Surgical treatment for fibrous dysplasia of femoral neck with mild but prolonged symptoms: a case series

Journal of Orthopaedic Surgery and Research

Naoki Ishiguro²  Hiroshi Urakawa²  Yoshihisa Yamada⁴  Hiroatsu Nakashima¹  Kozo Hosono³  Satoshi Tsukushi²  Yoshihiro Nishida² 

[1] Present address: Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, 5-161, Maehata, Tajimi, Gifu, Japan;Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, 65 Tsurumai, Showa, Nagoya 466-8550, Aichi, Japan;Orthopaedic Surgery, Aichi Cancer Center Aichi Hospital, 18 Kuriyado, Kake-machi, Okazaki City, Aichi, Japan;Orthopaedic Surgery, Nagoya Memorial Hospital, 4-305 Hirabari, Tenpaku-ku, Nagoya, Japan

关键词: Bone regeneration;    β-TCP;    Fibula strut;    Femoral neck;    Fibrous dysplasia;   

Others  :  1195285
DOI  :  10.1186/s13018-015-0208-6

 received in 2015-01-04, accepted in 2015-03-14,  发布年份 2015

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusions

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.

【 授权许可】

   
2015 Nishida et al.; licensee BioMed Central.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

【 参考文献 】

• [1]Lichtenstein L, Jaffe HL. Ewing’s sarcoma of bone. Am J Pathol. 1947; 23(1):43-77.
• [2]Tabareau-Delalande F, Collin C, Gomez-Brouchet A, Decouvelaere AV, Bouvier C, Larousserie F et al.. Diagnostic value of investigating GNAS mutations in fibro-osseous lesions: a retrospective study of 91 cases of fibrous dysplasia and 40 other fibro-osseous lesions. Mod Pathol. 2013; 26(7):911-21.
• [3]Ruggieri P, Sim FH, Bond JR, Unni KK. Malignancies in fibrous dysplasia. Cancer. 1994; 73(5):1411-24.
• [4]Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg Am Vol. 1986; 68(9):1415-22.
• [5]Bryant DD, Grant RE, Tang D. Fibular strut grafting for fibrous dysplasia of the femoral neck. J Natl Med Assoc. 1992; 84(10):893-7.
• [6]Guille JT, Kumar SJ, MacEwen GD. Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment. J Bone Joint Surg Am Vol. 1998; 80(5):648-58.
• [7]Harris WH, Dudley HR, Barry RJ. The natural history of fibrous dysplasia. An orthopaedic, pathological, and roentgenographic study. J Bone Joint Surg (Am Vol). 1962; 44-A:207-33.
• [8]Nakashima Y, Kotoura Y, Nagashima T, Yamamuro T, Hamashima Y. Monostotic fibrous dysplasia in the femoral neck. A clinicopathologic study. Clin Orthop Relat Res. 1984; 191:242-8.
• [9]Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW. Semistructural allografting in bone defects after curettage. J Surg Oncol. 1998; 68(3):159-65.
• [10]Shih HN, Cheng CY, Chen YJ, Huang TJ, Hsu RW. Treatment of the femoral neck amd trochanteric benign lesions. Clin Orthop Relat Res. 1996; 328:220-6.
• [11]Stephenson RB, London MD, Hankin FM, Kaufer H. Fibrous dysplasia. An analysis of options for treatment. J Bone Joint Surg Am Vol. 1987; 69(3):400-9.
• [12]Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW. Treatment of fibrous dysplasia involving the proximal femur. Orthopedics. 1998; 21(12):1263-6.
• [13]Arai E, Nakashima H, Tsukushi S, Shido Y, Nishida Y, Yamada Y et al.. Regenerating the fibula with beta-tricalcium phosphate minimizes morbidity after fibula resection. Clin Orthop Relat Res. 2005; 431:233-7.
• [14]Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 286:241-6.
• [15]Ippolito E, Farsetti P, Boyce AM, Corsi A, De Maio F, Collins MT. Radiographic classification of coronal plane femoral deformities in polyostotic fibrous dysplasia. Clin Orthop Relat Res. 2014; 472(5):1558-67.
• [16]Springfield DS. Massive autogenous bone grafts. Orthop Clin N Am. 1987; 18(2):249-56.
• [17]Thompson RC, Pickvance EA, Garry D. Fractures in large-segment allografts. J Bone Joint Surg (Am Vol). 1993; 75(11):1663-73.
• [18]Burchardt H, Glowczewskie FP, Enneking WF. The effect of Adriamycin and methotrexate on the repair of segmental cortical autografts in dogs. J Bone Joint Surg (Am Vol). 1983; 65(1):103-8.
• [19]Heiple KG, Chase SW, Herndon CH. A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg (Am Vol). 1963; 45:1593-616.
• [20]Burchardt H, Enneking WF. Transplantation of bone. Surg Clin N Am. 1978; 58(2):403-27.