Skip to main content
SpringerLink
Log in

Surgical Management of 121 Benign Proximal Fibula Tumors

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports.

Questions/purposes

We therefore analyzed the incidence of peroneal nerve palsy, knee stability, and local recurrence following surgical treatment of benign proximal fibula tumors.

Methods

We retrospectively reviewed the charts of 120 patients (121 tumors) with histologically confirmed aggressive benign tumors of the proximal fibula. There were 56 males and 64 females with an average age of 24 years (range, 2–64 years). The most common diagnosis was osteochondroma (38%) followed by giant cell tumor (19%). Pain (94%), palpable mass (39%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. Of the 121 tumors, 56 (46%) underwent en bloc resection. The minimum followup was 2 years (mean, 9 years; range 2 to 49 years; median, 7.4 years).

Results

Postoperative complications included nine peroneal nerve palsies (six transient, three permanent), one deep venous thrombosis, and one wound dehiscence. No long-term knee instability was seen with repair of the lateral collateral ligament. Ten patients had recurrences, with 70% of local recurrences occurring in patients who underwent intralesional excision.

Conclusions

Given the higher recurrence rate with curettage, patients with aggressive proximal fibula tumors benefit from en bloc resection. The overall morbidity is low, but postoperative permanent peroneal palsy remains a concern (3%).

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–B
Fig. 3
Fig. 4
Fig. 5A–B

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Bozkurt M, Yavuzer G, Tonuk E, Kentel B. 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. 2005;125:713–720.

    Article  PubMed  Google Scholar 

  3. Bozkurt M, Yilmaz E, Atlihan D, Tekdemir I, Havitcioglu H, Gunal I. The proximal tibiofibular joint: an anatomic study. Clin Orthop Relat Res. 2003;406:136–140.

    Article  PubMed  Google Scholar 

  4. Danese CA, Singer A. Lateral approach to the popliteal artery trifurcation. Surgery. 1968;63:588–598.

    CAS  PubMed  Google Scholar 

  5. Dardik H, Dardik I, Veith FJ. Exposure of the tibial-peroneal arteries by a single lateral approach. Surgery. 1974;75:377–382.

    CAS  PubMed  Google Scholar 

  6. DeLee JC, Riley MB, Rockwood CA Jr. Acute straight lateral instability of the knee. Am J Sports Med. 1983;11:404–411.

    Article  CAS  PubMed  Google Scholar 

  7. Draganich LF, Nicholas RW, Shuster JK, Sathy MR, Chang AF, Simon MA. The effects of resection of the proximal part of the fibula on stability of the knee and on gait. J Bone Joint Surg Am. 1991;73:575–583.

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Faezypour H, Davis AM, Griffin AM, Bell RS. Giant cell tumor of the proximal fibula: surgical management. J Surg Oncol. 1996;61:34–37.

    Article  CAS  PubMed  Google Scholar 

  10. Farooque M, Biyani A, Adhikari A. Giant cell tumours of the proximal fibula. J Bone Joint Surg Br. 1990;72:723–724.

    CAS  PubMed  Google Scholar 

  11. Gitelis S, Mallin BA, Piasecki P, Turner F. Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am. 1993;75:1648–1655.

    CAS  PubMed  Google Scholar 

  12. Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981;63:1257–1269.

    CAS  PubMed  Google Scholar 

  13. Kirgis A, Albrecht S. Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study. J Bone Joint Surg Am. 1992;74:1180–1185.

    CAS  Google Scholar 

  14. LaPrade RF, Wentorf F. Diagnosis and treatment of posterolateral knee injuries. Clin Orthop Relat Res. 2002;402:110–121.

    Article  PubMed  Google Scholar 

  15. Liu J, Hudkins PG, Swee RG, Unni KK. Bone sarcomas associated with Ollier’s disease. Cancer. 1987;59:1376–1385.

    Article  CAS  PubMed  Google Scholar 

  16. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res. 1984;186:172–181.

    PubMed  Google Scholar 

  17. Marcove RC, Heelan RT, Huvos AG, Healey J, Lindeque BG. Osteoid osteoma. Diagnosis, localization, and treatment. Clin Orthop Relat Res. 1991;267:197–201.

    Google Scholar 

  18. McDonald DJ, Sim FH, McLeod RA, Dahlin DC. Giant-cell tumor of bone. J Bone Joint Surg Am. 1986;68:235–242.

    CAS  PubMed  Google Scholar 

  19. Murray JA, Schlafly B. Giant-cell tumors in the distal end of the radius. Treatment by resection and fibular autograft interpositional arthrodesis. J Bone Joint Surg Am. 1986;68:687–694.

    CAS  PubMed  Google Scholar 

  20. Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am. 1984;66:269–274.

    CAS  PubMed  Google Scholar 

  21. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am. 1982;64:755–761.

    CAS  PubMed  Google Scholar 

  22. Unni KK. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, PA: Lippincott-Raven; 1996:1–9.

  23. Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am. 1996;78:204–211.

    CAS  PubMed  Google Scholar 

  24. Youdas JW, Wood MB, Cahalan TD, Chao EY. A quantitative analysis of donor site morbidity after vascularized fibula transfer. J Orthop Res. 1988;6:621–629.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Diane E. Grill, M.S. for her assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Matthew P. Abdel MD, Mark E. Morrey MD, Doris E. Wenger MD, Peter S. Rose MD & Franklin H. Sim MD

  2. First Department of Orthopedics, Athens University Medical School, Athens, Greece

    Panayiotis J. Papagelopoulos MD, Dsc

Authors
  1. Matthew P. Abdel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Panayiotis J. Papagelopoulos MD, Dsc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark E. Morrey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Doris E. Wenger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter S. Rose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franklin H. Sim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franklin H. Sim MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that waiver of informed consent was obtained from our Institutional Review Board given the minimal risk.

This investigation was performed at the Mayo Clinic, Rochester, MN, USA.

About this article

Cite this article

Abdel, M.P., Papagelopoulos, P.J., Morrey, M.E. et al. Surgical Management of 121 Benign Proximal Fibula Tumors. Clin Orthop Relat Res 468, 3056–3062 (2010). https://doi.org/10.1007/s11999-010-1464-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1464-8

Keywords

Search

Navigation