• Arthroscopic-assisted uni-portal non-coaxial endoscopic surgery
• Fibrous dysplasia of bone
• Minimally invasive

• Humans
• Female
• Middle Aged
• Arthroscopy/methods
• Fibrous Dysplasia of Bone/surgery
• Fibrous Dysplasia of Bone/diagnostic imaging
• Femur/surgery
• Femur/diagnostic imaging
• Femur/pathology
• Bone Transplantation/methods
• Treatment Outcome
• Minimally Invasive Surgical Procedures/methods
• Curettage/methods

• H-2024084 the Yunnan health training project of high level talents
• the Yunnan Revitalization Talent Support Program
• the first-class discipline innovation-driven talent program of Guangxi Medical University

• Femur
• Fibrous dysplasia
• Fixation
• Fracture
• Hip
• Osteotomies
• Surgery

• Humans
• Osteotomy/methods
• Bone Transplantation/methods
• Fibrous Dysplasia of Bone/surgery
• Arthroplasty, Replacement, Hip/methods
• Femur/surgery
• Curettage/methods

• bone disorder
• fibrous dysplasia
• narrative review
• orthopedic
• pediatric

• case report
• epiphysis
• fibrous dysplasia
• pediatric
• proximal femur

• bone lesion
• fibrous dysplasia
• histopathology
• monostotic
• radiography
• total hip arthroplasty (tha)

Fibrous dysplasia is a benign fibrous bone tumor that accounts for 5% to 10% of benign bone tumors. It can manifest as simple fibrous dysplasia (70%–80%), polyostotic fibrous dysplasia (20%–30%), with approximately the same incidence in men and women. We report a patient with a rare case of multiple fibrous dysplasia combined with proximal femoral shepherd deformity with pathological fracture of the femoral shaft complicated by nonunion. It is necessary to understand the disease in more detail to avoid overtreatment of benign lesions or misdiagnosis of malignant tumors and other diseases.

A 58-year-old man with polyostotic fibrous dysplasia, bilateral proximal femur deformity, Shepherd’s angle deformity, right femoral shaft pathological fracture complicated by nonunion, we under fluoroscopy, in the obvious proximal fracture, take osteotomy, and process the shape of the cut bone fragment to adapt it to the corrected force line, and then restore it back to its original position, using intramedullary nailing technology complete the operation. Three months after the operation, he came to the hospital for re-examination, and an X-ray of the right femur was taken. It was found that the fractured end had a tendency to heal. The patient was instructed to gradually bear weight. After six months of re-examination, the patient could walk with a walker. One year after the operation, the patient could walk without a walker and take care of himself at home. However, there was still stretch-like pain in the right lower back, but it was tolerable.

For patients with polyostotic fibrous dysplasia combined with proximal femoral shepherd deformity and pathological fracture of the femoral shaft with nonunion, osteotomy combined with intramedullary nailing is a simple and convenient way to correct the deformity and obtain correct fracture alignment.

• National Natural Science Foundation of China

• Fibrous dysplasia
• GNAS(R201C)
• RANKL
• Small-molecule inhibitor

• Animals
• Bone and Bones/pathology
• Denosumab/pharmacology
• Denosumab/therapeutic use
• Fibrous Dysplasia of Bone/drug therapy
• Humans
• Mice
• Mice, Transgenic
• Osteogenesis

Fibrous dysplasia is a rare benign intramedullary fibro-osseous lesion characterized by fibro-osseous proliferation with intervening areas of normal or immature bone. It can either be a monostotic or a polyostotic presentation. The etiology of fibrous dysplasia has been linked with a missense mutation in the GNAS1 gene on chromosome 20. The most common fibrous dysplasia is first diagnosed in children or young adults. There is no gender predilection. Overall, fibrous dysplasia constitutes 5% of all benign bone lesions.The monostotic form is the most frequent, accounting for 75% to 80% of fibrous dysplasia cases.

