Resection Of Proximal Fibula Research Articles

Proximal Resection of the Fibula in the Treatment of Proximal Fibular Chondrosarcoma

Introduction: Chondrosarcoma includes several anatomoclinical forms of tumors with cartilaginous histogenesis.It is a malignant tumor whose tumor cells are associated with a cartilage matrix.Case report: We present the case of a patient with stage 1 chondrosarcoma of the proximal part of the left fibula.The patient underwent a proximal fibula resection with a favorable outcome.Conclusion: Resection of tumors of the proximal fibula may cause knee instability, peroneal palsy through involvement of the external popliteal sciatic nerve or with local radiotherapy, a higher risk of delayed healing and the occurrence of fracture. Despite the risks of resection of the proximal fibula, good functional results can be obtained.

Clinical and radiologic outcomes following resection of primary proximal fibula tumors: Proximal fibula resection outcomes.

Reconstruction of the lateral collateral ligament (LCL) and biceps femoris tendon following proximal fibula resection is controversial. Postoperative knee instability and peroneal nerve dysfunction affect outcome. This study aimed to determine functional, clinical, and radiological outcomes of patients who underwent en bloc proximal fibula resections and to compare clinical and radiological instability rates for primary repair after type I and type II resections. Eleven patients with primary tumors of the proximal fibula were included. Musculoskeletal Tumor Society (MSTS) score and Lysholm knee score were used in the evaluation of functional outcomes. Clinical outcome was assessed using knee range of motion and knee varus stress test. Radiological outcome was assessed using varus stress knee radiographs. Knee stability was evaluated using the varus stress test at 30° of knee flexion and varus stress knee radiographs and graded in millimeters. Of the 11 tumors, 6 (54.6%) underwent type I resection. In five (45.4%) patients, type II resection was performed. The mean follow-up period was 32 ± 13.9 months (range, 12-55 months; median, 27 months). The mean knee joint lateral opening, MSTS score, and Lysholm knee score with type I versus type II resection were 5.7 ± 1.2 mm versus 6.4 ± 1.1 mm ( p = 0.247), 28.7 ± 1.8 (95.6%) versus 20.4 ± 7.7 (68%) ( p = 0.011), and 92.2 ± 8.8 versus 62.8 ± 20.4 ( p = 0.026), respectively. Postoperative complications of all patients included one (9.1%) deep tissue infection and one (9.1%) long-term knee instability. In one patient (9.1%) who underwent type II resection, above-the-knee amputation was performed after local recurrence. Primary repair of the LCL and biceps femoris tendon to the surrounding soft tissues after resection of proximal fibular tumors provides good clinical outcomes. Primary repair is a simple technique to perform with minimal morbidity. Peroneal nerve palsy was a problem, especially in type II resections. Level of Evidence: Therapeutic Level III.

Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children.

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.

Osteochondroma of the Proximal Fibula-Revisited

It was interesting to read the case report by Kumar et al., [1]. “Osteochondroma arising from the proximal fibula: a rare presentation”, where the authors mentioned about a case of a giant osteochondroma arising from the proximal fibula in an 18-year-old male without the complications of distal neurovascular deficit or a sarcomatous change. We congratulate the authors for such a nice presentation of this common tumour with various case scenarios. The authors mentioned in the title ‘Osteochondroma arising from the proximal fibula: a rare presentation’ which in fact contradicts the statement written in the discussion ‘the most common tumours found in the proximal fibula are osteochondromas, giant cell tumours, osteosarcomas and ewing’s sarcomas’ [1]. Literature gives identical statistics and concludes that the proximal fibula is a common site for symptomatic Osteochondroma [2]. Involvement of the tibia in a case of solitary osteochondroma of proximal fibula is rare and coalescence of kissing osteochondromata (facing osteochondromas of both tibia and fibula may show an interlocking growth at the abutting parts) in patients with multiple cartilaginous exostoses (MCE) may result in tibiofibular synostosis. Hence, the tibial involvement as mentioned by the authors could actually be the scalloping of the proximal tibia due to erosion on the contagious surface adjacent to the giant proximal fibular lesion. Though there were no symptoms of neurovascular involvement in the case reported by the authors, knowledge of the possible complications from the neurovascular involvement as mentioned by the authors should be born in mind especially in cases of a giant tumours at such a notorious anatomical site [1,3,4]. Preoperative nerve conduction studies and the angiography or colour doppler ultrasonography would be invaluable in planning definitive treatment. The authors did an en block resection of the lesion leaving a very small portion of the head of fibula where the lateral collateral ligament (LCL) was attached. In the one year follow-up they did not mention about the status of the knee joint laxity which could have judged the requirement of a LCL repair or reconstruction. Type 1 en block resection of proximal fibula is indicated for aggressive or epiphyseally located tumours where LCL repair and reconstruction is necessary to address the knee instability. Abdel Matthew et al., [5], in their study did en block resection of tumours at proximal fibula followed by LCL and biceps femoris repair or reconstruction. They found no functional knee instability. Last but not the least, further follow-up of the case is required keeping in mind the possibility of recurrence or the malignant transformation. The purpose of this letter is to highlight the key points regarding such an important entity. In the end, we wish to thank the authors for presenting such a difficult to treat case to the readers.

