(Disclaimer: This article is for general science purposes only, and the information in the following content has been processed to protect patient privacy)
Abstract: Pathological fractures differ from general traumatic fractures in that they can produce local fractures under minor external forces, which are associated with weakened bone structure and bone strength, and malignancy is a relatively common cause of pathological fractures. This patient had multiple myeloma, which caused pathological fracture of the pubic bone and produced local clinical symptoms. To relieve symptoms and prolong survival, comprehensive conservative treatment was used, and the patient’s symptoms were gradually relieved after chemotherapy.
[Basic information] Male, 65 years old
Disease Type】Pathological fracture
Hospital】Harbin First Hospital
Date of consultation】04/2021
Treatment plan】Conservative treatment (melphalan tablets, prednisone acetate tablets, pamidronate disodium injection)
Treatment period】2 weeks of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] Pain relief, resumption of activities
I. Initial consultation
The patient described that he felt pain in the perineal area with a mass, and the pain was more significant at night, and the pain was aggravated by slight external force. Therefore, after communicating with the patient and his family, the patient and his family agreed to be admitted to the hospital for comprehensive conservative treatment.
II. Treatment process
After the patient was admitted to the hospital, chemotherapeutic drugs such as melphalan tablets and prednisone acetate tablets were given orally to shrink the tumor lesion and improve the pain symptoms caused by tumor occupancy at the site of pathological fracture, and pamidronate disodium injection was given intravenously to inhibit the effect of osteoclasts and enhance bone formation to reduce pain at the site of pathological fracture. In addition, low-dose radiotherapy was taken as an adjunct to relieve the pathological fracture pain. In addition, because of the toxic side effects of chemotherapy drugs, I observed the patient’s basic condition during the drug administration. At the same time, the patient was asked to rest at home in bed for 6 weeks, avoiding local weight-bearing activities and pelvic pocket fixation to reduce the stimulation of the fracture end.
III. Treatment effect
After conservative treatment, the patient’s pelvic pain symptoms were improved and the local mass was reduced in size, and the patient was able to turn in bed on his own and even sit up to eat. After one month of outpatient review, the patient’s clinical symptoms were reasonably controlled and he could resume normal weight-bearing walking. However, the walking time and distance are still limited to a certain extent, and the patient is unable to participate in more than light exercises, such as walking too much or participating in moderate level exercises, such as running, which may induce local pain.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the bone strength is still relatively weak because the local fracture has not fully recovered. After discharge from the hospital, the patient should avoid local trauma in daily life, and also strengthen nutrition such as increasing milk intake appropriately, and actively treat the primary tumor to slow down the tumor progression so as to avoid the reoccurrence of local pathological fracture. If patients have symptoms of sudden local swelling, pain and restricted activity, they should follow up with orthopedic clinic in time to confirm whether there is a recurrence of pathological fracture, take CT to observe the bone quality, and if there is pathological fracture caused by tumor, they should be treated in time and limit weight-bearing walking, otherwise it may damage important structures such as bladder and urethra.
V. Personal insight
The occurrence of malignant tumor in patients with pelvic involvement leading to pathological fracture is a common phenomenon in the middle and late stages of tumor. Patients should not lose their confidence in treatment and cooperate with clinicians to complete the treatment process. Patients can improve their health by strengthening nutrition, ensuring sufficient rest and appropriate exercise, which can often improve the quality of survival and prolong the survival time, and even have the hope of complete cure.