Stevens Jarrad, Moin Sarah, Salter Donald, Patton James T
Department of Surgery, Orthopaedics, Royal Infirmary Edinburgh, Edinburgh, Scotland.
Knox Orthopaedic Group, Knox Private Hospital Melbourne, Melbourne, Australia.
JBJS Case Connect. 2019 Apr-Jun;9(2):e0022. doi: 10.2106/JBJS.CC.18.00022.
We report a rare case of desmoplastic fibroma (DF) of the midshaft femur presenting as a pathological fracture. This rare benign bone tumor was treated with an acute en bloc excision and femoral shortening over an intramedullary nail. Once union of the acute shortening had been achieved, further surgery was undertaken to lengthen the femur with the use of Intramedullary Skeletal Kinetic Distractors. At 3 years after fracture, our patient had achieved equal leg lengths, had normal knee function, and was disease free.
DF resulting in pathological fracture of the midshaft femur is extremely rare and has not been reported to occur in the femoral diaphysis. This location is important as preservation of the joint above and below is preferable and en bloc excision is recommended. Restoration of bone stock after en bloc excision is difficult and recurrence needs to be monitored.
我们报告了一例罕见的股骨干中段促纤维增生性纤维瘤（DF），表现为病理性骨折。这种罕见的良性骨肿瘤采用急性整块切除及通过髓内钉进行股骨缩短术治疗。一旦急性缩短实现愈合，便进一步采用髓内骨骼动力撑开器进行手术延长股骨。骨折后3年，我们的患者双下肢长度相等，膝关节功能正常，且无疾病复发。
导致股骨干中段病理性骨折的DF极为罕见，且尚未见发生于股骨干的报道。该部位很重要，因为最好保留上下关节，并建议进行整块切除。整块切除后骨量的恢复困难，需要监测复发情况。
