• Andrea Sambri, Lorenzo Gardini, Mattia Dalla Rosa, Guido Zavatta, Mert Keskinbora, Cristina Ferrari, Davide Maria Donati, and Giuseppe Bianchi.
• Department of Orthopaedics, IRCCS AOU Sant'Orsola Malpighi, Bologna, Italy. Andrea_sambri@libero.it.
• Arch Orthop Trauma Surg. 2021 Aug 1; 141 (8): 1277-1282.

IntroductionPost-radiation fractures of the femur (PRF) are difficult to treat and are associated with a high risk of delayed union and non-union. We report a series of patients affected by soft tissue sarcoma (STS) of the thigh, treated with limb-sparing surgery and perioperative radiotherapy (RT), to analyse post-radiotherapy femur fracture (FF) rate and its management.Material And Methods547 patients treated with surgery and RT for a deep primary STS of the thigh were included. "Periosteal stripping" and "bone tangential resection" were performed in case of tumor invasion. In the case of complete bone involvement, the patient received its complete resection and econstruction.ResultsTwenty-three (4.3%) patients underwent surgical procedures involving periosteum and cortical bone. In 11 (2.0%) patients a bone resection was required because of massive bone involvement. Six out of these 11 (54.5%) patients developed major complications (infection and aseptic loosening). At the time of STS excision, 11 patients (2.0%) underwent prophylactic intramedullary nailing (PIN). PRF occurred in 15 patients (3.0%) at a median follow up of 52 months (range 3-151). Among patients who developed PRF, three were treated with a prosthesis (no complications) and eight nailing (7/8, 87.5% did not heal and developed a non-union).ConclusionsGiven the potentially devastating complication of a PRF, PIN should be considered. We suggest prophylactic IM nail in patients at higher risk the time of STS excision. In other cases, IM nail can be postponed in the following years considering the prognosis.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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