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

What are pathological fractures

pathological fractures occur in children with diseases of the bones of the skeleton when exposed to a slight traumatic force. The cause of such fractures can be imperfect bone formation, fibrous and cartilaginous osteodysplasia, beriberi (rickets, scurvy), inflammatory diseases (osteomyelitis, tuberculosis), etc.

Pathogenesis (what happens?) during pathological fractures

Imperfect bone formation - congenital fragility of bones unknown etiology. In this disease, fractures are possible with a slight force effect: in children early age- when swaddling) shifting them, in older children - when trying to sit down, stand up - etc. Fractures are accompanied by soreness, pathological mobility and deformity, swelling and crepitus. There are subperiosteal fractures and fractures with complete displacement. Fractures are more common lower extremities, then top and ribs.

Symptoms of pathological fractures

Clinically, imperfect bone formation is manifested by the curvature of the limbs due to multiple repeated fractures or fractures of the bones, muscle hypotrophy, the presence of blue sclera, sometimes "amber teeth" and hearing loss. At congenital form already in a newborn, attention is drawn to the curvature of the limbs with the deflection of the bones outwards or anteriorly. In the area of fractures, dense callus is often palpated. The number of fractures in such "glass children" is significant. Despite the fragility of bones, fractures quickly grow together, however, as a result of muscle hypotrophy, incomplete adaptation of bone fragments, "elasticity" callus bone deformities occur. The disease is characterized by softness and suppleness of the skull bones in young children, which is the cause of head deformity in older children (mainly in the anteroposterior direction),

Diagnosis of pathological fractures

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

Treatment of pathological fractures

With imperfect bone formation, the treatment of fractures is reduced mainly to careful reposition, reliable immobilization until complete consolidation. The terms of fixation of the fracture are somewhat lengthened, despite the fact that the formation of callus occurs quickly and at the usual age, but it is still long time remains “elastic”, as a result of which the possibility of deforming the limb with a fused fracture remains.

Except local treatment fracture, general strengthening treatment is carried out: ultrasound irradiation, multivitamins, ergocalciferol (vitamin D), fish fat, calcium preparations, 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 outpatient settings in compliance with all the recommendations of the attending physicians of the hospital.

With frequently recurring fractures with severe and significant deformity 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 in most cases is the first symptom of a bone cyst and osteoblastoclastoma. As a result of a minor injury in the area of the most frequent localization pathological focus: proximal metaphysis humerus, proximal and distal metaphysis of the femur and proximal metaphysis of the tibia - pain occurs, moderate swelling and hemorrhage, deformity are noted. There is a loss of function. Big displacement bone fragments, as a rule, are not observed; therefore, pathological mobility and crepitus are uncharacteristic of fractures in children with the presence of a bone cyst or osteoblastoclastoma. The diagnosis of a pathological fracture is established after X-ray examination.

Bone cyst formation is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on acute hemodynamic disorders in the bone that occur during aneurysmal or solitary cysts stretched over time. Most solitary cysts are localized in the proximal tubular bones. The humerus (56%) and femur (23%) bones are most commonly 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 that form knee-joint). All patients have 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, 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, biopsy, etc.

With a lack of vitamins D and C, pathological fragility of bones occurs. With rickets and scurvy in children younger age fractures are observed. A minor injury or awkward movement is enough for a child with rickets to have a fracture. These fractures usually occur in lower third femur and on the bones of the forearm. Often they are subperiosteal. Complaints of pain are insignificant, and the fracture is often visible; in such cases, only with the development of calluses and curvature of the limb, a former fracture is detected, which is confirmed by an x-ray.

Complete rachitic fractures grow slowly and require, along with reliable immobilization, vigorous anti-rachitic general treatment.

Changes in bones at a scurvy meet less often. 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 epiphyseal line, which spread under the periosteum. Usually, hemorrhages occur in the region of the upper or lower end of the femur, the upper end of the tibia, in the ribs and humerus. At the site of the hemorrhage, the bone beams are destroyed and the integrity of the bone is broken. Clinically, there is swelling in the area of the limb, sharp pain during movement and palpation of the limb, thickening. Sometimes it is possible to palpate fluctuation under the muscles. The skin over the site of the most painful swelling is tense and shiny. The limb is in a forced position. On the skin - small petechiae, the gums swell and become bluish in color, in the presence of teeth there is gingivitis.

On the radiograph, a shadow is found around the diaphysis, which gives a hemorrhage, and sometimes the separation of the epiphysis from the metaphysis. The separation of the epiphysis, in addition, is determined on the radiograph 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.

Scurvy disease with bone lesions occurs with improper and malnutrition, directed artificial feeding. Sometimes children with bone disease due to beriberi C have a "well-fed" appearance; there are no signs of malnutrition, since the children have maintained their body weight, although they receive the same malnutrition.

