Surgical Management of Benign Tumors of the Proximal Fibula

Abstract

Benign tumors of the proximal fibula are clinically notable, often resulting in pain, cosmetic defects, and potential neurovascular compromise. These symptomatic lesions warrant surgical consultation, but specific procedure selection remains a topic of ongoing discussion. The fibula is widely considered an expendable bone, which permits a greater variety of surgical options relative to other skeletal locations. As a result, some authors suggested en bloc resections without reconstruction as a viable first-line option to decrease tumor recurrence risk. However, wide resections may still result in diminished postoperative functionality compared with the standard intralesional and marginal approaches. Thus, surgical management remains a multifactorial decision, and often orthopaedic surgeons rely on past clinical experience or surgical preference within this unique tumor location. This detailed review will summarize the published literature and discuss the outcomes and indications of various surgical approaches for benign tumors of the proximal fibula. Emphasis will be placed on balancing tumor recurrence risk and postoperative functionality within the context of histologic diagnoses and surgical approaches.

Use of Surgical Adjuvants Does Not Decrease Recurrence of Aneurysmal Bone Cysts in Surgical Intervention With Pediatric Patients

“…Other factors, including the choice of adjuvant, sex, and proximity to the physis, were not significantly associated with risk for recurrence. These data support the findings of previous studies regarding the relationship between adjuvant selection and recurrence while suggesting that an age association for recurrence may be earlier than what has been commonly reported in the literature 7,12–15 …”

“…These data support the findings of previous studies regarding the relationship between adjuvant selection and recurrence while suggesting that an age association for recurrence may be earlier than what has been commonly reported in the literature. 7,[12][13][14][15] The use of local adjuvants during intralesional curettage of active and aggressive benign tumors, such as giant cell tumors and low-grade cartilage tumors, has demonstrated the ability to extend the treatment margin and decrease rates of recurrence. 16,17 Despite the similarly active behavior of ABCs, the rates of recurrence after adjuvant utilization have been variable.…”

Transtibial Amputation With Fibulectomy and Fibular Collateral Ligament-Biceps Reconstruction: Surgical Technique and Clinical Experience

“…[13][14][15] Reattachment of the FCL and biceps at the time of proximal fibulectomy has demonstrated increased knee stability and improved functional outcomes by reconstructing the lateral stabilizers of the knee. 13,16 The lateral stabilizers are also important in patients with a transtibial amputation because malalignment of the residual limb increases forces across the ligaments of the knee, predisposing patients to early fatigue with prosthesis use. 7 After fibulectomy and FCL-biceps reconstruction, most of our patients returned to vigorous activity, including hiking, skiing, and CrossFit, and there was no reported instability when using a prosthesis.…”

Clinical effect of surgical resection on primary malignant and invasive bone tumours of the proximal fibula

“…The incidences of osteosarcoma and giant cell tumour in the proximal fibula are 2.3 and 2.8-8%, respectively. The main clinical manifestations are pain, common peroneal nerve palsy and swelling (3,4). The proximal fibular cortex is thinner and has more muscles and ligaments attached; these anatomical features lead to a higher probability of proximal fibular malignancy invading the surrounding soft tissue and developing into an extraosseous compartment tumour (5).…”

“…The bone cortex at the proximal end of the fibula is relatively thin, and the tumour can easily break through the bone cortex and invade the muscle. Most patients have been found in Enneking stage IIB; therefore, when selecting limb salvage surgery, sufficient surgical boundaries should be identified to obtain good oncological results (4,6). There is no unified surgical plan for fibular proximal malignant tumours, and proximal fibula tumours are usually treated with limb salvage surgery for extensive or radical resection (2).…”