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Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature

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Abstract

Purpose

Study reports clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours.

Methods

Nine patients with distal fibular tumours were observed between 2005 and 2010. A PubMed search was performed using the terms “fibula”, “lower limb tumour [cancer]”, “sarcoma”, “Ewing”, “peroneal”, “fibular metastasis”, and “limb-salvage surgery”.

Results

In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 tumours. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40–100 % in case of malignancies.

Conclusions

Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain, limping, and pathological fractures; in malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.

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References

  1. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jürgens H, Winkler K (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20:776–790

    Article  PubMed  Google Scholar 

  2. Zeytoonjian T, Mankin HJ, Gebhardt MC, Hornicek FJ (2004) Distal lower extremity sarcomas: frequency of occurrence and patient survival rate. Foot Ankle Int 25:325–330

    PubMed  Google Scholar 

  3. Lee SH, Kim HS, Park YB, Rhie TY, Lee HK (1999) Prosthetic reconstruction for tumours of the distal tibia and fibula. J Bone Joint Surg Br 81:803–807

    Article  PubMed  CAS  Google Scholar 

  4. Krishnan Unni K (1996) Dahlin’s bone tumors: general aspects and data on 11087 case, 5th edn. Lippincott-Raven, Philadelphia, pp 1–9

  5. Schneiderbauer MM, Gullerud R, Harmsen WS, Scully SP (2007) Fibular osteosarcomas: contaminated margins may not impact survival. Clin Orthop Relat Res 456:182–187

    Article  PubMed  Google Scholar 

  6. Mirra JM (1989) Giant cell tumours. In: Mirra JM (ed) Bone tumours. Clinical radiologic and pathologic correlations, vol 2. Lea and Febiger, Philadelphia

    Google Scholar 

  7. Schajowicz F, Cabrini RL, Gimenez I (1981) Microspectrophotometric quantitation of DNA in bone tumors with giant cells (osteoclastoma, osteosarcoma and chondroblastoma). Clin Orthop Relat Res 156:91–97

    PubMed  Google Scholar 

  8. Huvos AG (1991) Bone tumors: Diagnosis, treatment and prognosis, 2nd edn. W. B. Saunders, Philadelphia

    Google Scholar 

  9. Laitinen M, Hardes J, Ahrens H, Gebert C, Leidinger B, Langer M, Winkelmann W, Gosheger G (2005) Treatment of primary malignant bone tumours of the distal tibia. Int Orthop 29:255–259

    Article  PubMed  CAS  Google Scholar 

  10. Dieckmann R, Ahrens H, Streitbürger A, Budny TB, Henrichs MP, Vieth V, Gebert C, Hardes J (2011) Reconstruction after wide resection of the entire distal fibula in malignant bone tumours. Int Orthop 35:87–92

    Article  PubMed  Google Scholar 

  11. Capanna R, van Horn JR, Biagini R, Ruggieri P, Bettelli G, Campanacci M (1986) Reconstruction after resection of the distal fibula for bone tumor. Acta Orthop Scand 57:290–294

    Article  PubMed  CAS  Google Scholar 

  12. Mohler DG, Cunningham DC (1997) Adamantinoma arising in the distal fibula treated with distal fibulectomy: a case report and review of the literature. Foot Ankle Int 18:746–751

    PubMed  CAS  Google Scholar 

  13. Lubliner JA, Robbins H, Lewis MM, Present D (1985) Aneurysmal bone cyst of the fibula: en bloc resection with allograft reconstruction. Bull Hosp Jt Dis Orthop Inst 45:80–86

    PubMed  CAS  Google Scholar 

  14. Dogra AS, Kulkarni SS, Bhosale PB (1995) Distal fibular giant cell tumour. J Postgrad Med 41:83–84

    PubMed  CAS  Google Scholar 

  15. Uhl RL, Segalman KA, Fetto J, Present D (1990) Malignant fibrous histiocytoma of the distal fibula: a case report. Bull Hosp Jt Dis Orthop Inst 50:183–188

