title: Intentional marginal excision of osteosarcoma of the proximal fibula to preserve limb function.
abstract: Three cases of osteosarcoma (stage IIB) of the proximal fibula were successfully treated by marginal excision that preserved the common peroneal nerve and lateral stabilizers of the knee joint. Caffeine-assisted chemotherapy was administered to three boys, ages 15, 17, and 11 years, and resulted in a complete response. Two patients initially presented with peroneal nerve palsy that resolved completely with preoperative chemotherapy. The subsequent intentional marginal procedures resulted in preservation of the common peroneal nerves, lateral collateral ligaments, and biceps femoris tendons. In two cases the collateral ligament and biceps tendon were reattached to the tibia with a spike washer or suture anchors, and in the third case they were reattached by suture only to the ligamentous and capsular structure of the tibia. All three patients have normal ankle and knee joint function without evidence of recurrence 122, 120, and 61 months after surgery, respectively. Preservation of limb function without compromising the principles of tumor surgery is a desirable goal in any patient but particularly in young patients. For patients with osteosarcoma of the proximal fibula, this approach provides a better quality of life than conventional wide excision.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Kanazawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
authors.forename: Akitaka
authors.initials: A
authors.lastname: Nonomura
authors.forename: Koutarou
authors.initials: K
authors.lastname: Takazawa
authors.forename: Norio
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Katsuro
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005360:Fibula / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D019637:Orthopedic Procedures / Q000379:methods*; D012516:Osteosarcoma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome