This listing addresses severe fractures in bones weakened by underlying pathology (for example, osteoporosis, cancer metastasis, or other bone diseases). Even after a standard healing period, if these fractures remain non-united or cause chronic instability and severe functional limitations, the claimant may qualify at Step 3 of the sequential evaluation. Listing 1.19 focuses on the documented inability to sustain normal ambulation or upper-extremity use due to a pathologic fracture.
Listing 1.19
1.19 Pathologic fractures due to any cause (such as metastatic cancer, multiple myeloma, diabetes, osteoporosis, osteomyelitis, sickle cell disease, or Charcot arthropathy), in any bone, under continuing surgical management for fixation, or bone grafting, or prosthetic replacement. With all of the following:
- A fixation device, bone graft, or prosthesis that has failed to unite or has displaced or broken; or a recurrent fracture, a new fracture, or a piece of hardware (such as screws or plates) that has caused a fracture; and
B. Inability to ambulate effectively (see 1.00C6), or an inability to perform fine and gross movements effectively (see 1.00C7), or both; and
C. Expected to last for a continuous period of at least 12 months from the date of the original pathologic fracture.
Key Elements
• Pathologic origin of fracture
- Must be due to a pre-existing bone condition (e.g., cancerous lesion, osteoporosis, chronic infection) rather than standard trauma.
• Continuing surgical management - Hardware or a prosthesis is in place, but has malfunctioned (broken, displaced) or has failed to promote healing, or there has been a new or recurrent fracture.
• Significant functional limitation - Ineffective ambulation or limited fine/gross motor use of the affected extremity (or both).
• Twelve-month duration - Condition must be expected to remain severe for a full year from the initial pathologic fracture date.
Tips on Proving Listing 1.19
• Imaging and surgical documentation
- X-rays, MRIs, or CT scans showing the fracture’s non-union, hardware failure, or recurrent break. Operative reports confirming repeated attempts to repair or stabilize the fracture.
• Orthopedic follow-up notes - Records of ongoing or “failed” surgical management (e.g., plates or rods that shifted, additional bone grafts). Consistent documentation of severe pain, difficulty bearing weight, or limited arm-hand function.
• Physical therapy records - Demonstrate that normal ambulation or manual dexterity cannot be restored even with rehabilitation efforts.
• Real-world functional accounts - Statements from the claimant or caregivers about needing crutches, a walker, or being unable to handle objects if the upper extremity is involved.
• Specialist opinions - A treating orthopedist or oncologist (if cancer-related) linking the persistent fracture complications to a pathologic process, explaining why it’s unlikely to heal adequately within 12 months.
By compiling robust imaging evidence, detailed surgical histories, and clear functional assessments, a Social Security Disability lawyer can help demonstrate that a pathologic fracture—complicated by underlying disease or hardware failure—prevents normal standing, walking, or arm use for at least 12 months, thereby meeting Listing 1.19.