We report a case of unilateral monostotic fibrous dysplasia in a 30-year-old male in the proximal femur with Shepherd's crook deformity. The patient underwent a single-stage procedure of curettage of lesion and valgus osteotomy with dynamic hip screw (DHS) fixation and fibular strut graft. The lesion resulted in alteration of hip joint anatomy with a decrease in the neck-shaft angle to 114 degrees and leading to coxa vara. After surgical correction, the neck-shaft angle was restored to 130 degrees. The patient was followed up in the outpatient department (OPD), x-rays were taken, and signs of radiological healing were seen at three months. Partial weight-bearing was allowed at three months postoperatively and full weight-bearing at six months with no restriction in the activity. After six months, the patient was able to perform all activities without any difficulty, and shortening of 1.5 cm was compensated with footwear modification. No evidence of recurrence was noted in the follow-up x-ray.

Fibrous dysplasia of proximal femur treated with curettage and bone grafting and supported with an osteotomy to correct mechanical alignment provides excellent results. DHS, though old hardware, provides a versatile option to support osteotomy and helps in maintaining the correction. To support the neck femur after curettage, the fibula strut graft provides an excellent option. When the procedure is done in a single stage, it gives good functional and radiological outcomes along with early rehabilitation.

Fibrous dysplasia (FD) of bone can be present with pain, deformity and pathological fractures. Management is both medical and surgical. Little literature exists on the surgical management of both monostotic and polyostotic FD. We present our experience of limb reconstruction surgery in this pathological group of bone disease.

A retrospective cohort of children who underwent limb reconstruction surgery at a single high-volume paediatric centre was identified from a prospective database. Case notes and radiographs were reviewed. Surgical techniques, outcomes and difficulties were explored.

Twenty-one patients were identified aged between 7 and 13 at presentation to the limb reconstruction unit. Eleven were female, nine had McCune-Albright syndrome, seven had polyostotic FD and five had monostotic. Proximal femoral varus procurvatum deformity was the most common site requiring surgical intervention. The distal femur, tibia, humerus and forearm were also treated.

Methods include deformity correction with intramedullary fixation including endo-exo-endo techniques, elastic nailing, guided growth, circular fixator technique and fixator-assisted plating. Correction of deformity and leg length discrepancies was common.

The osteotomies went on to heal with no nonunions or delayed healing. We encountered secondary deformity at distal end of nails as the children grew as expected. These were managed with revision nailing techniques and in some cases external fixation. There was one implant failure, which did not require revision surgery.

The surgical management of pathological bone disease is challenging. Corrective osteotomies with intramedullary fixation can be very successful if appropriate limb reconstruction principles are adhered to. Deformity correction, guided growth and lengthening can all be successfully achieved in bone affected by FD. Polyostotic FD can be present with secondary deformities, and these can be difficult to manage.

Hampton MJ, Weston-Simmons S, Giles SN, et al. Deformity Correction, Surgical Stabilisation and Limb Length Equalisation in Patients with Fibrous Dysplasia: A 20-year Experience. Strategies Trauma Limb Reconstr 2021;16(1):41–45.

• Fibrous dysplasia
• Limb lengthening
• McCune-Albright syndrome
• Osteotomy

• allograft
• deformity
• fibrous dysplasia
• osteotomy
• polyostotic
• proximal femur
• shepherd’s crook

• cortical strut allograft
• diaphyseal pathological fractures
• internal plating
• monostotic fibrous dysplasia

• Bone Plates
• Bone Transplantation
• Child
• Diaphyses
• Female
• Femoral Fractures/etiology
• Femoral Fractures/surgery
• Fibrous Dysplasia, Monostotic/complications
• Fracture Fixation, Internal/instrumentation
• Fracture Fixation, Internal/methods
• Fractures, Spontaneous/etiology
• Fractures, Spontaneous/surgery
• Humans
• Humeral Fractures/etiology
• Humeral Fractures/surgery
• Male
• Retrospective Studies

