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Chait F, Bahlouli N, Faraj C, Mrani Alaoui N, Zouirech Y, El Alami Fellous SZ, El Madhi T, Allali N, El Haddad S, Chat L. Tibia vara caused by focal fibrocartilaginous dysplasia: A rare case report. SAGE Open Med Case Rep 2024; 12:2050313X241236150. [PMID: 38444693 PMCID: PMC10913507 DOI: 10.1177/2050313x241236150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
Focal fibrocartilaginous dysplasia is an uncommon benign bone condition that predominantly affects children and typically leads to varus deformities in the proximal tibia. It was first described by Bell in 1985. The etiology remains unknown and the diagnosis is radiological; biopsy is not necessary. We present a case of a 2-year-old child who presented to our department for a right limb varus deformity caused by focal fibrocartilaginous dysplasia.
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Affiliation(s)
- Fatima Chait
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Nourrelhouda Bahlouli
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Chaymae Faraj
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Nidal Mrani Alaoui
- Pediatric Surgery Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Yacine Zouirech
- Pediatric Surgery Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | | | - Tarik El Madhi
- Pediatric Surgery Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
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Coskun M, Akbulut D, Mirzazada J. Case report: Distraction osteogenesis of focal fibrocartilaginous dysplasia and literature review. Int J Surg Case Rep 2024; 115:109271. [PMID: 38262218 PMCID: PMC10832495 DOI: 10.1016/j.ijscr.2024.109271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Focal fibrocartilaginous dysplasia (FFCD) is a rare disease of the ulna that requires early surgical intervention. CASE PRESENTATION We present a juvenile case and the outcomes of a corrected deformity. The fibrotic band that adhered to the ulna was resected, the ulna was osteotomized, and then an external fixator was placed for lengthening. The ulna's distal physis line was extended by 18 mm so that it would be the same length as the distal physis line of the radius. Full functional recovery occurred within three months. CLINICAL DISCUSSION There have been 22 cases of ulnar FFCD reported in the literature. Our patient is the oldest reported thus far who developed radial head subluxation, but no dislocation occurred. CONCLUSION FFCD is a broad-spectrum disease. Although its course is generally poor for patients with a late diagnosis, it is possible to obtain good results with correction procedures.
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Left wrist pain in a teenager. Skeletal Radiol 2022; 51:2347-2349. [PMID: 35511245 DOI: 10.1007/s00256-022-04066-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 02/02/2023]
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Zhou DF, Zhou Y, Lou LX, Fu G, Yang Z. Diagnosis and treatment of focal fibrocartilaginous dysplasia of the distal ulna. J Pediatr Orthop B 2022; 31:493-499. [PMID: 34908031 DOI: 10.1097/bpb.0000000000000935] [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: 11/25/2022]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) of the distal ulna is a rare benign lesion resulting in progressive radiocapitellar dislocation, limb deformity and limitation in function. This study reported our experience with 10 cases and it aimed to determine a reasonable strategy for diagnosis and treatment. Ten cases treated from 2010 to 2018 in our department were retrospectively reviewed. The diagnosis was based on imaging features. All patients underwent lesion excision in the early stage and five patients required ulna lengthening in the second stage. The radiographic and functional outcomes were analyzed and reported. The median age at diagnosis was 32 months (range, 6-36 months). The median age at the time of surgery was 34 months (range, 10-40 months). The median clinical and radiographic follow-up period was 37 months (range, 24-50 months). The ulna was shortened by an average of 31 mm (range, 27-35 mm). There was no new radial head dislocation after lesion excision. For five cases of radial head dislocation, the median elbow varus angle before ulnar lengthening was 20° and it decreased to 5° after ulnar lengthening. Supination and pronation of the elbow increased from 50°-10° to 70°-30°. We believe that early excision of the lesion can prevent radiocapitellar joint dislocation in patients with FFCD of the ulna. Ulna lengthening can correct limb deformity and improve the range of motion.
