What dose/fractionation scheme would you employ for treatment of a bone with impending fracture prior to surgical fixation?

There are several advantages to pre-op RT. For example, the target is much better defined pre-op, and normal tissue exposure can be minimized compared to post-op RT. However, treatment fields should be constructed to minimize the risk of RT-related post-op complications including delayed wound healing. All the suggested fractionation schedules can be appropriate fractionation schedules in this scenario, depending upon the clinical situation. 8 Gy x 1 might be suitable when the situation is very palliative and the clinical goal is short-term palliation, or if the lesion is very radiation sensitive, such as most myelomas. We have a prospective trial of pre-op SBRT for bone mets that is nearing completion, and have found 9-10 Gy x 3 to be well...

What a great idea to do pre-op. I have never considered doing this on purpose. On occasion, it has happened because of timing issues.

If you can do rapid turnaround when seeing patients (consult-sim-treat in the morning) and then refer out for surgery, can do reduced field size compared to post-op and be done with it prior to them having surgery/post-op pain.

I agree with any of the normal fractionations - 8-10/1, 20/5, 30/10. I do see another answer mentioning SBRT and I'm not sure of the rationale for dose-escalation as the pain will be relieved via ORIF, but that may be an option.