Fibrous Cortical Defect Treatment & Management

  • Author: Bernardo Vargas, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jul 13, 2011
 

Medical Therapy

Casting usually is the most appropriate treatment after pathologic fracture in pediatric patients to avoid injuring the physes during surgery. If the lesion does not regress after casting and union of the fracture, curettage and grafting are necessary.

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Surgical Therapy

Surgery is recommended in cases of unstable fractures or if risk of pathologic fracture is high.

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Intraoperative Details

The surgical approach involves exposing the fracture site and developing a cortical window to curette the tumor. The lesional tissue is gray or brown-yellow. The texture is firm. Bone septa may be present, giving the impression of a multicameral lesion. As mentioned previously, surgery should be delayed, if possible, for lesions abutting a physis. Corticancellous allograft (author's preference) or autograft can be used, depending upon the size of the lesion.

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Follow-up

Following first diagnosis

Typical lesions do not require more than 1 follow-up examination and radiograph (after a 6-12 week interval). Large lesions must be followed with plain films every 4-6 months to assess progression. The lesion may increase in size. A lesion that measures more than 50% of the transverse diameter of the bone is susceptible to pathologic fracture. Patients must be instructed to avoid excessive activities in order to prevent acute fractures. Contact sports also must be avoided.

The natural history of NOF is involution and ossification as puberty is reached. This usually proceeds from the diaphyseal end to the metaphyseal end of the lesion.

Following fracture

Immobilization following fracture is continued until union is radiologically evident. At this point, if the lesion is not regressing and is at risk for refracture, curettage with or without internal fixation and grafting may be indicated.

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Complications

Injury to the physis and subsequent growth abnormalities are possible adverse effects of surgery for lesions abutting a physis.

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Outcome and Prognosis

The rarity of FCDs in adults confirms that these lesions regress with time. The prognosis is excellent in the unusual cases in which patients require curettage and bone graft.

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Future and Controversies

The etiology of FCD remains obscure (see Etiology).

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Contributor Information and Disclosures
Author

Bernardo Vargas, MD  Consulting Staff, Department of Pediatric Orthopedic Surgery, Pediatric Hospital of Geneva, Switzerland

Disclosure: Nothing to disclose.

Specialty Editor Board

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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  2. Jaffe H., Liechtenstein L. Non-osteogenic fibroma of the bone. Am J Pathol. 1942;18:205-221.

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  4. Arata M, Peterson H, Dahlin D. Pathological fractures through Non-Ossifying Fibromas. Review of the Mayo Clinic experience. J Bone J Surg. 1981;63A:980 - 988.

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  8. Peuchmaur M, Forest M, Tomeno B, Abelanet R. Multifocal nonosteogenic fibroma: report of a case with ultrastructural findings. Hum Pathol. Jul 1985;16(7):751-3. [Medline].

  9. Skrede O. Non-osteogenic fibroma of bone. Acta Orthop Scand1970;41(4):362-80. [Medline].

  10. Faure C, Laurent JM, Schmit P, Sirinelli D. Multiple and large non-ossifying fibromas in children with neurofibromatosis. Ann Radiol (Paris). 1986;29(3-4):369-73. [Medline].

  11. Hetts SW, Hilchey SD, Wilson R, Franc B. Case 110: Nonossifying fibroma. Radiology. Apr 2007;243(1):288-92. [Medline].

  12. Huzjan R, Vukelic-Markovic M, Brkljacic B, Ivanac G. The value of ultrasound in diagnosis and follow-up of fibrous cortical defect. Ultraschall Med. Oct 2005;26(5):420-3. [Medline].

  13. Loberant N, Samovsky M, Papura S. Gray-scale and Doppler characteristics of fibrous cortical defects in a child. J Clin Ultrasound. Sep 2003;31(7):369-74. [Medline].

  14. von Falck C, Rosenthal H, Gratz KF, Galanski M. Nonossifying fibroma can mimic residual lymphoma in FDG PET: additional value of combined PET/CT. Clin Nucl Med. Aug 2007;32(8):640-2. [Medline].

 
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Plain radiograph demonstrating multiple fibrous cortical defects in multiple bones.
Plain radiograph of fibrous cortical defect of the proximal tibia.
Lateral radiograph demonstrating a solitary fibrous cortical defect in the proximal tibia.
CT scan of the fibrous cortical defect shown in the plain radiographs in Images 2-3; note the cortical location and the sclerotic rim around the central lucency.
Methylene diphosphonate technetium bone scan of the fibrous cortical defect in Images 2-4; uptake is minimally increased at the site of the lesion.
Histologic section of a fibrous cortical defect demonstrating a bland fibrous stroma in the absence of nuclear atypia or mitoses; a few giant cells are scattered within the stroma.
 
 
 
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