Complications related to harvest of the proximal end of the fibula: a systematic review.

The fibula is a common source of bone graft used in skeletal reconstruction. Although in most cases only the diaphysis of the fibula is used, there are clinical scenarios in which the proximal end of the fibula and fibular head are harvested for use in articular reconstruction. The purpose of this systematic review is to determine the incidence of knee instability and peroneal nerve motor dysfunction associated with removal of the proximal end of the fibula and fibular head. A systematic search was performed using the PubMed, Ovid MEDLINE, and cochrane databases. Studies accepted for review included those that clearly reported donor site morbidity (instability or peroneal nerve motor dysfunction) after proximal fibula resection. All studies in which the proximal fibula was resected for bone graft or for marginal resection of tumor were included. Fifteen studies reporting a total of 337 patients were included. The rate of symptomatic knee instability after proximal fibula resection was 3.9%. The incidence of instability that was detectible on physical examination or stress radiographs was higher. Although transient motor dysfunction was not uncommon, the incidence of persistent peroneal nerve motor dysfunction was 2.6%. Although asymptomatic laxity is common, the incidence of symptomatic knee instability after resection of the proximal fibula is relatively low. The incidence of persistent peroneal nerve motor dysfunction is also low when the nerve is intentionally protected during surgery.

Outcomes and complications of fibular head resection

The fibular head is often used as donor graft material for reconstruction of defects of the distal radius. However little is known on the safety of such a procedure. This report describes the long-term donor-site morbidity following the procedure. Fourteen patients who underwent simple or marginal resections of the proximal fibula between 1990 and 2007 were reviewed. Subjective donor-site morbidity, knee and ankle range of motion and instability, presence of sensory or motor function loss, gait and fibular regeneration were assessed. The mean age at surgery was 25 years; six were male, eight were female and the mean follow-up was 11 years. Abnormal clinical findings were present in 10 patients (71.4 %): nine patients (64.3 %) had Grade 2 varus laxity at the knee confirmed by stress radiographs; one had sensory loss in the distribution of the superficial peroneal nerve. Patients with varus laxity had significantly higher mean age at surgery than those without varus laxity (p = 0.001). None had deformity at the knee or ankle. The range of joint movements was normal. All had a normal tibiotalar angle and none had proximal migration of the fibula. One patient demonstrated near-complete regeneration of the fibula. Donor-site morbidity following simple and marginal resection of the proximal fibula is acceptable. Older patients had a higher risk of demonstrable varus laxity at the knee but proximal fibula resection in children appears to be safe.

Une technique modifiée de résection des ostéochondroses de la fibula proximale

Summary Osteochondroma is one of the most common tumors arising from the proximal fibula. Surgical treatment of proximal fibula osteochondromas may vary from debulking to resection of proximal fibula. We describe a modified surgical technique for excision of proximal fibular osteochondromas, which preserves the Proximal Tibio-Fibular Joint. We present a series of six cases of symptomatic proximal fibular osteochondroma. Four cases were solitary osteochondromas while two were a manifestation of a hereditary multiple exostoses. Indication for surgery was peroneal nerve symptoms in three, cosmesis in one, restricted knee motion in one, and pain in one case. All these cases were operated by a modified resection technique where the head of fibula was preserved The proximal tibio-fibular joint was preserved. Lateral stabilizing structures of the knee were left undisturbed, and hence did not need repair. Complications occurred in two patients, one had marginal wound necrosis and one had persistent weakness of extensor haullicis longus. At a minimum follow up of 2 years none had recurrence or late disruption of proximal tibio-fibular joint.

