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.