Approach to Pathologic Fractures in Children

Amy K. Williams; Alexandre Arkader


Curr Orthop Pract. 2013;24(3):260-266. 

In This Article

Langerhans Cell Histiocytosis (Eosinophilic Granuloma)

Langerhans cell histiocytosis (LCH) is a group of disorders that range from a solitary bone lesion (eosinophilic granuloma) to multisystem and multiorgan involvement, all with the common factor being the presence of a "Langerhans cell" histologically. In patients with an osseous lesion, pain is the first symptom in 50–90% of the patients.[30,31] Long bone lesions are lytic and at times have a destructive appearance, tending to involve both the diaphysis and metaphysis. They are associated with cortical thinning and pathologic fracture.[1,32,33]

A pathologic fracture may lead to spontaneous healing of the lesion. However, due to the variability in its radiographic appearance, biopsy often is warranted for diagnostic confirmation. While solitary lesions can be observed and biopsy may stimulate healing, polyostotic disease is treated with chemotherapy.[1,31,34,35] Though solitary lesions are managed conservatively, patients with apparent solitary lesions need to be evaluated by a pediatric hematologist or oncologist to exclude systemic disease which can be fatal. Arkader et al's.[36] analysis of 79 children with LCH treated over a 30-year period showed that the majority of patients with single-bone involvement could be treated conservatively or with biopsy alone, and patients with multiple-bone involvement were most frequently treated with biopsy in conjunction with chemotherapy.[36]