Fibrous dysplasia: Clinical features, deformities, management, and outcomes
Mustafa Onur Karaca, Mustafa Özyıldıran1, Mahmut Kalem
1Sandıklı Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 03500 Sandıklı, Afyonkarahisar, Türkiye. mozyildiran@gmail.com.
Joint Diseases and Related Surgery
|March 30, 2026
Summary
Shepherd's crook deformity in fibrous dysplasia (FD) is more frequent in polyostotic cases and McCune-Albright syndrome (MAS). Valgus osteotomy can correct the deformity, but recurrence necessitates further surgery.
Area of Science:
- Orthopedics
- Genetics
- Radiology
Background:
- Fibrous dysplasia (FD) is a benign bone disorder characterized by the replacement of normal bone with fibrous tissue.
- Proximal femoral involvement is a common complication of FD, potentially leading to deformities.
- Shepherd's crook deformity is a characteristic bowing of the proximal femur, often associated with FD.
Purpose of the Study:
- To determine the incidence of shepherd's crook deformity in patients with fibrous dysplasia.
- To evaluate the rate of proximal femoral involvement in FD.
- To identify factors associated with the development of shepherd's crook deformity.
Main Methods:
- Retrospective analysis of 158 consecutive patients with FD (1990-2022).
- Inclusion of patient demographics, lesion characteristics, radiological findings, and treatment modalities.
- Assessment of deformity development, surgical outcomes, and need for secondary surgery.
Main Results:
- Shepherd's crook deformity occurred in 9 of 75 proximal femoral lesions (12%).
- Deformity was significantly more common in polyostotic FD (25.0%) than monostotic FD (5.9%) (p=0.026).
- Two patients with McCune-Albright syndrome (MAS) had shepherd's crook deformity; the rate was 9.6% in patients without MAS. Valgus osteotomy improved neck-shaft angle, but 3/9 patients required re-operation due to recurrence.
Conclusions:
- Observation is suitable for most FD lesions; surgery is reserved for symptomatic cases, fracture prevention, and deformity correction.
- Polyostotic FD and MAS are associated with a higher incidence of shepherd's crook deformity.
- While valgus osteotomy offers radiographic improvement, recurrence and the need for revision surgery are potential complications.
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