    PubMed  CAS  Google Scholar 

  16. Durak K, Bilgen O, Kaleli T, Aydinli U (1996) Distal fibula resection in osteochondroma. J Int Med Res 24:381–386

    PubMed  CAS  Google Scholar 

  17. Lampasi M, Magnani M, Donzelli O (2007) Aneurysmal bone cysts of the distal fibula in children: long-term results of curettage and resection in nine patients. J Bone Joint Surg Br 89:1356–1362

    Article  PubMed  CAS  Google Scholar 

  18. Abuhassan FO, Shannak AO (2009) Subperiosteal resection of aneurysmal bone cysts of the distal fibula. J Bone Joint Surg Br 91:1227–1231

    Article  PubMed  CAS  Google Scholar 

  19. Maccauro G, Liuzza F, Muratori F, Falcone G, Gosheger G (2003) A very rare localization of metastatic lung carcinoma to the interosseous membrane. Arch Orthop Trauma Surg 123:563–566

    Article  PubMed  CAS  Google Scholar 

  20. Ozaki T, Hillmann A, Lindner N, Winkelmann W (1997) Surgical treatment of bone sarcomas of the fibula. Analysis of 19 cases. Arch Orthop Trauma Surg 116:475–479

    Article  PubMed  CAS  Google Scholar 

  21. Norman-Taylor FH, Sweetnam DI, Fixsen JA (1994) Distal fibulectomy for Ewing's sarcoma. J Bone Joint Surg Br 76:559–562

    PubMed  CAS  Google Scholar 

  22. Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC (2000) Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg Am 82:1269–1278

    PubMed  CAS  Google Scholar 

  23. Yadav SS (1981) Ankle stability after resection of the distal third of the fibula for giant-cell lesions: report of two cases. Clin Orthop Relat Res 156:105–107

    Google Scholar 

  24. Eger W, Schorle C, Zeiler G (2004) Giant cell tumor of the distal fibula: fifteen-year result after en bloc resection and fibula reconstruction. Arch Orthop Trauma Surg 124:56–59

    Article  PubMed  Google Scholar 

  25. Naples JJ, Reeves A (1994) Osteochondroma of the fibula. J Foot Ankle Surg 33:43–45

    PubMed  CAS  Google Scholar 

  26. Ongürü O, Pabuçcu Y, Celasun B (2002) Intraosseous lipoma of the fibula. Clin Imaging 26:55–57

    Article  PubMed  Google Scholar 

  27. Leichtle CI, Leichtle UG, Gärtner V, Schimmel H, Hartmann JT, Rudert M (2006) Multiple skeletal metastases from a giant cell tumour of the distal fibula with fatal outcome. J Bone Joint Surg Br 88:396–399

    Article  PubMed  CAS  Google Scholar 

  28. Ramirez N, Perez C, Rivera YC (2001) Distal third fibular aneurysmal bone cyst: en bloc resection and proximal third fibular reconstruction. Am J Orthop (Belle Mead NJ) 30:237–240

    CAS  Google Scholar 

  29. Saglik Y, Yildiz Y, Atalar H, Gunay C (2008) The use of fibular autograft and ankle arthrodesis for aggressive giant cell tumor in the distal tibia: a case report. Foot Ankle Int 29:438–441

    Article  PubMed  Google Scholar 

  30. Saglik Y, Yildiz Y, Atalar H, Basarir K (2007) Primary angiosarcoma of the fibula: a case report. Acta Orthop Belg 73:799–803

    PubMed  Google Scholar 

  31. Palocaren T, Walter NM, Madhuri V, Gibikote S (2008) Schwannoma of the fibula. J Bone Joint Surg Br 90:803–805

    PubMed  CAS  Google Scholar 

  32. Grimer RJ, Taminiau AM, Cannon SR (2002) Surgical outcomes in osteosarcoma. Surgical subcommittee of the European osteosarcoma intergroup. J Bone Joint Surg Br 84:395–400

