Clinicians should explore potentially sinister causes of the fall, such as syncope, stroke, or myocardial infarction. Classically a fall leads to a painful hip with an associated inability to walk. Most hip fractures can be diagnosed, or at least suspected, from history alone. Arguably many more hip fractures could be described as pathological due to underlying osteoporosis, but this group is rarely labeled in this way. The two most frequent causes in relation to hip fractures are malignancy and bisphosphonate use. A pathological fracture is defined as a fracture caused by a disease process and not related to trauma. These patients are likely to have incurred multiple injuries and should be assessed and managed appropriately as per local trauma guidelines.Īround 5% of hip fractures have no history of trauma, and in these cases, an alternative cause should be suspected. Hip fractures that occur in younger adults are often the result of high-energy trauma. Many patients have multiple risk factors, and this, along with age-associated reduced bone quality, is the underpinning cause of most hip fractures. Risk factors for falls in the elderly population are numerous, but those with a strong independent association are a previous history of falls, gait abnormalities, the use of walking aids, vertigo, Parkinson disease, and antiepileptic medications. Patients with osteolytic spinal metastatic lesions causing pain, greater than 25% occupancy of the vertebral body, and involvement of the vertebral endplate or all 3 columns should be considered for prophylactic or therapeutic decompressive and stabilization surgery.The majority of hip fractures are the result of a fall in the elderly population. These factors should be considered in the decision-making process for surgery for spinal metastases. Vertebral posterior element and costovertebral joint involvement by tumor, primary tumor growth rate, and the presence of visceral metastases were associated with MESCC or nerve root compression. Pain, tumor size within the vertebral body, vertebral endplate and 3-column involvement, primary tumor growth rate, and multiple vertebral metastases were associated with increased risk for pathological fracture. The following items were assessed for association with pathological fracture or MESCC: tumor size, location, type, and morphology disease burden pain and function. Seventy-two patients with spinal metastases underwent decompressive and/or stabilization surgery for pathological fracture and/or MESCC or nerve root compression. Retrospective assessment of clinical and radiological parameters was undertaken in patients with spinal metastases. Therefore, the aim of this study was to identify and evaluate risk factors for pathological fracture and MESCC in patients with spinal metastases. In such cases, earlier surgical intervention has the potential to prevent permanent neurological deficit and disability and to maintain function and quality of life. Vertebral pathological fracture and metastatic epidural spinal cord compression (MESCC) due to metastatic cancer inevitably cause pain, neurological deficit, impaired function, and decreased quality of life and are indications for surgery.
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