce pain syndrome, improving microcirculation in tissues. As a rule, in the case of a pathological fracture of the spine, impulse currents, magnetic therapy, electrophoresis, vibration therapy.

Therapeutic exercise (physical therapy)

It is performed on the principle of gradually increasing the load under the supervision of an instructor. Exercise therapy is a good prevention of bedsores, activates the process of restoring muscle tone, joint mobility, blood circulation, and stimulates the regeneration of damaged tissues.

Massage

Relieves pain, relieves muscle tone, improves blood circulation in tissues. Massage can be done from the first days of treatment, as the patient recovers, the time of one session increases. After full recovery It is recommended to regularly undergo massage courses as a preventive measure.

Balanced diet

To speed up the healing process in daily diet the patient should include foods rich in silicon, magnesium, calcium, vitamins (fish and seafood, dairy products, legumes, nuts, fresh herbs, buckwheat and oat groats and etc.).

Conclusion

When following all doctor's recommendations and complex treatment pathological fracture of the spine without damage spinal cord the prognosis for recovery is favorable. Special attention should focus on treating the disease that caused the injury in order to avoid relapses and complications.

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, when oncological diseases Undoubtedly, the task of getting rid of the tumor (by surgery, radiation, chemotherapy, or a combination of these methods) comes to the fore. For pathological fractures caused by osteomyelitis, the patient is prescribed antibiotics. Surgery necessary for bone abscess. If the reason of this disease 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, 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 Surgical treatment of 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 occurred 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.

Occurs when there is a violation normal structure vertebral bone tissue and its destruction due to various diseases. Such fractures very often occur spontaneously, “out of the blue,” i.e. the traumatic factor is still present, but its strength may be very small.

Causes and mechanism of occurrence

In the vast majority of cases pathological fractures of the spine are compression fractures that can occur even with minor loads on the vertebral body, when the pathologically altered bone tissue cannot withstand even such a minimal load.

Pathological fracture of the spine can occur in diseases of the thyroid gland, accompanied by excessive formation of parathyroid hormone (hyperparathyroidism), which causes demyelination of bone tissue. Such fractures are also possible with various malignant neoplasms, as in cases where tumor process initially occurs in bone tissue and during metastasis. Another cause is osteomyelitis - a purulent-necrotic process that occurs both in the bone tissue itself and in the bone marrow, and in surrounding tissues. Osteomyelitis often occurs in children, as well as after endoprosthetics, any bone damage complicated by infection (most often Staphylococcus aureus). The cause of such fractures can also be an abscess that has developed in bone injury as a result of injury. However, most common cause is osteoporosis, in which the metabolism of bone tissue is disrupted, which causes a decrease in its density, changes in structure and microarchitecture, and this, in turn, leads to increased fragility of bones and their tendency to develop pathological fractures.

Clinical manifestations pathological fracture of the spine

Clinical signs pathological fracture of the spine are practically no different from “ordinary” ones and their only difference is the insignificant force of traumatic impact in pathological fractures, which is why they often go unnoticed and undiagnosed.

Due to a compression fracture of the vertebral body, it is deformed with a decrease in height, while the spine is deformed towards the damaged vertebral body and kyphosis occurs, which, in turn, can lead to damage to adjacent vertebrae, i.e. kyphosis may progress.

Compression fractures of vertebral bodies, incl. and in pathological fractures are often accompanied by damage to the spinal cord and its roots, which leads to characteristic symptoms in the form of pain, sensitivity disorders, paresis, dysfunction of the pelvic organs.

The diagnosis is confirmed using x-rays or MRI.

Treatment pathological fractures of the spine

The ability of bone tissue to restore its structure, incl. and bone tissue of the vertebrae in various diseases that cause pathological fracture of the spine, is noticeably reduced, therefore, when treating such fractures, it is necessary to eliminate or minimize the impact of the factors that caused pathological changes in bone tissue. Those. First of all, it is necessary to treat the underlying disease that caused such fractures.

Conservative treatment pathological fractures of the spine consists of strict bed rest and fixation of the affected part of the spine, however, the process of treatment of such fractures due to changes in the structure of bone tissue caused by these slow consolidation of fractures can be quite long, therefore various orthopedic designs (corsets, collars) are used, allowing, to a greater or lesser extent maintain the patient's capacity.

If conservative treatment is ineffective, and in some cases immediately after injury, surgical treatment is used. Surgical treatment is also used to prevent subsequent deformation of the damaged vertebra and adjacent vertebrae. For this purpose, the installation of metal structures can be used, which are fixed in the vertebral body and fix the damaged segment of the spine, creating the prerequisites for healing of the fracture and compensating for the lost supporting function spinal column. Currently, vertebroplasty is being increasingly used - the introduction of special bone cement into the vertebral body, which strengthens the vertebral body. Another surgical treatment option is kyphoplasty, the introduction of an air balloon into the vertebral body, which inflates under pressure and restores the lost height of the vertebra; after this, the air cavity is filled with cement.

