[Osteosynthesis and radiotherapy of the proximal femur: report of 6 cases].
OBJECTIVE
Post-radiation shaft fractures of long bones are uncommon. Late or partial healing increases the risk of stress fracture. Different fixation techniques have been proposed. Treatment of radiated bone is difficult. We report a series of 6 nonunions of the proximal femur after radiotherapy.


METHODS
Three patients had true fractures of irradiated bones several years after radiotherapy for bone or soft tissue tumors. Three other patients had pathological fractures or malignant osteolysis related to a myeloma and treated by osteosynthesis and post-operative radiotherapy.


RESULTS
Treatment required a total of 19 surgical procedures. There were nine stress fractures of ostheosynthesis material involving locked nails, cervicodiaphyseal nails and plates. There were no vascularized grafts in this series. At last follow-up the pathological fracture had healed in three cases, was stable but not healed in two, and required prosthetic reconstruction in one.


CONCLUSIONS
We emphasize the importance of rigorous patient selection for radiotherapy and the possible preventive effect of osteosynthesis in certain cases with a high risk of secondary fracture of an irradiated bone. Vascularized grafts may be useful for refractory nonunion and may be proposed as first line treatment for post-radiation fractures.
Simon
P
P
Service de Traumatologie, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg Cedex, France. Patrick.Simon@chru-strasbourg.fr
Jung
G-M
GM
Bonnomet
F
F
Babin
S-R
SR
D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006620:Hip Fractures / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects