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Gershkovich G, Kahan DM, Kozin SH, Zlotolow DA. Outcomes in Early Versus Late Presentation of Focal Fibrocartilaginous Dysplasia Affecting the Upper Extremity: A Review of 4 Cases. J Pediatr Orthop 2018; 38:e360-e368. [PMID: 29672435 DOI: 10.1097/bpo.0000000000001175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Focal fibrocartilaginous dysplasia (FFCD) is a rare disorder of the upper and lower extremities. In the distal ulna, a ligamentous tether emerging from the metaphysis crosses the physis and restricts growth, leading to deformity. Lesion excision before radiocapitellar subluxation has been shown to restore growth and allow remodeling. We review the outcomes of 4 patients with FFCD of the distal ulna after the occurrence of radiocapitellar incongruity. METHODS This retrospective review examined 4 patients diagnosed with FFCD of the distal ulna from 2007 to 2015. Diagnosis was based on radiographic parameters and pathology when available. The radiographic and functional outcomes are reported. RESULTS Three males and 1 female patient presented at an average of 37.5 months (range, 22 to 48 mo) with ulnar FFCD and radiocapitellar joint incongruity. The first patient had progressive radiocapitellar dislocation, poor motion, pain, and deformity. The second patient presented for a third opinion after previous surgery secondary to deformity progression and radial head dislocation. These patients required salvage procedures with creation of a 1-bone forearm. Patient 3 had frank dislocation of the radiocapitellar joint, yet maintained functional motion. This family elected for continued observation. Patient 4 had a 50% subluxation of the radiocapitellar joint and underwent tether excision and ulnar lengthening with an external fixator. Both joint congruity and deformity improved with functional forearm and elbow motion. CONCLUSIONS Delayed treatment of ulnar FFCD may require salvage procedures to maximize function and provide pain relief.
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Affiliation(s)
| | - David M Kahan
- Division of Orthopaedic Surgery, Cooper University Hospital, Camden, NJ
| | - Scott H Kozin
- Orthopaedic Surgery, Shriners Hospital for Children Philadelphia, Philadelphia, PA
| | - Daniel A Zlotolow
- Orthopaedic Surgery, Shriners Hospital for Children Philadelphia, Philadelphia, PA
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Correction of Angular Deformities Due to Focal Fibrocartilaginous Dysplasia Using Guided Growth: A Preliminary Report. J Pediatr Orthop 2017; 37:e183-e187. [PMID: 27261964 DOI: 10.1097/bpo.0000000000000785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Focal fibrocartilaginous dysplasia (FFCD) is a rare benign disorder that may result in tethering of the physis. These most commonly occur around the knee and may result in angular deformities of the involved extremity. To date treatment has ranged from observation, to curettage, to osteotomy. Our goal with this study is to evaluate the efficacy of guided growth in treating patients with angular deformity due to FFCD. METHODS This is a retrospective review, we included 3 patients with angular deformities due to FFCD who had undergone 8 plate placement. We reviewed their preoperative and postoperative radiographs, assessed their sagittal and coronal balance and number of procedures. RESULTS Three patients with FFCD of the femur with an average of 14 months underwent guided growth to correct their angular deformity. Once appropriate correction was achieved the hardware was removed. At final follow-up none of the patients required further surgical intervention for their angular deformity nor had they shown any evidence of recurrence. CONCLUSIONS FFCD is a rare benign disorder, they most commonly affects the proximal tibia and distal femur and can result in significant angular deformities. Our review of the literature found all of the cases involving the femur progressed to the point where they needed surgical intervention. This ranged from curettage to osteotomy. In this case series we present 3 cases of FFCD of the distal femur that were treated minimally invasively with guided growth. LEVEL OF EVIDENCE Level 4.
