Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution

Abstract

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%).