Safe Optimal Tear Drop View for Spinopelvic Fixation Using a Three-Dimensional Reconstruction Model of the Pelvis

Background@#Spinopelvic fixation (SPF) has been a challenge for surgeons despite the advancements in instruments and surgical techniques. C-arm fluoroscopy-guided SPF is a widely used safe technique that utilizes the tear drop view. The tear drop view is an image of the corridor from the posterior superior iliac spine to the anterior inferior iliac spine (AIIS) of the pelvis. This study aimed to define the safe optimal tear drop view using three-dimensional reconstruction of computed tomography images. @*Methods@#Three-dimensional reconstructions of the pelvises of 20 individuals were carried out. By rotating the reconstructed model, we simulated SPF with a cylinder representing imaginary screw. The safe optimal tear drop view was defined as the one embracing a corridor with the largest diameter with the inferior tear drop line not below the acetabular line and the lateral tear drop line medial to the AIIS. The distance between the lateral border of the tear drop and AIIS was defined as tear drop index (TDI) to estimate the degree of rotation on the plane image. Tear drop ratio (TDR), the ratio of the distance between the tear drop center and the AIIS to TDI, was also devised for more intuitive application of our simulation in a real operation. @*Results@#All the maximum diameters and lengths were greater than 9 mm and 80 mm, respectively, which are the values of generally used screws for SPF at a TDI of 5 mm and 10 mm in both sexes. The TDRs were 3.40 ± 0.41 and 3.35 ± 0.26 in men and women, respectively, at a TDI of 5 mm. The TDRs were 2.26 ± 0.17 and 2.14 ± 0.12 in men and women, respectively, at a TDI of 10 mm. @*Conclusions@#The safe optimal tear drop view can be obtained with a TDR of 2.5 to 3 by rounding off the measured values for intuitive application in the actual surgical field.

Proximal Junctional Kyphosis in Adult Spinal Deformity: Definition, Classification, Risk Factors, and Prevention Strategies

Proximal junctional problems are among the potential complications of surgery for adult spinal deformity (ASD) and are associated with higher morbidity and increased rates of revision surgery. The diverse manifestations of proximal junctional problems range from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). Although there is no universally accepted definition for PJK, the most common is a proximal junctional angle greater than 10° that is at least 10° greater than the preoperative measurement. PJF represents a progression from PJK and is characterized by pain, gait disturbances, and neurological deficits. The risk factors for PJK can be classified according to patient-related, radiological, and surgical factors. Based on an understanding of the modifiable factors that contribute to reducing the risk of PJK, prevention strategies are critical for patients with ASD.

Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS)

Background@#Denosumab (DEN) and zoledronic acid (ZOL) currently represent the most potent antiresorptive agents for the treatment of osteoporosis. Despite similar effects on bone resorption, these agents have distinct mechanisms of action. The objective of this study was to compare the effect of DEN and ZOL after two-year administration on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and persistence. @*Methods@#A total of 585 postmenopausal women with osteoporosis who did not use osteoporosis medications were retrospectively reviewed. 290 patients were administered 60 mg DEN subcutaneously every 6 months from 2017 to 2018, and 295 patients were treated with 5 mg ZOL intravenously yearly from 2015 to 2017. BMD, TBS, and C-terminal crosslinking telopeptide of type 1 collagen (CTX) measurements were obtained at baseline and two-year after DEN injection or ZOL infusion. @*Results@#After two-year follow-up, 188 patients in the DEN group and 183 patients in the ZOL group were compared. BMD change from baseline at two years was significantly greater in the DEN group compared with the ZOL group (P < 0.001). The changes of TBS in the DEN group were statistically significant compared with baseline (P < 0.001) and the ZOL group (P < 0.001). The DEN group led to significantly greater reduction of CTX compared with ZOL group (P = 0.041). @*Conclusion@#In postmenopausal women with osteoporosis, DEN was associated with greater BMD increase at all measured skeletal sites, greater increase of TBS, and greater inhibition of bone remodeling compared with ZOL.

Diagnosis and conservative treatment of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) has a diagnosis rate of 3% to 5% per year, but the number of cases requiring surgical treatments is very small, accounting for only 0.17% to 1.75% of all AIS patients. Most patients with AIS are diagnosed, treated, and managed in outpatient clinics.Current Concepts: AIS is a disease that occurs more frequently, and progresses faster, in females than in males. Scoliosis deformity can occur due to various causes. To differentially diagnose AIS, it is necessary to perform careful physical examinations, investigate family history, and check for neurological, growth, and developmental abnormalities. Definitive diagnosis of AIS can be performed through radiographic imaging. In the case of atypical curvature and symptoms, examinations such as magnetic resonance imaging could be required in addition to radiographic imaging. Treatment of AIS patients in outpatient clinics can be performed through observation, exercise, and orthosis. The selection and application of treatment methods and the termination period of the treatments are complexly affected by the age at the time of diagnosis; pattern, location and size of the curve; and growth potential.Discussion and Conclusion: AIS is a disease in which good results can be obtained with conservative treatments such as exercise and orthosis, which is generally applied in an outpatient setting. To properly treat AIS, it is necessary to have an in-depth understanding of the characteristics of AIS, timing of treatment, and factors influencing treatment.

Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management

Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.

Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management

Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.

Juvenile Idiopathic Scoliosis / 대한정형외과학회잡지

Juvenile idiopathic scoliosis includes scoliosis diagnosed from three to ten years old according to the chronological age. Spine growth in juveniles does not occur at a rapid rate spinal deformity does not show rapid progress. However, because of the intimate relationship between chest wall growth and the spine, decrease of chest wall capacity due to scoliosis could lead to development of cardiovascular and pulmonary complication, especially in early age. In scoliosis in early age, other causes of the deformity including neurological problems should be evaluated. If the scoliosis angle is more than 25 degrees, it could progress very easily, thus aggressive treatment is needed. A new growing-sparing surgical technique (growing rod and growth modulation) is introduced for improvement of spine and chest growth, and for prevention of crankshaft phenomenon.

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

PURPOSE: To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms. MATERIALS AND METHODS: We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores. RESULTS: From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01). CONCLUSION: One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS.

Is There Relationship between Brain Atrophy and Higher Incidence of Hip Fracture in Old Age?: A Preliminary Study

PURPOSE: The studies on the correlation between incidence of fall and brain atrophy have been going on to find out the cause of fall and its prevention. The purpose of this study was to explore the relationship between incidence of hip fracture and brain volume, measured by magnetic resonance image. MATERIALS AND METHODS: A total of 14 subjects with similar conditions (age, height, weight, and past history) were selected for this study. Fracture group (FG) was consisted of 5 subjects with intertrochanteric fracture. Control group (CG) had 9 subjects without intertrochanteric fracture. MRI-based brain volumetry was done in FG and CG with imaging software (V-works, CyberMed Co., Korea). Total brain (tBV), absolute cerebellar volumes (aCV) and relative cerebellar volumes (rCV) were compared between two groups. Student t-test was used to statistically analyze the results. RESULTS: In FG, average tBV, aCV and rCV were 1034.676+/-38.80, 108.648+/-76.80 and 10.50+/-0.72 cm3, respectively. In CG, average tBV, aCV and rCV were found to be 1106.459+/-89.15, 114.899+/-98.06 and 10.39+/-0.53 cm3, respectively, having no statistically significant difference (p>0.05). CONCLUSION: There was no significant difference between the fracture and control groups. Patients with neurologic disease such as cerebellar ataxia definitely have high incidence of fall that causes fractures and have brain changes as well. However, FG without neurologic disease did not have brain volume change. We consider that high risk of fall with hip fracture might decrease brain function which is not obvious to pickup on MRI.

case of metatropic dysplasia: operative treatment of severe kyphoscoliosis and limb deformities

