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Case Reports
. 2024 Feb;14(2):155-159.
doi: 10.13107/jocr.2024.v14.i02.4254.

A Closer Look at Fibrous Dysplasia Femur Fracture Five-year Follow-up: A Unique Case

Ravi Sauhta  1 , Dheeraj Makkar  2
Affiliations
Case Reports

A Closer Look at Fibrous Dysplasia Femur Fracture Five-year Follow-up: A Unique Case

Ravi Sauhta et al. J Orthop Case Rep. 2024 Feb.

Abstract

Introduction: Fibrous dysplasia (FD) is a benign skeletal disorder characterized by the replacement of normal bone tissue with disorganized fibrous tissue. Fractures are a significant complication of FD, particularly in the proximal femur, where deformities such as Shepherd's crook deformity can increase the risk.

Case report: We present a case study of a 44-year-old male with unilateral monostotic FD, Shepherd's crook deformity, and a pathological femoral shaft fracture. The initial surgical approach involved valgus osteotomy, dynamic condylar screw (DCS) fixation, and multiple osteotomies of the femoral shaft. However, the patient experienced a refracture and implant failure, necessitating a second surgical intervention with a double-angled DCS and additional fixation. Post-operative follow-up revealed successful bone union and deformity correction, although a limb length discrepancy was noted.

Conclusion: This case highlights the challenges in managing FD-related fractures and the importance of addressing deformities and achieving optimal alignment. Individualized treatment approaches, careful implant selection, and post-operative rehabilitation are crucial for successful outcomes in FD-associated fractures.

Keywords: Fibrous dysplasia; dynamic condylar screw; femur; shepherd crook.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Shepherd Crook deformity and mid-shaft fracture femur.
Figure 2
Figure 2
X-ray pelvis showing fibrous dysplasia of the head and neck of femur with thinned bony trabeculae.
Figure 3
Figure 3
Post- operative X-ray of valgus osteotomy with fracture fixation.
Figure 4
Figure 4
Osteotomy site with implant failure 10 weeks after the surgery.
Figure 5
Figure 5
Valgus osteotomy and double angle DCS fixation and subsequent X-ray 5 years later showing healing of the fracture and the osteotomy site.
Figure 6
Figure 6
Straight leg with shortening corrected with footwear modification and the ability of patient to walk without a crutch or a brace 5 years after the second surgery.
See this image and copyright information in PMC

References

    1. Polyostotic Fibrous Dysplasia. JAMA Surgery. JAMA Network. [[Last accessed on 2023 May 19]]. Available from: https://jamanetwork.com/journals/jamasurgery/article-abstract/543604 .
    1. DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am. 2005;87:1848–64. - PubMed
    1. Marie PJ, de Pollak C, Chanson P, Lomri A. Increased proliferation of osteoblastic cells expressing the activating Gs alpha mutation in monostotic and polyostotic fibrous dysplasia. Am J Pathol. 1997;150:1059–69. - PMC - PubMed
    1. Riminucci M, Liu B, Corsi A, Shenker A, Spiegel AM, Robey PG, et al. The histopathology of fibrous dysplasia of bone in patients with activating mutations of the Gs alpha gene:Site-specific patterns and recurrent histological hallmarks. J Pathol. 1999;187:249–58. - PubMed
    1. Dheenadhayalan J, Avinash M, Lakhani A, Rajasekaran S. Shepherd's crook deformity:How to set it straight. A five-step surgical guide. J Orthop Surg (Hong Kong) 2019;27:2309499019834362. - PubMed

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