Pazourek L., Rozkydal, Z. I.orthopaedic dpt., St. Anna Hospital, Medical faculty, Brno Features —Fracture in bone with pathological lesion decresing the stregth of bone — -Without trauma -Minimal violence -Normal traumatic mechanism - Etiology —Metabolic diseases —osteoporosis —osteomalacia, HPT — —Local lesions — bone metastasis, multiple myeloma — benign tumors — malignant tumors — —Congenital anomalies — osteogenesis imperfecta,.. — —Other entities — Paget´s disease of bone, fibrous dysplasia —osteomyelitis —osteonecrosis — — — MichalcoMikuláš58RTG3 MichalcoMikuláš58RTG1 Fr. by opening a bottle • i.m. osteosynthesis Increasing swelling and mass in upper arm X- ray repeated no finding • back pain after 3 months ♂ 53 let Metastasis of carcinoma —After 4 months referred to our clinic — —Exulceration — —Th 12 large osteolytic lesion —Risk o paraplegia — —Metastasis of carcinoma from small — cells MichalcoMikuláš58RTG5 MichalcoMikuláš58CT PřibylRené Fr. by driving a car •AO plate osteosynthesis • •Afterwards increasing mass • •X ray after 3 months OSTEOSARCOMA HIGH-GRADE ♂ 26 let LEIOMYOSARCOMA G3 —Fall on stairs —Supracondylar fr. — —Osteosynthesis with a nail — —Increasing pain and swelling — —After 6 months removal of metal a biopsy —Fracture not healed — —Referred to our clinic PawlusMartin68RTGap PawlusMartin68RTGboč PawlusMartin68MRI1 ♂ 42 let Bone metastases of carcinoma —Breast, prostate, kidney, lung, thyreoid gland — —Assessment of prognosis —Visceral or bone lesions, solitary or multiple lesions —Type of primary tumor, staging —Time of first occurrence —Sensitivity to other treatment —Comorbidities and general condition —Pathological fracture makes always the prognosis worse —Multidisciplinary access — — Mirel´s score points 1 2 3 Localisation Upper extr. Lowe extr. Pertrochant. region Pain low medium big Type Osteoplastic mixed Osteolytic Size <1/3 widht of bone 1/3 – 2/3 widht of bone >2/3 widht of bone ≤ 7 ponts Risk 4% Preventive ORIF no 8 points Risk 15% Indication for ORIF on border ≥ 9 points Risk 33% and more Indication for preventive ORIF D:\META\RTG\Kouřilová47RTG1.jpg D:\META\RTG\Kouřilová47AG1.jpg D:\META\RTG\Kouřilová47AG2.jpg D:\META\RTG\Kouřilová47RTG3.jpg TU-THA optimal solution •Metastasis of clear cells renal carcinoma (angiography with embolisation) D:\META\RTG\Trnčáková47RTG1.jpg D:\META\RTG\Trnčáková47AG11před.jpg D:\META\RTG\Trnčáková47RTG2.jpg •Condition after osteosynthesis for pathological fr. with metastasis of renal tumor, progresion of osteolytic lesion No adjuvant chermotherapy Angiography + embolisation, resection TU THA METASTASIS of thyroid carcinoma spurný Total thyroidectomia 7 years ago, radiotherapy and chemotherapy •X- ray osteosynthesis 2 years ago, no further treatment ♂ 58 let •No further treatment for humeral lesion •No radiotherapy • Disarticulation in shoulder D:\META\RTG\Zimková47RTG7.jpg D:\META\RTG\Zimková47RTG1.jpg D:\META\RTG\Zimková47CT3.jpg D:\META\RTG\Zimková47RTG3.jpg D:\META\RTG\Zimková47RTG4.jpg D:\META\RTG\Zimková47RTG5.jpg D:\META\RTG\Zimková47RTG6.jpg Total femur D:\META\RTG\Zimková47CT4.jpg Metastasis of breast carcinoma, good prognosis Dislocation of TU THA Kresová4x Kresová5x I:\TU - medici\mt\TU TEP rev\1.jpg I:\TU - medici\mt\TU TEP rev\4.jpg Proximal humeru Head prosthesis Reverse total shoulder replacement I:\TU - medici\mt\TU CKP\1.jpg I:\TU - medici\mt\TU CKP\2.jpg I:\TU - medici\mt\TU TEP rev\2.jpg I:\TU - medici\mt\TU TEP rev\3.jpg TU-TKA 83 84 88 94 93 Metastasis in diaphyseal region —Femur and humerus —Types —i.m. nail —Resection + cement a osteosynthesis —Resection + intercalary spacer —Resection + bone graft and osteosynthesis —Radiotherapy in a case of nonradical surgery i.m. nail a b c d e • Tumor in situ • paliative surgery • wrong prognosis •Adjuvant radiotherapy Curretage + osteosynthesis + cement 4 6 1 2 Resection + i.m. nail and cement 2 3 5 6 Diaphyseal spacer 1 2 3 4 6 7 Primary malignant bone tumors —Osteosarcoma, Ewing sa, chondrosarcoma —Pathological fracture —Worse prognosis —High risk of dissemination —Less chance for local control —Amputation ? 11.jpg 13.jpg 12.jpg 14.jpg 15.jpg ♂13 let boy By throwing of a ball High grade osteosarcoma Orthesis chemotherapy Resection bone graft plate 21.jpg 23.jpg 22.jpg ♀73 let, Dediferentiated chondrosa G3 Pathol. fracture Amputation