Treatment of Radiation-Associated Fractures: A Critical Analysis Review

Fractures that result from radiation-induced bone damage are a recognized adverse effect of radiation therapy (RT).

The mechanisms of damage from RT are thought to be related to impaired vascularity, aberrations in osteoclast and osteoblast-mediated bone turnover, and compromise of cortical and trabecular microarchitecture.

Treatment of radiation-associated fractures is challenging, with rates of delayed union and nonunion of >50%.

Fracture management strategies, each with its own profile of risks and benefits, include prophylactic intramedullary nailing of long bones, open reduction and internal fixation with adjunctive iliac crest or vascularized fibular grafting, and endoprosthetic reconstruction.