Surgical management of proximal fibular tumors: risk factors for recurrence and complications

Abstract

ObjectivesThe aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management.MethodsPatients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables.ResultsIn the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems.ConclusionsPeroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.

Surgical Management of Benign Tumors of the Proximal Fibula

“… 12 , 19 , 20 Cadaveric analyses demonstrate that only 7.12% of weight from the knee is transferred through the fibula, which drops to less than 1% when the fibular head is resected. 21 However, through its contribution to the proximal tibiofibular joint, the fibula dissipates torsional stress at the ankle and alleviates lateral bending of the tibia, and resections of the fibular head may compromise joint stability. 22 - 24 …”

“… a Analyses used the same patient sample; data regarding procedure selection (Sun et al 4 ) and tumor recurrence (Guo et al 21 ) were reported separately. …”

“…For most benign tumors of the proximal fibula, intralesional and marginal excision procedures have shown similar postoperative tumor recurrence rates as en bloc resections (Table 2 ). 1 , 21 Guo et al 21 retrospectively analyzed 44 patients with benign proximal fibula tumors who underwent either intralesional excision or a type I resection and identified potential risk factors for local recurrence. One GCT of bone managed by a type I resection was the only recurrence within the benign tumor cohort, and there was no statistical difference in recurrence rate between the intralesional and type I treatment groups.…”

“…Benign nonaggressive tumors within the proximal fibula, such as osteochondromas, enchondromas, simple bone cysts, and chondroblastomas, demonstrate a low risk of recurrence after intralesional and marginal excisions (Table 2 ). 1 , 21 Accordingly, if surgery is the desired management choice for stable nonaggressive tumors in this anatomic location, the intralesional approach is a recommended initial surgical intervention. 1 , 31 Dahlin et al 52 reported on 30 cases including chondroblastoma with a cure rate of 90%, with the remaining recurrences adequately treated by revision curettage and no noted surgical complications.…”

Successful outcome after intralesional curettage for spindle cell hemangioma of fibula: a case report

“…To date, the main treatment choice for bular tumor is segmental or subperiosteal resection, in case of local recurrence at surgical site [17][18][19]. Given that preoperative digital radiograph indicated that the vascular mass on bula was solitary, and part of both cortex and cancellous bula were not involved, intralesional curettage was selected as the surgical intervention in this case for achieving the maximum retention of healthy bony structure.…”