title: [Insufficiency fractures after irradiation therapy - case series].
abstract: BACKGROUND
  Radiation therapy plays an essential part in modern treatment regimes of musculoskeletal tumors. Nevertheless damage to the surrounding tissue does occur inevitably. Postradiogenic changes of bone are associated with decreased stability and an increased fracture rate. The orthopedic surgeon therefore faces a challenging situation with altered bone metabolism, changes in perfusion and soft tissue problems.
  
  
  METHODS
  We present 3 cases of radiation induced fractures during the treatment of soft tissue tumors, all of which received radiation doses of > 58 Gy. All fractures occurred over 1 year after the exposure to radiation in otherwise uneventful follow ups.
  
  
  RESULTS
  Postoperative follow up showed fracture healing or in the case of the arthroplasty, osseous integration without further complications.
  
  
  CONCLUSIONS
  Radiation doses of ≥ 58 Gy are a major risk factor for pathological fractures in long bones. Regardless of their low incidence, fracture rates between 1,2 and 6,4 % prove their importance. Local tumor control has therefore to be weighed against the resulting decrease in bone quality and stability. Treatment options should always take into consideration the increased risk for complications such as infection, pseudarthroses and wound healing disorders. Our results show that substitution of vitamin D and calcium as well as the the use of reamed intramedullary implants benefits the outcome.
authors.affiliation: Klinik und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Braun
authors.forename: Florian
authors.initials: F
authors.lastname: Pohlig
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lenze
authors.forename: Clemens
authors.initials: C
authors.lastname: Netter
authors.forename: Miriam
authors.initials: M
authors.lastname: Hadjamu
authors.forename: Hans
authors.initials: H
authors.lastname: Rechl
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Eisenhart-Rothe
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy*; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000601:surgery; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010025:Osteoradionecrosis / Q000175:diagnosis* / Q000601:surgery*; D011832:Radiation Injuries / Q000175:diagnosis* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy*