Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to XXXX .

@entity1 @entity174 @entity5 @entity3677 @entity158 @entity3
PURPOSE AND METHODS: We reviewed 64 orthopedic stabilization procedures in 60 consecutive @entity1 diagnosed with @entity3 to previously unirradiated femurs, acetabula, and humeri with pathologic or impending pathologic @entity174 . Thirty-five @entity1 who received adjuvant postoperative radiation therapy were compared with 29 @entity1 who were treated with surgery alone. Many potential perioperative and @entity5 prognostic variables were evaluated. RESULTS: On univariate analysis, surgery plus radiation therapy and prefracture functional status were the only significant predictors of @entity1 who achieved normal use of the extremity (with or without @entity158 ) after surgery; on Cox multivariate analysis, only postoperative radiation therapy was significant (P = .02). Surgery-related factors such as use of @entity3677 , location of @entity174 , and type of surgery were not associated with improved functional status. The estimated probability of achieving normal use of the extremity (with or without @entity158 ) any time was 53% for postoperative radiation therapy versus 11.5% for surgery alone (P < .01). Second orthopedic procedures to the same site were more frequent in the group that received surgery alone. The actuarial median survival duration of the surgery-alone group was 3.3 months, compared with 12.4 months for the postoperative radiation therapy group (P = .02). CONCLUSION: While this study is limited by possible unaccountable selection biases, only postoperative radiation therapy was associated with @entity1 regaining normal use of their extremity (with or without @entity158 ) and undergoing fewer reoperations to the same site. The improved overall survival associated with postoperative radiation therapy may represent selection bias.
