Stop, Think, Stage, Then Act

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.