Book Review

Diagnosis and Management of Pathologic Fractures

N Engl J Med 1994; 330:227January 20, 1994

Article

Diagnosis and Management of Pathologic Fractures
Edited by Joseph M. Lane and John H. Healey. 176 pp., illustrated. New York, Raven Press, 1993. $110. ISBN: 0-7817-0062-0

Lane and Healey, orthopedists from the Hospital for Special Surgery with world-renowned expertise in orthopedic oncology and the treatment of metabolic bone diseases, have recruited a group of orthopedists, primarily from Cornell University Medical College, to produce this valuable reference. This textbook fills a void in the orthopedic literature that previously has been addressed only piecemeal. The focus is not limited to a particular cause of pathologic fractures, as in other books on osteoporosis and Paget's disease. Nor is it limited primarily to a discussion of the orthopedic surgical treatment of pathologic fractures, as in notable textbooks on metastatic bone disease. Rather, this book describes the primary metabolic and oncologic conditions that can lead to pathologic fractures: osteoporosis, osteogenesis imperfecta, Paget's disease, metastatic bone disease, primary malignant bone neoplasms, and primary benign bone neoplasms.

In focusing on the diseases as potential causes of pathologic fractures, the authors of each chapter include an extensive description of the pathophysiology, clinical presentation and manifestations, and diagnostic features of the underlying disease process, in addition to the principles of treatment. In fact, introductory chapters on the biology of fracture repair, osteoporosis, and metastatic bone disease review basic concepts almost to the exclusion of discussion of pathologic fractures themselves. In keeping with this broad approach, sections on treatment discuss preventive medical and surgical management when appropriate, as well as recommendations about operative and nonoperative orthopedic treatment. When applicable, the sections on treatment are extended to cover considerations in elective surgery and the management of associated nonskeletal problems that are manifestations of the primary disease.

This book's principal strength from an orthopedic point of view is the authors' presentation of only the management options and plans for clinical care with which they have had personal success. Instead of giving a lengthy review of all potential surgical options, the book presents the authors' approach and rationale. Although much of the information presented in the chapter on the treatment of osteoporotic fractures is presented in more comprehensive basic textbooks on orthopedic fractures, this discussion is limited to treatment recommendations for the patient with poor bone stock. Excellent bibliographies, especially those following the chapters dealing with operative management, provide the interested reader with detail to complement the book.

This reference is recommended primarily for orthopedic residents, fellows, and practitioners who seek a basic understanding of the pathophysiology of pathologic fractures and the advice of those with extensive experience from which to draw in the management of these difficult problems.

Franklin H. Sim, M.D.
Mayo Medical School, Rochester, MN 55905