Fibrous Cortical Defect eMedicine Orthopedics

Description: Phemister provided the first description of fibrous cortical defect (FCD) in 1929. Sontag and Pyle reported a radiologic description in 1941,1 and in 1942, Jaffe and Lichtenstein described clinical and anatomic aspects and the natural history.2 Also called nonossifying or nonosteogenic fibroma, this benign tumor probably is the most frequent bony lesion in children, occurring in up to 30-40% of children.3 The condition is most common in adolescents. Fibrous cortical defect is a term coined to describe the smaller variety of nonossifying fibromas.4 However, no histologic difference exists between the lesions. When the lesion is large enough to encroach upon the medullary canal, the term nonossifying fibroma (NOF) is used. In this article, the terms FCD and NOF are interchangeable. The authors believe that these should be considered the same entity. These lesions are, in fact, developmental abnormalities as opposed to benign neoplasms. FCD usually is an incidental finding on radiographs. Pathologic fracture is a rare first presentation. FCD can exist in multiple sites (see Image 1). FCD may be difficult to diagnose in the presence of pain or swelling of soft tissues. Always benign, these lesions may result in pathologic fracture. Fractures and impending fractures are the indications for surgical intervention. Association with other bone lesions such as aneurysmal bone cyst is rare.
Synonyms and related keywords: FCD, nonosteogenic fibroma, nonossifying fibroma, metaphyseal fibrous defect, fibrous tumor, bone tumor
Bernardo Vargas-Barreto, MD & Mark Clayer, MD 2008