Modified resection technique for proximal fibular osteochondromas

Abstract

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.

Clinical, Radiological and Surgical Pitfalls in Fibular Tumors

“…Type I excision defined by Malawer et al (7) was performed on 4 patients while type II excision was performed on 2 patients, modified excision defined by Mootha et al (8) was performed on 4 patients and above-knee amputation was performed on one patient in wide resection. Wide excision was performed on 3 diaphysis located ewing sarcoma cases and 2 metastasis ( Figure 1).…”

“…One of these patients developed permanent drop foot since peroneal nerve was not protected due to tumor, the other three patients had complete recovery. Modified resection technique has been defined in fibula proximal zone osteochondroma in order to protect LCL (8). LCL reconstruction should be performed to prevent knee instability.…”

Secondary Chondrosarcoma from an Osteochondroma of the Proximal Tibia Involving the Fibula

“…Any systematic study has not evaluated the role of arthrodesis of the proximal tibiofibular joint in knee stability and functional outcomes after resection of the proximal fibula. Most studies, in which type IV resection was included, reported that the arthrodesis of the proximal tibiofibular joint is not essential 16). Einoder and Choong17) also noted that wide resection of the fibular head for a tumor might not require reconstruction, unlike treatment of traumatic disruption of the lateral ligamentous structures of the knee.…”

Osteochondroma of the Proximal Fibula-Revisited

“…Literature gives identical statistics and concludes that the proximal fibula is a common site for symptomatic Osteochondroma [2].…”