    Article  PubMed  CAS  Google Scholar 

  33. Lindner NJ, Ramm O, Hillmann A, Roedl R, Gosheger G, Brinkschmidt C, Juergens H, Winkelmann W (1999) Limb salvage and outcome of osteosarcoma. The University of Muenster experience. Clin Orthop Relat Res 358:83–89

    Article  PubMed  Google Scholar 

  34. Kanazawa Y, Tsuchiya H, Nonomura A, Takazawa K, Yamamoto N, Tomita (2003) Intentional marginal excision of osteosarcoma of the proximal fibula to preserve limb function. J Orthop Sci 8:757–761

    Article  PubMed  Google Scholar 

  35. Carnesale P (1998) General principals of tumors. In: Canale ST (ed) Campbells’s operative orthopaedics, 10th edn. Mosby, St. Louis, pp 647–648

    Google Scholar 

  36. Pickering R (2003) Arthrodesis of ankle, knee, and hip. In: Pickering RM (ed) Campbells’s operative orthopaedics, 10th edn. Mosby, St. Louis

    Google Scholar 

  37. Carrell W (1938) Transplantation of fibula in the same leg. J Bone Joint Surg 20:627–634

    Google Scholar 

  38. Herring CL Jr, Hall RL, Goldner JL (1997) Replacement of the lateral malleolus of the ankle joint with a reversed proximalfibular bone graft. Foot Ankle Int 18:317–323

    PubMed  Google Scholar 

  39. Gauzy JS, Kany J, Cahuzac JP (2002) Distal fibular reconstruction with pedicled vascularized fibular head graft: a case report. J Pediatr Orthop B 11:176–180

    Article  PubMed  Google Scholar 

  40. Casadei R, Ruggieri P, Giuseppe T, Biagini R, Mercuri M (1994) Ankle resection arthrodesis in patients with bone tumors. Foot Ankle Int 15:242–249

    PubMed  CAS  Google Scholar 

  41. Bozkurt M, Yavuzer G, Tonuk E, Kentel B (2005) Dynamic function of the fibula. Gait analysis evaluation of three different parts of the shank after fibulectomy: proximal, middle and distal. Arch Orthop Trauma Surg 125:713–720

    Article  PubMed  Google Scholar 

  42. Jones RB, Ishikawa SN, Richardson EG, Murphy GA (2001) Effect of distal fibular resection on ankle laxity. Foot Ankle Int 22:590–593

    PubMed  CAS  Google Scholar 

  43. Jones RB, Ishikawa SN, Richardson EG, Murphy GA (2001) Effect of distal fibular resection on ankle laxity. Foot Ankle Int 22(7):590–593

    PubMed  CAS  Google Scholar 

  44. Bickels J, Kollender Y, Pritsch T, Meller I, Malawer MM (2007) Knee stability after resection of the proximal fibula. Clin Orthop Relat Res 454:198–201

    Article  PubMed  Google Scholar 

  45. Erler K, Demiralp B, Ozdemir MT, Basbozkurt M (2004) Treatment of proximal fibular tumors with en bloc resection. Knee 11:489–496

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, University Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy

    Carlo Perisano, Emanuele Marzetti, Maria Silvia Spinelli, Calogero Graci, Carlo Fabbriciani & Giulio Maccauro

  2. Centre for Sports and Exercise Medicine, Queen Mary, University of London Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Rd, London, E1 4DG, UK

    Nicola Maffulli

Authors
  1. Carlo Perisano
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  2. Emanuele Marzetti
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  3. Maria Silvia Spinelli
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  4. Calogero Graci
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  5. Carlo Fabbriciani
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  6. Nicola Maffulli
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  7. Giulio Maccauro
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Correspondence to Nicola Maffulli.

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Level of evidence: IV

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Perisano, C., Marzetti, E., Spinelli, M.S. et al. Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature. International Orthopaedics (SICOT) 36, 1907–1913 (2012). https://doi.org/10.1007/s00264-012-1536-3

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  • DOI: https://doi.org/10.1007/s00264-012-1536-3

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