Surgical management of 121 benign proximal fibula tumors

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%).

Fig. 1

Aggressive proximal fibula tumors with a substantial soft tissue mass may elevate and stretch the common nerve peroneal nerve.

Fig. 2A–B

(A) Figure representing locations of representative cross-sections (A–C) of the proximal fibula. (B) Schematic depicting a Type I en bloc resection at various cross-sections (A–C) through the proximal fibula. Type I resection includes removal of the proximal part of the fibula and a thin muscle cuff in all dimensions while preserving the peroneal nerve and all motor branches.

Fig. 3

This figure depicts a Type I en bloc resection of a proximal fibula tumor with a thin muscle cuff in all dimensions. Of note, the common peroneal nerve and common popliteal artery and vein are preserved.

Fig. 4

Type I en bloc proximal fibula resections require detachment of the lateral collateral ligament and biceps femoris tendon. After the resection, the tibiofibular joint is exposed.

Fig. 5A–B

(A) An AP radiograph of a 55-year-old man who underwent Type I en bloc resection with repair of the lateral collateral ligament and biceps femoris tendon with suture anchors is shown. (B) A lateral radiograph of the same patient is shown. At most recent followup, he was ambulating without any issues.