• Free nonvascularized fibular autograft
• Harris hip score
• epiphyseal closure
• femoral neck
• graft union
• pediatric patients
• tumor-like lesions

• Adolescent
• Autografts
• Bone Neoplasms/pathology
• Bone Neoplasms/surgery
• Child
• Epiphyses/diagnostic imaging
• Epiphyses/pathology
• Epiphyses/surgery
• Female
• Femoral Neck Fractures/diagnostic imaging
• Femoral Neck Fractures/pathology
• Femoral Neck Fractures/surgery
• Fibula/transplantation
• Follow-Up Studies
• Humans
• Male
• Postoperative Complications
• Prognosis
• Radiography
• Plastic Surgery Procedures
• Retrospective Studies

Osteofibrous dysplasia (OFD) is a developmental skeletal disorder, and cases with a giant affected area in the pelvis are rare.

In this case report, a 48-year-old man presented with a large tumor in the right iliac region that turned out to be OFD. The patient had rebound tenderness in his right hip. After radiography examination, magnetic resonance imaging examinations and some physical examination, extensive bone destruction in the right ilium was confirmed. Moreover, changes in bone mineral density and peripheral cortical bone sclerosis with surrounding soft tissue swelling were observed. Thus, this patient was considered to have giant monostotic OFD of the ilium. The tumor-related area was removed completely by surgery, and the remaining cavity was filled by artificial bones from the opposite ilium. According to the results of follow-up, the patient had normal flexion and extension activities of the right hip joint, and there was no evidence of recurrence of the tumor.

Suture of iliopsoas and gluteus medius muscle following focus curettage and bone grafting is a promising and effective method to treat giant OFD of the ilium. It is a feasible way to fill a large cavity after removing a lesion like the one is this case.

• Osteofibrous dysplasia
• Monostotic type
• Giant tumor
• Ilium
• Case report

• Benign lytic lesions
• Proximal femur
• Synthetic bone graft

This paper assesses whether treating patients with fibrous dysplasia of proximal femur by internal fixation with correction of the deformity, if present, without grafting is enough or not.

This study is a retrospective study using patient's medical records, including analysis of 19 patients with fibrous dysplasia of proximal femur treated by internal fixation only and followed up between 2000 and 2017 for at least 2 years. Epidemiologic data, clinical manifestations, radiologic and histologic investigations, surgery, functional outcomes, and complications in these patients were analyzed.

The study included 12 male patients and 7 female patients, with a mean age of 20.74 years. Of these, two patients presented with pathologic fractures, two presented with shepherd's crook deformity, and the remaining presented with hip pain and limping. Implants used for internal fixation were intramedullary nail in four patients, dynamic hip screw in eight patients, cannulated screws in four patients, broad dynamic compression plate in two patients, and narrow dynamic compression plate in one patient. The mean follow-up period was 53.58 months. Four patients had postoperative complications. The mean Musculoskeletal Tumor Society score was 27.63 points.

The optimal management option for fibrous dysplasia of proximal femur is debatable. We suggest that internal fixation without grafting has a good local control and satisfactory functional long-term outcome.

Fibrous dysplasia is a rare benign, intramedullary, fibro-osseous lesion. It is thought to be a developmental disorder of bone maturation where normal lamellar bone is replaced by irregular trabecular bone ensnared with fibrous dysplastic tissue that is unable to complete maturation resulting in significant loss of mechanical strength. This, together with the inability to mineralize sufficiently, leads to deformity, pain, and pathological fractures. It typically presents in young adults, with an equal representation in both genders. Surgical intervention is necessary in mild cases with chronic symptoms to prevent pathological fractures or to correct deformities.

