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Review
. 2021 Mar;55(2):184-188.
doi: 10.5152/j.aott.2021.20080.

Excision of fibrous band and application of tension band plating in focal fibrocartilaginous dysplasia: A case report and literature review

Sancar Bakırcıoğlu  1 , Engin Türkay Yılmaz  1 , Kemal Kösemehmetoğlu  2 , Güney Yılmaz  1
Affiliations
Review

Excision of fibrous band and application of tension band plating in focal fibrocartilaginous dysplasia: A case report and literature review

Sancar Bakırcıoğlu et al. Acta Orthop Traumatol Turc. 2021 Mar.

Abstract

Focal fibrocartilaginous dysplasia (FFCD) is a rare disease that can cause angular deformities of long bones. The common pathologic finding is a thick fibrotic band extending from epiphysis to metaphysis on one side of the bone. The tethering effect of the fibrotic band around the growth plate is thought to be the main etiology for the development and progression of the deformity. FFCD mostly affects the proximal tibia and the distal femur. The literature contains different treatment options. Here, we present the case of a 20-month-old girl with FFCD on the medial side of the distal femur causing varus deformity. Our treatment protocol included excision of the fibrotic band from the medial side and application of a two-hole plate for guided growth on the lateral side of the distal femur. Deformity correction was achieved rapidly with no complications. A literature review is also presented along with pathologic and magnetic resonance imaging findings.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1. a–d
Figure 1. a–d
Preoperative standing X-ray shows varus and procurvatum deformity of the distal femur. The mechanical lateral distal femoral angle mLDFA was 132° (a, b). The mLDFA was 88°, and acceptable alignment was achieved in the 12-month follow-up after surgery (c). The 2-year follow-up X-ray shows good coronal plane alignment and 1.5 cm limb-length discrepancy (d)
Figure 2. a, b
Figure 2. a, b
T1- (a) and T2- (b) weighted sequences revealed a hypointense fibrotic band extending from the epiphysis to the metaphyseal area (white arrows) on the medial side of the distal femur. The thick low-signal lesion blends with the periosteum proximally
Figure 3. a–d
Figure 3. a–d
Femoral varus deformity of the patient caused by focal fibrocartilaginous dysplasia (a). Intraoperative fluoroscopy image showing tension band plating in place after excision the fibrous band (b). Appearance of the fibrous tissue (white arrow) after retraction of the vastus medialis (c). Bony area (white arrow) after excision of the fibrous lesion starting from the level of the physis to the metaphyseal groove (d)
Figure 4. a, b
Figure 4. a, b
(a) Low-power field view demonstrates mature adipocytes at the bottom and hyalinized fibrous tissue resembling a tendon and papillary synovial tissue on top (40×, hematoxylin and eosin). (b) High-power magnification reveals synovial lining on the hyalinized hypocellular fibrous tissue (200×, hematoxylin and eosin)
See this image and copyright information in PMC

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