Pathologic fractures can be caused by any type of bone tumor, but the overwhelming majority of pathologic fractures in the elderly are secondary to metastatic carcinomas. Multiple myeloma is also common in the elderly and has a high incidence of pathologic fractures. Diagnostic laboratory tests and imaging of multiple myeloma and metastatic tumors allow earlier diagnosis and intervention, which lead to decreased morbidity. Chemotherapy and radiation therapy have improved treatment of metastatic disease, but have a variable effect depending on the tumor type. The goals of surgical treatment of impending or pathologic fracture are to provide pain relief and a functionally stable and durable construct that will allow the patient to ambulate shortly after surgery and will persist for the life of the patient. Fixation of metastatic pathologic fractures requires reinforcement or replacement of the compromised bone with a rigid and durable construct. Rehabilitation and prevention of postoperative complications are imperative. The overall effectiveness of treatment in pathologic fractures is improved with a multidisciplinary approach.
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