Recurrent Fibrous dysplasia is a very challenging condition to treat. Any new developments in this field...
it is a challenging case u must redo with grafting and must hope better
I did lateral closed wedge osteotomy, extensive currettage, allografting and DCs fixation
@Vaishya: There are many treatment options. One should keep in mind the tendency to recurrence in cases with fibrous dysplasia. Anyway, valgus osteotomy with grafting and plate seems well done. The other two modalities involve what Dr. Maaty recommends (the most often done, which I also would do ) and the radical solution - wide resection and tumour prosthesis.
But is only 18 yrs old. How long can we expect a tumor prosthesis to last in this case?
Yes, the young age is an important concern against THR. That is why I would redo curettage and bone grafting once more and again while expecting a favourable development to osteosclerosis (which I have observed in similar cases). Then when the osteogenic process has reached a relatively stable course, I would do the wedge osteotomy to correct the deformity.
Totally agree with Raju Vaishya and Panayot Tanchev... Wedge osteotomy, extended curettage and fixation but real need to preserve head vascularization. Do we have any informations about it? My preference would be GAMMA Nail at his age
Hallo, Rayu,
there are very limited data on the effects of drug therapy in this condition. While use of the bisphosphonate alendronate orally failed to improve symptoms (pain, functional status), some cases treated with zoledronic acid (ZOL) intravenously are encouraging (Continuous effect with long-term safety in zoledronic acid therapy for polyostotic fibrous dysplasia with severe bone destruction. Wu D, Ma J, Bao S, Guan H. Rheumatol Int. 2015, Apr; 35(4):767-72). One might even try denosumab.
Based on my (small....) experience, I personally would suggest to use ZOL 4 or 5 mg maybe as single shot or a second infusion after 3-6 months. Clearly, this therapy is not labelled and only supported with very limited data, but otherwise I would not expect severe side effects of one or two infusions other than the well known short term post-infusion "influenza-like-illness-syndrome" (in 20 per cent of treated people). Please replete Vitamin D3 in case of deficiency before and supplement calcium 500-1000 mg plus Vit.D circa 1000 I.U. for at least 1, better 3 months after ZOL infusion.
Wish You and Your patient godd success!!!
well done ..i am happy with the lateral wedge osteotomy and the choice of implant .DCS better than other implants
Dear Rayu
I agree with your local treatment saving the hip joint.
Adjuvant or neoadjuvant APD/bisfos/denosumab may indeed be considered.
We now use this standard in these cases. Would combine a fibula and a lateral angle blade plat; see attached file.
Kind regards
PS you can also use this plate for your other femur + nail non-union ;-)
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