Fibrous cortical defects (FCDs) are benign lesions that are bony in structure and are a type of fibroxanthoma, histologically similar to larger non-ossifying fibroma (NOF). Non-ossifying fibroma is a part which is related to intramedullary segment. Different terms such as fibroxanthoma, non-osteogenic fibroma, and benign fibrous histiocytoma are used for fibrous cortical defects. FCDs usually does not causes any symptoms except pain. However, if the pain increases to half the bone’s diameter, it can cause severe pain and increase the risk of sustaining bone fracture. The most prone sites of fibrous cortical defects (FCD) incorporate distal femur, tibia and among these most of them show various imperfections. Most of the times FCDs occur when lesions created ossify and get convert into the dense areas of bone, sometimes these lesions may enlarge and increase the problem. The occurrence of fibrous cortical defects is around 40% children and is quite common in young adults. FCD is also known as non-solidifying fibroma (NOF), a term which is regularly utilized when the tumor or lesion is large and expands upon the focal part of the bone called the medullary canal.
FCDs are usually diagnosed through an X-ray. However, if it becomes severe, radiology can be used to determine the growth of the lesion. FCD lesions are benign and normally do not require any treatment. These lesions often go away on their own without surgery as soon as the child starts to grow, they do not turn into cancer. However, if these lesions increase and do not go away, treatments such as casting are required during surgery to prevent metaphyseal injuries. If still FCD does not get recovered, curettage and bone grafting may be required.
FCDs require medical therapy to treat pediatric pathologic fracture to avoid any further injury during surgery. The surgical procedure involves exposing the lesion to curette the tumor. Furthermore, allografting or auto grafting can be performed, depending on the size of the lesion. Prognosis is good and rapid in patients undergoing curettage and bone grafting.
Identification of FCDs involve plain X-rays, CT scan, MRI scan, and whole-body scans.
Curettage involves scraping out the tumor from the bone. If the pathological condition is severe i.e. if the medical reports indicate to fibroblasts in fibrous stroma, giant cells, and lack of bone development at the FCD site, bone grafting surgery is likely to be performed. Bone grafting surgery involves auto grafting procedure which is performed using a bone from the child’s own body. The other alternatives available are allografting procedure (bone from another person’s body), grafting using cement, or some bone substitute, which is chemically prepared in the laboratory.
Furthermore, sometimes some chemicals are used to put in the hole during the surgery. These chemicals prevent the tumor from reappearing in the future. In severe cases, if the fracture is unstable, due to presence of large lesion, plate and screws can be used to stabilize the bone. The chances of the reoccurrence of nonossifying fibroma after surgery are low.
Key players operating in the global fibrous cortical defect treatment market include B. Braun, Surgival, Straumann, Jeil Medical, and DePuy Synthes.
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