Overview
A pathological fracture occurs when a bone breaks at a site weakened by disease, such as a tumor or metabolic bone disorder 1. In the ankle and foot, these fractures can arise from underlying conditions that compromise bone integrity, leading to instability and pain 1.Diagnosis
Diagnosis is based on clinical presentation and imaging, with suspicion raised by the mechanism of injury relative to the fracture severity 1.
Radiographs are the primary imaging modality 1.
Further investigations may include bone density scans or biopsy to identify underlying pathology 1.Management
Management is guided by the underlying cause of the pathological fracture 1.
Treatment aims to stabilize the fracture, manage pain, and address the underlying pathology 1.
Surgical intervention may be required for stabilization, especially in weight-bearing bones 1.
Pain management strategies are crucial, involving multimodal approaches 1.Key Recommendations
Assess postsurgical opioid use risk preoperatively 1.
Opioid-naïve patients should not start opioids preoperatively unless non-opioid multimodal analgesia fails 1.
If opioids are prescribed at discharge, patients should receive clear instructions 1.References
1 Dillane D, Ramadi A, Nathanail S, Dick BD, Bostick G, Chan K et al.. Elective surgery in ankle and foot disorders-best practices for management of pain: a guideline for clinicians. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2022. link