The advantage of kyphoplasty is the ability to correct deformities of both the vertebra itself and the spinal column as a whole, as well as the possibility of safer injection of cement into an already prepared cavity.

A pathological fracture is a violation of the integrity of the bone, which occurs at the site of its pathological restructuring. It differs from a regular fracture in that it is caused by minor impacts - it could be a small blow, a fall from a low height, or even a simple muscle strain. Otherwise, the signs of such injuries completely coincide with the manifestations characteristic of ordinary fractures.

Causes of pathological fractures

Such an injury is a consequence of a decrease in bone strength, which is caused by various diseases and pathological conditions:

osteomyelitis;
hyperparathyroidism;
bone tumor.

The most common condition that can result in a pathological fracture is a decrease in bone density due to osteoporosis. With this disease, bone metabolism is disrupted, and the processes of catabolism (destruction) prevail over the processes of bone formation. This disease occurs latently for a long time, often it can be diagnosed only after a fracture has occurred.

Based on their origin, they distinguish between primary and secondary osteoporosis. The former become a consequence natural processes that occur in the body. They develop after menopause, in old age or due to unknown reasons - such osteoporosis is called idiopathic.

The appearance of secondary osteoporosis can result from:

endocrine diseases;
diseases of the digestive system;
rheumatic and connective tissue diseases;
blood diseases;
kidney pathologies.

Hyperparathyroidism is a pathology in which the hormone is released parathyroid glands in excess quantities. It leads to demineralization of bones and, as a result, their increased fragility.

Osteomyelitis is a purulent-necrotic process that affects the bone and Bone marrow. It is caused by pus-producing bacteria that enter from a site of inflammation, through the bloodstream, or after penetrating trauma.

A change in the structure of the bone, which may result in a pathological fracture, also occurs as a result of the development cancerous tumor. When it occurs, bone tissue also becomes very fragile.

The occurrence of a pathological fracture

The most common pathological fractures are:

vertebrae;
epiphysis of the radius;
neck of the femur.

As mentioned above, such bone fractures occur as a result of small impacts, such as a fall from a low height. In some cases, the person who received such an injury does not even realize it exists. Thus, a vertebral fracture may not cause any symptoms - pain appears only when several neighboring vertebrae are injured.

Diagnostics

A pathological fracture is diagnosed based on the patient's complaints, examination data and taking into account the nature of the injury - if the force on the bone tissue was insignificant.

X-ray data are important. You can also assess the condition of the bone and tissues surrounding it using computed tomography and magnetic resonance imaging. When conducting such examinations, changes become visible that make possible occurrence pathological fracture.

Densitometry is used to diagnose osteoporosis. If a bone tumor is suspected, scintigraphy is performed. In some cases accurate diagnosis can be formulated only after a biopsy. In addition, in some cases, blood tests can help, such as determining calcium levels and alkaline phosphatase. However, the data from such surveys are non-specific and are used only as additional ones.

Treatment of pathological fractures

Therapeutic tactics depend on the underlying disease that led to changes in bone tissue, as well as the location of the injury and its nature. Pathological fractures are treated using the same methods that promote rapid healing of ordinary fractures, however, due to changes in bone structure, recovery times tend to be significantly longer.

The fixation method is used in 70% of cases. It involves the application of a plaster or polymer bandage, which holds the bone fragments motionless until it completely heals. In this case, the fixed muscles remain motionless for a long time, which leads to their atrophy and, as a consequence, an increased risk of recurrent fracture.
The extension method, or traction method, is used in cases where constant stretching of the injured area is necessary to reduce the displacement of debris. In this case, special weights are used, the weight of which decreases as the bones grow together.
The surgical method involves combining bone fragments and fastening them during surgery. To fix the fragments, special internal and external fixing structures are used.

Pathological fractures of the spine are treated by fixing the damaged part, and strict adherence to bed rest. Using special orthopedic structures- corsets and collars - allows you to maintain functionality during slow recovery after injury. If the joint has been damaged, endoprosthetics can be performed.

Of great importance is the treatment of the underlying disease, as a result of which a pathological fracture became possible. Thus, for osteoporosis, it is necessary to take medications that help restore normal bone structure, improve the structure and mineral composition of bone tissue. Osteomyelitis is treated with antibiotics, and if a cancerous tumor is present, it is eliminated surgically, through radiation and chemotherapy or a combination of these methods.

Prevention

Today, pathological fractures are not only well treated - they can often be prevented. To do this, it is necessary to promptly diagnose the disease that can lead to such an injury and begin its treatment.

For example, patients with osteoporosis need to take the above-mentioned medicines, which affect the structure of bone tissue. It must be borne in mind that most over-the-counter drugs recommended for the treatment of this disease are ineffective, since the substances they contain are not absorbed by the body. However, treatment prescribed by a specialist after examination and diagnosis will stop or at least slow down the development of this disease.

Problems such as a fractured vertebra, wrist, or hip due to decreased bone density can cause long-term disability and disability normal life. Attentive attitude to your own health and timely prevention will help you avoid these troubles, help maintain health and wellness for many years.