| Summary: | Background and purpose: Non-ossifying fibroma (NOF) is one of the most commonly seen benign bone tumours. Although renowned for their benign behaviour and tendency for spontaneous healing, these tumours can occasionally exhibit an aggressive course. Few published papers have focused on the treatment options of symptomatic NOFs.The aim of this case report is to discuss the clinical presentation of a painful and unusually aggressive multiple NOF of the distal tibia in a female adolescent patient. Case presentation: The case of a 17-year-old female patient who was complaining of a painful swollen right lower leg for the past few months. The symptoms became gradually worse, preventing her from sporting activities and becoming more and more debilitating. The patient was diagnosed with a particularly aggressive multiple non-ossifying fibroma of the distal tibia and fibula. She was treated with lesion curettage, bone grafting and external fixation with good clinical and radiological outcomes. Conclusion: Non-ossifying fibroma is a benign lesion that only requires observation in most of the cases. However, symptomatic lesions with aggressive behaviour or complicated with pathologic fracture may warrant surgical intervention.
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