Evaluation of pathological fractures in orthopaedic practice with emphasis on histopathology and anaesthetic challenges: a hospital-based cross-sectional study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i2.2812Keywords:
Pathological fracture, Orthopaedic oncology, Histopathology, Metastatic bone disease, Anaesthesia, Perioperative complications, Bone tumourAbstract
Background
Pathological fractures occur through structurally weakened bone and require coordinated orthopaedic stabilization, histopathological diagnosis, and careful anaesthetic management.
Objectives
To evaluate the clinical profile, histopathological spectrum, orthopaedic management, anaesthetic challenges, and perioperative complications among patients presenting with pathological fractures
Methods
A hospital-based descriptive cross-sectional study included 100 consecutive patients with pathological or impending pathological fractures treated at Government Medical College and Government General Hospital, Rajanna Sircilla, Telangana, India, from November 2025 to April 2026. Clinical characteristics, fracture site, histopathological diagnosis, orthopaedic treatment, anaesthetic technique, anaesthetic challenges, and perioperative complications were collected using a structured proforma and summarized using descriptive statistics.
Results
The mean age was 44.8 ± 17.6 years, and 58.0% of patients were male. Fractures followed trivial trauma in 63.0% of cases, while 21.0% occurred spontaneously and 16.0% were impending fractures. The femur was the most commonly affected bone (48.0%). Malignant lesions accounted for 65.0% of cases, with metastatic carcinoma comprising 38.0% of all diagnoses. Internal fixation was the most common surgical procedure (43.0%). General anaesthesia was used in 52.0% of patients, followed by regional anaesthesia (36.0%). Anaesthetic challenges occurred in 62.0% of patients, mainly preoperative anaemia (34.0%), cardiopulmonary comorbidities (28.0%), anticipated major blood loss (25.0%), and positioning difficulties (22.0%). Perioperative complications were reported in 29.0%, most commonly blood transfusion (18.0%), severe postoperative pain (14.0%), and intraoperative hypotension (12.0%). No intraoperative deaths occurred.
Conclusion
Malignant bone disease, particularly metastatic carcinoma, was the leading cause of pathological fractures. Histopathological confirmation guided definitive management, while the high prevalence of anaesthetic challenges and perioperative complications highlights the importance of multidisciplinary care and individualized perioperative planning.
Recommendations
Early multidisciplinary assessment, timely biopsy, optimization of anaemia, adequate blood product preparation, and structured postoperative analgesia are recommended to improve patient outcomes.
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Copyright (c) 2026 Dr. Kandukuri Arun, Dr. Annam Sadhana, Dr. Radhika Chendragiri
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