Approach to Pathologic Fractures in Children

Amy K. Williams; Alexandre Arkader


Curr Orthop Pract. 2013;24(3):260-266. 

In This Article

Fibrous Cortical Defects and Nonossifying Fibromas

Fibrous cortical defects (FCDs) and nonossifying fibromas (NOFs) are benign latent, sometimes active lesions that are usually asymptomatic and found incidentally.

Estimates are that over 10% of children have at least one FCD. These lesions are most commonly found in the metaphysis of the distal femur, proximal tibia, and fibula. While FCDs usually are asymptomatic, they may be associated with a chronic stress type pathologic fracture, mostly in young athletes that generally requires activity modification and rest.[7,19]

NOFs are larger than FCDs and may involve large areas of the bone, leading to pathologic fracture.[7] Most lesions tend to spontaneously heal over time, but while the fracture tends to heal uneventfully,[7,9,20] pathologic fracture does not seem to stimulate healing of the lesion,[2,21] and refracture may be a concern.[7,22]

While pathologic fractures associated with FCDs and NOFs should be treated conservatively, some recommend prophylactic curettage and bone-grafting if there is a high risk of pathologic fracture, which is hard to quantify but probably includes lesions that involve more than 50% of the bone width associated with significant cortical thinning,[7,19,20,22] or in cases of recurrent fractures.