To begin with, the fibrous cortical defect is a benign fibrous tumour occurring, in the cortex of the metaphysis, only in the long bones of children and young adolescents. The term “fibrous cortical defects” has been given, as these lesions are composed of fibrous tissue.
In fact, both the nonossifying fibromas and fibrous cortical defects are benign, self-healing fibrous defects that occur in the metaphyses of long bones in the younger age groups.
How is a fibrous cortical defect caused ?
The basic pathology is a fibrous proliferation arising from the periosteum and is probably based upon a developmental defect. The etiology of fibrous cortical defects though still remains unknown.
How is a fibrous cortical defect different from nonossifying fibromas ?
According to Jaffe and Lichtenstein, in some cases, the fibrous lesion persevered, increased in size and extended into the marrow cavity. They considered these large lesions that now occupied the medullary cavity to be neoplasms evolving from fibrous cortical defects, and they termed them nonosteogenic or nonossifying fibromas. Except for their size and the extent of metaphyseal involvement, nonossifying fibromas and fibrous cortical defects are indistinguishable, sharing a common clinical presentation and features of histology. They may be referred to collectively as metaphyseal fibrous defects.
What is the clinical presentation of fibrous cortical defect ?
The clinical and radiographic features of metaphyseal fibrous defects are fairly consistent.
The fibrous cortical defect occurs usually under ten years of age. Males are affected more frequently than females. The lesions are most commonly located in the thigh, followed by the shinbone.
The fibrous cortical defect is seen as a small radiolucent defect in the metaphyseal cortex, in close proximity to the growth plate.
They have asymptomatic, self-limited natural history.
Lesions may be asymptomatic. However, as they grow, they may become painful or undergo pathologic fracture. Occasionally, a patient may present with pain and swelling secondary to a stress fracture.
What is the radiologic presentation of fibrous cortical defect ?
On radiographs, fibrous cortical defects are small, subperiosteal, intracortical, metaphyseal lesions. When fibrous cortical defects grow, they become non ossifying fibromas, occupying an eccentric location in the medullary cavity of long-bone metaphyses, and usually involve, but do not breach, the adjacent cortex.
Computed tomography (CT) scans and also magnetic resonance imaging (MRI) scans are rarely needed to make a diagnosis of the fibrous cortical defect.
How is the fibrous cortical defect diagnosed ?
They are frequently detected incidentally on radiographs. The diagnosis most often can be made definitively based solely on the patient’s history, physical examination, and plain radiographic appearance.
Because of their very typical appearance and presentation, recognizing these lesions and making the definitive diagnosis should not be difficult in most cases. However, when a radiolucent lesion fails to demonstrate the classic characteristics of a fibrous cortical defect or nonossifying fibroma, referral to an orthopaedic oncologist is indicated. CT and/or MRI then can be used to better characterize the lesion.
How is the fibrous cortical defect treated ?
These lesions are quite benign, are in all probability self-limiting and heal by themselves. Only when these lesions are large, they are liable to fracture and they need treatment. The treatment in these cases would be bone curettage and filling up of the cavity with bone chips.
Pathologic fractures in lesions should be treated with cast or surgical immobilization until the fracture has healed. Once it has healed, curettage and subsequent bone grafting can be done.
Awareness of the prevalence and diagnostic features of these lesions could save children and their families other costly and non essential diagnostic tests, at the same time alleviate the anxiety of overdiagnosis of bone tumours.
As the risk for malignant transformation essentially is nonexistent, the key concern and indication for radiographic monitoring of these fibrous defects is avoidance of pathologic fracture.
How to find and reach orthopedic surgeons for fibrous cortical defect treatment ?
Now you can find and reach orthopedic surgeons for fibrous cortical defect treatment from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions from multiple orthopedic surgeons, get cost estimates for fibrous cortical defect treatment from different hospitals, compare things and then choose an orthopedic surgeon for fibrous cortical defect treatment.
Find, reach and choose an orthopedic surgeon for fibrous cortical defect treatment on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