A 19-year-old Chinese woman presented with non-traumatic, nonspecific left hip pain during basketball training. X-rays demonstrated a ground glass lesion, 10 cm in length, in her left femoral neck, which is a classic sign of fibrous dysplasia. No other deformities were noted. She was managed conservatively with analgesia for 6 months; however, her condition did not improve and a decision was made for surgical intervention. The lesion was a type 1 lesion according to the Ippolito radiological classification of fibrous dysplasia, which is a lesion with mild deformities. Therefore, we performed minimal curettage and insertion of a free autologous fibula strut harvested from her left leg, for structural stability. No implants were used. The operation was successful and her postoperative course was uneventful. Histology confirmed the diagnosis of fibrous dysplasia. She achieved partial weight bearing at 4 weeks postoperation, and full weight bearing at 8 weeks, and returned to basketball at 12 weeks. At 1-year follow-up, she returned to competitive basketball and remained pain free with no complications.

Fibrous dysplasia is a rare and benign fibrous tumor of the bone that presents mostly in a young patient population. From our case, we have shown that it is possible to treat young patients with uncomplicated Ippolito type 1 fibrous dysplasia with a minimally invasive approach of using a cortical bone graft for structural augmentation of the affected area, without the use of implants. They are able to fully return to an active and vigorous lifestyle without restriction of activities or long-term risks of orthopedic implant complications.

• Autologous bone graft
• Femoral neck
• Fibrous dysplasia
• Fibula strut
• Implants

• bone grafting
• curettage
• fibrous dysplasia
• internal fixation
• osteotomy

• Blade plate
• Fibrous dysplasia
• Intramedullary nail
• McCune-Albright syndrome
• Proximal femur

Reports showing high recurrence rates for intralesional curettage and bone grafting have made the current treatment principle for fibrous dysplasia controversial. This study aimed to report the postoperative clinical outcomes from three minimally invasive surgical strategies we use for monostotic fibrous dysplasia (MFD).

Twelve patients with MFD presenting with no pathologic fracture or deformity and treated with one of three surgical strategies—plain open biopsy, plain alpha-tricalcium phosphate (ATP) reconstruction, and prophylactic bridge plating—were included. There were nine men and three women, with median age of 38 years. Mean follow-up was 88 weeks. Five cases involved the proximal femur, two each involved the femoral and tibial diaphyses, and one each involved the distal humerus, radial diaphysis, and proximal tibia. All cases were reviewed for functional and radiological outcomes.

Median time to full activity was 1 day (range 1 to 3) for the plain open biopsy group, while the prophylactic bridge-plating and plain ATP reconstruction groups had longer median recovery times (59 days, range 3 to 143, and 52 days, range 11 to 192, respectively). Musculoskeletal Tumor Society scores at last follow-up were excellent for all the cases (mean 29.6, range 25 to 30). Radiological analysis using Gaski et al.’s criteria showed plain open biopsy resulted in partial resolution of proximal femoral lesions, while ATP reconstruction and prophylactic plating resulted in no change and progression in this lesion site, respectively. For femoral diaphyseal lesions, prophylactic plating resulted in partial resolution, while ATP reconstruction resulted in no change. In the tibial diaphysis, prophylactic plating resulted in partial resolution, while plain open biopsy resulted in no change. For the lesions involving the distal humerus and the proximal tibia, plain open biopsy resulted in partial resolution, while for the radial diaphyseal lesion, ATP reconstruction resulted in no change. Radiological progression was limited in 11 (92%) cases, and none had postoperative complications.

Plain open biopsies for asymptomatic lesions; prophylactic bridge plating for symptomatic, large diaphyseal lytic lesions; and plain ATP reconstructions for both small and large nondiaphyseal symptomatic lytic lesions may be acceptable alternatives to curettage-incorporating procedures for MFD.

