Non-Metabolic causes of pathological fractures in Kenyatta national hospital in Kenya: a descriptive prospective study.

Abstract

Background: Pathological fractures pose a major challenge to surgeon since he has to treat both the fracture and the pathology associated with it. This study was aimed at determining the pattern of nonmetabolic causes of pathological fractures in Kenyatta National Hospital.

Methods: Thirty-eight patients with 53 non-metabolic pathological fractures admitted to the orthopaedic wards were recruited into the study during the period of April 2002 and January 2003. Patient’s demographic and clinical data was collected by the lead investigator. Data was collected by the use of a questionnaire designed for the study. The data was analysed using Microsoft excel software.

Results: 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 most common causes of these fractures were malignancy, which constituted 47% of all fractures, followed by infection (31%). Osteomyelitis was the cause of all the paediatric pathological fractures. The lower limb was the most common site of pathological fractures regardless of age (47%) and the spine was second (43%). While patients with spinal fractures presented with the complaints of back pain and difficulty in walking, trivial trauma was the most common complaint of patients with appendicular skeleton fractures.

Conclusion: The most common cause of non metabolic pathological fractures in adults was malignancy and osteomyelitis was the most common cause of pathological fracture in children. While there are some differences in the aetiology of these fractures in Kenya from what is documented in literature, the sites and mode of presentation concur although a significant percentage of patients present late.