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Fibrous tether of the distal femur produced unilateral genu valgus with subsequent patellar dislocation: case report and review of the literature. J Pediatr Orthop B 2016; 25:573-81. [PMID: 26990056 DOI: 10.1097/bpb.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fibrous tether at the distal femur is a rare condition that causes angular deformity of the lower extremity; only 18 cases have been reported previously. We report the case of a 2-year-old boy presenting with unilateral genu valgus. The patient had a subsequent lateral patellar dislocation, 1 year after surgical correction. A second surgery was performed to correct this patellar dislocation. Intraoperative finding indicated contracted lateral patellar retinaculum. To the best of our knowledge, this is the first report of such a finding. The natural history is still not understood. At the 6-month-follow-up visit, the patient still has good results without recurrent patellar dislocation or angular deformity. We also review the literature in terms of proper treatment and results of treatment.
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Sun B, Zhang ZH, Chen XY, Huang SH, Liu ZL. Focal fibrocartilaginous dysplasia in the thoracic vertebra: A case report. Oncol Lett 2014; 8:1539-1542. [PMID: 25202364 PMCID: PMC4156278 DOI: 10.3892/ol.2014.2331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/29/2014] [Indexed: 11/09/2022] Open
Abstract
Focal fibrocartilaginous dysplasia (FFCD) is a rare, paraneoplastic disease that often presents in children and teenagers. Previous studies have reported cases of lesions in the proximal tibia and distal femur, as well as lesions in the upper extremities. The present study describes a case of FFCD on the transverse process and the rib. The imaging findings were found to correspond with the typical observations of FFCD and a biopsy from the nidus revealed pathological results similar to those of previous reports. Thus, the present study demonstrated that FFCD affects tubular bones as well as flat bones. Further studies are required to investigate the underlying mechanism and treatment of FFCD.
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Affiliation(s)
- Bo Sun
- Department of Orthopaedics, The First Affiliated Hospital of Hainan Medical College, Haikou, Hainan 570102, P.R. China
| | - Zhi Hong Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xuan Ying Chen
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Shan Hu Huang
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhi Li Liu
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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The natural history of focal fibrocartilaginous dysplasia in the young child with tibia vara. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:579-86. [DOI: 10.1007/s00590-013-1346-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 10/14/2013] [Indexed: 11/25/2022]
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6
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Gopinathan P, Anwar MH, Raju K, Bhaskar A, Hussain Y. Tibia vara secondary to focal fibro-cartilaginous dysplasia of proximal tibia. Orthopedics 2008; 31:91. [PMID: 19292147 DOI: 10.3928/01477447-20080101-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P Gopinathan
- Department of Orthopedics, University of Calicut, Medical College, Calicut, Kerala, India
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Jouve JL, Kohler R, Mubarak SJ, Nelson SC, Dohin B, Bollini G. Focal fibrocartilaginous dysplasia ("fibrous periosteal inclusion"): an additional series of eleven cases and literature review. J Pediatr Orthop 2007; 27:75-84. [PMID: 17195802 DOI: 10.1097/bpo.0b013e31802b7139] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) is a benign condition first described in 1985 as a cause of tibia vara. We are reporting on 11 cases. The lesions involved proximal tibia (9 cases), distal femur (1 case), and distal ulna (1 case). We believe that this entity represents a bony anchor preventing natural sliding of the periosteum during growth (an "epiphysiodesis-like" effect). For the tibia, we believe this is the pes anserinus. We are suggesting that this entity be called a "fibrous periostal inclusion." Treatment indications result from this concept: (1) for tibial lesions with a metaphyseal-diaphyseal angle less than 20 degrees observation for 6 to 12 months; (2) if the deformity improves, the tether likely broke spontaneously, and no treatment is required; and (3) curettage early if the deformity worsens. This will be followed by rapid correction into physiological valgus (tibia) and prevent the need for osteotomy. Early curettage for other less common locations is recommended.
