Pathologic fracture as a complication in the treatment of Ewing's sarcoma

The purpose of the current study was to define the outcome of patients with Ewing's sarcoma who sustained a fracture either at initial presentation or subsequent to multimodal treatment, and to identify parameters that may influence the treatment of these patients. The age of the 21 males and 14 females who sustained a fracture during the treatment for Ewing's sarcoma averaged 15 years (range, 4-30 years) at diagnosis. Fourteen patients presented with a pathologic fracture, whereas 21 patients had a fracture develop subsequent to the initial treatment at a mean of 4 years (range, 1-19 years). The femur was the most common location (50%). At a mean followup of 10 years (range, 1-33 years), 21 of 35 patients (60%) were alive and free of disease. There was no local recurrence, but there was one postradiation sarcoma associated with the fracture. Comparing the followup of patients who sustained the fracture at presentation with the followup of patients who subsequently had a fracture, no statistically significant difference was found (117 months versus 124 months). Overall, pathologic fracture in association with Ewing's sarcoma does not seem to be a negative prognostic parameter with respect to survival in this series. Therefore, a fracture at presentation may not mandate amputation. However, it occurs frequently subsequent to initial multimodal treatment because of delayed fracture healing. Because conservative or minimal osteosynthesis have high failure rates, more aggressive resection and reconstruction have to be considered carefully.