Patient Guide to
Non-Ossifying Fibroma
Los Angeles Orthopaedic Medical
Center
2501 S. Hope St. Los Angeles, CA 90007
What is a non-ossifying fibroma? How is a non-ossifying fibroma diagnosed?
A Non-ossifying Fibroma (NOF) is one  Asymptomatic and usually discovered as an
of the most common benign bone tumors found
in 30 to 40% of children between 8 to 20 years
of age. They typically are non-cancerous, or
life-threatening and do not spread to other areas
of the body.
A NOF is a result from failure of the
bone to properly close at its outer shell. They
tend to persist or increase in size as the child
grows but decrease in size or close once growth
ends.
Where do non-ossifying fibromas commonly
occur?
What are the symptoms of a non-ossiyfing
fibroma?
 Well-defined border
 Clear lesion located on the outer portion of
the bone
 Near the ends of bone
incidental finding after a child has a minor
injury and a plain x-ray is taken in the ER.
 History of pain at a nearby joint rather than
at the lesion, and symptoms fit a sprain or
strain injury.
 If there was pain before the injury that
seems to arise from the lesion, the diagnosis
of NOF is highly suspect.
What is the treatment?
The most common complication of a
NOF is a fracture to the bone from increased
stress related to injury or lesions that occupy
more than 50% of the bones diameter.
Immobilization in a cast is the treatment of
choice with close observation by an
Orthopaedic doctor. These fractures heal well
with a normal amount of callous but the NOF
may or may not resolve. Surgery is
recommended for those patients who do not
properly heal with a cast, or are likely to re-
break the bone again.
Treatment options
Non-surgical: Most lesions tend to heal
spontaneously by being replaced with normal
bone as the child becomes skeletally mature.
Surgery: A NOF in a structurally
compromising location may need surgery
including scraping the inside of the bone
(curettage). The hole left following this may
require donor bone or a bone graft substitute to
fill the defect.
Useful links:
http://orthoinfo.aaos.org/category.cfm?topcategory=Tu
mors
http://www.posna.org/index?service=page/pat 2501 S. Hope St. Los Angeles, CA 90007
ientInformation
What is an osteochondroma?
Patient Guide to
Osteochondroma Solitary osteochondromas are thought to be the
most common non-cancerous (benign) bone
tumor resulting from a developmental
abnormality of bone. It occurs when part of the
growth plate forms an outgrowth on the surface
of the bone. They become cancerous less than
1% of the time.
Multiple osteochondromatosis is diagnosed
when two or more osteochondromas are seen on
plain X-rays. About 70 percent of the time, it is
inherited. About 30 percent of the time, it
occurs randomly. A patient may also have
deformities of the forearms, a short stature, and
knock-knees and ankles. This is caused by
abnormal growth in the bones affected by the
osteochondromas. These can become
malignant about 10-20% of the time with large
tumors.
How are osteochondromas diagnosed?
Plain x-ray: Will show the bony growth with a
stalk (pedunculated) or without a stalk (sessile)
Computed tomography (CT) scan: used to
look for cartilage on the surface of the bony
Los Angeles Orthopaedic Medical growth or the lesion continuous with the bones
Center outershell (cortex)
Common presenting symptoms
 Painless bump near the joints (most
commonly knee and shoulder)
 Found at the ends of any long bone, and
along the pelvic and shoulder bones.
 If the stalk of a pedunculated
osteochondroma breaks, pain and swelling
may start immediately.
 Located under a tendon causing snapping of
the tissue over the tumor may cause
activity-related pain.
Treatment Options
Observation: Most of the time, solitary
osteochondromas are not removed surgically.
The doctor will carefully observe it. He or she
may want to take regular X-rays to keep track
of any changes.
Surgical: Surgery is recommended when
growth is complete (a mature skeleton by X-ray
evaluation) before removing. This decreases the
chance of the tumor growing back.
Surgery may be considered when: fluid. It is a benign condition (non-cancerous)
usually found in patients younger than 20 years of
• Is causing pain with activity age. UBCs occur in one bone, in one location.
• Puts pressure on a nerve or blood vessel
• Has a large cap of cartilage

Where does a UBC commonly occur?