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Affiliation(s)
- Da-Fei Zhou
- Department of Orthopaedics of the Fourth Clinical Medical College of Peking University, Beijing, China
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Lou L, Li X, Gong L, Zhang W, Zhou D, Cheng X, Cheng K, Yu A. Magnetic resonance imaging of focal fibrocartilaginous dysplasia - findings derived from a three-dimensional gradient echo sequence. Pediatr Radiol 2022; 52:58-64. [PMID: 34542676 DOI: 10.1007/s00247-021-05175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/31/2021] [Accepted: 07/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Focal fibrocartilaginous dysplasia is a rare benign bone lesion of young children that causes deformities in the extremities. However, the pathogenesis and treatments have not been defined and the MR manifestations have been less well described. OBJECTIVE To describe the MR manifestations of focal fibrocartilaginous dysplasia, especially on the T1-W three-dimensional (3-D) volumetric interpolated breath-hold examination (VIBE) sequence. MATERIALS AND METHODS In this retrospective study, the authors reviewed the MR and radiographic images, pathology and medical records of 21 cases of focal fibrocartilaginous dysplasia. All cases were evaluated by spin-echo MRI sequence. Among them, 17 cases were evaluated by T1-W 3-D VIBE sequence. RESULTS The cohort consisted of 13 boys and 8 girls ages 4-75 months. In 14 cases, focal fibrocartilaginous dysplasia was located in the tibia, 3 in the femur and 4 in the ulna. MRI 3-D VIBE sequence findings showed all cases had hypointense fiber band structures in the bone defect areas. The fibrous bands in the lower extremities ended in the epiphysis or epiphyseal plate, and in the upper extremities the epiphysis or carpal bone. Ten cases had hyperintensities that might represent cartilage composition. Four cases had cartilage signals that were continuous with the epiphyseal cartilage. MR spin-echo sequence findings showed that bone marrow edema of the adjacent joint was observed in eight cases, enlargement of the epiphyseal plate in three cases and medial meniscus injury in five cases. CONCLUSION The 3-D VIBE sequence reveals useful details in focal fibrocartilaginous dysplasia.
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Affiliation(s)
- Luxin Lou
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China
| | - Xinmin Li
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China
| | - Lihua Gong
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China
| | - Dafei Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China
| | - Kebin Cheng
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East St., Xicheng District, Beijing, 100035, China.
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Dussa CU, Döderlein L. [Correction of complex defomities around the Knee Joint]. DER ORTHOPADE 2021; 50:559-569. [PMID: 34160640 DOI: 10.1007/s00132-021-04117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
Complex deformities around the knee joint are usually severe and have several aetiologies. They can be present in one or more planes, with variations in severity between planes. The occurrence and progression of the deformity can be influenced by local and systemic factors. Several types of osteotomies and fixation methods are available to correct these complex deformities. The selection of the osteotomy used to correct a deformity depends on the type of deformity, its severity and its aetiology. Therefore, precise planning taking into consideration the above factors is necessary to achieve the goal.
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Affiliation(s)
- Chakravarthy U Dussa
- Orthopädische Kinderklinik Aschau, Bernauer Str. 18, 83229, Aschau/Chiemgau, Deutschland.
| | - Leonhard Döderlein
- Orthopädische Gemeinschaftspraxis in der Aukammklinik, Wiesbaden, Deutschland
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Bian Z, Lyu X, Guo Y, Zhu Z, Feng C, Yang J, Dong Y. Focal fibrocartilaginous dysplasia of the distal femur. J Pediatr Orthop B 2020; 29:466-471. [PMID: 32453122 DOI: 10.1097/bpb.0000000000000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) of the distal femur is a rare disorder that results in a varus or valgus of knee. Due to the small number of cases and unconfirmed natural history of the disease, treatment methods remain variable. This study aimed to determine a strategy to successfully manage distal femoral FFCD. Nine case of femoral FFCD treated in our department between 2008 and 2018, together with 22 cases from literature, were retrospectively reviewed. Tibiofemoral anatomical axis angle (TFA) was used to evaluate and follow the deformities. Treatment methods and outcome were analyzed. Five methods were used to manage the disease: osteotomy with tether release in 14 cases with mean TFA of 29°; simple tether release in eight cases with mean TFA of 31°; guide growth without tether release in 3 case with mean TFA of 27°; guide growth with tether release in 3 case with mean TFA of 27°; and observation in three cases with mean TFA of 23°.Deformity was resolved in all 31 patients. The analysis of the 31 cases in the literature and our experience suggests that femoral FFCD can be successfully managed by simple tether release and curettage. Osteotomy can be avoided. In case of mild deformity (TFA < 25°), it is reasonable to follow-up till 2-3 years of age; if no progress occurs, spontaneous resolution can be expected.