Metatropic dysplasia is a rare but severe spondyloepimetaphyseal dysplasia characterized by long trunk and short extremities. The exact incidence is not known; however, 81 cases have been reported in the literature till now. Due to progressive kyphoscoliosis, there is a reversal of proportions in childhood [shortening of trunk with relative long extremities]. The diagnostic radiographic findings include marked platyspondyly [wafer-thin vertebral bodies], widened metaphyses [dumbbell-shaped tubular bones] and small epiphysis and a specific pelvic shape. The severe kyphoscoliosis is relentless and resistant to conservative treatment with bracing. Operative treatment is controversial due to the recurrence of deformity despite aggressive correction. We, here in report a case of this rare dysplasia and its follow-up after corrective surgery for spine and limb deformity. The excellent correction and good functional pulmonary status at 6-year follow-up has never been previously reported.

Changes in Level of the Conus after Corrective Surgery for Scoliosis: MRI-Based Preliminary Study in 31 Patients

BACKGROUND: Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. METHODS: To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. RESULTS: The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80degrees +/- 17.19degrees and 33.23degrees +/- 14.39degrees, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). CONCLUSIONS: The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.

Effect of Tightening Torque on Abutment-Fixture Joint Stability using 3-Dimensional Finite Element Analysis / 대한치과보철학회지

STATEMENT OF PROBLEM: Loosening or fracture of the abutment screw is one of the common problems related to the dental implant. Generally, in order to make the screw joint stable, the preload generated by tightening torque needs to be increased within the elastic limit of the screw. However, additional tensile forces can produce the plastic deformation of abutment screw when functional loads are superimposed on preload stresses, and they can elicit loosening or fracture of the abutment screw. Therefore, it is necessary to find the optimum tightening torque that maximizes a fatigue life and simultaneously offer a reasonable degree of protection against loosening. PURPOSE: The purpose of this study was to present the influence of tightening torque on the implant-abutment screw joint stability with the 3 dimensional finite element analysis. MATERIAL AND METHODS: In this study, the finite element model of the implant system with external butt joint connection was designed and verified by comparison with additional theoretical and experimental results. Four different amount of tightening torques (10, 20, 30 and 40 Ncm) and the external loading (250 N, 30degrees C) were applied to the model, and the equivalent stress distributions and the gap distances were calculated according to each tightening torque and the result was analyzed. RESULTS: Within the limitation of this study, the following results were drawn; 1) There was the proportional relation between the tightening torque and the preload. 2) In case of applying only the tightening torque, the maximum stress was found at the screw neck. 3) The maximum stress was also shown at the screw neck under the external loading condition. However in case of applying 10 Ncm tightening torque, it was found at the undersurface of the screw head. 4) The joint opening was observed under the external loading in case of applying 10 Ncm and 20 Ncm of tightening torque. 5) When the tightening torque was applied at 40 Ncm, under the external loading the maximum stress exceeded the allowable stress value of the titanium alloy. CONCLUSION: Implant abutment screw must have a proper tightening torque that will be able to maintain joint stability of fixture and abutment.

Comparison of Apical Axial Derotation between Adolescent Idiopathic and Neuromuscular Scoliosis with Pedicle Screw Instrumentation

STUDY DESIGN: A retrospective study. PURPOSE: To compare outcomes of apical derotation with pedicle screws in idiopathic and neuromuscular scoliosis (NMS). OVERVIEW OF LITERATURE: No information about apical derotation in NMS with pedicle screws is available. METHODS: We performed deformity correcting surgery using pedicle screw constructs on 12 adolescent idiopathic scoliosis (AIS) patients (mean age 14.1 years) and 16 NMS patients (mean age 16.5 years). Preoperative, postoperative, and final follow-up radiographs were analyzed for Cobb's angle and pelvic obliquity, while apical rotation was measured on CT scans using the Aaro-Dahlborn method. RESULTS: For AIS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 57.3degrees, 2.8degrees, and 20.4degrees, respectively, and postoperatively they were 16.8degrees, 1.1degrees and 14.7degrees, respectively, showing significant correction. For NMS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 75.6degrees, 13.7degrees, and 42.9degrees, respectively, and postoperatively they were 27.1degrees, 5.8degrees, and 34.1degrees, respectively, also showing significant correction. There were no significant differences between AIS and NMS patients Cobb's angle p=0.306, pelvic obliquity p=0.887 and apical derotation p=0.113degrees. There were no differences in curve severity in the three groups (AIS, NMS >80degreesand NMS 80 NMS group (p=0.04). CONCLUSIONS: Apical axial derotation can be achieved with posterior only pedicle screw fixation in NMS without anterior release, with comparable results in idiopathic scoliosis.

