Abstract
BackgroundResection of proximal fibular osteosarcoma involving the posteromedial aspect of the fibula is challenging. Reconstruction using a gastrocnemius flap may result in significant lateral instability and abnormal knee movement. Furthermore, postoperative gait may be disturbed by foot drop resulting from scarification of the common peroneal nerve.MethodsBetween January 2011 and December 2013, five patients with proximal fibular osteosarcoma were treated via the double-approach procedure using en bloc resection without a gastrocnemius flap. Simultaneously, all patients received one-stage tenodesis of the anterior tibial and toe extensor tendons. Clinical outcomes, including local tumor recurrence, complications, and functional outcomes, were evaluated.ResultsThe mean follow-up duration was 47.2 months (range 42–52 months). No patients experienced local recurrence. The patients’ Enneking functional scores were excellent (80%) or good (20%) at the final follow-up.ConclusionsIn patients with proximal fibular osteosarcoma, the double-approach procedure allows easier and safer en bloc tumor resection with vessel and nerve protection. One-stage tenodesis without a gastrocnemius flap is associated with good functional outcomes.
Highlights
Resection of proximal fibular osteosarcoma involving the posteromedial aspect of the fibula is challenging
Patients were eligible for inclusion if they had proximal fibular osteosarcoma histologically proven by core needle biopsy and underwent one-stage en bloc tumor resection via the doubleapproach procedure and tenodesis of the anterior tibial and toe extensor tendons without a gastrocnemius flap
Tumor involvement is likely in the posteromedial region, which is near the posterior tibial vessels and nerves; amputation is chosen because of the difficulty of achieving a wide surgical margin
Summary
Resection of proximal fibular osteosarcoma involving the posteromedial aspect of the fibula is challenging. Reconstruction using a gastrocnemius flap may result in significant lateral instability and abnormal knee movement. Postoperative gait may be disturbed by foot drop resulting from scarification of the common peroneal nerve. As the most common primary malignant bone tumor, osteosarcoma usually involves the metaphyses of the distal femur, proximal tibia, or proximal humerus. The proximal fibula is an uncommon site for osteosarcoma. Treatment typically includes preoperative neoadjuvant chemotherapy, surgical resection, and postoperative adjuvant chemotherapy. Joint-sparing procedures with wide surgical margins are the standard surgical intervention. Described by Malawer, type-II resection is most appropriate for dealing with proximal fibular osteosarcoma. If there is marked tumor involvement in the posteromedial region, which is near to the posterior
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