Fibrous Dysplasia in Humerus Shaft - Fixation or Curettage?: A Case Report

Fibrous dysplasia is a benign skeletal condition characterized by abnormal osteoblastic differentiation and maturation, typically affecting the lower extremity and craniofacial skeleton. It usually manifests in the first three decades of life, with symptoms starting in early childhood. Radiologically, it appears as an expansile, lytic, intramedullary, diaphyseal, or metaphyseal lesion. Treatment options include nonsurgical surveillance, pharmacotherapy, and surgery. Bisphosphonates can manage painless lesions, whereas surgery is necessary for pathological fractures. Alternative treatments include curettage, bone grafting, and internal fixation.

A 24-year-old woman experienced pain in her right arm for 3 years, which had worsened over the past 3 months and was accompanied by swelling for 2 months. The pain was insidious, gradually progressive, and diffuse over the diaphyseal region of the humerus. Examination revealed bony swelling and thickening, restricted shoulder movement and no distal neurovascular deficit.Radiologically, there was an expansile lytic lesion involving the middle and distal third of the diaphysis of the right humerus, suggesting pathological fractures. A magnetic resonance imaging scan revealed an expansile intramedullary lesion involving almost the entire shaft of the right humerus, sparing the proximal metaphyseal region. Histopathological examination revealed hemorrhagic giant cells with fibroblastic proliferation, with no signs of malignancy. Intramedullary fixation was performed with an intramedullary interlocking nail. She began gentle shoulder range-of-motion exercises and pendulum exercises. The patient experienced significant pain relief with good functional outcome and signs of fracture healing.

Long bones with fibrous dysplasia that manifest as pathological fractures may be painful and have limited mobility. The fracture can heal, pain can be reduced, and the functional range of motion can be restored by stabilizing the lesion with an intramedullary implant without curettage or bone grafting.