Salvage Surgery for Coxa Vara in a Case of Symptomatic Polyostotic Fibrous Dysplasia: A Case Report

Abstract Background: Fibrous dysplasia (FD) is a rare benign bone disorder characterized by the replacement of normal bone with fibro-osseous tissue, often resulting in structural deformities and fractures. Polyostotic FD affecting weight-bearing bones like the femur may present with significant functional impairment. Case Presentation: An 18-year-old female presented with left hip pain and limited mobility. Radiographs revealed polyostotic FD with coxa vara and femoral Shepherd’s crook deformity. She had previously undergone subtrochanteric valgus osteotomy with plate fixation, which failed, leading to a recurrence of the deformity within a year. Intervention: A salvage procedure was performed involving extensive curettage of the lesion, corticocancellous iliac crest bone grafting with a bone graft substitute, and corrective valgus osteotomy fixed using a proximal femoral locking compression plate. Histopathology confirmed the presence of fibrous dysplasia. Outcome: At the 7-year follow-up, the patient remained asymptomatic with improved mechanical alignment, increased bone density at the femoral neck, and no recurrence of deformity. Functional outcomes were excellent, with the Harris Hip Score improving from 27 to 97. Conclusion: This case highlights the effectiveness of a combined approach involving deformity correction, curettage, bone grafting, and stable fixation in the management of complex femoral deformities in polyostotic FD. Early mechanical correction and structural reconstruction are essential to prevent recurrence and ensure long-term functional success.