Fracture risk and follow-up indications in lower limb non-ossifying fibromas
Acta Orthopaedica et Traumatologica Turcica, cilt.60, sa.3, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 60 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.5152/j.aott.2026.25318
- Dergi Adı: Acta Orthopaedica et Traumatologica Turcica
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals, Biomedical Reference Collection: Corporate Edition (EBSCO)
- Anahtar Kelimeler: NOF, Non-ossifying fibroma, Pathologic fractures
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Hayır
Özet
Objective: This study aimed to evaluate the course of non-ossifying fibromas (NOFs) on basis of radiological parameters, determine the risk factors for management and define follow-up strategies. Methods: A retrospective review was performed on 104 skeletally immature patients who were followed for a minimum of 3 consecutive years. Radiographic evaluations included measurement of lesion size, cortical thinning, and distance from the physis. Lesions were classified according to the radiological maturation stages described by Ritschl et al, and the transition time between each stage was recorded. Fracture risk was assessed using radiographic, computed tomography, and magnetic resonance imaging (MRI)-based criteria, including cortical involvement percentage, cortical breach, lesion size, absence of neocortex, presence of syndesmosis, and the “Pac-Man sign” as defined by Baghdadi et al. Results: The mean age at diagnosis was 11.3 years. Pathological fractures occurred in 11 patients (10.6%), with 90.9% showing >50% cortical involvement on anteroposterior views and 100% on lateral views. Cortical thinning and disruption were present in all fracture cases. The mean time for radiological progression from Ritschl stage A to B was 17.3 ± 9.9 months, from stage B to C was 24.9 ± 16.2 months, and from stage C to D was 27.3 ± 15.9 months. Overall, the average duration from initial stage A to complete resolution at stage D was 44.9 ± 26.9 months. The fracture risk score in initial radiologic evaluation was significantly higher in patients who presented with fractures (P = .001). In distal tibial lesions, the “Pac-Man” sign was related to fractures (P = .001). Conclusion: This study demonstrated that stage B lesions, cortical thinning, and involvement of more than 50% of bone markedly increased the risk of pathological fracture, and the presence of the “Pac-Man” sign served as a reliable predictor. These findings held important clinical value, as they supported proactive monitoring and timely intervention in high-risk NOF lesions to prevent preventable fractures. Level of Evidence: Level III, Prognostic Study.