Pathological fracture F102

Current RMA Instruments

Changes from previous Instruments

ICD coding

ICD-10-AM codes: M84.49, T79.1, R57.8, S86.9, T14.20, M84.19, M84.09, T90.2, T91.1, T92.1, T93.1, T93.2

Brief description

Pathological fractures are fractures that occur in bones that have become weakened by an underlying condition or disease. Because the bones are weaker, even normal activities resulting in minor force being applied to the bone can result in fractures. 

Confirming the diagnosis

A combination of clinical evaluation and imaging studies (e.g. X-rays, MRI, CT, and/or bone scans) will usually be required for confirming this diagnosis.

This diagnosis can be established by general practitioners. The advice of orthopaedic surgeons, endocrinologists, oncologists or rheumatologists may also be relevant. 

Additional diagnoses covered by these SOPs

• Acute vascular shock resulting from the fractured bone
• Acute compartment syndrome resulting from the fractured bone
• Fat embolism resulting from the fractured bone
• Fragility fracture
• Insufficiency fracture
• Minimal trauma fracture 
• Secondary fracture
• Spontaneous fracture
• Wound infection as a result of penetration of the skin by bony fracture fragments 

Conditions not covered by these SOPs

• Stress reaction (of bone) # – An imaging finding (from CT, MRI or bone scan) with no cortical disruption and fracture present.  Can be diagnosed as non-SOP if symptomatic (causation is as for stress fracture).  Otherwise not a disease or injury.
• Bone bruise # – Bleeding into and swelling of bone due to acute trauma, but without fracture. 

* another SOP applies

^# non-SOP condition

Clinical onset

Once the fracture has been confirmed, the clinical date of onset can be taken from the date in which the individual first experienced symptoms consistent with the fracture. Note that the clinical onset of the underlying disease is different.

Clinical worsening

Pathological fractures tend to heal poorly and commonly require fixation.  Specialist medical advice is likely to be required if clinical worsening is being considered.