Long Bone Fractures Research Articles

The influence of mini-fragment plates on the mechanical properties of long-bone plate fixation.

Objective:Mini-fragment plates (MFPs) are increasingly used in fracture surgery to provide provisional fixation. After definitive fixation, the surgeon decides whether to remove the plates or leave them in place as additional fixation, based on the perceived biomechanical influence of the MFP. However, there are no current biomechanical studies to guide this decision. Therefore, the purpose of this study was to evaluate the influence of MFPs on the four-point bending and torsional stiffness of long bone transverse and simple wedge fracture fixation constructs.Methods:Fourth-generation composite bone cylinders were cut to produce transverse (AO-OTA classification 12-A3) and simple wedge (AO-OTA classification 12-B2) fracture models. The specimens were fixed using a low-contact dynamic compression plate (LC-DCP) and MFPs. Specimens were tested in four-point bending and torsion utilizing 3 different MFP orientations.Results:No statistically significant differences in bending stiffness were found between control and MFP groups for transverse fracture constructs. MFPs significantly increased the bending stiffness for wedge fracture constructs under certain loading conditions. This increase was observed when MFPs were positioned both orthogonal (85.1% increase, P = .034) and opposite (848.2% increase, P < .001) to the LC-DCP. MFPs significantly increased the torsional stiffness for both transverse and wedge fracture constructs when MFPs were positioned both orthogonal (transverse: 27.7% increase, wedge: 16.7% increase) and opposite (transverse: 28.4%, wedge: 24.2% increase) to the LC-DCP.Conclusions:Our results indicate that including MFPs in definitive fixation can increase the bending and torsional stiffness of a long-bone fracture fixation construct. This suggests that the biomechanical influence of MFPs should be considered. However, clinical studies will be required to test the applicability of these findings to the clinical setting.

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis.

Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel-Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.

VEGF mediates fat embolism-induced acute lung injury via VEGF receptor 2 and the MAPK cascade

Fat embolism (FE) is a lethal medical emergency often caused by fracture of long bones and amputation of limbs. Vascular endothelial growth factor (VEGF) promotes angiogenesis and increases vascular permeability. We tested the hypothesis that VEGF plays a critical role in FE-induced acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). Fat tissues were collected from male Sprague-Dawley rats, and animal oil was extracted and mixed with water to form fatty micelles. The micelles were then injected into the tail vein to produce FE and ALI in rats. Lung weight gain was measured as the index of pulmonary edema. The expression of pulmonary VEGF was evaluated by real-time PCR and western blot analysis. Inducible nitric oxide synthase (iNOS) and phosphorylation of mitogen-activated protein kinase (MAPK) were determined by western blot analyses. Interleukin-1β (IL-1β) was quantified by ELISAs. Hematoxylin and eosin staining was used to evaluate the pathological damage of ALI. In this study, we found that animal oil-induced FE significantly increased pulmonary VEGF expression and MAPK phosphorylation. We also evaluated the inflammatory response after FE and found that iNOS and IL-1β significantly increased after FE. Systemic administration of SU-1498, an antagonist of VEGF receptor 2 (VEGFR-2), significantly attenuated the FE-induced inflammatory response and histological damage. This study suggested that VEGF is involved in FE-induced ARDS via the VEGFR-2 and MAPK cascades, which induce IL-1β release and iNOS upregulation. Blockade of could be used to treat FE-induced pulmonary damage.

Racial and Ethnic Differences in the Management of Pain Among Children Diagnosed with Long Bone Fractures in Pediatric Emergency Departments

Purpose: Racial/ethnic disparities in the management of pain among children in the emergency department (ED) setting have been previously documented. Because long bone fractures are commonly managed in the ED setting, we performed this multi-institutional study to test the hypotheses that minority children (non-Hispanic [NH] black, Hispanic, Other) with long bone fractures are 1) less likely to receive analgesics, 2) less likely to receive opioids, and 3) less likely to achieve pain reduction than NH white children. Methods: We performed a retrospective …

Evaluation of Long Bone Fractures in Infants for Non-Accidental Trauma: An Analysis of Physician Assessment and Documentation at a Tertiary Care Medical Center

Background: Fractures are the second most common infant and toddler injury resulting from child abuse. Yet fractures are not always evaluated for possible non-accidental trauma often due to the lack of recognition and incomplete work-up by the evaluating physician. When non-accidental injuries are missed it can result in more serious or fatal injury. In this study, we aim to determine how well a tertiary center follows the clinical guidelines in evaluating infants with long bone fractures established by the American Academy of Pediatrics (AAP). …

