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Desmoplastic Fibroma: A Rare Pathological Midshaft Femoral Fracture Treated With Resection, Acute Shortening, and Re-lengthening

A Case Report

Stevens, Jarrad FRACS, FAOrthoA1,4; Moin, Sarah2; Salter, Donald MD, FRCPath, FRCPEd3; Patton, James T. FRCSEd, FRCS1

doi: 10.2106/JBJS.CC.18.00022
Case Reports

Case: We report a rare case of desmoplastic fibroma (DF) of the midshaft femur presenting as a pathological fracture. This rare benign bone tumor was treated with an acute en bloc excision and femoral shortening over an intramedullary nail. Once union of the acute shortening had been achieved, further surgery was undertaken to lengthen the femur with the use of Intramedullary Skeletal Kinetic Distractors. At 3 years after fracture, our patient had achieved equal leg lengths, had normal knee function, and was disease free.

Conclusions: DF resulting in pathological fracture of the midshaft femur is extremely rare and has not been reported to occur in the femoral diaphysis. This location is important as preservation of the joint above and below is preferable and en bloc excision is recommended. Restoration of bone stock after en bloc excision is difficult and recurrence needs to be monitored.

1Department of Surgery, Orthopaedics, Royal Infirmary Edinburgh, Edinburgh, Scotland

2School of Medicine, The University of Edinburgh, Edinburgh, Scotland

3Department of Pathology, Royal Infirmary Edinburgh, Edinburgh, Scotland

4Knox Orthopaedic Group, Knox Private Hospital Melbourne, Melbourne, Australia

E-mail address for J. Stevens:

Investigation performed at Royal Infirmary Edinburgh, Edinburgh, Scotland

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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