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Abstract
Focal fibrocartilaginous dysplasia is a benign bone lesion known to cause deformity around the knee in young children. Three cases affecting the long bones of the upper limb have been reported, and little is known of the natural history. This study reports seven more cases affecting the upper extremity. All patients presented with deformity in early childhood. The location was the radius in two, the ulna in three, the proximal phalanx in one, and the middle phalanx in one. The radiographic appearance of the condition is diagnostic, regardless of the bone it affects. Proportional shortening of the affected segment was present in all patients. The phalangeal cases had marked deformity and were osteotomized, with early recurrence of the deformity in one case. The forearm lesions did not all resolve spontaneously. In the two patients with 7-year follow-up, the length discrepancy increased from 0.5 cm to 2 cm and a degree of cosmetic deformity remained, without functional impairment. Ulna lesions place the radiocapitellar joint at risk for dislocation and should be observed for this complication.
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Affiliation(s)
- Nicholas C Smith
- Department of Orthopaedics, Children's Hospital at Westmead, Sydney, Australia.
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Ruchelsman DE, Madan SS, Feldman DS. Genu valgum secondary to focal fibrocartilaginous dysplasia of the distal femur. J Pediatr Orthop 2004; 24:408-13. [PMID: 15205624 DOI: 10.1097/00004694-200407000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report a case of unilateral genu valgum secondary to focal fibrocartilaginous dysplasia (FFCD) isolated in the posterolateral cortex of the distal femur. This case is the first incidence of a discrete fibrous band occurring in conjunction with a FFCD lesion in the distal posterolateral femur treated with excision of the tether and the overlying periosteum with curettage of the cortical focal fibrocartilaginous defect. Treatment was considered successful with gradual resolution of the 30 degrees valgus deformity over 24 months, and we avoided the necessity of corrective osteotomy and its associated risks. To our knowledge, resolution of genu valgum secondary to FFCD in the distal posterolateral femur after curettage has not been previously described in the literature.
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Affiliation(s)
- David E Ruchelsman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases Orthopaedic Institute, New York, New York 10003, USA
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10
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Abstract
Focal fibrocartilaginous dysplasia is a rare benign entity, previously described as a factor responsible for causing tibia vara at the walking age. We report here the case of a child with tibia valga due to focal fibrocartilaginous dysplasia of the lateral part of the proximal tibia. To our knowledge, this is the first observation of a lesion located in the lateral proximal tibia. Clinical, radiographic and magnetic resonance imaging surveillance was performed. Spontaneous resolution of the lesion with correction of the angular deformity did occur.
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Affiliation(s)
- Mafalda Santos
- Vila Nova de Gaia Central Hospital, Vila Nova de Gaia, Portugal
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Postovsky S, Militianu D, Bialik V, Vlodavsky E, Elhasid R, Peled M, Arush MWB. Concomitant focal fibrocartilaginous dysplasia of the tibia and eosinophilic granuloma of the jaw in a child. J Pediatr Orthop B 2002; 11:172-5. [PMID: 11943994 DOI: 10.1097/00009957-200204000-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This 2-year-old child presented with concomitant eosinophilic granuloma of the lower jaw and focal fibrocartilaginous dysplasia of the right tibia. Her eosinophilic granuloma was diagnosed on the basis of the clinical picture, imaging studies and the characteristic histologic appearance. Focal fibrocartilaginous dysplasia was revealed incidentally during the eosinophilic granuloma staging process. After chemotherapy, all signs of eosinophilic granuloma subsided, but focal fibrocartilaginous dysplasia remained without signs of clinical or radiographic progression. The importance of differentiating these two conditions is stressed in order to avoid ineffective and inappropriate treatment of focal fibrocartilaginous dysplasia.