• Alpha-tricalcium phosphate
• Fibrous dysplasia
• Minimally invasive approach
• Open biopsy
• Prophylactic bridge plating

• benign
• curettage
• joint salvage
• pathologic fracture
• proximal femur
• tumor

• Benign bone tumor
• Proximal femur
• Reinforcement
• Treatment

The proximal femur is one of the most common sites involved by fibrous dysplasia. In cases with mild deformity that does not require corrective surgery, occasional patients suffer sustained pain because of repeated microfractures. This study aimed to clarify the outcomes of surgery with autogenous fibular cortical strut grafting and compression hip screw fixation.

Since 2002, eight consecutive patients (nine hips) with femoral neck fibrous dysplasia without severe deformity were prospectively treated with autogenous fibular strut grafting and compression hip screw fixation.

Mean age of patients was 35 years. Mean follow-up of patients after surgery was 75 months. Most of the patients could walk with full weight-bearing 2 weeks after surgery. Functional score of lower extremity was significantly improved from 65 % to 95 % (P = 0.001). Femoral neck angle was increased from 127 to 130. Donor site of strut cortical fibula showed good regeneration with β-tricalcium phosphate.

Autogenous fibular cortical strut grafting and compression hip screw fixation achieved good post-operative function and provided an early return to work for adult patients with fibrous dysplasia of the femoral neck with mild but prolonged symptoms. Morbidity in the donor site of fibula strut is minimal with the use of β-tricalcium phosphate.

• Adolescent
• Adult
• Allografts
• Bone Diseases/surgery
• Bone Neoplasms/surgery
• Bone Transplantation
• Child
• Child, Preschool
• Curettage
• Female
• Humans
• Male
• Middle Aged
• Plastic Surgery Procedures/methods
• Retrospective Studies
• Young Adult

Fibrous dysplasia (FD) is a rare bone disorder in which normal medullary bone is replaced by fibro-osseous tissue. It typically presents in childhood with pain, skeletal deformities, gait abnormalities and occasionally, fatigue fractures. The management of FD remains a challenge. Surgical procedures have been developed to provide symptom relief, correct skeletal deformity and offer mechanical support in cases at risk of fracture. However, there is a paucity of data on the management of acute femoral neck fractures in the adult population with FD. We report the case of a 23-year-old man with a shepherd’s crook deformity secondary to FD, who sustained an intra-capsular femoral neck fracture whilst playing football. The patient initially underwent closed reduction and internal fixation with cannulated screws. However, during the procedure, a guide wire broke whilst inside the femoral head. The patient was referred to the senior author, who undertook a second operation to remove the metalwork and correct the varus deformity using a closing-wedge femoral osteotomy, whilst achieving osteosynthesis at the fracture site. At 1-year follow-up, the patient is pain-free and demonstrates a full range of movement. These cases can be technically demanding and carry a greater risk of complication. It is important that preoperative planning is undertaken and surgery performed by individuals with experience in managing FD and complex femoral neck fractures. Correction of the skeletal deformity whilst fixing the fracture will help restore the mechanical axis and reduce the risk of a recurrent fracture.

The aim of this study was to summarize oncological and functional results and to investigate surgical treatment methods and efficacies by conducting a retrospective study of patients with fibrous dysplasia (FD) in the proximal femur. A total of 15 patients with FD in the proximal femur were selected. Among them, 12 cases were monostotic and 3 cases were polyostotic. In addition, 2 cases were accompanied by shepherd’s crook deformity. All cases received internal fixation following focus curettage and impaction grafting. Among them, valgus osteotomy was conducted for 2 cases of shepherd’s crook deformity. All patients were followed up for 12–32 months. For 2 patients with shepherd’s crook deformity in the proximal femur, the collodiaphysial angle was recovered after an orthopedic procedure following osteotomy. In addition, no patient presented with postoperative recurrent lesions. At 3 months following surgery, local bone resorption was visible in the bone grafting area. Between 8 and 12 months after surgery, the bones in the bone grafting area had healed, pain had disappeared and gaits were nearly normal. An effective internal fixation following thorough focus curettage and allograft bone transplantation is an effective method of treating FD in the proximal femur. For patients with shepherd’s crook deformity, it is also necessary to perform valgus osteotomy to recover hip joint function.

