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Nonossifying fibromas of the distal tibia: possible etiologic relationship to the interosseous membrane.

Muzykewicz DA, Goldin A, Lopreiato N, Fields K, Munch J, Dwek J, Mubarak SJ - J Child Orthop (2016)

Bottom Line: The remaining two lesions occurred directly posterior.The vast majority of distal tibial NOFs occur in a distinct anatomic location at the distal extent of the interosseous membrane, which may have etiologic implications.IV (case series).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.

ABSTRACT

Purpose: Nonossifying fibromas (NOFs) present in a characteristic pattern in the distal tibia. Their predilection to this region and etiology remain imprecisely defined.

Methods: We performed a retrospective chart review of patients between January 2003 and March 2014 for distal tibial NOFs. We then reviewed radiographs (XRs), computed tomography (CT), and magnetic resonance imaging (MRI) for specific lesion characteristics.

Results: We identified 48 distal tibia NOFs in 47 patients (31 male, 16 female; mean age 12.3 years, range 6.9-17.8). This was the second most common location in our population (30 % of NOFs), behind the distal femur (42 %). Thirty-four lesions had CT and nine had MRI. Thirty-one percent were diagnosed by pathologic fracture. Ninety-six percent of lesions were located characteristically in the distal lateral tibia by plain radiograph, in direct communication with the distal extent of the interosseous membrane on 33 of the 34 (97 %) lesions with CT available for review and all nine (100 %) with MRI. The remaining two lesions occurred directly posterior.

Conclusions: The vast majority of distal tibial NOFs occur in a distinct anatomic location at the distal extent of the interosseous membrane, which may have etiologic implications.

Level of evidence: IV (case series).

No MeSH data available.


Related in: MedlinePlus

Bilateral distal fibular NOFs, each in communication with the distal extent of the interosseous ligament on MRI
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Fig7: Bilateral distal fibular NOFs, each in communication with the distal extent of the interosseous ligament on MRI

Mentions: Furthermore, there is a normal and well-described distal migration of the fibula relative to the tibia with growth of the pediatric ankle. This differential distal migration of the fibula to the tibia does not occur in children with a tibiofibular synostosis [10]. Such differential growth rates may provide traction on the interosseous ligament from fibular migration, contributing to NOF development. Alternatively, either longitudinal “pistoning” or the known external rotation of the fibula with respect to the tibia during normal gait may generate such traction. Interestingly, while not the focus of the current study, we have also encountered NOFs of the distal fibula, which, on MRI, can communicate directly with the distal extent of the interosseous membrane (Fig. 7), suggesting that such a process may affect either end of this structure. The two posteriorly localized lesions clearly show no relationship to the interosseous membrane (Fig. 5). Unfortunately, no MRI was available for review in either case, so precise soft tissue attachments could not be defined. One could theorize that an alternative structure (such as the posterior inferior tibiofibular ligament) may explain these variants.Fig. 7


Nonossifying fibromas of the distal tibia: possible etiologic relationship to the interosseous membrane.

Muzykewicz DA, Goldin A, Lopreiato N, Fields K, Munch J, Dwek J, Mubarak SJ - J Child Orthop (2016)

Bilateral distal fibular NOFs, each in communication with the distal extent of the interosseous ligament on MRI
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940240&req=5

Fig7: Bilateral distal fibular NOFs, each in communication with the distal extent of the interosseous ligament on MRI
Mentions: Furthermore, there is a normal and well-described distal migration of the fibula relative to the tibia with growth of the pediatric ankle. This differential distal migration of the fibula to the tibia does not occur in children with a tibiofibular synostosis [10]. Such differential growth rates may provide traction on the interosseous ligament from fibular migration, contributing to NOF development. Alternatively, either longitudinal “pistoning” or the known external rotation of the fibula with respect to the tibia during normal gait may generate such traction. Interestingly, while not the focus of the current study, we have also encountered NOFs of the distal fibula, which, on MRI, can communicate directly with the distal extent of the interosseous membrane (Fig. 7), suggesting that such a process may affect either end of this structure. The two posteriorly localized lesions clearly show no relationship to the interosseous membrane (Fig. 5). Unfortunately, no MRI was available for review in either case, so precise soft tissue attachments could not be defined. One could theorize that an alternative structure (such as the posterior inferior tibiofibular ligament) may explain these variants.Fig. 7

Bottom Line: The remaining two lesions occurred directly posterior.The vast majority of distal tibial NOFs occur in a distinct anatomic location at the distal extent of the interosseous membrane, which may have etiologic implications.IV (case series).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.

ABSTRACT

Purpose: Nonossifying fibromas (NOFs) present in a characteristic pattern in the distal tibia. Their predilection to this region and etiology remain imprecisely defined.

Methods: We performed a retrospective chart review of patients between January 2003 and March 2014 for distal tibial NOFs. We then reviewed radiographs (XRs), computed tomography (CT), and magnetic resonance imaging (MRI) for specific lesion characteristics.

Results: We identified 48 distal tibia NOFs in 47 patients (31 male, 16 female; mean age 12.3 years, range 6.9-17.8). This was the second most common location in our population (30 % of NOFs), behind the distal femur (42 %). Thirty-four lesions had CT and nine had MRI. Thirty-one percent were diagnosed by pathologic fracture. Ninety-six percent of lesions were located characteristically in the distal lateral tibia by plain radiograph, in direct communication with the distal extent of the interosseous membrane on 33 of the 34 (97 %) lesions with CT available for review and all nine (100 %) with MRI. The remaining two lesions occurred directly posterior.

Conclusions: The vast majority of distal tibial NOFs occur in a distinct anatomic location at the distal extent of the interosseous membrane, which may have etiologic implications.

Level of evidence: IV (case series).

No MeSH data available.


Related in: MedlinePlus