Stop, Think, Stage, Then Act

  • J. J. WilleumierEmail author
  • C. W. P. G. van der Wal
  • R. J. P. van der Wal
  • P. D. S. Dijkstra
  • M. A. J. van de Sande


The treatment of pathologic fractures should be the final stage of a concise pathway including diagnostics, imaging, and survival prediction. If the treatment of a pathologic fracture is rushed, this can lead to severe and needless complications. Several important pitfalls should be avoided:
  • The cause of a pathologic fracture or the origin of a solitary lesion should be known. Without a final diagnosis, a new solitary lesion should always be regarded as primary tumour.

  • One should be cautious of a spontaneous fracture or of a fracture after minimal trauma, since there can be an underlying pathology.

  • It is important to realise that a pathologic fracture does not heal like a traumatic fracture. This must be considered when deciding on the treatment strategy.

  • Pain is not a firm prognostic factor for the risk of an impending fracture. More than one lesion can be present in a bone, so complete imaging is essential.

  • The treatment strategy should depend in great part on the expected survival. The aim of the treatment should be to give the patient a stable limb in a single operation. The extent of the surgery and the implant should thus be in balance with the expected survival, preventing overtreatment and unnecessary complications.

Therefore, it is important to “stop, think, stage, then act”.


Bone metastasis Pathologic fracture Primary bone tumour Diagnostics Biopsy Imaging Survival 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • J. J. Willeumier
    • 1
    Email author
  • C. W. P. G. van der Wal
    • 1
  • R. J. P. van der Wal
    • 1
  • P. D. S. Dijkstra
    • 1
  • M. A. J. van de Sande
    • 1
  1. 1.Department of Orthopaedic SurgeryLeiden University Medical CenterLeidenThe Netherlands

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