• curettage and bone grafting
• fibrous dysplasia
• internal fixation
• osteotomy
• proximal femur

• Adult
• Cervical Vertebrae/injuries
• Diagnosis, Differential
• Fibrous Dysplasia, Monostotic/complications
• Fibrous Dysplasia, Monostotic/diagnosis
• Fractures, Spontaneous/etiology
• Humans
• Magnetic Resonance Imaging
• Male
• Spinal Fractures/etiology
• Tomography, X-Ray Computed

• Adolescent
• Adult
• Aged
• Bone Neoplasms/surgery
• Bone Transplantation/methods
• Child
• Child, Preschool
• Curettage
• Female
• Femoral Neoplasms/surgery
• Fibula/surgery
• Giant Cell Tumor of Bone/surgery
• Humans
• Joints/surgery
• Male
• Middle Aged
• Plastic Surgery Procedures/methods
• Tibia/surgery
• Transplantation, Homologous

• Child
• Female
• Femur/abnormalities
• Femur/diagnostic imaging
• Femur/surgery
• Fibrous Dysplasia, Polyostotic/diagnostic imaging
• Fibrous Dysplasia, Polyostotic/surgery
• Humans
• Orthopedic Fixation Devices
• Osteotomy
• Radiography
• Recovery of Function

• fracture
• gnas
• g_s alpha
• pain
• outcomes
• scoliosis

• Fibrous Dysplasia of Bone/surgery
• Humans
• Pain/drug therapy

• Bone Density Conservation Agents/therapeutic use
• Diphosphonates/therapeutic use
• Fibrous Dysplasia, Monostotic/drug therapy
• Fibrous Dysplasia, Monostotic/pathology
• Fibrous Dysplasia, Monostotic/surgery
• Humans

• Adult
• Elbow Joint/diagnostic imaging
• Elbow Joint/pathology
• Elbow Joint/surgery
• External Fixators
• Fibrous Dysplasia, Polyostotic/diagnostic imaging
• Fibrous Dysplasia, Polyostotic/pathology
• Fibrous Dysplasia, Polyostotic/surgery
• Humans
• Male
• Radiography
• Treatment Outcome

• Adolescent
• Adult
• Arthrography
• Biopsy
• Bone Cysts/complications
• Bone Cysts/pathology
• Child
• Female
• Femoral Neck Fractures/diagnostic imaging
• Femoral Neck Fractures/etiology
• Femoral Neck Fractures/surgery
• Femur Neck/diagnostic imaging
• Femur Neck/pathology
• Fibrous Dysplasia of Bone/complications
• Fibrous Dysplasia of Bone/pathology
• Follow-Up Studies
• Fracture Fixation, Internal/methods
• Fractures, Spontaneous
• Hip Joint/diagnostic imaging
• Hip Joint/physiopathology
• Humans
• Male
• Osteotomy/methods
• Range of Motion, Articular
• Retrospective Studies
• Time Factors
• Treatment Outcome

• Adult
• Bone Screws
• Female
• Femur/abnormalities
• Femur/surgery
• Fibrous Dysplasia, Polyostotic/diagnostic imaging
• Fibrous Dysplasia, Polyostotic/surgery
• Humans
• Orthopedic Fixation Devices
• Osteotomy/methods
• Radiography

• Adolescent
• Bone Cysts/complications
• Bone Neoplasms/complications
• Child
• Child, Preschool
• Female
• Fibroma/complications
• Follow-Up Studies
• Fracture Healing
• Fractures, Spontaneous/etiology
• Fractures, Spontaneous/therapy
• Humans
• Male
• Orthopedics/methods
• Osteosarcoma/complications
• Outcome and Process Assessment, Health Care
• Pediatrics/methods
• Retrospective Studies
• Treatment Outcome