Osteofibrous Dysplasia of the Tibia

Abstract

Introduction: Osteofibrous dysplasia (OFD) is a benign fibro-osseous lesion that occurs in childhood. OFD almost exclusively affects the tibia with or without fibular involvement. Studies to date have shown that the natural history of this tumor is unclear due to its rarity. Several authors have reported that both curettage and localized subperiosteal excision carry the risk of recurrence. However, few published series have provided detailed rationale for when and how surgical intervention must be chosen. Furthermore, pathologic fracture, one of the important factors that troubles patients and leads surgeons to consider surgical intervention, has not been described in previous studies. Our study of a large patient group reports on the behavior and postoperative recurrence of OFD.

Materials and Methods: We reviewed the medical records of 55 patients who were diagnosed with OFD of the tibia and showed typical features of this tumor. The patients presentation, disease course, history of pathologic fracture, typical radiographic features, surgical treatment history, and surgical results were investigated.

Results: The longitudinal OFD lesion size peaks at a mean 13.3 years of age with a mean maximum proportionate size of 0.33. These lesions in 92% of the patients spontaneously presented with a stable disease course, while those in the other 8% continued increasing. There were no significant predictive factors of disease course. Among surgically treated lesions, we noted a higher rate of recurrence after curettage than after excision (p < 0.001). Patients who underwent curettage and suffered recurrence were significantly younger than those who did not (p = 0.01).

Conclusions: Our data suggest that observation can be the primary form of treatment for patients with OFD and that the disease would stop advancing with time. If surgery is necessary due to severe morbidity, we recommend wide resection rather than curettage to prevent recurrence, especially for younger patients.