Refracture of a healed tibial shaft fracture after irradiation for post-traumatic squamous-cell carcinoma.

Abstract

A 58-year-old man, who had been operated on 17 years ago for an open Grade III tibial shaft fracture, developed 14 years after the fracture had healed a poorly differentiated squamous cell carcinoma at the site of the old scar. Seventeen years after the original injury, the carcinoma was completely excised and the area irradiated. Fourteen months later a spontaneous fracture of the tibial shaft occurred at the same site. After radical excision of the necrotic bone and affected skin, AO-external osteosynthesis was performed which failed, and 8 months after surgery a septic pseudarthrosis occurred which persisted, though no local recurrence of the carcinoma was clinically or histologically diagnosed. Amputation in the upper third of the tibia was successful without local or systematic recurrence during follow-up.