A Rare Case of Ribbing Disease– Diagnosis and Management
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Ribbing diseases is rare and have only been occasionally reported. A case of Ribbing disease affecting bilateral tibia which was diagnosed based on computed tomography (CT), magnetic resonance imaging (MRI), and histopathological features and managed by intramedullary reaming is reported.

A 45 year old female presented with complaints of pain in the right leg for the past four 4 months duration and in the left leg 3 years back for which she had taken treatment at an outside hospital where she underwent saucerization of the left tibia as a case of low- grade osteomyelitis. CT scan showed circumferential cortical thickening with almost complete replacement of the medullary cavity. MRI revealed bone marrow edema and minimal adjacent soft- tissue inflammation. Based on the above radiological correlation, the patient was diagnosed to have ribbing disease.

The patient was treated with NSAIDs and pamidronate, with no symptomatic betterment patient underwent right tibia intramedullary reaming. This treatment was performed with the surgical steps to avoid complications such as a fracture or false route that may occur due to the difficulty in piercing the closed medullary cavity. The patient’s pain decreased postoperatively, and pain in the left tibia that was mild, decreased with analgesics. The patient has been followed up at 6 months interval for the past 4 years and the patient is symptom free in the right leg and pain in the left leg has been manageable with mild analgesics with exacerbation of symptoms and with full range of movement in knees post operatively.

The diagnosis of Ribbing disease is challenging and often misdiagnosed. Ribbing disease is an uncommon cause of a common symptom. It is a rare diaphyseal sclerosing dysplasia. With lack of clinical signs of infection and biochemical evidence of metabolic bone disease and positive clinical, radiological and histological features in favour of ribbing disease helped in arriving at the diagnosis. Intramedullary reaming of the affected bone has been useful in providing symptomatic betterment .

source: http://www.jocr.co.in/wp/2020/07/10/jocr-2020-v10-i04-1808-fulltext/