Should internal fixation or treatment be performed first for pathological fractures?

The treatment strategy for pathological fractures should be determined based on the patient's specific condition and underlying cause. Generally, if the fracture is mild, conservative management may be adopted, such as immobilization with braces or casts, combined with medication during the healing period to promote bone union and relieve pain. For more severe fractures or cases with complex etiologies, surgical intervention may be required initially—such as open reduction and internal fixation—to stabilize the fracture and restore normal anatomical structure. When deciding whether to perform internal fixation first or address the underlying cause first, physicians typically consider multiple factors including the patient’s age, overall health, fracture type, etiology, and expected treatment outcomes. In cases where the pathological fracture is caused by tumor compression, tumor resection may need to be performed before fracture fixation and further treatment. Additionally, if the fracture results in severe joint dysfunction, joint replacement surgery might be necessary to restore joint function.