Focal fibrocartilaginous dysplasia: consideration of healing process

Outcomes in Early Versus Late Presentation of Focal Fibrocartilaginous Dysplasia Affecting the Upper Extremity: A Review of 4 Cases

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.

Correction of Angular Deformities Due to Focal Fibrocartilaginous Dysplasia Using Guided Growth: A Preliminary Report

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.

Focal fibrocartilaginous dysplasia in the ulna with the radial head dislocation: a case report and literature review

Focal fibrocartilaginous dysplasia (FFCD) is a rare benign bone lesion, which mainly occurs in the proximal tibia. In the upper extremity, only 21 cases have been reported so far and 14 of these involved the ulna. We present an additional case of FFCD in the distal ulna that showed progressive bowing of the right forearm and the radial head dislocation. Resection of the abnormal tissue, osteotomy of the radius and ulna, and gradual lengthening of the ulna were performed. On the basis of the previously published data of 14 cases and our data, we have summarized the etiology, clinical features, natural history, and treatment of FFCD in the ulna.

Fibrous tether of the distal femur produced unilateral genu valgus with subsequent patellar dislocation: case report and review of the literature

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.

Focal fibrocartilaginous dysplasia in the thoracic vertebra: A case report

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.

Focal fibrocartilaginous dysplasia in the humerus

Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity of the long bones in young children. It has most commonly been encountered in the proximal tibia, and very rarely in the long bones of the upper limb, that is, the proximal humerus, distal radius, ulna, and proximal phalanx. Only one case of focal fibrocartilaginous dysplasia of the proximal humerus has been reported previously. The present study reports two such additional cases that were diagnosed in late childhood. The clinical presentation and radiographic findings are described with an emphasis on the natural evolution of the disease. Limb-length discrepancy is anticipated in these children in the long-term follow-up and, therefore, surgical intervention should be considered in the treatment.

Focal fibrocartilaginous dysplasia ("fibrous periosteal inclusion"): an additional series of eleven cases and literature review

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.

Focal fibrocartilaginous dysplasia in the humerus

Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity of the long bones in young children. It has most commonly been encountered in the proximal tibia, and very rarely in the long bones of the upper limb, that is, the proximal humerus, distal radius, ulna and proximal phalanx. Only one case of focal fibrocartilaginous dysplasia of the proximal humerus has been reported previously. The present study reports two such additional cases that were diagnosed in late childhood. The clinical presentation and radiographic findings are described with an emphasis on the natural evolution of the disease. Limb-length discrepancy is anticipated in these children in the long-term follow-up and, therefore, surgical intervention should be considered in treatment.

Focal fibrocartilaginous dysplasia in the upper limb: seven additional cases

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.

Genu valgum secondary to focal fibrocartilaginous dysplasia of the distal femur

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.

Tibia valga due to focal fibrocartilaginous dysplasia: case report

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.

The histological spectrum of subperiosteal fibrocartilaginous pseudotumor of long bone (focal fibrocartilaginous dysplasia)

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.