Clinical Outcome of Monostotic Fibrous Dysplasia Over Proximal Femur Treated with Intramedullary Nailing and Bisphosphonate Therapy

ABSTRACT

Introduction: Fibrous dysplasia (FD) of bone is an enigma with no proper guideline. Treatment currently consists of curettageand bone grafting in an attempt to eradicate the lesion and to prevent progressive deformity. No definite criteria have beenestablished to identify patients at high risk of presenting pathological fractures.Purpose: The purpose of the study was to explore the effect of combination bisphosphonate therapy in diminishing pain,preventing fractures, lowering N-telopeptide values, and leading to partial resolution of FD lesions.Materials and Methods: At Medical College, Kolkata, 10 patients with monostotic FD in lower extremities were treated between2014 and 2018 and included in the study. All patients underwent full skeletal survey followed by core needle biopsy with the helpof magnetic resonance imaging and C-arm guidance. After confirmation, closed intramedullary nail without reaming was usedin all cases. Bone grafting was not performed. Zoledronic acid was given intravenously at the dose of 4 mg every 6 months.Patients were allowed full weight-bearing on the affected extremities on the 2nd post-operative day.Results: Seven patients were female and three were male; their mean age was 26.9 years. The mean duration of follow-upwas 30.5 months. We get good to average results. Clinicoradiological improvement of all cases was observed.Conclusion: As a result of this study, we believe that intramedullary fixation can be performed successfully. Treatment ofmonoostotic fibrous dysplasia with adjuvant bisphosphonate therapy resulted in effective pain control and early return offunctional activity. This will avoid problems that may occur following pathological fractures.