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World J Clin Oncol. Jun 24, 2026; 17(6): 119535
Published online Jun 24, 2026. doi: 10.5306/wjco.119535
Published online Jun 24, 2026. doi: 10.5306/wjco.119535
Risk factors for postoperative pathological fractures in lower extremity soft tissue sarcoma patients undergoing limb-sparing surgery
Axel Horsch, Christopher Baus, Julian Deisenhofer, Andre Lunz, Andreas Geisbüsch, Burkhard Lehner, Department of Orthopedics, University Hospital Heidelberg, Heidelberg 69118, Baden-Württemberg, Germany
Author contributions: Horsch A and Lehner B designed the study and secured funding; Baus C and Horsch A developed the methodology, performed the formal analysis and investigation; Horsch A drafted the original manuscript; Baus C contributed to the materials and methods and results sections; Lehner B, Baus C, Deisenhofer J, Geisbüsch A and Lunz A contributed to review and editing of each subsequent version of the manuscript.
Supported by Heidelberg University.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Medical Faculty of Heidelberg.
Informed consent statement: According to the approval of the Ethics Committee and in compliance with German law governing retrospective studies, this study did not require written informed consent from individual patients. The Ethics Committee granted a waiver of informed consent because the study was retrospective in nature, only previously collected clinical data were analyzed, no additional diagnostic or therapeutic procedures were performed, and the study posed no additional risk to the participants.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: sharing statement: The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
Corresponding author: Axel Horsch, Associate Professor, Department of Orthopedics, University Hospital Heidelberg, Schillerbachel Street 200a, Heidelberg 69118, Baden-Württemberg, Germany. axel.horsch@med.uni-heidelberg.de
Received: January 30, 2026
Revised: April 7, 2026
Accepted: May 8, 2026
Published online: June 24, 2026
Processing time: 143 Days and 21.7 Hours
Revised: April 7, 2026
Accepted: May 8, 2026
Published online: June 24, 2026
Processing time: 143 Days and 21.7 Hours
Core Tip
Core Tip: Postoperative pathologic fractures are an underrecognized late complication following limb-sparing surgery for lower extremity soft tissue sarcoma (STS). In this retrospective cohort of 266 patients with long-term follow-up, fractures occurred predominantly in the femur and often several years after treatment. Partial bone resection and osteoporosis were independently associated with increased fracture risk, whereas radiotherapy showed an elevated but not statistically significant association. These findings underscore the importance of long-term surveillance and careful risk stratification in patients undergoing limb-sparing management for STS.