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Affiliation(s)
- Sergey Postovsky
- Department of Pediatric Hematology Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Kim CJ, Choi IH, Cho TJ, Chung CY, Chi JG. The histological spectrum of subperiosteal fibrocartilaginous pseudotumor of long bone (focal fibrocartilaginous dysplasia). Pathol Int 1999; 49:1000-6. [PMID: 10594847 DOI: 10.1046/j.1440-1827.1999.00967.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinicopathological features in six cases of focal fibrocartilaginous dysplasia (FFCD) which involved either the tibia (n = 4) or the femur (n = 2) were reviewed. All cases presented clinical and radiological characteristic features, and histopathological findings were analyzed in five of the six cases. The subject group comprised three boys and three girls, ages ranged from 12 to 18 months. Histologically, the individual lesions showed regional variation in cellularity, amount of fibrous and cartilaginous components. Paucicellular areas were mainly composed of dense fibrous tissue while more cellular areas contained foci of fibrocartilaginous element. The chondrocytes and stellate cells around cartilaginous area were positive for S-100 protein. One case contained both hyaline and fibrocartilage, and architecturally mimicked normal tendinous insertion. One case, which involved proximal tibia, was purely composed of fibrous tissue without fibrocartilage. All cases formed undulating and irregular borders against underlying cortical bone. Histopathologically variable spectrum suggests a strong possibility of undergoing transition from initial cellular and cartilagnous to late paucicellular, fibrous phase. Although any evidence that can explain basic pathogenesis or prognostic histological parameter is lacking, we believe that the term FFCD is not relevant because the presence of fibrocartilage is not an essential feature, and it can cause confusion with other pathological processes. We propose the term 'subperiosteal fibrocartilaginous pseudotumor of long bone' for this unique clinicopathological entity with which heterologous cartilaginous element can be associated.
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Affiliation(s)
- C J Kim
- Deaprtment of Pathology, Seoul National University college of Medicine, Seoul, Korea
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13
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Abstract
Genu varum is a relatively common finding in children. Physiologic bowing, which is seen most often, has a well-documented favorable natural history. Idiopathic tibia vara is the most common of the pathologic conditions that are associated with bowed legs; treatment strategies vary with the patient's age and the stage of disease and deformity. Genu varum may also accompany systemic conditions, such as achondroplasia, vitamin D-resistant rickets, renal osteodystrophy, and osteogenesis imperfecta-all of which can result in short stature. Indications for intervention are not always well defined. A rare disorder, focal fibrocartilaginous dysplasia, usually requires no treatment. Standing radiographs of the entire lower limbs are necessary for surgical planning, as the deformity can sometimes affect the distal femur rather than the proximal tibia. Restoration of the mechanical axis of the limb is the principal goal of treatment; the particular type of internal fixation is of secondary importance.
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14
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Cockshott WP, Martin R, Friedman L, Yuen M. Focal fibrocartilaginous dysplasia and tibia vara: a case report. Skeletal Radiol 1994; 23:333-5. [PMID: 7939830 DOI: 10.1007/bf02416986] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 2-year-old black boy with focal fibrocartilaginous dysplasia is described with illustrations of the typical radiographic appearances supplemented by computed tomographic and magnetic resonance images. Since this rare condition is self-correcting, diagnosis is important so that surgical intervention and biopsy can be avoided and conservative management instituted.
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Affiliation(s)
- W P Cockshott
- Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Vallcanera Calatayud A, Sangüesa Nebot C, Martinez Fernandez M, Cortina Orts H. Varus deformity of the distal end of the femur secondary to a focal fibrous lesion. Pediatr Radiol 1994; 24:74-5. [PMID: 8008507 DOI: 10.1007/bf02017672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Severe unilateral varus deformity of the distal end of the femur secondary to a focal fibrous lesion is reported. It is a malformative process rare at this level, this being the first report of it in the radiological literature. The conventional radiograph is pathognomonic and CT is useful in the confirmation of the fibrous tissue. Osteotomy is indicated only if the deformity progresses or the angle of varus is severe.
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Affiliation(s)
- W B Greene
- University of North Carolina, Chapel Hill 27599-7055
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Zayer M. Tibia vara in focal fibrocartilaginous dysplasia. A report of 2 cases. ACTA ORTHOPAEDICA SCANDINAVICA 1992; 63:353-5. [PMID: 1609610 DOI: 10.3109/17453679209154802] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Zayer
- Department of Orthopedics, Angelholm Hospital, Sweden
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