Rai Aman, Harshvardhan J K Giriraj, Suryakumar Sundar, Sitsabesan C, Tavfiq M Mohd
Department of Orthopedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
J Orthop Case Rep. 2025 May;15(5):50-55. doi: 10.13107/jocr.2025.v15.i05.5552.
Fibrous dysplasia is a benign skeletal condition characterized by abnormal osteoblastic differentiation and maturation, typically affecting the lower extremity and craniofacial skeleton. It usually manifests in the first three decades of life, with symptoms starting in early childhood. Radiologically, it appears as an expansile, lytic, intramedullary, diaphyseal, or metaphyseal lesion. Treatment options include nonsurgical surveillance, pharmacotherapy, and surgery. Bisphosphonates can manage painless lesions, whereas surgery is necessary for pathological fractures. Alternative treatments include curettage, bone grafting, and internal fixation.
A 24-year-old woman experienced pain in her right arm for 3 years, which had worsened over the past 3 months and was accompanied by swelling for 2 months. The pain was insidious, gradually progressive, and diffuse over the diaphyseal region of the humerus. Examination revealed bony swelling and thickening, restricted shoulder movement and no distal neurovascular deficit.Radiologically, there was an expansile lytic lesion involving the middle and distal third of the diaphysis of the right humerus, suggesting pathological fractures. A magnetic resonance imaging scan revealed an expansile intramedullary lesion involving almost the entire shaft of the right humerus, sparing the proximal metaphyseal region. Histopathological examination revealed hemorrhagic giant cells with fibroblastic proliferation, with no signs of malignancy. Intramedullary fixation was performed with an intramedullary interlocking nail. She began gentle shoulder range-of-motion exercises and pendulum exercises. The patient experienced significant pain relief with good functional outcome and signs of fracture healing.
Long bones with fibrous dysplasia that manifest as pathological fractures may be painful and have limited mobility. The fracture can heal, pain can be reduced, and the functional range of motion can be restored by stabilizing the lesion with an intramedullary implant without curettage or bone grafting.
骨纤维发育不良是一种良性骨骼疾病，其特征为成骨细胞分化和成熟异常，通常累及下肢和颅面骨骼。它通常在生命的前三十年出现，症状始于儿童早期。在放射学上，它表现为一种膨胀性、溶解性、髓内、骨干或干骺端病变。治疗选择包括非手术监测、药物治疗和手术。双膦酸盐可用于处理无症状病变，而病理性骨折则需要手术治疗。其他治疗方法包括刮除术、骨移植和内固定。
一名24岁女性右臂疼痛3年，在过去3个月中加重，并伴有肿胀2个月。疼痛隐匿，逐渐加重，弥漫于肱骨骨干区域。检查发现骨肿胀和增厚，肩部活动受限，远端无神经血管缺损。放射学检查显示，右肱骨骨干中、远三分之一处有一个膨胀性溶骨性病变，提示病理性骨折。磁共振成像扫描显示，一个膨胀性髓内病变几乎累及右肱骨整个骨干，近端干骺端区域未受累。组织病理学检查显示有出血性巨细胞和成纤维细胞增生，无恶性迹象。采用髓内交锁钉进行髓内固定。她开始进行轻柔的肩部活动范围练习和钟摆练习。患者疼痛明显缓解，功能恢复良好，有骨折愈合迹象。
表现为病理性骨折的骨纤维发育不良长骨可能疼痛且活动受限。通过使用髓内植入物稳定病变，无需刮除或骨移植，骨折可以愈合，疼痛可以减轻，活动范围功能可以恢复。
