Objective: Extended intralesional curettage followed by cementation is widely accepted for the treatment of low-grade cartilaginous tumors of the long bones. However, the necessity of prophylactic internal fixation to prevent post-operative fractures remains controversial. The aim of this study is to assess fracture risk and functional outcomes in patients undergoing extended curettage and cementation for lower extremity cartilaginous tumors without prophylactic fixation.
Materials and
Methods: This retrospective study included 98 patients with lower extremity cartilaginous tumors treated with extended curettage and polymethylmethacrylate cementation without prophylactic fixation between 1996 and 2024. Fracture incidence, oncological outcomes, and functional results assessed by Musculoskeletal Tumor Society, Harris Hip Score, Knee Society Score, and American Orthopaedic Foot and Ankle Society Score were analyzed over a mean follow-up of 56 months.

Results: Post-operative fractures occurred in five patients (5%), four of which were incomplete and managed successfully with conservative treatment or limited fixation. All fractures achieved union without long-term functional compromise. No local recurrence, metastasis, or infection was observed. At final follow-up, all patients were classified as having no evidence of disease. Functional outcomes were excellent, with mean scores exceeding 90% across all scoring systems.

Conclusion: Extended curettage and cementation without prophylactic fixation provides oncologically safe treatment, acceptable fracture risk, and excellent functional outcomes for selected lower extremity cartilaginous tumors. Avoiding routine fixation eliminates implant-related complications and imaging artifacts while preserving mechanical stability when meticulous surgical technique and controlled post-operative rehabilitation are applied.