Review Question - QID 4629

Based on the clinical history and figures shown, the patient likely has a osteofibrous dysplasia. The next best step would be to observe the patient.

Osteofibrous dysplasia is a form of fibrous dysplasia that predominantly affects the anterior tibia. It often presents as painless swelling and can cause anterior or anterolateral bowing to the affected tibia. The first line of treatment is observation as most of these lesions regress prior to adulthood.

Springfield et al. found that 19 of 32 patients had diagnosis changed after evaluating patients for ossifying fibroma, fibrous dysplasia, osteofibrous dysplasia or adamantinoma of the tibia. They conclude that osteofibrous dysplasia may be a precursor of adamantinoma.

Marks et al. review malignant and benign fibrous tumors of bone. They indicate that osteofibrous dysplasia is best treated with conservative measures. In contrast, malignant entities such as malignant fibrous histiocytoma and fibrosarcoma must be treated with wide resection.

Figure A shows a radiograph of a tibia affected by osteofibrous dysplasia. The anterior cortex is fully expanded with a radiolucent lobular pattern. Figure B shows a histological slide of the same lesion; there is fibroblastic proliferation with interspersed islands of woven bone. A key feature is the presence of osteoblastic rimming.

Incorrect Answers

Answer 2: Bracing is not indicated here given that the patient has no pain.
Answer 3: Casting is not used in treatment of osteofibrous dysplasia
Answer 4: Curettage and bone grafting is used to treat aneurysmal bone cysts, not osteofibrous dysplasia
Answer 5: Osteotomy with deformity correction may be utilized when there is significant deformity persisting after skeletal maturity