Fibrous Dysplasia of Radius Bone-excision and Fibula Graft: A Case Report

Fibrous dysplasia (FD) is a congenital disorder in which the bone is distorted and replaced by poorly organized and structurally unsound fibrous tissue. The disorder can be localized to a single bone or affects multiple bones. Although any bone can be affected, the bones of the upper extremity are less commonly involved by the disease. The disease process results in deformity of the bones and is often complicated by pathological fractures.

A 14-year-old girl presented with gradually progressive deformity of the right forearm for the past 1 year associated with mild pain. Skeletal radiographs of the right forearm revealed an expansile lytic lesion with ground glass appearance involving the proximal meta-diaphysis of the right radius, with its resultant bowing. The zone of transition was narrow and there was no evidence of matrix calcification. The lesion was causing thinning of the bony cortex. With this radiographic appearance in mind, a diagnosis of FD of the radius was put forth. The lesion was managed surgically. The proximal three-fourth of the radius bone was exposed and the lesion was excised along with 1 cm of normal bone on the distal side. Proximally, a thin shell of the cortex was preserved after curettage of the proximal end of the radius. Fibular cortical strut graft was harvested from the leg of same side. Graft length was kept 2 cm more than the excised bone to avoid shortening of the forearm. The graft was beveled on the distal end and jammed into the shaft of the distal radius such that 1 cm of graft was inside the original bone. A long arm or above elbow splint was applied keeping the elbow at 90 degrees of flexion and the forearm in supination for a total of 6 months. The patient was being followed up regularly. Follow-up radiographs obtained at 7 months revealed complete incorporation of the cortical bone graft with reformation of the intramedullary bone canal and restoration of hand and elbow function.

Non-vascularized fibular cortical strut grafting is an effective treatment modality for FD of radius bone. External or internal fixation is not necessary if a tightly fitting cortical graft is jammed into the defect caused by lesion excision.