Muscle Imbalance in Volleyball Players Initiates Scoliosis in Immature Spines: A Screening Analysis

STUDY DESIGN: Retrospective comparative study using radiographs and clinical findings. PURPOSE: To test the hypothesis that asymmetric loading of immature spines in young athletes initiates scoliosis. OVERVIEW OF LITERATURE: Scoliosis in athletes has been reported in the literature, but its causative factors have not been investigated. METHODS: We compared the incidence, type and magnitude of scoliotic curves in volleyball players with those in the non-player population. One hundred sixteen adolescent volleyball players were grouped for selective screening. Data regarding their playing duration, handedness, age, height, and menarchal status (in girls) were recorded, along with clinical examination and radiological investigation when necessary. We analyzed data from 46,428 non-player school children, and their data were compared to athletes to determine differences. RESULTS: Volleyball players had a statistically significant increase in the incidence of scoliotic spinal curves. Playing hand dominance was related to the curve direction. Cobb angle had no significant correlation with the duration of playing. CONCLUSIONS: There is a five-fold increase in the incidence of mild scoliosis in volleyball players. A high percentage (41%) of asymmetry was present on the Adams forward bending test, as compared to controls. The curves were either thoracic or thoracolumbar.

Study of Bone Quality and Growth Characteristics of Growth Plate following Limb Transplantation between Animals of Different Ages-results of an Experimental Study on Male Syngeneic Rats / 대한정형외과학회잡지

BACKGROUND: Osteoporosis of transplanted/grafted bone is well known in the immediate post bone transplantation/bone grafting period. In limb transplantation, the growth plates in the transplanted limbs retain their longitudinal growth properties. However, there is a paucity of reports on what happens to the bone and the growth potential of the growth plate when limb transplantation between a juvenile donor and an adult recipient is performed. MATERIALS AND METHODS: Ten juvenile to juvenile hind limb transplants and five juvenile to adult hind limb transplants were performed in male syngeneic Lewis rats. Osteoporosis in the isochronograft as well as the heterochronograft limbs was measured by 3D micro-CT. In addition, the increase in tibial length, after transplantation was measured and compared with the increase in the tibial length of the opposite non-operated limbs. RESULTS: The 3D CT parameters indicate a significantly inferior bone quality in the heterochronografts compared with the isochronografts. After transplantation, the increase in the tibial length of the isochronografts was similar the increase in length of the opposite juvenile non operated tibiae and the heterochronograft tibias. CONCLUSION: Age is a significant factor that affects the bone quality, resulting in post transplant osteoporosis in heterochronografts compared with isochronografts. However, the growth plate after transplantation remains unaffected by the difference in age and continues to grow at its own inherent rate in adult recipients as it does in the juvenile recipients.

Minimally Invasive Anterior Approach in Open Reduction of Displaced Supracondylar Fractures of Humerus in Children

PURPOSE: To evaluate the outcomes of minimal anterior approach and thumb assisted technique, in children with Gartland type III supracondylar humerus fracture, who were operated by this technique. MATERIALS AND METHODS: Forty two children with Gartland type III supracondylar fractures of the humerus with severe swelling were taken up for minimal open reduction and K-wire fixation. The technique used was a minimal incision in the cubital fossa and thumb assisted reduction of the fracture. Stabilization of fractures was done with 1.6 mm Kirschner wires. RESULTS: The outcomes were excellent in 40 cases good in 2 cases. No complications including malunion or scar contracture were seen. CONCLUSION: This technique is safe, effective and can be used for irreducible, displaced supracondylar fractures of the humerus in children

The Incidence of Infection in Interlocking Intramedullary Nailing after Skeletal Traction of Distal Femur

PURPOSE: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. MATERIALS AND METHODS: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. RESULTS: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. CONCLUSION: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.

