Pathological fractures of the femur after radiation therapy for soft tissue tumor: a case series of seven patients treated with repeated internal fixation

Abstract

Introduction: Pathological femoral fracture (PFF) after radiation therapy (RT) for soft tissue tumor is a debilitating complication with a high rate of nonunion that requires multiple subsequent procedures and hindrance of functional activity. We aimed to evaluate healing rate after repeated internal fixation in a case series of PFF after RT. Materials and methods: We retrospectively reviewed the records of patients who had PFF after RT and were treated at our center between 2007 and 2018. We analyzed our surgical protocols and fracture healing rate. Interpretation: We identified and analyzed a total of seven patients (six females and one male) whose mean age at fracture was 58?years. Primary tumors consisted of soft tissue sarcoma (n = 5), melanoma (n = 1), and desmoid tumor (n = 1). All primary tumors were treated with surgical excision and adjuvant RT. The mean follow-up duration after fracture was 33?months (range, 16?58). At the last follow-up, five out of seven fractures had completely healed, and two lesions showed delayed union at 15 and 16?months, respectively. Among the five complete unions, one fracture was healed after the first fixation. The remaining four lesions were treated with second internal fixation due to nonunion/metal failure or delayed union. The mean time to radiologic healing after the last fixation was 6.8?months (range, 5?8). Conclusions: Our results suggest that bones within the RT field retain healing capacities, and that repeated internal fixation may be a viable option for the treatment of PFF after RT.