Diagnosis is difficult when there is still no large hematoma and the child's complaints are vague. During this period, carers of the child note that touching him and shifting causes crying. With the appearance of swelling, sharp local pain, an increase in body temperature, an inflammatory process is suspected - epiphyseal osteomyelitis, phlegmon. An error in diagnosis leads to the fact that an incision is made to the patient, during which only a hemorrhage is detected, and after surgery, the true nature of the disease is revealed.

General treatment of beriberi C, proper nutrition, the creation of rest of the pronounced limb quickly improves the condition of the child.

At inflammatory diseases bone tissue can be destroyed, which leads 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 region 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, this type of fracture is called spontaneous (spontaneous).

Recognition of a pathological fracture in osteomyelitis is not difficult. Often children begin to complain of increased pain in the limb. With complete fractures with displacement, pathological mobility, deformity and shortening of the limb are determined. Often a fracture is discovered by chance, during dressings. Clarifies the diagnosis of X-ray examination.

Pathological fractures in osteomyelitis are sometimes accompanied by exacerbation inflammatory process, with insufficient immobilization, deformities and shortening of the limb occur, in rare cases false joints are formed.

With tuberculous lesions, 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, lumbar region and intensifies when walking, defecation, changing posture.

Thus, the symptoms of pathological fractures of the spine do not differ fundamentally from ordinary fractures. A specific difference is the minimum 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 manipulations, laboratory and instrumental examinations.

MRI equipment

On initial stage the doctor examines 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 will be general analysis blood. According to the data obtained as a result of this analysis, we can conclude what negative process is taking place in the body.

Instrumental diagnosis of pathological fractures includes:

X-ray (determine the location of the fracture, its severity).
Computed tomography and magnetic resonance imaging (allows you to examine the structure of the vertebrae and assess soft tissue damage).
Scintigraphy and contrast myelography (reveals 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 adherence to the pastel regimen, the use of fixing devices and drug therapy. At a fracture cervical use orthopedic Shants collar, with 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 be very delayed 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 of 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 of the spine is aimed primarily at restoring its height with the help of vertebroplasty and kyphoplasty.

For a complicated compression fracture, open operation in order to remove parts of the vertebra that compress the spinal cord and nerve roots, then vertebral segment is fixed with a special metal structure and the vertebral body is filled with bone cement.

The tactics of treating patients with spinal tumors will be somewhat different. With formations of a benign type, complete removal the affected area, in the case of malignant neoplasms, 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.

Given 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 scheduled examinations by a doctor, to comply with certain restrictions on the load.

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;
physiotherapy exercises (LFK);
massage;
balanced diet.

Physiotherapy

They are prescribed from the first days after the injury and are necessary to reduce swelling, reduce pain syndrome, improve microcirculation in tissues. As a rule, in the case of a pathological fracture of the spine, impulse currents, magnetotherapy, electrophoresis, vibrotherapy.

Therapeutic exercise (LFK)

It is performed on the principle of a gradual increase in 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, stimulates the regeneration of damaged tissues.

Massage

It 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 the recommendations of the doctor and complex treatment pathological fracture of the spine without injury spinal cord the prognosis for recovery is favorable. Special attention should focus on treating the disease that provoked this injury in order to avoid relapses and complications.

A pathological fracture is a bone fracture that has occurred from the impact of a slight force or from a physiological load on a bone that has been altered by some pathological previous process. It can be inflammatory, dystrophic, tumor, dysplastic, infectious, etc. processes. The occurrence of pathological fractures mainly falls on the areas of pathological bone remodeling.

How are so-called pathological fractures treated?

To prescribe the right treatment for the patient, specialists conduct a thorough diagnosis of the disease in the patient in a variety of ways. Treatment of pathological bone fractures There are medical and surgical. Medical treatment is the application antibacterial agents and other chemotherapy drugs, vitamin D preparations. Surgical treatment depends on the underlying disease, on its nature, on the prevalence of the pathological process.

In general, the treatment of fractures of this type practically does not differ much from the treatment of ordinary fractures. But, as a rule, with pathological fractures, the periods of immobilization are lengthened. Orthopedic devices are used whenever possible for pathological fractures. special methods. For example, the Shevtsov-Matsukatov apparatus, the Ilizarov apparatus. These devices allow you to keep the patient's capacity even if the consolidation is very slow.

The most important for the treatment of pathological fractures is the identification of the cause of the painful restructuring of the bone, its elimination. For example, when oncological diseases, undoubtedly, the task of getting rid of the tumor comes to the fore (by surgery, with the help of radiation, chemotherapy, or a combination of these methods). In pathological fractures caused by osteomyelitis, antibiotics are prescribed to the patient. Surgery necessary for bone abscess. If the reason this disease osteoporosis needs treatment metabolic disorders tissues (bone) with the help of drugs that improve the microarchitectonics of bones and mineral composition bones.

