Learning Radiology xray montage

Pathologic Fracture

General Considerations

  • By definition, a fracture that occurs through bone which was previously abnormal
  • Most frequent through a metastatic lesion or multiple myeloma
    • May also involve enchondroma, unicameral bone cysts
  • Suspect when there is an avulsion fracture in an unusual location, spontaneous avulsion of lesser trochanter in adult
  • May occur in osteoblastic as well as osteolytic metastases

Clinical Findings

  • Acute pain without antecedent trauma
  • Soft tissue swelling or mass which may pre-date fracture
  • Most common primary sites are breast, prostate and lung

Imaging Findings

  • Fracture line extending through a destructive lesion in the bone
    • Usually transverse in direction
  • Surrounding bone may demonstrate
    • Endosteal scalloping
    • Cortical destruction
    • Permeative pattern
  • Frequently associated with a soft tissue mass
  • Chondroid or osseous tumor matrix
  • MRI
    • Decreased T1 marrow signal in lesion
    • Soft tissue mass and infiltration of the muscle

Differential Diagnosis

  • On MRI, non-pathologic fracture-related hematoma
  • Insufficiency fractures are seen with osteoporosis, not associated with a visible focal abnormality
  • Fatigue fractures occur with repetitive stress in normal underlying bone


  • If the bone is weight-bearing, such as the femur, intramedullary rodding is frequently used
  • Radiation if lesion is radiosensitive
    • While radiation may help pain, it may also delay osseous healing
  • Cement or bone graft may be used to fill a significant defect

pathologic fracture

Pathologic Fracture of Humerus. There is a permeative, lytic, and destructive lesion (black arrows) in the midshaft of the humerus with endosteal scalloping. There is a transverse pathologic fracture (white arrows) through the lesion.
For this same photo, click

Pathologic Fracture of Femur

Pathologic Fracture of Femur. There is a permeative, lytic, and destructive lesion in the proximal femur with endosteal scalloping. There is a transverse pathologic fracture through the lesion.

For more information, click on the link if you see this icon


Pathologic Fracture. E. David Weinberg, M.D. February 1931 Radiology, 16, 282-287.