The frequently used terminology “pathological fracture” can lead to an inappropriate interpretation, since the fracture itself is not pathological, but rather the bone, which can present various structural, metabolic, dysplastic changes, among others. Therefore, it is more appropriate to discuss fractures that occur in children with pre-existing bone changes.

The breadth of this topic requires a delimitation of the topics to be covered. Fractures in children resulting from infectious processes or metabolic disorders, such as rickets and osteopsatirosis, will not be discussed here. Our focus will be on stress fractures, differential diagnosis and fractures resulting from pre-existing tumor or pseudo-tumor bone lesions.

Among the most common benign tumor lesions in childhood that can lead to fractures, osteoblastoma and chondroblastoma stand out. Osteoblastoma, located in the metaphysis of long bones, initially eccentric cortical, is locally aggressive, causing microfractures due to erosion of the cortical bone. The progressive destruction of the cortex can lead to complete fractures, facilitating local dissemination and complicating oncological treatment. Chondroblastoma affects the epiphyseal region of growing long bones and can lead to arthralgia and deformity.

The treatment for these benign lesions is surgical, preferably carried out as soon as possible to prevent the progression of local bone destruction. Segmental resection is the best indication to avoid local recurrences. However, the articular location of chondroblastoma requires a specific surgical approach, followed by local adjuvants and, when necessary, bone grafting.

The most common malignant bone neoplasms in childhood, such as osteosarcoma and Ewing’s sarcoma, require early diagnosis and immediate treatment. In cases of fractures upon diagnosis, local oncological control may require ablative surgeries, such as Van-Ness gyroplasty, which alters joint function and requires psychological support for the patient.

In addition to malignant neoplasms, fractures in children may be associated with pseudo-tumor lesions, such as simple bone cyst, aneurysmal bone cyst, fibrous dysplasia and eosinophilic granuloma. Treatment varies according to the lesion and may involve resection, intralesional curettage and filling with autologous bone graft.

In summary, fractures in children associated with pre-existing tumor or pseudo-tumor bone lesions require a multidisciplinary approach and an individualized treatment plan, considering the location, extent and characteristics of the lesion, as well as the patient’s general condition. Early diagnosis and appropriate treatment are essential to prevent complications and ensure good functional recovery.