Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution
Keywords:radiation-induced fracture, pathological fracture, endoprosthetic replacement
Background: Radiation-induced pathological fractures of the proximal femur are difficult to treat due to frequent non-union and hardware failure using standard fracture fixation techniques. This case series investigates endoprosthetic replacement as a treatment option.
Methods: A retrospective folder review from a private hospital in Cape Town, of patients who had sustained a radiation-induced pathological fracture, was reviewed using descriptive statistics.
Results: Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the five patients that were analysed, all five sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%).
Conclusion: This case series seeks to highlight the high failure rates seen when treating this condition with standard trauma instrumentation or biological methods. Further research is needed, but endoprosthetic replacement may be a viable alternative solution.
Level of evidence: Level 4