Hybrid Surgical Treatment with External Fixation and Intramedullary Nailing for Fractures Associated with Fibrous Dysplasia in Patients with McCune-Albright Syndrome: A Case Series

Abstract

Introduction: Polyostotic fibrous dysplasia associated with McCune-Albright syndrome is a rare skeletal disorder characterized by progressive bone fragility, deformity, and pathological fractures. Surgical management remains challenging because of poor bone quality, recurrent deformity, and the risk of fixation failure. Combined use of external fixation and intramedullary stabilization may improve mechanical support while allowing correction of complex deformities.

Objective: To describe the clinical and radiological outcomes of patients with polyostotic fibrous dysplasia associated with McCune-Albright syndrome treated with external fixation and intramedullary nailing at a national referral center.

Methods: A retrospective case series was conducted including three patients with polyostotic fibrous dysplasia and McCune-Albright syndrome who underwent surgical treatment using a combination of external fixation and intramedullary nailing. Clinical records, operative reports, and radiographic studies were reviewed. Outcomes included radiographic consolidation and postoperative clinical evolution.

Results: Three patients were included. The first was an 8-year-old male with bilateral proximal femoral fractures treated with flexible intramedullary nailing and external fixation. The second was a 26-year-old female with a left tibial fracture managed with intramedullary nailing and external fixation. The third was a 32-year-old female with right tibial involvement treated using the same surgical strategy. Radiographic consolidation was achieved in all patients within six months of surgery. Adequate mechanical stabilization and satisfactory alignment were obtained in all cases, with no evidence of fixation failure during the follow-up period.

Conclusions: Combined external fixation and intramedullary nailing provided stable fixation and reliable bone healing in patients with polyostotic fibrous dysplasia associated with McCune-Albright syndrome. This technique appears to be an effective option for the management of fractures and complex deformities in compromised bone, achieving 100% union in this series at six months postoperatively.