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Affiliation(s)
- Zhen Bian
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
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8
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Spontaneous resolution of focal fibrocartilaginous dysplasia of femur on long-term follow-up: case report and review of literature. J Pediatr Orthop B 2019; 28:127-131. [PMID: 30444750 DOI: 10.1097/bpb.0000000000000570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) is a rare developmental disorder frequently leading to angular deformities in young children. It most commonly affects the proximal tibia followed by distal femur. There are totally 22 reported cases of FFCD of femur. We report a case of FFCD of distal femur as a cause of varus deformity that was managed nonoperatively. The deformity resolved spontaneously over a period of 8 years. This is the second reported case of spontaneous resolution of angular deformity secondary to FFCD of distal femur. We strongly recommend to observe the behavior of deformity over a period of 24 months before any surgical intervention is planned.
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Ulnar focal cortical indentation: a progressive, deforming variant of focal fibrocartilaginous dysplasia. Pediatr Radiol 2019; 49:187-195. [PMID: 30443667 DOI: 10.1007/s00247-018-4294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/20/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Focal fibrocartilaginous dysplasia is a rare growth disturbance of bone resulting in deformity. In the ulna, focal fibrocartilaginous dysplasia is particularly rare, and the characteristic fibroligamentous tether can result in progressive deformity with progressive dislocation of the radial head. The fibroligamentous tether is similar in appearance and function to the Vickers ligament seen in Madelung deformity. The imaging features of ulnar focal fibrocartilaginous dysplasia include a unilateral angular deformity in the ulna with a radiolucent cortical defect and surrounding sclerosis, with secondary radial bowing or radial head dislocation. Focal fibrocartilaginous dysplasia of the ulna has been described using the term ulnar focal cortical indentation. OBJECTIVE To review the clinical and radiologic features of four cases of ulnar focal cortical indentation occurring in pediatric patients. MATERIALS AND METHODS We retrospectively reviewed picture archiving and communication system and electronic medical record imaging findings with surgical correlation of ulnar focal cortical indentation at two large specialty pediatric hospitals. RESULTS Ulnar focal cortical indentation lesions typically arise in the ulnar metaphysis and result in angular forearm deformities with progressive radial deformity including radial head dislocation. Early surgical intervention prevents progression of the deformity and retains range of motion. CONCLUSION Ulnar focal cortical indentation, although rare, is likely a progressive form of focal fibrocartilaginous dysplasia resulting in significant deformity and disability. Early recognition of the characteristic imaging features is important for early surgical intervention to preserve range of motion and prevent radial head dislocation.
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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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Goldin A, Muzykewicz DA, Dwek J, Mubarak SJ. The aetiology of the non-ossifying fibroma of the distal femur and its relationship to the surrounding soft tissues. J Child Orthop 2017; 11:373-379. [PMID: 29081852 PMCID: PMC5643931 DOI: 10.1302/1863-2548.11.170068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF's location and aetiology. METHODS Charts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompassed a diagnosis of NOF of the distal femur by imaging, and histologically, if available. Radiographs, CT and MRI were used to characterise the relationship of the NOF lesions with the surrounding soft tissues. RESULTS The 68 NOFs from 60 patients were included. By radiograph, 41 (60.3%) of the 68 lesions appeared at the medial and 25 (36.7%) at the lateral aspect of the distal femur. In total, 41 lesions had CT scans, showing 22 NOFs (53.7%) attached to the origin of the medial gastrocnemius, 12 (29.3%) to the origin of the lateral gastrocnemius and four (9.8%) at the attachment of the adductor magnus. Of the CT scans, 93% identified the NOF's relationship with an adjoining tendon of the distal femur. Six had MRIs, all of which showed attachment at the medial gastrocnemius. CONCLUSION The study reveals a relationship between tendinous structures and NOFs. NOFs of the distal femur occur most commonly at the origin of the medial and lateral gastrocnemius. They may originate from the physis/metaphysis but they do not always attach to the physis, as we observe them 'migrating' as patients grow. More research is required to understand the exact aetiology of NOFs.