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

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 localization.

Among various damage 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 backdrop 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 arthroplasty. If the diaphyseal part 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 by internal or external metal structures, and can be used different techniques transosseous osteosynthesis.

With these fractures that occurred against the background of tumor-like lesions and benign tumors it is necessary to adhere to surgical active tactics and carry out bone resection, combining with osteosynthesis in the very first days after the appearance of a fracture, without waiting for the fragments to grow together.

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 can 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 the bone tissue, and during metastasis. Another reason is osteomyelitis - a purulent-necrotic process that occurs both in the bone tissue itself and in the bone marrow, as well as in the surrounding tissues. Osteomyelitis often occurs in children, as well as after arthroplasty, 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, the most common cause is osteoporosis, in which the metabolism of bone tissue is disturbed, which causes a decrease in its density, a change in structure and microarchitectonics, and this, in turn, leads to increased fragility of bones and their tendency to pathological fractures.

Clinical manifestations pathological fracture of the spine

Clinical signs pathological fracture of the spine practically do not differ from the “usual” ones and their only difference is the insignificant force of the traumatic effect 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 the vertebral bodies, incl. and in pathological fractures are often accompanied by damage to the spinal cord and its roots, which leads to the occurrence characteristic symptoms in the form of pain, sensory disturbances, paresis, dysfunction of the pelvic organs.

Diagnosis is confirmed by X-ray 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, in the treatment of such fractures, it is necessary to eliminate or minimize the impact of 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 in strict bed rest and fixation of the affected spine, however, the process of treating such fractures due to changes in the structure of bone tissue due to these slow consolidation of fractures can be quite long, so various orthopedic structures (corsets, collars) are used, which allow to a greater or lesser extent maintain the capacity of the patient.

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 prerequisites for the healing of the fracture and compensating for the lost support function. spinal column. Currently, vertebroplasty is being used more and more actively - the introduction of special bone cement into the vertebral body, which strengthens the vertebral body. Another option for surgical treatment 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 that, the air cavity is filled with cement.

The advantage of kyphoplasty is the ability to correct the deformity of both the vertebra itself and the spinal column as a whole, as well as the possibility of a safer introduction 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 an ordinary fracture in that it is caused by influences that are insignificant in strength - it can 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 leads to 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. In this disease, bone metabolism is disturbed, and the processes of catabolism (destruction) prevail over the processes of bone formation. This disease is hidden for a long time, often it can be diagnosed only after a fracture has occurred.

By origin, primary and secondary osteoporosis is distinguished. The first becomes the result natural processes that take place in the body. They develop after menopause, in old age or due to unknown causes - such osteoporosis is called idiopathic.

Secondary osteoporosis can be caused by:

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

Hyperparathyroidism is a pathology in which the release of a hormone parathyroid glands in excess. 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 an inflammatory site, through the bloodstream, or after a penetrating injury.

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

The occurrence of a pathological fracture

Most often, a pathological fracture is subjected to:

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

As mentioned above, such bone fractures occur as a result of small shock effects, such as a fall from a low height. In some cases, the person who has received such an injury is not even aware of its presence. So, 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 surveys, 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, such as determining the level of calcium and alkaline phosphatase. However, the data of such surveys are non-specific and are used only as additional data.

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 heal conventional fractures faster, however, due to changes in bone structure, recovery times are usually significantly increased.

The fixation method is used in 70% of cases. It involves the imposition of a plaster or polymer bandage that keeps the bone fragments motionless until it is completely fused. At the same time, the fixed muscles remain motionless for a long time, which leads to their atrophy and, as a result, an increased risk of fracture recurrence.
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 operative method involves the combination of bone fragments and their fastening during surgical operation. To fix the fragments, special internal and external fixing structures are used.

Pathological fractures of the spine are treated by fixing the damaged section, while strict adherence to bed rest. Use of special orthopedic structures- corsets and collars - allows you to maintain capacity for slow recovery after injury. In the event that the joint has been damaged, arthroplasty can be performed.

Of great importance is the treatment of the underlying disease, as a result of which a pathological fracture became possible. So, with osteoporosis, it is necessary to take drugs that help restore the normal structure of bones, improve the structure and mineral composition of bone tissue. Osteomyelitis is treated with antibiotics, and if there is a cancerous tumor, 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 diagnose a disease that can lead to such an injury in a timely manner and begin its treatment.

For example, patients with osteoporosis need to take the above-mentioned medicines that 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 contained in them are not absorbed by the body. However, the treatment prescribed by a specialist after examinations and diagnosis will stop or at least slow down the development of this disease.

Problems such as a broken vertebra, wrist, or hip as a result of low bone density can lead to long-term disability and loss of life normal life. Attentive attitude to one's own health and timely prevention will help to avoid these troubles, help to maintain health and good health for many years.