Osteofibrous dysplasia of the tibia in a young adult treated by Sofield osteotomy Wei Ting Lee a , Wilson Wang b and Shamal Das De b INTRODUCTION O steofibrous dysplasia is a benign fibrous-osseous disease that was first described by Frangenhein in 1921. 1 It is a condition known by many names (monosototic fibrous dysplasia, variant of fibrous dysplasia 2 ) and Campanacci first coined the term osteofibrous dyspla- sia 3 in 1981. Osteofibrous dysplasia frequently occurs in the tibia and fibula, although occurrences in other parts of the body such as the ulna and maxilla have been described. 4 This condition commonly presents in the first decade of life before puberty but also has been described in the newborn. 5 Most osteofibrous dysplasias have a benign course. We report a 10-year follow-up of a patient with osteofibrous dysplasia treated surgically using corrective osteotomy. This case highlights osteofibrous dysplasia’s benign nature and that deformity correction can be undertaken without excision of the tumor. This case study also described use of Sofield osteotomy for deformity correction. CASE REPORT The patient first presented to her doctors overseas at the age of 4 years with the chief complaint of 1-month pain over the right leg. There were no obvious deformities noted during the initial assessment, and radiographs showed a lytic lesion in the right tibia. An excisional biopsy of the lesion and bone grafting of the resulting defect were done. The histology of the lesion correlated with the clinical diagnosis of fibrous dysplasia. Postoperatively, the patient was protected with a plaster of Paris cast, which was removed approximately 6 weeks after the operation. Subsequently, the patient presented with a small recurrent swelling over the anterior aspect of the right leg. This was again excised 1 year after the initial operation. The patient was not seen again until the age of 7 years when she complained of pain over the right leg. There was also increased anterior bowing of her right tibia. Her radiograph showed an expansion in the diaphyseal region of the tibia with some thickening of the bony cortex at the posterior aspect of the shaft with cystic and sclerotic areas over the anterior cortex. In view of the history of surgical recurrence, the decision was made by her primary physician then for nonsurgical treatment and referral to our unit for a second opinion. Initial radiographs showed severe anterior bowing of her right tibia (Figure 1) and a leg-length discrepancy of 2.5 cm. The patient was still able to ambulate but with a limp. The decision was made then for no further surgical procedure until she attained skeletal maturity. She was protected with a caliper and allowed to bear weight fully. The risk of pathologic fracture of the right tibia also was explained to her parents. The patient was followed in the outpatient clinic until the age of 17 years. She still complained of deformity of the right tibia, leading to difficulty in ambulation. However, there was no further increase in size of the lesions or worsening of the tibial deformity over the last few years. It was decided then that the patient had achieved skeletal maturity and would be suitable for surgical correction of the deformity. Excision of the diseased anterior tibial cortex with corrective osteotomy (Sofield osteotomy 6 and intra- medullary nailing) was performed in this patient. The tibia was exposed through an anteromedial incision, and a separate incision was made over the patellar tendon for the introduction of an intramedullary nail (Figures 2 and 3). The deformity of the tibial segment was assessed intraoperatively, and the decision was made with regards to the number of tibial segments required to correct the deformity. The length of the tibia was measured, and it was determined that each osteotomized block should have a height of 1.5-2 in. (over the anterior cortex) and 1 in. (over the posterior cortex). Based on this calculation, five osteotomized segments were made and thereafter, the tibial FIGURE 1. Radiographs of the patient’s right tibia during the initial presentation. 1940-7041 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins a University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System b Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Correspondence to Dr Wei Ting Lee, MBBS, Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore Tel: þ 65 6772 4342; fax: þ 65 6777 0280; e-mail: leeweiting@gmail.com CASE REPORT E48 Current Orthopaedic Practice Volume 21  Number 6  November/December 2010