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Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
In the application of physical activity, exercise, and rehabilitation, metastatic bone lesions are a commonly encountered and expected issue that must be carefully addressed and understood. In addition to primary bone cancers and metastatic disease, osteoporosis and osteopenia also pose a risk of pathologic fracture. Depending on the therapist’s practice setting, there may be a dearth of information beyond a passing mention of osteoporosis, osteopenia, or metastatic disease. As physician team members are often focused on saving their patient’s life and optimizing medical and emotional quality of life, the same level of information to establish bony stability may not be available as compared to the interest clinicians who administer physical activity. In these cases where there is a concern for bone stability, advocacy for the patient, and facilitating a diagnostic workup is important to comprehensively manage the individual’s physical activity status. If a fall or injury occurred in a high-risk pathologic fracture scenario, it can substantially worsen the remaining quality of life. Conversely, if the pathologic fracture risk is small and the therapist resorts to excessively conservative treatments, their patient may not be able to enjoy an optimal quality of life as their physical status was unnecessarily restricted.
Bone metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Rupert Berkeley, Muaaze Ahmad, Rikin Hargunani
Diagnosis of a metastatic pathological fracture requires radiological demonstration of an underlying focal bone lesion. Plain radiography and CT may identify a focal osteolytic process at the site of fracture. MRI, however, is the most accurate imaging modality in this context and will generally demonstrate focal low T1W and high T2W/STIR signal intensity within the marrow with or without additional supportive findings of cortical disruption, endosteal scalloping, and paraosseous soft tissue mass (Figure 30.15). Marrow signal abnormality associated with traumatic (i.e. non-pathological) fracture is more ill-defined with no underlying bone destruction, mass, or soft tissue component and will demonstrate improvement in appearance over time.
The Breast
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
On the other hand, patients that present with large carcinomas or with carcinomas that may have invaded the pectoral fascia should be treated by a radical mastectomy, i.e., Halsted type. However, if they have undergone a modified radical mastectomy, and the pathology revealed tumor near the fascia, local irradiation is advisable in the hope of preventing local recurrence. Patients who present with locally advanced disease, with or without systemic metastases, may require hygienic mastectomy to control the infection and/or bleeding. If the wound is grossly contaminated, it can be dressed for 4 to 5 days to allow for it to granulate prior to the application of skin graft. Patients with locally and regionally advanced disease are being treated with three courses of chemotherapy, and if these tumors regress, they are then submitted for mastectomy.57 Surgery may play a role in the management of patients with metastatic disease. Emergency decompression of the spine and fusion can save the patient from paralysis. Internal orthopedic fixations for pending or actual pathological fracture can keep the patient functional. The beneficial affect of oophorectomy and/or adrenalectomy or hypophysectomy in patients with metastases has been well recognized and will be further discussed under hormonal manipulation.
“Pathological” fractures in spinal cord injuries and disorders: Insight into International classification of diseases, ninth revision coding
Published in The Journal of Spinal Cord Medicine, 2023
Rachel Elam, James Doan, Frances Weaver, Cara Ray, Scott Miskevics, Beverly Gonzalez, William Obremskey, Laura Carbone
Epidemiological studies of osteoporosis utilizing administrative data in persons with spinal cord injury or disorder (SCID) who sustain lower extremity fractures have also commonly excluded pathological fractures.7–10 Although the rationale for this is often not explicitly stated, the implication is that a pathological fracture is secondary to a localized process (such as malignancy) rather than osteoporosis. However, it is not known whether these fractures are indeed osteoporotic, and therefore should be included, as provider patterns for allocation of ICD-9 diagnosis codes in the setting of osteoporotic fractures in patients with SCID are poorly characterized. We hypothesized that some Veterans with SCID with a diagnosis of a lower extremity pathological fracture identified from administrative databases would have no apparent metastatic cancer to bone or other localized disorder of bone. Moreover, the interpretation of what constitutes a pathological fracture to physicians caring for patients with SCID who sustain a fracture was explored by surveying an expert panel.
Incidence and demographics of giant cell tumor of bone in The Netherlands: First nationwide Pathology Registry Study
Published in Acta Orthopaedica, 2018
Arie J Verschoor, Judith V M G Bovée, Monique J L Mastboom, P D Sander Dijkstra, Michiel A J Van De Sande, Hans Gelderblom
Patients with GCT-B typically present with pain, swelling, and often decreased joint movement. In 5–30% of patients a pathologic fracture is noted (Athanasou et al. 2013, van der Heijden 2014b). Although this tumor rarely metastasizes, it is known to be locally aggressive, which may result in joint destruction and, uncommonly, neurological deficit in axial tumors (Athanasou et al 2013). Treatment options are curettage, curettage with an adjuvant treatment, or resection with joint replacement (van der Heijden 2014a). In GCT-B the local recurrence rate is 6–42% (Balke et al. 2008, van der Heijden 2014b). Recently, denosumab, a human IgG2 monoclonal antibody against RANKL, was registered for use in GCT-B and showed tumor response in 2 phase II studies (Thomas et al. 2010, Chawla et al. 2013).
Economic burden of skeletal-related events in patients with multiple myeloma: analysis of US commercial claims database
Published in Journal of Medical Economics, 2018
Debajyoti Bhowmik, Dionne M. Hines, Michele Intorcia, Rolin L. Wade
SREs were identified by the presence of at least one diagnosis or procedure code indicative of PF, SCC, RAD, or SURG. A hierarchy was used to classify SRE codes that were recorded within a 21-day window. Specifically, if surgery or radiation to bone occurred within 21 days after a pathological fracture, those procedures were assumed to be treatment for the fracture, and the SRE was classified as pathological fracture. Similar logic was used to identify and classify surgical and radiation treatments that occurred within 21 days after a spinal cord compression. Finally, if a pathological fracture occurred within 21 days after a spinal cord compression, the SRE was coded as a spinal cord compression. Outside of this hierarchy, SRE codes that occurred at least 21 days apart were considered separate, distinct SREs7.