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Affiliation(s)
- A. Goldin
- Department of Orthopaedic Surgery, Rady Children’s Hospital, 3020 Children’s Way, Mail Code 50620, San Diego, CA 92123, USA and Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - D. A. Muzykewicz
- Department of Orthopaedic Surgery, Rady Children’s Hospital, 3020 Children’s Way, Mail Code 50620, San Diego, CA 92123, USA and Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - J. Dwek
- Department of Orthopaedic Surgery, Rady Children’s Hospital, 3020 Children’s Way, Mail Code 50620, San Diego, CA 92123, USA
| | - S. J. Mubarak
- Department of Orthopaedic Surgery, Rady Children’s Hospital, 3020 Children’s Way, Mail Code 50620, San Diego, CA 92123, USA and Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
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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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Feczko P, Emans P. Hereditary bilateral genu recurvatum: Case report of a family. Knee 2017; 24:137-143. [PMID: 27876420 DOI: 10.1016/j.knee.2016.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/09/2016] [Accepted: 09/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Genu recurvatum is a rare condition in children and adolescents. The origin can be osseous, ligamentous and mixed. METHODS We describe for the first time a family inclusive two brothers and their mother with hereditary bilateral genu recurvatum of unknown etiology. The possible underlying pathology and treatment are discussed. RESULTS The underlying pathology of the early closure of the apophysis of the tibial tuberosity remained unclear. The mother was never treated, one of the brothers received a tibial osteotomy as a young adult. Both patients developed end-stage osteoarthritis of both knees which was successfully treated by a bilateral computer-navigated TKA. At seven to eight years after implantation in the older brother (left and right knee, respectively) and three to four years after implantation in the younger brother (right and left knee, respectively), the Visual Analogue Scale (VAS) pain score on a 0 to 100 scale was 0 of both brothers, the EQ-5D health status was 80 (scale of 0 to 100), the satisfaction was 10 (scale of 10) of both brothers. The Knee Injury and Osteoarthritis Outcome Score (KOOS) function of the younger brother of 75 (scale 0 to 100) and of the older brother 100. The KOOS sport of the younger brother was 10 (scale 0 to 100), whereas that of the older brother 85. CONCLUSIONS Hereditary bilateral genu recurvatum with end-stage osteoarthritis can be successfully treated with computer-navigated TKAs; however, impingement of the patella on the proximal tibia and the position of the tibial keel are of concern.
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Affiliation(s)
- Peter Feczko
- Department of Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands.
| | - Pieter Emans
- Department of Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
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Focal fibrocartilaginous dysplasia in the ulna with the radial head dislocation: a case report and literature review. J Pediatr Orthop B 2017; 26:41-47. [PMID: 26919618 DOI: 10.1097/bpb.0000000000000286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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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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Jibri Z, Chakraverty J, Thomas P, Kamath S. Focal fibrocartilaginous dysplasia and spontaneously resolving bowing of the leg. J Pediatr 2013; 163:1527.e1. [PMID: 23932213 DOI: 10.1016/j.jpeds.2013.06.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
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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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Abstract
Focal fibrocartilaginous dysplasia (FFCD) is an uncommon, yet well documented, cause of long-bone angular deformities in children. We report two unusual cases of FFCD involving the tibia: one within the proximal tibia inducing genu valgum and one apparent FFCD lesion of the distal tibia that generated a varus deformity of the distal tibia. To our knowledge, this is the first reported case of FFCD in the distal tibia. Each lesion led to an angular deformity that required surgical management.
