Dr Randall on the Identification and Management of Non-Ossifying Fibromas

"Non-musculoskeletal radiologists may still sound the alarm, but treatment [of patients with NOFs] should be avoided because they often will resolve, and you just need to follow these patients to demonstrate stability."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, the chair of the Department of Orthopedic Surgery, and a professor at UC Davis Comprehensive Cancer Center, outlined common diagnostic criteria and management approaches for non-ossifying fibroma (NOFs).

NOFs are a type of benign pediatric bone lesions commonly diagnosed in individuals aged 5 to 20 years. These lesions are observed in approximately 30% to 40% of children on routine radiographs, though their true incidence is unknown because most patients remain asymptomatic.

Despite their commonality, NOFs can sometimes grow larger, potentially weakening the bone and increasing the risk of fracture, particularly if they exceed half the width of the bone or cause cortical thinning. However, Randall noted that surgical intervention is remarkably rare, as these lesions are typically self-limiting and regress on their own. Therefore, observation is generally the recommended course of action, he explained, adding that ongoing surveillance may not even be necessary once stability is established. Fewer than 5% of all cases require any form of intervention, such as curettage and bone grafting, Randall noted.

The unnecessary anxiety and psychological stress experienced by patients and their families due to a lack of understanding about these benign lesions is a significant concern, Randall asserted. He explained that non-musculoskeletal radiologists who are unfamiliar with this lesion might "raise the alarm" upon its identification despite the fact that NOFs frequently resolve spontaneously, leading to unwarranted referrals and interventions. He emphasized the importance of following patients simply to demonstrate stability, advocating for the avoidance of treatment given their common resolution. This highlights a critical need for better education among healthcare professionals and families regarding the self-correcting nature and typical course of NOFs, Randall concluded.