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Progressive loss of bone matrix, biopsy, and minor trauma are some of the reasons for the occurrence of a pathological fracture. Pathological fracture can be the presenting feature or it can occur during treatment. There are many reports on osteosarcoma and pathological fracture, most of these reports only dealing with patients without metastases at diagnosis. The incidence of pathological fracture in osteosarcoma is from 5% to 12%. 70% of all osteosarcomas will arise around the knee, but 5-6% arise in the proximal femur. Osteosarcoma is the commonest primary bone sarcoma arising with an incidence of approximately 3 per million population/year. Review of multicentre data may suggest an optimum treatment for this patient group. The high incidence of metastases both at diagnosis and subsequently suggests this group of patients are at very high risk. These results are significantly worse than expected, and it proved impossible to identify any group who fared well. The estimated five-year survival was 14%. Chemotherapy was used when appropriate and eight patients then underwent limb salvage surgery, six had an amputation, and three had palliative treatment. Five patients were referred after internal fixation of the fracture prior to diagnosis. Seven patients had metastatic disease at diagnosis. Twelve patients had a fracture at diagnosis and five developed a fracture after the diagnosis. Their age range was from 9 to 84 (mean age 42) with nine patients under the age of 40 and eight above the age of 40. Scoring systems have been developed to assess the fracture risk of bone metastases, the Mirels classification is the one that has gained the most traction, although its poor sensitivity (35%) means that it is not without its controversy 5.Seventeen patients underwent treatment for a pathological fracture of the proximal femur due to osteosarcoma. In principle, every osteolytic focus in the femoral neck or the spine is at risk of a pathological fracture. Practical pointsĪ radiologist should mention the possibility of a pathological fracture if an osteolytic metastasis is seen. Pathological fractures are feared by oncologists because they may cause immobilization of their patients, especially when the spine or lower extremities are affected. In addition, in adult patients, the avulsion of the femoral lesser trochanter should be considered a pathological fracture until proven otherwise 4. The most common location for pathological fractures are 4: Fragility fractures on the other hand, are acute fractures in osteoporotic patients due to a single event of minimal trauma. Insufficiency fractures are fractures due to multiple minor events causing a cumulative load on weakened osteoporotic bone. Paget disease, osteopetrosis), although the term insufficiency fracture is probably more correct 4. It can be used in the setting of generalized metabolic bone disease (e.g. The term pathological fracture is usually reserved for tumors, either benign or malignant, although it has been used in the setting of osteomyelitis.