Treatment of proximal fibular tumors with en bloc resection

Proximal fibular tumor resection has always been a challenge to an orthopedic surgeon due to the proximity of two major structures; the peroneal nerve and anterior tibial artery. Extra-articular resection of the proximal tibiofibular joint, sacrificing of peroneal nerve and split resection of lateral tibial wall are major points of debate. Malawer described two types of resection for aggressive benign and malignant tumors of the proximal fibula, type I for benign and type II for malignant tumors. Between 1992 and 2002, nine male patients with proximal fibula tumors were treated by en-bloc resection as described either by Malawer and or by one of two new resection techniques. Of the nine tumors, six were diagnosed as giant cell tumor (one of them recurrent), two as osteosarcoma and one as benign fibrous histiocytoma. The mean age of the patients was 23.6 (20-48) years. The mean follow up period was 42.8 months (15-117). There were no complications leading to a secondary surgical procedure+no local recurrence. Tumor volume was over 250 ml in two GCT cases, so the deep peroneal nerve was sacrificed to provide a wide margin. Iatrogenic peroneal nerve palsy developed in two patients. Late tendon transfers were performed for the management of drop foot. Our results indicate that if tumor is recurrent or has a large volume, wide resection (including deep peroneal nerve) should be done. Despite satisfactory tumor management, functional outcomes turned out to be variable, therefore precise ligament and muscle reconstruction is recommended.