Biomechanics in Pathological Fractures
In the setting of a benign or malignant lesion the altered physiology and mechanics may lead to pathological fractures. Patient outcome depends on proper diagnosis, staging and treatment of pathological fractures. On conventional X rays or computed tomography scan (CT) images it becomes extremely difficult to assess the clinical fracture risks.
Editorial
In the setting of a benign or malignant lesion the altered physiology and mechanics may lead to pathological fractures. Patient outcome depends on proper diagnosis, staging and treatment of pathological fractures. On conventional X rays or computed tomography scan (CT) images it becomes extremely difficult to assess the clinical fracture risks. Accurate predication can’t be made by experienced clinicians [1].
In common cancer types such as thyroid, kidney, lung, prostate and breast cancer the primary cell tumor cell seeding will occur in bone [2, 3, 4]. Tumor cells invades the fertile environment for seeding in bone marrow of the axial skeleton of long bones, skeletal parts of skull, ribs and spine [3, 5, 6]. The physical status and expected survival of patient with pathological fractures which require complex surgical procedures are weighed by the operating surgeons. Preventive surgery for pathological lesion with an impending fracture is better than surgical treatment of actual pathological fractures which is less complex and is Growth Factors IGF-1 Resistance Exercise Stimulates Formation FGF-2 Eccentric Muscle Contraction Stimulates Formation having better survival rates [3, 6, 7]. The lesions which don’t jeopardize the bone mechanical integrity is treated with standalone or combination of biosphospates, hormonal therapy, chemotherapy, analgesics, radiation therapy conservatively to relive the pain and prevent further seeding of primary cell tumor [8].
Patient-specific finite element (FE) and computed tomography based rigidity analysis (CTRA) are the mechanical models for the fracture risk assessment [9]. These are extensively studied in past two decades. The outcome of the studies is positive and they are now in clinical practice.
We will further focus on bone and muscle metabolic interaction which are interconnected both anatomically and physiologically. Bone and muscle releases secretory factors with paracrine-endocrine cross talk which influence nearby tissues, distant organs, muscle to bone and bone to muscle interaction [10] (Table 1).
As the days advance the latest research in treating the pathological fractures are improving with combination of monoclonal antibodies, targeted immunotherapy etc. for reduction of pathological lesion and prevention in loss of bone density, osteopenia, osteoporosis and mechanical strength. The early diagnosis and proper intervention will reduces the occurrence of pathological fractures which increases the quality of life.
| Matrix Molecules | ||
|---|---|---|
| SPARC | Resistance Exercise | Promotes Mineralisation |
| MMP-2 | Resistance Exercise | Promotes Healing / Remodelling |
| BMP-1 | Blast trauma to Muscle | Procollagen Cleaving / Bone Formation |
| Inflammatory Factors | ||
| IL-6 | Muscle Contraction | Bone Resorption / Turnover |
| IL-7 | Muscle Contraction | Bone Resorption |
| IL-15 | Resistance Exercise | Increase Bone / Decrease Adiposity |
Table 1: Myokines (peptides) secreted by muscle to influence bone, the mechanisms which stimulate release, and the bone metabolis
References
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Gralow JR, Biermann JS, Farooki A, Fornier MN, Gagel RF, et al. (2013) NCCN Task Force Report: Bone Health In Cancer Care. J Natl Compr Canc Netw 11(S3): S1-50.
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Mavrogenis AF, Pala E, Romagnoli C, Romantini M, Calabro T, et al. (2012) Survival analysis of patients with femoral metastases. J Surg Oncol 105: 135-141.
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Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, et al. (2013) Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 22(2): 132-138.
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Van der Linden YM, Dijkstra PD, Kroon HM, Lok JJ, Noordijk EM, et al. (2004) Comparative analysis of risk factors for pathological fracture with femoral metastases. J Bone Jt Surg Br 86(4): 566-573.
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Derikx LC, van Aken JB, Janssen D, Snyers A, Van der Linden YM, et al. (2012) The assessment of the risk of fracture in femora with metastatic lesions: Comparing case-specific finite element analyses with predictions by clinical experts. J Bone Jt Surg Br 94(8): 1135-1142.
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Takeda S, Karsenty G (2001) Central control of bone formation. J Bone Miner Metab 9(3): 195-198.
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