Monostotic fibrous dysplasia of the proximal femur: natural history and predisposing factors for disease progression.
Monostotic fibrous dysplasia of the proximal femur has a variable clinical course, despite its reported limited tendency to progress. We investigated the natural history and predisposing factors for progression of dysplasia in a group of 76 patients with a mean follow-up of 8.5 years (2.0 to 15.2). Of these, 31 (41%) presented with an asymptomatic incidental lesion while 45 (59%) presented with pain or a pathological fracture. A group of 23 patients (30%) underwent early operative treatment for pain (19: 25%) or pathological fracture (4: 5%). Of the 53 patients who were initially treated non-operatively, 45 (85%) remained asymptomatic but eight (15%) needed surgery because of pain or fracture. The progression-free survival of the observation group was 81% (sd 6.4%) at five-years follow-up. An initial presentation of pain (p < 0.001), a limp (p < 0.001), radiological evidence of microfracture (p = 0.001) and younger age (< 17 years) (p = 0.016) were significant predisposing factors for disease progression. The risk of experiencing pain or pathological fracture is considerable in monostotic fibrous dysplasia of the proximal femur. Patients presenting with pain, a limp or radiological evidence of microfracture have a high chance of needing surgical treatment.
Seoul National University Hospital, Department of Orthopaedic Surgery, 101 Daehak-ro Jongno-gu, Seoul, 110-744, South Korea.
I
I
Han
E S
ES
Choi
H-S
HS
Kim
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology; D005269:Femur / Q000473:pathology / Q000601:surgery; D005358:Fibrous Dysplasia, Monostotic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D055815:Young Adult
Fibrous dysplasia; Monostotic; Natural history; Pathologic fracture; Proximal femur