Too Much Bone

Background Following bone fracture, normal repair results in fiber osseous healing at the fracture site. If not repaired by rigid plate fixation (ORIF), in rare occasions, tear in the dura may lead to cerebrospinal fluid egress to the subperiosteal tissues leading to enlargement of the bone, that is, “a growing fracture.” In even more rare cases, bone overgrowth may be pathologically exaggerated.

Methods A case report of a 56-year-old male patient referred for an orbital problem. He was initially told at another institution that nothing could be done about it. When evaluated in August 2015, visual acuity was 20/50 and 20/300. The decreased vision on the left was felt to be secondary to cataract surgery. A year later following cataract surgery, acuity improved to 20/25 on the left, but it dropped to 20/300 on the right. Near vision was 10 and 3 pt. Automated perimetry revealed severely constricted fields on the right. External examination was remarkable for displacement of the globe 3 cm inferiorly and laterally by 22 mm. The patient had a 0.9 log unit right afferent pupillary defect and moderately severe limitation in elevation and abduction OD. OCT confirmed evidence of an optic neuropathy with severe loss of the ganglion cell subanalysis.

Discussion The patient was hit with a baseball bat in the forehead at the age of 4 years. In 1977, he had headaches and was told that he had a residual fracture. He underwent surgery during which they “scraped the inside of the bone.” For the past 10 years, he has had progressive proptosis and inferior displacement of the globe. CT and MR demonstrated intraosseous proliferation involving the right orbit and right interior cranial fossa. Patient underwent a transcranial orbitotomy with removal of the bone, both from the orbit and interior cranial fossa, with substantial improvement in globe position.

Conclusion Traumatic reactive fibrous bone neoformation is a rare complication of fractures. Surgical intervention is possible to improve the clinical situation.