OPERATIVE MANAGEMENT OF FIBROUS DYSPLASIA OF THE PROXIMAL FEMUR - A SINGLE CENTRE EXPERIENCE.

Abstract

Introduction - Fibrous dysplasia is a benign           condition of bone which can range from an innocuous lytic lesion to a complex deformity. The varied presentation          necessitates an individualized approach. A number of surgical techniques and implants have been used in different series with satisfactory results however an ideal method of treatment is yet to be identified.Patients and Methods A retrospective study was conducted in the authors institution to review the management of fibrous dysplasia of the proximal femur. Over a 5 year period 6 males and 2 females with an average age of

28.6 years with biopsy proven fibrous dysplasia of the          proximal femur were operated on for indications of (1)              stabilization of impending or established pathological fracture,(2)deformity correction and (3)to arrest progression of a lytic lesion. The surgeries done were curettage and intra medullary nailing(3), corrective osteotomy and intra medullary nailing(2) and curettage and bone grafting(2).In one patient the survey was abandoned due to intra operative hypotension.Results The average follow up was 21.8 months (6-50 months). The fractures and osteotomies united at a mean of 4.8 months. The complications encountered were one non union, sepsis and disseminated intravascular coagulation in one patient. One patient had incomplete correction of deformity while in the rest there was no recurrence of deformity. There were no wound related complications and all but one patient returned to work.Conclusions Curettage of the lesion followed by intra medullary nailing with appropriate osteotomies in case of a deformity is a satisfactory treatment for fibrous dysplasia of the proximal femur. It allows anatomical realignment and provides intra medullary splinting along the entire length of the femur decreasing stress shielding and recurrence of  deformity. In view of the rarity of these cases and the         perioperative issues a referral to a tertiary care centre with the necessary expertise and equipment would be prudent.