Chronic Osteomyelitis and Pathologic Fractures Following Radiation-Treated Sarcoma Complicated by Knee Effusion: A Case Report

Chronic osteomyelitis in the setting of recent soft tissue cancers, also known as sarcoma, and radiation therapy presents a clinical challenge due to poor wound healing and impaired vascularity. We present the case of a 64-year-old female patient with a history of sarcoma treated with proton beam therapy who developed chronic osteomyelitis, abscess formation, and pathologic fractures of the tibia and fibula. The course was further complicated by recurrent knee effusion and concerns for septic arthritis. Despite repeated surgical recommendations for above-knee amputation and antibiotic therapy, the patient elected to pursue conservative management. This case highlights the interplay between cancer, tissue damage from radiation therapy, and chronic infection, as well as challenges in achieving adequate treatment.