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Gottschalk HP, Light TR, Smith P. Focal fibrocartilaginous dysplasia in the ulna: report on 3 cases. J Hand Surg Am 2012; 37:2300-3. [PMID: 23101526 DOI: 10.1016/j.jhsa.2012.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 08/02/2012] [Accepted: 08/05/2012] [Indexed: 02/02/2023]
Abstract
Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity in young children. It is most commonly encountered in the proximal tibia, with few cases documented in the upper extremity. We report 3 cases affecting the ulna. In each case, the fibrous tissue appeared to anchor itself in the ulnar diaphysis, behaving as a tether that retards growth. All 3 patients had excision of the fibrous tissue. There was concern for radial head subluxation before surgical intervention, but all patients maintained a congruent radiocapitellar articulation. The visible deformity improved in all 3 patients, although the limbs remained shorter than the contralateral side. In our limited series, we believe that early excision of the fibrous tissue tether can prevent radiocapitellar joint dislocation in patients with focal fibrocartilaginous dysplasia of the ulna.
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Affiliation(s)
- Hilton P Gottschalk
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL 60153, USA
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Spontaneous resolution of angular deformity of the distal femur in focal fibrocartilaginous dysplasia: a case report. J Pediatr Orthop B 2010; 19:161-3. [PMID: 20051915 DOI: 10.1097/bpb.0b013e3283361b11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) is a rare cause of angular deformities around the knee in children. The FFCD lesion most commonly affects the proximal tibia and less commonly the distal femur. We report a case of distal femoral varus deformity secondary to FFCD. Spontaneous resolution of the deformity occurred during a 7-year period. Previous reported femoral cases showed progressive deformity and required treatment with soft-tissue releases with or without osteotomy. This is the first reported femoral case of spontaneous resolution of angular deformity secondary to FFCD. We recommend a trial of observation for distal femoral lesions before surgical intervention.
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Ringe KI, Schirg E, Rosenthal H, Berendonk H, Galanski M. Unilateral tibia vara in a toddler caused by focal fibrocartilaginous dysplasia. J Radiol Case Rep 2009; 3:14-7. [PMID: 22470683 DOI: 10.3941/jrcr.v3i9.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Focal fibrocartilaginous dysplasia (FFCD) of the tibia is a rare tumor like lesion probably caused by a failure of differentiation in the pes anserinus area. The children usually present with unilateral tibia vara and conspicuous walking features. The radiographic appearance of FFCD is pathognomic. In most cases this benign condition undergoes spontaneous resolution. Curettage or corrective osteotomy is only indicated when the deformity is persistent or progressive. We report the case of a 14 months old toddler diagnosed with FFCD. The characteristic radiographic and MRI features are presented. Further, we present for the first time the sonographic appearance of FFCD.
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Ando A, Hatori M, Hosaka M, Hagiwara Y, Kita A, Ochiai T, Itoi E. A patient with focal fibrocartilaginous dysplasia in the distal femur and review of the literature. TOHOKU J EXP MED 2008; 215:307-12. [PMID: 18679004 DOI: 10.1620/tjem.215.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Focal fibrocartilaginous dysplasia (FFCD) is a rare and benign bone lesion that induces bowing deformity of the long bones in young children. Excessive production of fibrocartilage by abnormal differentiation in the metaphysis or by trauma during delivery or after birth is thought to cause growth disturbance. Radiologically, the lesion is characterized by a lucent defect with marginal sclerosis in the medial metaphysis of the long bone. However, there have been few reports about the initial radiological changes of FFCD before bowing started. We report a patient with FFCD in the left distal femur in whom the radiological changes were serially observed during the course of the disorder. A 2-week-old boy first visited our hospital because of left thigh pain. Plain radiographs did not show any abnormal findings at that time. At 10 weeks, a well-defined lucent defect with bony fragment inside was observed in the distal femoral medial cortex. At 1 year, this bony fragment gradually vanished but varus deformity progressed and reached approximately 40 degrees at the age of 2. After removal of the lesion, osteotomy and immobilization was performed with Ilizarov external fixator comprising rings, rods and wires. Complete bone union was achieved 3 months after operation. It is noteworthy that we could observe the initial radiological changes of FFCD before varus deformity occurred. As far as we know, there have been no descriptions of the bony fragment inside a lucent defect of the lesion. Radiological features may vary in the early phase of FFCD.
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Affiliation(s)
- Akira Ando
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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