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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 5, 658-664.
doi: 10.1302/0301-620X.88B5.17358  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Osteofibrous dysplasia of the tibia

IS THERE A NEED FOR A RADICAL SURGICAL APPROACH?

R. S. Lee, MRCS, Specialist Registrar1; S. Weitzel, FRCS (Trauma & Orth), Specialist Registrar1; D. M. Eastwood, FRCS, Consultant Orthopaedic Surgeon1; F. Monsell, FRCS, Consultant Orthopaedic Surgeon2; J. Pringle, FRCS, Consultant Histopathologist1; S. R. Cannon, FRCS, Consultant Orthopaedic Surgeon1; and T. W. R. Briggs, FRCS, Consultant Orthopaedic Surgeon1

1 Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
2 Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK.

Correspondence should be sent to Mr R. S. Lee at Flat 4, Monterey Lodge, Frithwood Avenue, Northwood, Middlesex HA6 3GA, UK; e-mail: leerobert9{at}hotmail.com

Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process.

We retrospectively reviewed 16 patients who were diagnosed as having osteofibrous dysplasia initially or on the final histological examination. Their management was diverse, depending on the severity of symptoms and the extent of the lesion. Definitive (extraperiosteal) surgery was localised ‘shark-bite’ excision for small lesions in five patients. Extensive lesions were treated by segmental excision and fibular autograft in six patients, external fixation and bone transport in four and proximal tibial replacement in one. One patient who had a fibular autograft required further excision and bone transport for recurrence. Six initially underwent curettage and all had recurrence. There were no recurrences after localised extraperiosteal excision or bone transport. There were three confirmed cases of adamantinoma.

The relevant literature is reviewed. We recommend extraperiosteal excision in all cases of osteofibrous dysplasia, with segmental excision and reconstruction in more extensive lesions.




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eLetters:

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Conservative management of osteofibrous dysplasia
Robert J Grimer, et al.
J Bone Joint Surg Br Online, 8 Aug 2006 [Full text]
Authors' reply
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J Bone Joint Surg Br Online, 13 Sep 2006 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General