Results of Rodding and Impact on Ambulation and Refracture in Osteogenesis Imperfecta: Study of 21 Children

Introduction:Delay in presentation and surgical intervention is quite usual in osteogenesis imperfecta (OI) because of various local and cultural beliefs. The purpose of this study is to review the results of 21 children who had intramedullary rodding and its effect on ambulation and refracture.Methods:We reviewed 21 children with a clinical diagnosis of OI. The mean age of children at presentation was 8.74 years (3–21 years). All children had recurrent fractures of long bones. Twenty eight femurs and 21 tibiae were stabilized with intramedullary rodding. Ambulatory status was assessed by the Hoffers and Bullock's (H and B) grading, and muscle power was recorded using the Medical Research Council, U. K., grade. Ten children had received intravenous bisphosphonates preoperatively. Postoperatively, the children were assessed for ambulatory status, pain, and ability for independent self-care.Results:The mean followup period was 34 months (24–48 months). Rush rods were used in 20 femurs, the Fassier–Duval (FD) rods in 6 femurs, and in two cases, with narrow intramedullary canals, Kirshner (K) wires were used. For the tibiae, 15 children received rush rods and in 6 cases, an FD rod was used. The mean time to fracture union was 8 weeks (6–12 weeks). Before surgery, 13 children were in H and B Grade 4 (wheel-chair independent or carried by parents usually in a developing country), four were able to ambulate with a walking aid (H and B Grade 3b), and four children were able to walk about in the house without aids (H & B Grade 2). After the rodding procedure, the ambulatoty status improved in 11 (50%) children. Seven children (33%) became household physiologic walkers (H & B Grade 3b), three achieved independent ambulation with orthosis (H & B Grade 1b), and one child with mild OI could walk unaided (H & B Grade 1a). No child had deterioration in ambulatory status. Only two children had refractures at the distal end of the rod due to continual growth of bones.Conclusions:Intramedullary rodding treatment for recurrent fractures in children with OI improves their mobility potential. It also and prevents repeated cast application, disuse wasting, and osteopenia which can lead to deterioration in the quality of the long bones.

Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste’s national referral hospital

ObjectivesOur objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving...

Osteogenesis Imperfecta: Skeletal Outcomes After Bisphosphonate Discontinuation at Final Height.

Intravenous cyclical bisphosphonates are widely used to treat children with moderate to severe osteogenesis imperfecta (OI). Bisphosphonates are often discontinued when growth is completed, but subsequent skeletal changes have not been studied in detail. We assessed 31 patients (22 females) with OI who had started intravenous bisphosphonates (either pamidronate or zoledronic acid) before 13 years of age, were treated for at least 2 years (range 4.7-15.7 years), and discontinued treatment after completion of growth, when their age ranged from 13.4 to 20.0 years (mean 16.4 years). At 4 years after treatment discontinuation, lumbar spine areal bone mineral density (BMD) had increased by 4% (p < 0.05). Peripheral quantitative computed tomography of the radius showed a decrease in trabecular volumetric BMD at the distal metaphysis of 19% but an increase in cortical volumetric BMD of 4% (p < 0.05 for both). None of the patients sustained a new vertebral compression fracture during follow-up. The proportion of patients with new long-bone fractures was higher in the 2 years before treatment discontinuation than in the last 2 years of follow-up (42% and 16%, respectively; p < 0.05). © 2019 American Society for Bone and Mineral Research.

Two cases of fractures in neonates associated with maternofetal vitamin D deficiency

Vitamin D supplementation is essential for the entire population, especially during pregnancy and in the pediatric period. We report two case studies of full-term newborns who presented long-bone fractures associated with severe vitamin D deficiency transmitted to them by their mothers, even though maternal supplementation had been implemented according to the existing recommendations. These observations encourage the investigation of neonatal vitamin D deficiency in the presence of long-bone fractures in the absence of traumatic birth and the necessity of reenforcing the means of prevention and the selection of risk groups in order to adjust vitamin D supplementation during pregnancy individually.

Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures.

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855). Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

A novel phase field method for modeling the fracture of long bones.

