Osteofibrous Dysplasia of the Clavicle Managed with Intravenous Bisphosphonates: A Case Report and Review of Literature.

Abstract

Osteofibrous dysplasia is a fibro-osseous benign lesion of childhood and infancy that are commonly seen in the anterior shin of the tibia. Osteofibrous dysplasia in the clavicle is rare and in this study, we reported a case of osteofibrous dysplasia arising in the midshaft of the clavicle. An 11-year boy presented with complaints of pain and swelling over his left clavicle and was unable to do overhead abduction following a fall while playing 2 years back. Initially, the patient was diagnosed with a left clavicle fracture and was treated conservatively. The pain subsided after 3 months. The patient had re-injury after 6 months, following which pain and swelling of the left clavicle were gradually progressive. On examination, there was a diffuse swelling extending from the medial end to the lateral end of the left clavicle, which was tender, and bony-hard in consistency. The range of movements of the left shoulder was painful and terminally limited. A percutaneous core-needle biopsy was done, suggestive of a benign fibro-osseous lesion. An open biopsy was done from the tumor-normal bone junction, and caseous materials were found inside the medullary canal, the microscopic finding shows fibroblastic proliferation and osteoblastic proliferation laying down the woven bone. We treated the case with intravenous pamidronate injection in 6 months intervals for 2 years. The patient improved symptomatically achieving a full range of movements of the affected shoulder with good radiological consideration of the lesion. Osteofibrous dysplasia is uncommonly seen in the clavicle, and if it is seen, it may mimic osteomyelitis clinically. It should be differentiated from other lesions by radiological, histopathological, and immunohistochemistry findings.