TREATMENT OF FEMORAL FRACTURES AFTER IRRADIATION

Twelve fractures of the femur occurred after irradiation in 12 patient s during the past 15 years. All 12 patients had excision of a soft tis sue sarcoma of the thigh. The periosteum was stripped in every case. T he fractures had a deceptively innocuous radiographic appearance, whic h showed minimal comminution, displacement, and shortening. Treatment of the fractures was difficult and demanding. At a mean followup of 37 months, bony union was achieved in only four patients, and in all fou r cases union was delayed beyond 12 months. Because fracture healing t ypically is delayed, a loadsharing device such as an intramedullary na il may be preferable in treating these fractures. Primary or delayed b one grafting may be necessary, for no fracture united without bone gra ft. For elderly patients with low supracondylar fractures, primary end oprosthetic replacement may effect quicker rehabilitation. The possibi lity of local recurrence of tumor should be ruled out before definitiv e surgical treatment of the fracture, Closed, antegrade nailing in the presence of recurrent tumor may contaminate the flap for a salvage pr ocedure such as hemipelvectomy and may compromise chances for cure.