Unveiling a Silent Bone Lesion: Pathological Fracture in a Child With Non-Ossifying Fibroma

Non-ossifying fibroma (NOF) is a benign, self-limiting fibrous bone lesion commonly seen in children and adolescents, generally affecting the metaphysis of long bones. Although typically asymptomatic, larger NOF lesions can predispose patients to pathological fractures, especially in weight-bearing bones. An 11-year-old boy presented to the emergency room following a minor knee trauma that caused pain and an inability to bear weight on the affected leg. Imaging studies identified a large, well-defined lytic lesion in the distal femur, primarily suspected to be an aneurysmal or simple bone cyst with a related pathological fracture. Surgical management included open reduction and internal fixation (ORIF) of the fracture, curettage of the lesion, and bone grafting. Histopathological analysis confirmed the lesion as an NOF, demonstrating typical cellular patterns and evidence of fracture-associated changes. In conclusion, this case highlights the importance of considering NOF in pediatric patients with fractures following minor trauma. Recognition of NOF and prompt intervention, as illustrated here, are necessary for effective treatment, particularly in large lesions within weight-bearing bones.