Clinical and radiological outcomes after surgical treatment in fibrous dysplasia: experience from a National Referral Center in Mexico

Abstract

Introduction: Fibrous dysplasia (FD) is a benign bone disorder of genetic origin caused by mutations in the GNAS gene, characterized by the replacement of normal medullary bone with immature fibro-osseous tissue. It accounts for approximately 5–7% of benign bone tumors and may occur in monostotic, polyostotic, or syndromic forms, such as McCune–Albright syndrome. Disease progression may lead to decreased mechanical strength, pain, pathological fractures, and severe deformities, including the classic “shepherd’s crook” deformity of the proximal femur. Despite advances in treatment, surgical management remains challenging because of high failure rates (11–50% in pediatric populations) and frequent graft resorption, often necessitating multiple reoperations. Furthermore, there is no consensus regarding the optimal fixation method.

Objective: To compare the clinical and radiological outcomes of different surgical treatment modalities for fibrous dysplasia at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico.

Methods: A retrospective, observational, analytical cohort study was conducted. Patients of any age diagnosed with fibrous dysplasia (monostotic, polyostotic, or syndromic forms) who underwent surgical treatment at INR-LGII between 2005 and 2023 were included. All patients had a minimum postoperative follow-up of two years. Surgical techniques evaluated included intramedullary nailing, plate fixation systems, and external fixation devices.

Results: Patients treated with hybrid osteosynthesis or locked intramedullary nailing demonstrated the most favorable postoperative outcomes, both radiologically and in terms of return to activities of daily living.

Conclusions: Intramedullary nailing and hybrid osteosynthesis appear to be the most effective surgical options for the treatment of deformities and pathological fractures associated with fibrous dysplasia.