A 14-year-old boy is found incidentally to have a well-defined eccentric lytic lesion in the posteromedial cortex of the distal femoral metaphysis with a scalloped sclerotic margin. He is completely asymptomatic and the lesion involves less than half of the cortical diameter. The most appropriate management is:

• A Wide en bloc resection
• B Curettage with autogenous bone grafting
• C Radiofrequency ablation of the lesion
• D Observation with periodic radiographs, as the lesion usually ossifies and resolves spontaneously ✓

Explanation

The description is typical of a non-ossifying fibroma (fibrous cortical defect when small), the most common benign fibrous lesion of bone in children. It is asymptomatic, metaphyseal, eccentric and cortically based with a sclerotic rim, and it characteristically fills in and ossifies with skeletal maturity, disappearing by adulthood. Asymptomatic lesions need only observation. Surgery is reserved for lesions threatening pathological fracture or causing repeated fractures.

Reference: Maheshwari's Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.