Abstract
Purpose
We retrospectively reviewed cases of en bloc resection of the proximal fibula for the treatment of tumor arising from the fibular head.
Materials 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 145° flexion except one patient with flexion contracture of 5°. 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.
References
1. Bickels J, Kollender Y, Pritsch T, Meller I, Malawer MM. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res. 2007. 454:198–201.
2. Draganich LF, Nicholas RW, Shuster JK, Sathy MR, Chang AF, Simon MA. The effects of resection of the proximal part of the fibula on stability of the knee and on gait. J Bone Joint Surg Am. 1991. 73:575–583.
3. Einoder PA, Choong PF. Tumors of the head of the fibula: good function after resection without ligament reconstruction in 6 patients. Acta Orthop Scand. 2002. 73:663–666.
4. Enneking WF, Dunham W, Gebherdt MC, Malawer N, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of musculoskeletal system. Clin Orthop Relat Res. 1993. 286:241–246.
5. Erler K, Demiralp B, Ozdemir MT, Basbozkurt M. Treatment of proximal fibular tumors with en bloc resection. Knee. 2004. 11:489–496.
6. Farooque M, Biyani A, Adhikri A. Giant cell tumors of the proximal fibula. J Bone Joint Surg Br. 1990. 72:723–724.
7. Healey JH, Knnedy JG. Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL, editors. Bone and soft tissue tumors about the knee. The adult knee. 2001. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins;511.
8. Kanazawa Y, Tsuchiya H, Nonomura A, Takazawa K, Yamamoto N, Tomita K. Intentional marginal excision of osteosarcoma of the proximal fibula to preserve limb function. J Orthop Sci. 2003. 8:757–761.
9. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res. 1984. 186:172–181.
10. Schenck RC. Bucholz RW, Heckman JD, editors. Injuries to the knee: injuries to the collateral ligaments of the knee. Rockwood and Green's fractures in adults. 2001. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins;1884–1892.
11. Unni KK. Dahin's bone tumors: general aspects and data on 11,087 cases. 1996. 5th ed. Philadelphia: Lippincott-Raven;1–9.
12. Scranton PE Jr, McMaster JG, Kelly E. Dynamic fibular function: a new concept. Clin Orthop Relat Res. 1976. 118:76–81.