Non-Ossifying Fibroma (NOF) Specialist Surgeon Singapore 

Surveillance and Prophylactic Stabilization of Fibrous Defects

We manage non-ossifying fibroma (NOF) by distinguishing between benign "scars" that will resolve and large lesions that threaten the mechanical integrity of the bone. Under the clinical direction of Dr. Saminathan Suresh Nathan, our protocols emphasize vigilant surveillance. However, when a fibroma involves more than 50% of the bone diameter, we intervene with precision curettage and grafting to prevent a catastrophic pathological fracture. The non-ossifying fibroma is a very common benign condition of the bone that presents in the teen years and is usually picked up incidentally. It has a bland appearance with sclerotic margins and is usually asmptomatic.They usually occur at the point of long bones where tendons attach to bone. Occasionally they may be so big as to confuse the diagnosis with something malignant. There is usually no reason to remove these lesions unless they are active on bone scan so as to be mistaken for a malignant bone tumor. Occasionally they may be big enough to cause pain due to a stress fracture as they weaken the bone especially around the hip.

Surgical Considerations

• Fracture Risk Assessment: Clinical and radiological evaluation using the Mirels' scoring or diameter-based thresholds to determine the need for surgical intervention.

• Precision Curettage: Meticulous removal of fibrous tissue followed by bone grafting to accelerate the biological "filling" of the cortical defect.

• Activity Management: Providing clear, evidence-based guidance on sports and loading restrictions during the observation or healing phases.

Figure. This child had a right distal femur tumor. This was characteristic of non-ossifying fibroma but due to the size needed to be curretted and cemented.