Unilateral femoral deformity due to a focal fibrous tether

Abstract

The purpose of this paper is to assess the radiological features of the unilateral angular deformity of the distal end of the femur secondary to a focal fibrous tether. Only five cases of this entity have been reported in the literature. We report another two patients. Magnetic resonance study was performed on one of them, which has not been used in previous cases. Both cases are described with illustrations of the typical radiographic appearances supplemented by CT and MR imaging.

A Patient with Focal Fibrocartilaginous Dysplasia in the Distal Femur and Review of the Literature

“…However, it is unclear whether a severe deformity like the present case will be corrected by curettage alone, and whether such a severe deformity will be acceptable from biomechanical or cosmetic point of view for a long time. Like other reports of the femur (Rodríguez et al 1998;Ruchelsman et al 2004), an osteotomy corrected the varus deformity and achieved complete union in the present case without any complication. Pin and plaster is one of the most common operative procedures to maintain the corrected position.…”

“…The characteristic plain radiographic findings in the tibia are as follows: (a) a well-defined, obliquely positioned lucent defect in the medial tibial metaphyseal cortex, (b) sclerosis along the lateral border of the lesion, (c) absent bone margin superomedially, (d) a location distal to the proximal tibial physis (Rodríguez et al 1998). …”

“…An extensive literature survey reveals that there have been 89 (53 men and 34 women) patients of FFCD (Table 1) (Rodríguez et al 1998;Ohno et al 2005;Eren et al 2006;Bakman and Monu 2007;Jouve et al 2007). Most patients visited the hospital between 12 and 24 months because this disorder was usually noticed by the parents after the onset of ambulation.…”

“…Though the lesions initially progressed, spontaneous correction usually began around the age of 24 months because of the rupture of the fibrocartilaginous lesion (Jouve et al 2007). However, spontaneous correction did not occur as expected in the femur and humerus (Rodríguez et al 1998;Choi et al 2000;Eren et al 2006;Jouve et al 2007). Femoral and humeral cases with severe deformity or shortening after conservative treatment were At the age of 1 year, the bony fragment almost vanished but a unilateral femoral varus deformity with a lucent defect and the marginal bone sclerosis at the medial aspect of the distal femur became apparent (Fig.…”

“…They suggested that excessive production of fibrocartilage in the proximal tibia might cause a growth disturbance, resulting in a varus deformity. After the first report by Bell et al, FFCD involving the distal femur, proximal humerus, and distal ulna was also reported (Choi et al 2000;Santos et al 2002;Ruchelsman et al 2004;Smith et al 2004;Eren et reported (Rodríguez et al 1998;Eren et al 2006). The potential for spontaneous correction may vary depending on the affected sites (Choi et al 2000).…”