Pathological fracture
Meaning of pathological fracture: For the purposes of this Statement of Principles, pathological fracture: (a) means an acquired break of bone as a result of an applied force that ordinarily would not cause bone breakage in a healthy bone; and (b) includes: (i) acute vascular shock, acute compartment syndrome, or fat embolism resulting from the fractured bone; (ii) pathological fracture or insufficiency stress fracture due to focal bone weakness; (iii) pathological fracture or insufficiency stress fracture due to global bone weakness; (iv) periosteal, muscular, fascial, skin, nerve or vascular damage directly caused by the displaced fractured bone; and (v) wound infection as a result of penetration of the skin by bony fracture fragments (compound fracture).
Reasonable Hypothesis (RH) — Statement of Principles No. 64 of 2024
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting pathological fracture or death from pathological fracture with the circumstances of a person's relevant service:
- (1)having one of the following medical conditions involving the affected region of bone at the time of clinical onset: (a) benign neoplasm; (b) malignant primary or secondary neoplasm; (c) osteomalacia; (d) osteomyelitis; (e) osteonecrosis; (f) osteoporosis; or (g) Paget disease of bone;
Note: osteomalacia and osteonecrosis are defined in the Schedule 1 - Dictionary.
- (2)having ankylosing spondylitis at the time of clinical onset of vertebral pathological fracture;
- (3)smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non- union;
Note: One gram of tobacco is considered to be equivalent to one cigarette.
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (4)having diabetes mellitus at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (5)having osteoporosis at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (6)having vitamin D deficiency, with a serum 25(OH)D level of less than 50 nanomoles per litre at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (7)having a Body Mass Index (BMI) of 40 or greater at the time of the fracture non-union;
Note: BMI is defined in the Schedule 1 - Dictionary.
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (8)inability to obtain appropriate clinical management for pathological fracture before clinical worsening;
Balance of Probabilities (BoP) — Statement of Principles No. 65 of 2024
5 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, pathological fracture or death from pathological fracture is connected with the circumstances of a person's relevant service:
- (1)having one of the following medical conditions involving the affected region of bone at the time of clinical onset: (a) benign neoplasm; (b) malignant primary or secondary neoplasm; (c) osteomalacia; (d) osteomyelitis; (e) osteonecrosis; (f) osteoporosis; or (g) Paget disease of bone;
Note: osteomalacia and osteonecrosis are defined in the Schedule 1 - Dictionary.
- (2)having ankylosing spondylitis at the time of clinical onset of vertebral pathological fracture;
- (3)smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non- union;
Note: One gram of tobacco is considered to be equivalent to one cigarette.
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (4)having diabetes mellitus at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the pathological fracture.
- (5)inability to obtain appropriate clinical management for pathological fracture before clinical worsening;
