Non-ossifying fibroma: natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up.

BACKGROUND: The aim of this study was to assess and present the radiological morphology of the non-ossifying fibroma (NOF), to describe the life span according to the Ritschl-stages in an effort to determine critical stages with regard to pathological fractures and discuss the need for a follow-up. METHODS: Reports of a consecutive series of 87 patients with 103 NOFs and a mean follow-up of 27 months were analysed according to the Ritschl-stages with regard to age at time of diagnosis, localisation, duration of stage and symptoms. RESULTS: Mean patient age in our series was 20 years and lesions most frequently affected the long bones of the lower extremity. Nineteen lesions were categorized in stage A, 53 in stage B, 17 in stage C and 14 in stage D. Most lesions were detected incidentally. In six of ten clinically symptomatic patients with an average age of ten years a pathological fracture occurred, and four of them were located in the tibia. All of these were in stage B with a mean length of 44 mm, an average expansion in relation to the bone-diameter of 75 % in transversal and 87 % in sagittal plane. Duration of the stages was variable. In the critical stage B the mean was 21 months. CONCLUSION: The non-ossifying fibroma follows a characteristic radiomorphological course with variable duration of each stage. Stage B lesions were found to be at an increased risk of fracture, and the age range over which fractures occur was wide. No fractures were detected in the other three stages. Follow-up, including clinical survey and imaging, at six to twelve month intervals may therefore be considered in the case of larger stage B lesions until stage C is reached.

Novel endoscopic sacroiliac screw removal technique: reduction of intraoperative radiation exposure.

OBJECTIVE: We report in the following on our technique of endoscopic sacroiliacal screw removal as a new extra-articular endoscopic method in soft tissue surgery, aimed at the reduction of radiation exposure for both the patient and the surgical teams. Patients who underwent endoscopic implant removal from the dorsal pelvic ring (Group A) were retrospectively compared with a control group, in which the screws were removed via the conventional approach (Group B). The parameters of interest were the extent of x-ray exposure in seconds and surgical duration in minutes as well as approach related peri- and postoperative complications. RESULTS: 34 screws were removed endoscopically from 28 patients in group A and 35 screws from 29 patients in group B. The mean skin-to-skin time in group A was 36.1 (15-111) min and 32.7 (12-114) min in group B. The difference was not statistically significant (p > 0.05). The average radiation time in group A was 5.7 ± 3.2 s (range, 0-101 s), while in group B the radiation time was significantly longer (52.6 ± 23 s (range, 0-239 s); p = 0.005). CONCLUSIONS: Endoscopic screw removal from the posterior pelvic ring reduces the intraoperative radiation time whereas the skin-to-skin times do not differ from the conventional procedure. LEVEL OF EVIDENCE: Case-control study, Level III.