title: Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature.
abstract: OBJECTIVE
  Study reports clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours.
  
  
  METHODS
  Nine patients with distal fibular tumours were observed between 2005 and 2010. A PubMed search was performed using the terms "fibula", "lower limb tumour [cancer]", "sarcoma", "Ewing", "peroneal", "fibular metastasis", and "limb-salvage surgery".
  
  
  RESULTS
  In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 tumours. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40-100 % in case of malignancies.
  
  
  CONCLUSIONS
  Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain, limping, and pathological fractures; in malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.
authors.affiliation: Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, L go A Gemelli 1, 00168 Rome, Italy. carloperisano@hotmail.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Perisano
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marzetti
authors.forename: Maria Silvia
authors.initials: MS
authors.lastname: Spinelli
authors.forename: Calogero
authors.initials: C
authors.lastname: Graci
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbriciani
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Giulio
authors.initials: G
authors.lastname: Maccauro
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis; D001843:Bone Cements; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018786:Bone Substitutes; D016025:Bone Transplantation; D004210:Dissection; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D018786:Bone Substitutes