The osteochondroma is removed at the level of

the normal bone. Some of the inside of the bone
may also be removed.

How will my child do in the long run with an

osteochondroma?
Children usually do really well. If the tumor
does not cause a lot of pain, it can be left
alone for life. Also, it is important to note that
an oteochondroma stops growing when a
child reaches skeletal maturity (i.e. when he
or she stops growing.

Useful links:
http://orthoinfo.aaos.org/category.cfm?topcategory=Tu
mors
http://www.posna.org/index?service=page/patientInfor
mation

Patient Guide to
Unicameral Bone Cyst The location of the cysts tends to be in the upper arm
(proximal humerus) or thighbone (proximal femur). Less
common locations include the pelvis, ankle (talus) or heel
Los Angeles Orthopaedic Medical (calcaneus).
Center
2501 S. Hope St. Los Angeles, CA 90007

What is a unicameral (simple) bone cyst?

A unicameral (simple) bone cyst is a cavity found How are UBC’s diagnosed?
within a bone that is filled with straw colored
Plain X-rays: show a hollow cavity in the
metaphyseal portion of the bone with a well-
defined cortical rim.
Computed tomography (CT) scan: ordered
when the UBC is not typical in it appearance to
help determine the architecture of the bone.
Common presenting symptoms
 Asymptomatic
 Pain with weight-bearing activities from
thinning of the bone.
 Incidental finding with a pathologic fracture
through the cyst, the affected arm or leg may
have pain, swelling and deformity.
Treatment Options
Non-Surgical: A UBC without pain or other
symptoms that the doctor discovers when
evaluating another problem can be watched with
repeated X-rays and routine doctor exams.
Pathologic fractures occasionally incite a healing
process not requiring surgical intervention.
Surgical option #1: The doctor may treat it by
draining the cyst (aspiration) and injecting it with
a steroid or with demineralized bone from the
bone bank, supplemented occasionally with bone
marrow from the person's pelvis. This method of
treatment may require more than one
aspiration/injection.
Surgical option #2: UBC in a structurally
compromising location may need surgery
including scraping the inside of the bone
(curettage). The hole left following this may
require donor bone or a bone graft substitute to
fill the defect. Depending on the size and location
of the cyst, treatment with an internal fixation
device may also be needed.
Surgery is recommended when
 UBCs at risk of a pathologic fracture need
treatment.
 UBC is painful, growing larger or in a
location that may fracture
Useful links:
http://orthoinfo.aaos.org/category.cfm?topcategory=Tumors
http://www.posna.org/index?service=page/patientInformatio
Patient Guide to
Bone Tumors
Los Angeles Orthopaedic Medical
Center
2501 S. Hope St. Los Angeles, CA 90007
Description
A tumor is a lump or mass of abnormal tissue and
may be benign or rarely malignant (cancerous). For
most bone tumors, the cause is unknown. A growing
tumor may replace healthy tissue with abnormal
tissue and may weaken the bone, causing it to break.
Aggressive tumors can lead to disability or death,
particularly if signs and symptoms are ignored.
Most bone tumors are non-cancerous (benign),
usually not life threatening. Some are cancerous
(malignant). Malignant tumors can spread cancer
cells throughout the body (metastasize) through the
blood or lymphatic system. Occasionally infection,
stress fractures and other non-tumor conditions can
closely resemble tumors.
Most common types of malignant bone cancer in
children are:
• Osteosarcoma is the second most common
bone cancer. It occurs in two or three new
people per million people each year. Most
cases occur in teenagers. Most tumors occur
around the knee. Other common locations
include the hip and shoulder.
• Ewing's sarcoma most commonly occurs
between age 5 and 20. The most common
locations are the upper and lower leg,
pelvis, upper arm and ribs.
Most common types of benign bone tumors.
• Non-ossifying fibroma
• Unicameral (simple) bone cyst
• Osteochondroma
• Giant cell tumor,
• Enchondroma
• Osteoid osteoma
• Fibrous dysplasia.
How are bone tumors diagnosed?
If you think you might have a bone tumor, see your
doctor as soon as possible for diagnosis and
treatment. The doctor will collect detailed
information about your general health and the
tumor's type, size, location and possible extent of
spread.
Symptoms
Most patients with a bone tumor will experience:
• Pain in the area of the tumor. The pain is
generally described as dull and achy. It may or
may not get worse with activity. The pain often
