Modern treatment of pathological fractures in children

Pathological fractures in children occur from a variety of causes. The clinician has to develop an individual strategy that weighs up the pros and cons of treatment, considering the bone biology and the biomechanics at the fracture site. Determining the lesional pathology is paramount, whether it is in the form of a neoplastic or non-neoplastic entity, so that bone heating can be maximized. Time-efficient protection and reconstruction of the child's musculoskeletal system is the aim of the surgeon's intervention. The whole strategy must be individualized to every situation. Combinations of diseases, fracture sites, and children are many, whereas treatment options are fewer. Options include non-operative management with observation, and intratesional resection with or without bone grafting, and with or without internal fixation. A thoughtful, disciplined, and systematic approach will be successful most often. The goals of treating a child's pathological fracture are all based on establishing a diagnosis. Only after establishing the diagnosis with certainty can a proper treatment strategy be formulated. Fracture management is then based on five points: (a) pain relief and comfort of the child; (b) achieve local control or containment of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture union; and (e) restoration of function. Maintaining perspective will facilitate optimal patient care and minimize the confounding variables that seem to plague the treatment of pathological fractures.