Fibrous dysplasia of femur, treated with fibular bone graft

Abstract

Background: Fibrous dysplasia is a benign bony lesion managed surgically with curettage, bone grafting, and, in some cases, internal fixation. Aims: Study result of cortical bone grafting with fibular strut graft in patient of symptomatic dysplastic lesion without varus deformity of proximal femur. Case Report: A 25-year-old female presented with pain in left hip for 3 months which increased in intensity during walking. Clinically there was no swelling or deformity and tenderness. Range of hip joint movement was normal. The patients had no endocrine disturbances. X-rays of left proximal femur showed radiolucent cystic area involving trochanter, neck, and 30% head at postero-inferior aspect. No pathological fracture was seen. Image showed homogeneous loss of the normal trabecular pattern, with a ground-glass appearance caused by fibrous dysplasia. Patient underwent dual autogenous non-vascularized fibular strut grafts. The dual fibular graft was used as a bridge in the dysplastic lesion in femoral neck and it was securely anchored to the head of femur as well as lateral femoral cortex. The fibular graft was providing excellent structural support without any need for any form of internal fixation. At routine follow-up at 8 months, patient was found ambulating at her own without any substantial pain at the hip joint. Conclusion: For carefully selected patients (symptomatic dysplastic lesion without varus deformity of proximal femur) cortical bone grafting with fibular strut graft is an excellent procedure which provide strong structural support to biomechanically weakened bone.