Pathologic Versus Impending Fracture

  • Maria Silvia Spinelli
  • Andrea Piccioli


The constant improvement of medical therapies has led to the longer survival of patients affected by carcinoma and a consequent increase in the number of patients with bone metastasis. In the natural history of bone metastatic patients they Skeletal Related Events (SREs) are likely to occur. SREs are: pathologic fracture of the long bones, the need of surgical procedures on the bone, spinal compression, and radiotherapy on the bone. SREs have a well-documented negative impact on clinical outcomes and on pain, reduce the quality of life and survival, and increase morbidity. The most frequent complication among SREs is the pathological fracture, which is defined as a fracture that occurs spontaneously or with a low-energy trauma in the site of a preexisting bone lesion. For the patient with bone metastasis, a pathological fracture is always a dramatic event and should be considered a matter of urgency in the orthopedic treatment of these patients. The aim of a high quality of care is to prevent a pathologic fracture; given that the bone lesions are known, these should be treated before the bone fractures with a preventive osteosynthesis. This imminent risk of fracture that may occur in daily activities is a specific diagnosis and is given the name impending fracture.The aim of this chapter is to focus on different aspects of pathologic and impending fracture, including diagnostic and clinical aspects, the impact on survival and on health resource utilization.


Pathologic fracture Impending fracture Bone metastasis Survival estimation Economic burden 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Maria Silvia Spinelli
    • 1
  • Andrea Piccioli
    • 2
  1. 1.Traumatology and Orthopaedic Unit“Fatebenefratelli - Isola Tiberina” HospitalRomeItaly
  2. 2.General Direction of Health ProgramItalian Ministry of HealthRomeItaly

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