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Management of Radiation-associated Fractures

Dr. Cannon is Assistant Professor, Department of Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. Dr. Lin is Associate Professor, Department of Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center. Dr. Lewis is Associate Professor, Department of Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center. Dr. Yasko is Professor and Chief, Musculoskeletal Oncology, Department of Orthopaedic Surgery, Northwestern University, Chicago, IL.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cannon, Dr. Lin, Dr. Lewis, and Dr. Yasko.

Reprint requests: Dr. Cannon, Department of Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009.

High-dose radiation is injurious to bone and is a known risk factor for the development of late fracture. Management of radiation-induced fractures is generally thought to be difficult, with prolonged healing times and a high nonunion rate. There is a relative paucity of literature to guide treatment. Fractures of the long bones typically should be managed with intramedullary nailing. A low threshold should exist for supplemental bone grafting, and a vascularized fibula graft should be considered for persistent nonunion. To prevent refracture, fixation should be left in situ indefinitely. Resection of the fracture site and reconstruction with an oncologic endoprosthesis is an effective salvage procedure. Periarticular fractures should be treated with joint arthroplasty, which allows early mobilization and avoids prolonged healing times. Fractures of expendable bones, primarily the clavicle, typically should be managed with débridement or resection.