Pediatric Pathologic Fracture

  • Etiology:
    — Fracture that occurs through abnormal bone which occurs spontaneously or after minor trauma
    — Can be caused by benign or malignant lesions
  • Imaging Radiograph: Besides the fracture an underlying benign or malignant bone tumor is seen
  • DDX: Insufficiency fracture in patient with generalized metabolic bone disease such as osteopetrosis or osteoporosis
  • Complications: Fracture non union
  • Treatment: Treat underlying bone tumor along with fracture
  • Clinical:

Radiology Cases of Pathologic Fracture

Radiology Cases of Pathologic Fracture Through Fibrous Cortical Defect

Radiograph of a pathologic fracture through a fibrous cortical defect
AP and lateral radiographs of the distal femur show a thin linear lucency running obliquely through a large, lucent, well corticated lesion in the femoral metaphysis.

Radiology Cases of Pathologic Fracture Through Unicameral Bone Cyst

Radiograph and CT and MRI of unicameral bone cyst of the femur
AP radiograph of the hip (upper left) shows a metaphyseal lesion that is expansile and lytic in appearance with a narrow zone of transition and no periosteal reaction. There is a transversely oriented linear density within it representing a fallen fragment sign. Coronal CT without contrast of the hip (upper right) better shows the cystic nature of the lesion and the fallen fragment. Coronal (left lower) T2 MRI without contrast of the hip shows the cystic nature of the lesion and axial T2 MRI (right lower) shows fluid / fluid levels within the lesion due to hemorrhage.
Radiograph of pathologic fracture through a unicameral bone cyst
AP (above) and frog-leg (below) radiographs of the hips shows an intramedullary lesion in the left hip metaphysis with multiple locules and without periosteal new bone. A lucent defect is seen along its medial cortical surface on both views.