{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:36:40Z","timestamp":1792039000764,"version":"4.4.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1125","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective:<\/jats:title>\n                  <jats:p>To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign lesions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and materials:<\/jats:title>\n                  <jats:p>Retrospective review of children with suspected bone tumours referred to a specialist musculoskeletal oncology service between September 2019 and August 2020. Data recorded included patient age and gender, lesion location, the presence of a pathological fracture on the initial plain radiograph, and the final diagnosis made either by image-guided biopsy\/curettage or based on typical imaging features.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>231 patients were included with 233 lesions (138 males and 93 females with mean age 10.5 years, range 3\u2009months\u201318 years). Final diagnosis was based on histology in 85 (36.5%) cases and imaging in 148 (63.5%) cases, 52 (22.3%) lesions classed as non-neoplastic, 139 (59.7%) as benign and 42 (18%) as malignant. Pathological fractures were seen in 41 cases (17.6%) at presentation, involving the humerus in 19 (46.3%), the femur in 14 (34.1%), the tibia in 3 (7.3%), the fibula and radius in two each (4.9%) and the second toe proximal phalanx in 1 (2.4%) (p &amp;lt; 0.001). The commonest underlying lesions included simple bone cyst (n = 17; 41.5%) and non-ossifying fibroma (n = 10; 24.4%). Only 4 cases (9.75%) were malignant, one case each of osteosarcoma, Ewing sarcoma, leukaemia and BCOR undifferentiated round cell sarcoma. Pathological fracture occurred in 27.7% of non-malignant lesions and 9.5% of malignant lesions, this difference being statistically significant (p &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p>Pathological fractures were seen in 17.6% of paediatric bone tumours, tumour-like lesions, being significantly associated with humeral location and non-malignant diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge:<\/jats:title>\n                  <jats:p>Demonstrates the frequency, location and underlying diagnosis of pathological fractures in paediatric bone tumour and tumour-like lesions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1259\/bjr.20201341","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T18:06:25Z","timestamp":1627495585000},"source":"Crossref","is-referenced-by-count":17,"title":["Pathological fracture in paediatric bone tumours and tumour-like lesions: A predictor of benign lesions?"],"prefix":"10.1093","volume":"94","author":[{"given":"Boussad","family":"Chaib","sequence":"first","affiliation":[{"name":"Department of General Medicine, Maidstone Hospital , Kent , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Royal National Orthopaedic Hospital , Stanmore , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3876-2150","authenticated-orcid":false,"given":"Michael","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal National Orthopaedic Hospital , Stanmore , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Saifuddin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal National Orthopaedic Hospital , Stanmore , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"2024050215280743800_b1","volume-title":"Imaging in Pediatric Skeletal Trauma: Techniques and Applications [Internet","author":"Davies","year":"2008"},{"key":"2024050215280743800_b2","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1302\/2046-3758.110.2000120","article-title":"Pathological fractures in children","volume":"1","author":"De Mattos","year":"2012","journal-title":"Bone Joint Res"},{"key":"2024050215280743800_b3","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/BCO.0b013e318294bfee","article-title":"Approach to pathologic fractures in children","volume":"24","author":"Williams","year":"2013","journal-title":"Curr Orthop Pract"},{"key":"2024050215280743800_b4","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1148\/rg.2018180073","article-title":"Imaging features and management of stress, atypical, and pathologic fractures","volume":"38","author":"Marshall","year":"2018","journal-title":"Radiographics"},{"issue":"1 Suppl","key":"2024050215280743800_b5","doi-asserted-by":"crossref","first-page":"S149","DOI":"10.1016\/j.otsr.2015.05.010","article-title":"Pathological fractures in children: diagnosis and treatment options","volume":"102","author":"Canavese","year":"2016","journal-title":"Orthop Traumatol Surg Res"},{"key":"2024050215280743800_b6","first-page":"457","article-title":"Fractures through bone cysts: unicameral bone cysts, aneurysmal bone cysts, fibrous cortical defects, and nonossifying fibromas","volume":"51","author":"Dormans","year":"2002","journal-title":"Instr Course Lect"},{"key":"2024050215280743800_b7","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/01.blo.0000155375.88317.6c","article-title":"Pathologic fractures in children","author":"Ortiz","year":"2005","journal-title":"Clin Orthop Relat Res"},{"key":"2024050215280743800_b8","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.injury.2006.07.040","article-title":"Early management of pathological fractures in children","volume":"38","author":"Jackson","year":"2007","journal-title":"Injury"},{"key":"2024050215280743800_b9","unstructured":"Soft Tissue and Bone Tumours\n          \n\u00a0WHO Classifications of Tumours [Internet]. 5th ed. International Agency for Research on Cancer, World Health Organisation, International Academy of Pathology, WHO Classification fo Tumours Editorial Board\n.\n2020\n. 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