Giant nonossifying fibroma of the distal tibia in adolescents treated by curettage and intralesional cementation

Abstract Background. Fibrous cortical defects and nonossifying fibromas are the most common benign non-neoplastic bone lesions occurring in the metaphyses of long bones in children and adolescents. Giant nonossifying fibromas (NOF) are not asymptomatic but usually present with pain and/or pathological fractures due to increased stress. Materials and methods. 20 adolescent patients, 14 males and 6 females, with mean age 18 years and 6 months (range, from 16 to < 21 years); presented to the National Institute of Neuromotor system, Egypt, between September 2007 and September 2009, with giant nonossifying fibromas of the distal tibia. Diagnosis was made by clinical examination, plain radiographs, magnetic resonance imaging, and histopathological reports. Treatment was achieved by curettage without bone graft, but with intralesional filling with bone cement. Evaluation concerning pain, functional activity using MSTS scoring, pathological fracture, and local recurrence were done over a mean follow-up period of 6 years and 2 months (range, 5 to 7 years). Results. Pain and functional activity improved in the twenty patients with mean MSTS score of 29.2 (range, 25 to 30). There was no pathological fracture, no local recurrence, no change in the cement-bone interface, and no arthro- genic problems over the follow-up period. The p value was <0.05. Conclusion. Giant nonossifying fibromas can be treated simply and effectively by curettage and intralesional cementation with excellent functional results.