A proximal humerus fracture is an injury to the shoulder joint that necessitates medical attention. While it is one of the most common fracture injuries impacting the elder community and those who suffer from traumatic falls or forceful collisions, there are almost no validated computational methods that can accurately model these fractures. This could be due to the complex, inhomogeneous bone microstructure, complex geometries, and the limitations of current fracture mechanics methods. In this paper, we develop a novel phase field method to investigate the proximal humerus fracture. To model the fracture in the inhomogeneous domain, we propose a power-law relationship between bone mineral density and critical energy release rate. The method is validated by an in vitro experiment, in which a human humerus is constrained on both ends while subjected to compressive loads on its head, in the longitudinal direction, that lead to fracture at the anatomical neck. CT scans are employed to acquire the bone geometry and material parameters, from which detailed finite element meshes with inhomogeneous Young modulus distributions are generated. The numerical method, implemented in a high performance computing environment, is used to quantitatively predict the complex 3D brittle fracture of the bone and is shown to be in good agreement with experimental observations. Furthermore, our findings show that the damage is initiated in the trabecular bone-head and propagates outward towards the bone cortex. We conclude that the proposed phase field method is a promising approach to model bone fracture.

Comparative occurrence pattern of fractures in cattle and buffaloes

Background and Aim:Dairy animals play an important role in the Indian economy. Knowledge of the occurrence pattern of long bone fractures in bovine may help in strategizing the possibilities of treatment and prognosis. This study aimed to find out the comparative occurrence pattern of fractures in cattle and buffaloes.Materials and Methods:A total of 278 fractures of bovine (171 in cattle and 107 in buffaloes), presented to the Department of Veterinary Surgery and Radiology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India, during a study of 1 year, were investigated for the occurrence pattern, in relation to species, age, body weight, gender, bone involved, type of fracture (closed or open), and the presentation of bovine as standing or in recumbent state.Results:The overall hospital occurrence of fractures in bovine was 4.24% and most of the fractures resulted from slipping and falling on hard floor. Of 278 fractures, the majority (90.28%) involved long bones (n=251; 103 buffaloes and 148 cattle). Forelimb fractures were recorded more common in buffaloes (64.08%), whereas the cattle suffered more of hind limb fractures (60.23%). Cattle also included 11 cases of bilateral fractures of metacarpal (n=3), tibia (n=1), radius and ulna (n=1), and mandible (n=6). Fracture of olecranon constituted 6.83% (n=19) and majority (n=15) were in buffaloes. The cattle had higher percent of open fractures (54.38%) as compared to that in buffaloes (17.76%). Marginally higher percentage of cattle (33.33%) suffering from fracture were recumbent as compared to buffaloes (23.36%) and femur fractures were found to be a leading cause of recumbency (100% in cattle and 75.00% in buffaloes).Conclusion:Species-specific differences in the occurrence pattern of fractures exist among cattle and buffaloes. Cattle are found to be more susceptible (1.5 times) to fractures as compared to buffaloes. The buffaloes are vulnerable to forelimb fractures while the cattle to the hind limb. As compared to forelimb, long bone fractures of hind limb are more commonly associated with recumbency in bovine. Cattle are more prone to mandible fractures and the open fractures of long bones as compared to buffaloes.

A study of functional outcome of humeral diaphyseal fractures treated with dynamic compression plate

Fractures of the humerus comprise approximately 5% to 8% of all extremity fractures, and shaft fractures account for approximately 3% of all long-bone fractures. Majority of humerus shaft fracture can be treated with conservative management but nowadays surgical indications in humerus fracture are increasingly being adopted. In this study 20 patients of humerus shaft fractures has been rated with 4.5 dynamic compression plate with posterior approach in SSG Hospital Baroda. After one year follow up 19 patients out of 20 having good functional result.

Orthopedic injuries in patients with multiple injuries: Results of the 11th trauma update international consensus conference Milan, December 11, 2017.

In blunt trauma, orthopedic injuries are often associated with cerebral and torso injuries. The optimal timing for definitive care is a concern. The aim of the study was to develop evidence-based guidelines for damage-control orthopedic (DCO) and early total care (ETC) of pelvic and long-bone fractures, closed or open, and mangled extremities in adult trauma patients with and without associated injuries. The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held. The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb. Orthopedic priorities may be: to save a life: control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: treat dislocations, articular fractures, distal fractures. While DCO is the best initial treatment to reduce surgical load, ETC should be applied in stable or stabilized patients to accelerate the recovery of normal functions. Systematic review of predominantly level II studies, level II.

