Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. Jan-Feb 2018;52(1):3-9.
doi: 10.4103/ortho.IJOrtho_323_16.

Fibulectomy for Primary Proximal Fibular Bone Tumors: A Functional and Clinical Outcome in 46 Patients

Affiliations
Free PMC article

Fibulectomy for Primary Proximal Fibular Bone Tumors: A Functional and Clinical Outcome in 46 Patients

Zile Singh Kundu et al. Indian J Orthop. .
Free PMC article

Abstract

Background: Primary benign and malignant tumors of the proximal fibula are not very common. Upper fibula being an expendable bone; the majority of the primary bone tumors at this site are usually treated with en bloc proximal fibulectomy. There is scarce literature on functional results, difficulties faced during dissection when to preserve or sacrifice common peroneal nerve and importance of lateral collateral ligament repair after proximal fibulectomy. The present study attempts at assessing these variables.

Materials and methods: This retrospective study included 46 patients; 30 males and 16 females with age ranging from 12 to 44 years (average: 26 years) operated between 2003 and 2014. There were 34 benign and 12 malignant tumors. All were treated with proximal en bloc fibulectomy as indicated and decided by the operating surgeon keeping in view its extent on magnetic resonance imaging. Peroneal nerve sacrifice or preservation was decided as per the type (benign/malignant), its involvement by the tumor and the extent of the tumor. In 14 (for 12 malignant and two benign giant cell tumors [GCTs]) patients, the peroneal nerve required resection for the margins. Partial upper tibial resection was performed in cases of malignant tumors and three GCTs. The followup ranged between 24 and 120 months (median: 48 months).

Results: Patients with peroneal nerve resection had inferior functional outcome than those without peroneal nerve resection. There was no higher risk of tibia fracture in patients with partial tibial resection. Lateral collateral reconstruction yielded better results and should be performed in all cases. Functional outcome was significantly better in patients with benign tumors than in patients with malignant tumors as these required neither resection of the peroneal nerve nor large amount of muscle excision. The functional results were evaluated using Musculoskeletal Tumor Society (MSTS) score, and clinical outcomes were evaluated using knee and ankle movements and stability. The overall average MSTS score was 26.50.

Conclusions: With good reconstruction of lateral ligament we can achieve good results after proximal fibulectomy for benign as well as malignant tumor without much instability. With partial upper tibial resection (i.e., the extra-articular resection of proximal tibiofibular joint) adequate margins are feasible even in malignant tumors.

Keywords: Benign; Ewing's tumor; Giant cell tumors; bone tumor; en bloc resection; fibula; malignant; musculoskeletal system; proximal fibula.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) X-ray of knee with proximal part leg bones anteroposterior and lateral views showing giant cell tumor of proximal fibula (b) X-ray of knee joint with proximal part of leg bones showing that the patient was treated with proximal fibulcetomy (c) Peroperative photograph showing that common peroneal nerve was preserved
Figure 2
Figure 2
(a) X-ray of the knee joint anteroposterior and lateral views showing massive giant cell tumor of proximal fibula (b) Excised specimen of proximal fibular large giant cell tumor (c) X-ray of knee joint with leg bones anteroposterior and lateral views showing the proximal fibula has been resected along posterolateral part of proximal tibia
Figure 3
Figure 3
X-ray of knee joint with leg bones anteroposterior view showing (a) Ewing sarcoma proximal fibula (b) Post chemotherapy Ewing sarcoma became very well defined and easy to excise
Figure 4
Figure 4
X-ray of knee joint with leg bones anteroposterior and lateral views showing (a) Osteosarcoma proximal fibula after chemotherapy (b) widely excised proximal fibula
Figure 5
Figure 5
(a) X-ray of the knee joint with leg bones anteroposterior and lateral views showing osteochondroma of proximal fibula. (b) Clinical photograph showing foot drop, which was present preoperatively. (c) Peroperative photograph showing common peroneal nerve dissected and decompressed. (d) X-ray of the knee joint with leg bones anteroposterior and lateral views showing proximal fibulectomy

Similar articles

See all similar articles

References

    1. Unni KK. Dahlin's Bone Tumors: General Aspects and Data on 11087 Cases. 5th. Philadelphia: Lippincott-Raven; 1996. pp. 1–9.
    1. Miller TT. Bone tumors and tumorlike conditions: Analysis with conventional radiography. Radiology. 2008;246:662–74. - PubMed
    1. Purohit S, Pardiwala DN. Imaging of giant cell tumor of bone. Indian J Orthop. 2007;41:91–6. - PMC - PubMed
    1. Ma LD. Magnetic resonance imaging of musculoskeletal tumors: Skeletal and soft tissue masses. Curr Probl Diagn Radiol. 1999;28:29–62. - PubMed
    1. Abdel MP, Papagelopoulos PJ, Morrey ME, Wenger DE, Rose PS, Sim FH. Surgical management of 121 benign proximal fibula tumors. Clin Orthop Relat Res. 2010;468:3056–62. - PMC - PubMed

LinkOut - more resources

Feedback