Modified resection technique for proximal fibular osteochondromas

Osteochondroma is one of the most common tumors arising from the proximal fibula. Surgical treatment of proximal fibula osteochondromas may vary from debulking to resection of proximal fibula. We describe a modified surgical technique for excision of proximal fibular osteochondromas which preserves the proximal tibio-fibular joint (PTFJ). We present a series of six cases of symptomatic proximal fibular osteochondroma. Four cases were solitary osteochondromas while two were a manifestation of a hereditary multiple exostoses. Indication for surgery was peroneal nerve symptoms in three, cosmesis in one, restricted knee motion in one, and pain in one case. All these cases were operated by a modified resection technique where the head of fibula was preserved. The PTFJ was preserved. Lateral stabilizing structures of the knee were left undisturbed, and hence did not need repair. Complications occurred in two patients, one had marginal wound necrosis and one had persistent weakness of extensor haullicis longus. At a minimum follow-up of 2 years, none had recurrence or late disruption of PTFJ.

Proximal fibula resection in the treatment of bone tumours

We present a large study of patients with proximal fibula resection. Moreover we describe a new classification system for tumour resection of the proximal fibula independent of the tumour differentiation. In 57 patients the functional and clinical outcomes were evaluated. The follow-up ranged between sixmonths and 22.2years (median 7.2years). The indication for surgery was benign tumours in ten cases and malignant tumours in 47 cases. In 13 of 45 patients, where a resection of the lateral ligament complex was done, knee instability occurred. In 32 patients a resection of the peroneal nerve with resulting peroneal palsy was necessary. Patients with peroneal resection had significantly worse functional outcome than patients without peroneal resection. An ankle foot orthosis was tolerated well by these patients. Three of four patients with pathological tibia fracture had local radiation therapy. There was no higher risk of tibia fracture in patients with partial tibial resection. Resection of tumours in the proximal fibula can cause knee instability, peroneal palsy and in cases of local radiation therapy, a higher risk of delayed wound healing and fracture. Despite the risks of proximal fibula resection, good functional results can be achieved.

The Clinical Results of En Bloc Proximal Fibula Resection for the Treatment of Fibular Head Tumor

Purpose: We retrospectively reviewed cases of en bloc resection of the proximal fibula for the treatment of tumor arising from the fibular head. Materals and Methods: Between April 1996 and August 2006, 10 patients who underwent en bloc proximal fibular resection and were followed for at least 12 months were included in this study. The mean age was 27.1 years (range, 5-60 years) and the mean follow-up duration was 64.7 months (range, 12.7-140.6 months). The type of en bloc resection was classified according to the Malawer’s resection criteria and the postoperative clinical results were evaluated according to the range of motion, knee joint stability and Musculoskeletal Tumor Society (MSTS) functional scoring system. Results: All patients were able to move the knee joint from 0° extension to 145o flexion except one patient with flexion contracture of 5o. Grade 1 lateral instability of the knee joint was present in two patients. The average MSTS function score was 92.6% (range, 73-100%). There was one patient with lung metastasis who was underwent lobectomy, but there were no patients with local recurrence. Conclusion: En bloc resection of the proximal fibula for the treatment of tumors arising from the fibular head is a useful therapeutic method that preserves the knee stability and promotes good functional outcome

Dynamic function of the fibula. Gait analysis evaluation of three different parts of the shank after fibulectomy: proximal, middle and distal

The purpose of this case study was to investigate the dynamic features of fibular movement to gait pattern by analyzing the gait of individuals with three different parts of the fibula resected. Gait analyses revealed that proximal fibula resection impaired knee stability, whereas distal fibula resection disturbed ankle kinematics significantly. Except a mild secondary quadriceps weakness, middle fibula resection did not cause a significant biomechanical disturbance on gait.