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Gorham's disease of the fibula: a case report
Balaji Zacharia1, Jayaprakash Chundarathil, Kumaran C Meethal
1Government Medical College, Calicut, India. balaji.zacharia@gmail.com
Insights
Gorham's disease, a rare bone disorder, can affect the fibula. Conservative treatment showed positive outcomes in a pediatric case, suggesting further study is needed for fibular graft efficacy.
Area of Science:
- Orthopedics
- Rare Diseases
- Vascular Anomalies
Background:
- Gorham's disease (massive osteolysis) is a rare idiopathic condition causing bone destruction.
- It's typically associated with lymphangiomatosis and affects cancellous bone.
- The fibula, primarily cortical bone, is not commonly considered a site for Gorham's disease.
Observation:
- A 13-year-old boy presented with a 2-year history of pain and 1-year history of muscle atrophy.
- The case involved Gorham's disease localized to the distal fibula.
- The patient experienced pain and swelling in the left ankle.
Findings:
- Conservative management, including analgesics, anti-inflammatories, and immobilization, was implemented.
- At 3-year follow-up, the patient ambulated without restrictions, with no further disease progression observed on radiographs.
- Occasional pain and swelling localized to the left ankle persisted.
Implications:
- This case challenges the notion that Gorham's disease does not affect the fibula.
- Further research is required to determine the efficacy of fibular grafts in treating Gorham's disease.
- Conservative treatment may be a viable option for distal fibular Gorham's disease due to its unpredictable course and potential for spontaneous arrest.
Unlabelled:
Gorham's disease, or massive osteolysis, is a rare condition characterized by the spontaneous onset of osteolysis in an otherwise healthy individual. Such osteolysis is related to localized endothelial proliferation of lymphatic vessels (lymphangiomatous osteolysis) resulting in destruction and absorption of bone, and is commonly thought to affect primarily cancellous bone. In this article, we describe a case of Gorham's disease involving the fibula in a 13-year-old boy with a 2-year history of pain and a 1-year history of muscle atrophy. The patient was treated with analgesics and anti-inflammatory drugs, and a period of immobilization. At the 3-year follow-up visit, the patient was ambulating without restrictions, although he experienced occasional episodes of pain and swelling localized to the left ankle; and follow-up radiographs revealed no further progression of the disease. Current literature suggests that the fibula, being primarily cortical bone, is not likely to be affected by Gorham's disease and that fibular grafts may be used in the treatment of the disorder. However, since this case depicts the disorder localizing to the distal fibula, we believe further studies are needed to validate the usefulness of fibular grafts in the treatment of the condition. Because the course of the disease is unpredictable and may arrest spontaneously, and based on the results observed in the patient described in this article, conservative treatment may be appropriate for Gorham's disease localized to the distal fibula.
Level Of Clinical Evidence:
4.
