J Korean Orthop Assoc.  2007 Oct;42(5):630-635. 10.4055/jkoa.2007.42.5.630.

Importance of Extraperiosteal Excision in Surgical Treatment of Osteofibrous Dysplasia

• Jung ST
• Kim HJ
• Kim MS

• KMID: 2186470
• DOI: http://doi.org/10.4055/jkoa.2007.42.5.630

Abstract

PURPOSE: This study reviewed the outcome of the surgical treatment of osteofibrous dysplasia (OFD) involving the long bones in order to demonstrate the necessity of an extraperiosteal excision.
MATERIALS AND METHODS
This study was a retrospective review of 10 cases of OFD, who underwent surgical treatment from August 1996 to August 2003. All cases were diagnosed by the final histology. There were 5 males and 5 females with a mean age of 12.4 years (range, 4.2-42.6 years). Seven, 1 and 2 involved the tibia, fibular, and femur, respectively. For surgical treatment, an extraperiosteal excision, subperiosteal excision or curettage and bone grafting was selected. Recurrences and bony union were observed using the serial radiographs. The mean follow-up duration was 4.2 years (range, 2.2-6.6 years).
RESULTS
Six, 1 and 3 patients underwent an extraperiosteal excision, subperiosteal excision, and curettage and bone grafting, respectively. Two patientswho underwent curettage and one patient who underwent subperiosteal excision suffered recurrences. There were two cases of non-union in the extraperiosteal excision group which required bone grafting. There were no infections or pathological fractures.
CONCLUSION
An extraperiosteal excision for OFD is required in patients with skeletal immaturity, corresponding to the surgical indications.

Keyword

Osteofibrous dysplasia; Extraperiosteal excision

MeSH Terms

Bone Transplantation
Curettage
Female
Femur
Follow-Up Studies
Fractures, Spontaneous
Humans
Male
Recurrence
Retrospective Studies
Tibia

Figure

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  Fig. 1 A case of localized extraperiosteal excision. (A) 4.2-year old boy who suffered from a fracture twice visited showing a growing mass in the lower leg. An eccentric intracortical osteolytic lesion with a sclerotic margin was demonstrated at the proximal third of the tibia. (B) A localized extraperiosteal excision with a fibular strut bone graft was performed because of the sudden expansion of the mass, which was confined to less than 50% of the bony circumference. (C) Irregularly arranged bony trabeculae lying within a relatively hypocellular fibroblastic proliferation is the typical finding of osteofibrous dysplasia. (D) Two years and 8 months after surgery, the radiograph shows the evidence of union and no finding of recurrence.

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  Fig. 2 A case of segmental extraperiosteal excision. (A) A 7.3-year old boy suffered lower leg pain and a growing mass. A eccentric osteolytic lesion with a sclerotic margin was demonstrated. (B) A segmental extraperiosteal excision and external fixation with Ilizarov was performed because of the extensive lesion over 50% of the bony circumference, which resulted in bony weakness. (C) Bone transport was performed for the bony defect. (D) Four years and 2 months after surgery, the radiograph shows evidence of union and no recurrence.

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