awakens the patient at night.
• Although tumors are not caused by trauma,
occasionally injury can cause a tumor to start
hurting. Injury can cause a bone weakened by
tumor to break, which often leads to severe
pain.
• Some tumors can also cause fevers and night
sweats
• Many patients will not experience any
symptoms, but will instead note a painless mass.
Medical history and physical exam:
Tell the doctor your complete medical history. This
includes any medications you take, details about any
previous tumors or cancers that you or your family
members may have had, and symptoms you are
experiencing. Your doctor will physically examine
you. The focus is on the tumor mass, tenderness in
bone and any impact on joints and/or range of
motion. In some cases, the doctor may want to
examine other parts of your body to rule out cancers
that can spread to bone.
Imaging and tests ordered:
X-rays/MRI/CT: Different types of tumors exhibit
different characteristics on X-ray. Some dissolve
bone or make a hole in the bone. Some cause extra
formation of bone. Some can result in a mixture of
these findings. Some tumors have characteristic
findings on X-rays. In other cases, it may be hard to
tell what kind of tumor is involved.
You may need more imaging studies to further
evaluate some tumors. These may include MRI
(magnetic resonance imaging) or CT (computed
tomography).
Blood and or urine tests. If these tests are not
adequate to diagnose your tumor, you may require a
biopsy.
Biopsy: Involves removing a sample of tissue from
the tumor. The tissue sample is examined under a
microscope. There are two basic methods of doing a
biopsy.
• Needle biopsy: The doctor inserts a needle
into the tumor to remove some tissue. This
may be done while you are under local
anesthesia in the doctor's office. Or a
radiologist may do it, using an X-ray
machine or CT or MRI scanner to help
direct the needle to the tumor.
• Open biopsy: The doctor uses surgery to
remove tissue. This is generally done
through a small incision while you are
under general anesthesia in an operating
room.
Treatment
Benign tumors: In many cases, benign tumors just
need to be watched. Some can be treated effectively
with medication. Some benign tumors will disappear
over time; this is particularly true for some benign
tumors that occur in children. Certain benign tumors
can spread or become cancerous (metastasize).
Sometimes your doctor may recommend removing
the tumor (excision) or using other treatment
techniques to reduce the risk of fracture and
disability. Some tumors may come back--even
repeatedly--after appropriate treatment.
Malignant tumors: If you are diagnosed with a
malignant bone tumor, you might want to get a
second opinion to confirm it. If you have bone
cancer, your treatment team may include several
specialists. These may include an orthopaedic
oncologist, a medical oncologist, a radiation
oncologist, a radiologist and a pathologist.
Treatment goals include curing the cancer and
preserving the function of your body. To treat
malignant bone tumors, doctors often combine
several methods. Treatment depends upon various
factors including whether the cancer has spread.
metallic implant (prosthesis) or bone
transplant.
• Amputation removes all or part of an arm
or leg when the tumor is large and/or nerves
and blood vessels are involved.
• Radiation therapy uses high-dose X-rays.
This kills cancer cells and shrinks tumors.
• Systemic treatment (chemotherapy) is
often used to kill tumor cells when they
have spread into the blood stream but
cannot yet be detected on tests and scans.
Chemotherapy is generally used when
cancerous tumors have a very high chance
of spreading.
After Treatment
When treatment for a bone tumor is finished, you
may need more X-rays and other imaging studies.
These can confirm that the tumor is actually gone.
You may need to have regular doctor visits and tests
every few months. When the tumor disappears, it is
important to monitor your body for its possible
return (relapse).

• Localized stage cancer cells are contained

to the tumor and surrounding area.
• Metastatic stage cancers have spread
elsewhere in the body. Tumors at this stage
are more serious and harder to cure.

Generally the tumor is removed using surgery.

Often radiation therapy is used in combination with
surgery.

• Limb salvage surgery removes the

cancerous section of bone but keeps nearby
muscles, tendons, nerves and blood vessels.
If possible, the surgeon will take out the
tumor and a margin of healthy tissue around
it. The excised bone is replaced with a