(Disclaimer: This article is for general science purposes only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Pathologic fractures occur in the absence of definite trauma due to primary disease invasion of the bone, resulting in a severe deficiency in bone strength. The patient in this case was the one who developed a pathological fracture during the treatment of multiple myeloma, and during the turning process only a click was heard, and the leg became deformed, severely painful, and swollen. The fracture caused the patient exceptional pain. Finally, through fracture incision and internal fixation + bone cement strengthening, the patient regained the ability to walk and continued tumor-related treatment.
[Basic information] Male, 51 years old
Disease Type】Pathological fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Fracture incision and internal fixation + bone cement reinforcement
Treatment Period】Inpatient treatment for 14 days, regular outpatient follow up
Treatment effect】The incision healed well, walking returned to normal, and continued tumor-related treatment.
I. Initial consultation
Patient Mr. Gao found the orthopedic department through consultation in the oncology hospital. After further understanding with the patient and his family, we learned that this is a patient with multiple myeloma who has been receiving anti-tumor treatment and had a fracture during turning over one night. Because of the hematological tumor, the blood clotting function was very poor and the thigh swelling was very strong. The long-term tumor torture made the patient very thin, which was in contrast to the swollen thigh. Through a series of examinations and imaging tests, it was confirmed that the tumor caused pathological fracture. The patient also knew that this kind of fracture was very difficult to treat, but in order to relieve the pain, the patient and the family unanimously requested aggressive surgical treatment.
II. Treatment history
Pathological fracture is different from ordinary fracture, and it is not a simple open surgery. Before the surgery, we prepared enough plasma, platelets and red blood cells for the patient, and also evaluated the function of the patient’s vital organs and consulted with the oncologist about the expected survival time for this tumor. After all preparations were made, the patient was operated on, and the procedure was performed as an incisional internal fixation of the fracture + bone cement strengthening. In other words, the fracture was fixed with an internal fixation plate and reinforced with bone cement.
III. Treatment results
The incision healed well after surgery without infection and necrosis. The incision healed 2 weeks after surgery, and the stitches were removed, and the patient was successfully discharged from the hospital. The stability of the fracture end was restored and the morphology was normalized through the surgery. The patient was discharged with relief of thigh swelling and pain and was able to move on his own. Next, the patient could be transferred back to the oncology department to continue anti-tumor treatment. The patient was basically able to take care of himself, while the quality of life was significantly improved, and the patient was very satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s symptoms have improved after the treatment. Although the surgery is completed, it does not mean the end of the treatment. There are many precautions for the patient in the subsequent treatment.
1. the need for regular review of fracture healing at the fracture end and not to put weight on the ground too early to avoid re-fracture.
2. active screening of other bone conditions throughout the patient’s body to detect other possible metastatic lesions as early as possible to avoid another pathological fracture.
3. Patients should adjust their dietary structure, mainly with high protein and high calories, such as beef, milk, eggs, etc., to enhance their resistance and resistance to disease.
4. In life, pay attention to rest and avoid overexertion; avoid high-intensity exercise and choose relatively calm ways such as walking.
V. Personal insight
Pathological fracture is different from ordinary fracture, because there is local bone lesion, so it is difficult to heal the fracture. For pathological fractures caused by cancer, as in this case, palliative internal fixation surgery is sometimes an option in order to relieve pain and improve the quality of life, which does not require fracture healing or even complete recovery, but to relieve the patient’s pain as much as possible. It is also important to note that the patient will need to be referred to the relevant specialty for continued treatment of the primary disease after the fracture treatment is completed.