Relationship of Risser Sign with Chronological Age, Menarche in Elementary, Middle, and High School Students in Korea / 대한정형외과학회잡지

PURPOSE: This study was undertaken to investigate the relationship between the Risser sign and chronological age and menarche in elementary, middle, and high school students, and to investigate the reliability of the Risser sign. MATERIALS AND METHODS: We reviewed 1, 870 spine standing AP X-rays, which included the iliac crest. We tried to identify a correlationbetween the Risser stage and chronological age, and between Risser stage and menarche. In addition, we investigated inter-observer error in the determination of Risser stage. RESULTS AND CONCLUSION: The mean ages of Risser 1, 2, 3 and 4 female students were 12.9, 13.3, 13.6, and 14.3 years, and the mean ages of Risser 1, 2, 3 and 4 male students were 14.0, 14.3, 14.5, and 15.6 years (Spearman's rho=0.560, p<0.01). The mean menarchal age of female students were 12 years 4 months, which is 7 months earlier than the mean chronological age of Risser 1 in female students. Wefound that it takes 24 months to progress from menarche to iliac crest maturation (Risser 4) (Spearman's rho=0.571, p<0.01). The percentage of agreement in the determination of Risser stage by three orthopaedic surgeons was 73.3%, showing good reliability with a Kappa value of 0.739-0.783.

Diastasis of the Symphysis Pubis after Delivery / 대한정형외과학회잡지

PURPOSE: The objectives of this study are to observe the clinical characteristics, outcome of treatment and incidence of diastasis of the symphysis pubis after delivery and to evaluate the risk factors of the lesion. MATERIALS AND METHODS: Seventy-six patients diagnosed with diastasis of the symphysis pubis were reviewed. The diagnostic criteria of diastasis were; 1) positive signs and symptoms of pelvic instability, 2) radiological evidence of widening of the symphysis pubis by more than 6 mm and/or vertical mobility of more than 3 mm, or widening of the sacroiliac joint by more than 4 mm. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed using the chi-square test, t-test, and by logistic regression. RESULTS: Seventy-six diastasis of the symphysis pubis were diagnosed in 24,089 deliveries during the study period. Joint widening ranged from 3 mm to 34 mm. Twenty-three cases had accompanying vertical mobility. Pain in the pelvic joint and walking difficulty were most common clinical characteristics. History of pelvic girdle relaxation during pregnancy was found to increase the risk of the lesion (P=0.0028). CONCLUSION: We found that a history of pelvic girdle relaxation during pregnancy was a risk factor of diastasis of the symphysis pubis after delivery. Early detection and satisfying results by optimal treatment are associated with recognizing the lesion's characteristic clinical findings.

Osteofibrous Dysplasia of the Tibia in Children / 대한정형외과학회잡지

PURPOSE: To define the natural history and treatment of osteofibrous dysplasia, we compared the clinical courses of two groups: one group with a surgical treatment and the other group with a conservative treatment. MATERIALS AND METHODS: Seven cases (4 male, 3 female) were followed for more than two years (average f/u: 7 years 2 months). Four cases conservatively and three cases operatively by curettage and bone graft. Were treated the clinical and radiological findings of the two groups were compared. RESULTS: Two of three cases that received surgical treatment had been diagnosed with lesion recurrence by radiography, which showed expansion of the cortical shell, resorption of grafted bone, and reactive bone formation. One other case exhibited shrinkage and confinement of the lesion to the anterior cortex. Two cases, which were treated conservatively, showed shrinkage of the lesion and an other two cases showed no change in the size in radiogram. CONCLUSION: Asymmetrical intra-cortical osteolytic lesion of the tibia in children should be suspected as osteofibrous dysplasia and carefully observed until skeletal maturity, unless the structural integrity is seriously endangered.