Neutral Sphingomyelinase 2 (SMPD3) Deficiency in Mice Causes Chondrodysplasia with Unimpaired Skeletal Mineralization

SMPD3 deficiency in the neutral sphingomyelinase (Smpd3-/-) mouse results in a novel form of juvenile dwarfism, suggesting smpd3 is a polygenetic determinant of body height. SMPD3 controls homeostasis of the sphingomyelin cycle in the Golgi compartment, essential for membrane remodeling, initiating multiform vesicle formation and transport in the Golgi secretory pathway. Using the unbiased Smpd3-/- genetic model, this study shows that the perturbed Golgi secretory pathway of chondrocytes of the epiphyseal growth zone leads to dysproteostasis, skeletal growth inhibition, malformation, and chondrodysplasia, but showed unimpaired mineralization in primary and secondary enchondral ossification centers. This has been elaborated by biochemical analyses and immunohistochemistry of long bones of Smpd3-/- mice. A more precise definition of the microarchitecture and three-dimensional structure of the bone was shown by peripheral quantitative computed tomography, high-resolution microcomputed tomography, and less precisely by dual-energy X-ray absorptiometry for osteodensitometry. Ablation of the Smpd3 locus as part of a 980-kb deletion on chromosome 8 in the fro/fro mutant, generated by chemical mutagenesis, is held responsible for skeletal hypomineralization, osteoporosis, and multiple fractures of long bones, which are hallmarks of human osteogenesis imperfecta. The phenotype of the genetically unbiased Smpd3-/- mouse, described here, precludes the proposed role of Smpd3 as a candidate gene of human osteogenesis imperfecta, but suggests SMPD3deficiency as the pathogenetic basis of a novel form of chondrodysplasia.

Метаболические нарушения костной ткани у пациентов с переломами длинных костей, осложнённых хроническим остеомиелитом

Introduction The article deals with a topic of how disorders of bone tissue metabolism affect the treatment outcomes after fractures of long bones complicated by chronic osteomyelitis. Purpose To study the feasibility of therapy aimed at correcting metabolic disorders in the bone tissue in patients with long bone fractures complicated by chronic osteomyelitis. Materials and methods Assessment of bone metabolic disorders in fractures of long bones complicated by chronic osteomyelitis, and of the effectiveness of treatment involving a combined therapy including surgical, antibacterial and anti-inflammatory treatment, and also a drug correction of the metabolic disorders detected. A retrospective study was conducted with stratified randomization of comparison groups. Results Changes in bone remodeling that are specific to this group of patients with increased resorption intensity were identified. In addition, high frequency of secondary hyperparathyroidism and metabolic disorders of the D hormone was observed in the patients with this pathology. The effectiveness of a combination of drugs for the correction of bone tissue metabolism disorders (calcium supplements, osseinhydroxyapatite complex, active metabolite of vitamin D and bisphosphonate) was evaluated by comparing the terms of consolidation. Conclusion Evidence was obtained of a significant reduction in the duration of treatment in the external fixation device by using the combined therapy aimed at correcting bone tissue metabolism.

Effect of fluoride coating on degradation behaviour of unidirectional Mg/PLA biodegradable composite for load-bearing bone implant application

Biodegradable composites of unidirectionally reinforced 50-Mg/PLA (50% Mg wire by volume) were investigated to replace conventional non-degradable metallic implants for fixing long-bone fractures. This study presents the advantages of fluoride-coated magnesium alloy AZ31 wires in unidirectionally reinforced Mg/PLA biodegradable composites. The samples were also evaluated for degradation over a duration of 56 days by immersion in phosphate buffered saline solution at the human body temperature of 37 °C; variations in wet mass, dry mass, and pH were used as the indicators for degradation. The 50-C-Mg/PLA composite (with coated wires) suppressed mass loss, controlled the pH, and promoted the deposition of Ca and P compounds. Further, the retention of tensile and flexural properties significantly improved for the immersion period as the interface was better protected by the coating. The results indicate that the 50-C-Mg/PLA composite has good potential as a biodegradable implant for load-bearing bone fractures.

