May 30, 2024

Non-Ossifying Fibroma (NOF) is a non-neoplastic skeletal disorder characterized by fibrous proliferation in the metaphysis. It is also called FIBROUS CORTICAL DEFECT/ FIBROXANTHOMAS.

As per WHO, NOF is not a true neoplasm but it is a developmental disorder.

Non-Ossifying Fibroma (NOF)


NOF is the most common skeletal lesion approximately 30 % in the first second decade.

Trauma in the region of muscle attachment with the formation of a focal sub-periosteal hemorrhage.

Male: Female= 2:1


Eccentrically located in the metaphysis of the long bone, tibia, and femur most commonly affected.

Clinical Features

Most NOF are asymptomatic and are detected incidentally

Some present with swelling, mild deformity, and with pathological fracture.

Radiological Features

It is well defined, usually oval, lytic lesion arising eccentrically on the metaphyseal cortex with a long axis parallel to the long axis of the bone.

Surrounded by a thin sclerotic rim (narrow zone of transition) which is deficient on the external side of the lesion

Typical NOF is > 2 cm in diameter and often extends to the medullary cavity.

Typical fibrous cortical defect lesion < 2cm in diameter and confined to the cortex.

Soap Bubble Appereance

Ritschl Four Stages of Non-Ossifying Fibroma

Stage ALesion moves towards metaphysis with bone growth and may increase in size, exhibiting more polycyclic, grape-shaped borders
Stage BInvolution and filling with bone tissue; mineralization tends to start in the diaphysis and proceeds toward the growthh plate
Stage CInvolution and filling with bone tissue; mineralization tends to start in the diaphysis and proceeds toward the growth plate
Stage DCompletely calcified lesion resembling a large bony islet


Spindle Shaped fibroblast arranged in a whorled and storiform pattern.

Histologically indistinguishable from benign fibrous histiocytoma of bone.


NOF most are asymptomatic and detected incidentally.

If the lesion is large and lytic we need to follow up with a serial radiograph

A lesion with longitudinal extension > 22 mm and > 50 % diameter of bone has a higher risk of pathological fracture.

Symptomatic, large, non-ossifying, lower limb lesions with a high risk of pathological fracture should be treated with curettage and appropriate reconstruction.

In case of fracture; appropriate splinting and reassess after fracture healing.

See also: Enchondroma

See also: Osteosarcoma

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