Non metabolic causes of pathological fractures in Kenyatta National Hospital

Abstract

This was a prospective study over a period of 10 months from the month of April 2002 to January 2003. The purpose of the study was to determine the pattern of non metabolic causes of pathological fractures in Kenyatta National Hospital. The study assessed the causes, sites, presentation and management of non metabolic causes of pathological fractures at the hospital. Methodology: Patients with non metabolic causes of pathological fractures admitted to the orthopaedic wards were recruited into the study. Demographic data, data on the cause of the fracture, site of the fracture, presentation and management of the patient was collected. This data was analysed and presented in tables, charts and graphs. Results: Thirty eight patients with 53 fractures were recruited into the study. The age range was between 1 to 74 years with a peak age in the sixth decade, the male to female ratio was 1:1. The prevalence of non metabolic pathological fractures among patients with fractures was 2.62%. Te most common causes of these fractures were malignant causes which formed 47% of the fractures followed by infection with 31% of the fractures. Osteomyelitis formed 100% of all the peadiatric pathological fractures. The lower limb was the most common site of pathological fractures in which 47% of these fractures were located followed by the spine with 43%. Patients with spinal fractures presented with two main complaints, that of back pain and difficulty in walking. Trivial trauma was the most common complaint of patients with appendicular skeleton fractures, found in 45% of these patients. The management of these fractures was mainly conservative. Conclusions: While there are some differences in the causes of these fractures from what is documented in literature, the sites and presentations concur. The most common cause of non metabolic pathological fractures was malignancy and osteomyelitis was established as the most common cause of pathological fracture in children. Recommendations: Studies should be carried out to assess the management outcomes of the individual causes of pathological fractures especially those due to malignancy and osteomyelitis. Another study should also be carried out on all the causes of pathological fractures including metabolic bone disease in order to establish the complete picture of these fractures.