An important marker explained

The “classic metaphyseal lesion,” a unique corner fracture of long bones, has long been considered a specific marker of child abuse. Although a few paid defendant “experts” have attempted to challenge this concept, it has continued to be accepted by child abuse specialists. A useful series of classic metaphyseal lesions, collected from a group in Paris, has provided helpful new information on these fractures. These investigators studied 67 children with these lesions, accumulated over several years. They focused on children in whom there had been a confession by a perpetrator. The confessions described the types of forces generating the injury, as well as the typical situations in which they occurred (eg, diapering, dressing). Interestingly, classic metaphyseal lesions of the shoulder were associated with subdural hematomas, a plausible but previously unreported association. This study strengthens and adds to our understanding of these important markers of abuse. Article page 154▶ Classic Metaphyseal Lesions among Victims of AbuseThe Journal of PediatricsVol. 209PreviewTo use legal statements by perpetrators to gain new insights into the causative mechanism of classic metaphyseal lesion (CML). The CML, so called “corner fracture,” is considered a highly specific marker for abuse in infants. However, the precise correlation between CMLs and abusive head trauma is still unknown. Full-Text PDF

Identifying a Niche: Development of the Orthopedic Radiation Oncology Clinic

The Orthopedic Radiation Oncology Clinic (OROC) was recently developed to identify patients at risk of pathologic fracture of weight bearing long bones, to provide education to patients and staff regarding fracture risk and weight bearing restrictions, to provide rapid access for radiation therapy services, to provide timely access for orthopedic surgical interventions and to provide follow-up services for patients with Metastatic Bone Disease (MBD). At our institution, prior to the development of the OROC clinic, on-call orthopedic evaluation was utilized to determine a patient’s pending fracture risk as identified in the radiographic report. The use of orthotic devices was limited to spinal braces and Radiation Oncology follow-up care and rehabilitation services was minimal and inconsistent. As orthopedic surgical intervention reduces pain, preserves function, minimizes fracture risk and improves quality of life, the OROC clinic was developed as an interdisciplinary assessment for patients with MBD to the appendicular skeleton. It is facilitated by an Orthopedic Oncology Surgeon, a Radiation Oncologist and a Clinical Specialist Radiation Therapist (CSRT) and operates weekly. The CSRT is the liaison and primary contact for referring physicians and specialists. Within the OROC clinic, the responsibilities of the CSRT are to triage referrals, identify diagnostic imaging required for patient fracture risk assessment, coordinate rapid access radiation therapy, patient navigation including assessment and education. From April to July 2018, a retrospective quality assurance chart review from the OROC clinic was completed. Information regarding fracture risk category and interventions including referrals, orthotic devices and patient education material were collected. 29 patient consultations and 9 follow-up visits occurred. 11/29 (38%) patients were identified as high risk of pathologic fracture and received restricted weight bearing instructions. 5/29 (17%) were offered prophylactic orthopedic intervention. 20/29 (69%) received palliative radiation therapy. 4/29 (14%) were referred for prosthetic and orthotic devices and 3/29 (10%) were referred for physiotherapy services. Preliminary data supports the interdisciplinary OROC objective of providing rapid access to centralized coordinated care in an effort to improve patient education, time to treatment, provide follow-up and rehabilitation services. Future partnership with a community based rehabilitation program will ensure consistency of post treatment care for patients with skeletal related events of the appendicular skeleton. Further research is required to measure outcomes in addition to establishing best practices for patients with MBD of the appendicular skeleton.

Photodynamic intramedullary bone stabilization of pathological fractures

Pathological fractures of long tubular bones are stabilized with conventional implants. Essentially, plates and intramedullary nails are used for stabilization and are two different techniques, which compete with each other with respect to the surgical treatment. A large number of such means of osteosynthesis are commercially available but are primarily focused on acute fractures in otherwise biologically healthy bones. The pathological fracture or the treatment of impending pathological fractures due to metastatic osteolysis differs from the treatment of healthy bones in some fundamental aspects. The characteristics of pathological fractures make the development of new technologies that meet the specific needs of both the patient and the surgeon desirable. Anew approach in treatment is stabilization of internal long bone fractures by the use of acylindrical balloon implant, which is introduced into the bone via asmall proximal or distal hole and then filled and expanded to amuch larger diameter with aliquid monomer. The curing process is initiated with the application of blue light forming arigid implant by polymerization (IlluminOss™). Many of the well-known disadvantages of conventional implants can be eliminated with this technology. Specifically, with respect to the irregular shape of the natural medullary canal it is possible to completely fill the medullary canal of the tubular bone. The filling of the canal provides torsional stability without the use of interlocking screws. Similarly, the use of the balloon technique enables minimally invasive surgery and furthermore permits the additive use of conventional metallic plates whenever necessary. The new balloon techniques show high primary stability in the treatment of pathological shaft fractures. In particular cases, the addition of asupplemental plate osteosynthesis is recommended.