title: Malignant proximal fibular tumors: surgical management of 112 cases.
abstract: BACKGROUND
  Malignant tumors of the proximal part of the fibula are rare. We sought to analyze the presenting characteristics, postoperative complications, and local recurrences of malignant tumors in the proximal part of the fibula in a large series of patients.
  
  
  METHODS
  We identified 112 histologically confirmed malignant tumors of the proximal part of the fibula from the time period between 1910 and 2007. The sex ratio was nearly equal (fifty-four male, fifty-eight female). The average age of the patients was 27.6 years, and the average follow-up period was 5.7 years.
  
  
  RESULTS
  Osteosarcoma (44%) was the most common diagnosis. Pain (86%), palpable mass (51%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. One hundred and three (92%) of 112 underwent curative surgical treatment. The two most common procedures were amputation in fifty (45%) of 112 patients and Malawer type-II resection in twenty-four (21%) of 112 patients. Deliberative sacrifice of the peroneal nerve was performed in seventy-four patients (66%). Postoperative complications occurred in fourteen (12.5%) of 112 patients, including wound issues (ten of 112), peroneal nerve palsy despite nerve preservation (two of twenty-nine), and posterior tibial artery thrombosis (two of 112). No long-term knee instability was seen in the fifty-three patients who underwent resection with lateral collateral ligament reconstruction. Fifty-six patients (50%) developed distant metastases and twelve (11%) had local recurrences.
  
  
  CONCLUSIONS
  Osteosarcomas are the most common malignant tumor of the proximal fibula. Complication rates are modest and long-term knee instability was not seen in patients undergoing reconstruction of the lateral collateral ligament. Local recurrence following resection is not uncommon and metastatic dissemination is the main cause of death. This series represents the largest collection of such tumors for which there is extended follow-up and data on surgical complications.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. abdel.matthew@mayo.edu
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Abdel
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
authors.forename: Mark E
authors.initials: ME
authors.lastname: Morrey
authors.forename: Carrie Y
authors.initials: CY
authors.lastname: Inwards
authors.forename: Doris E
authors.initials: DE
authors.lastname: Wenger
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.forename: Franklin H
authors.initials: FH
authors.lastname: Sim
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005360:Fibula / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult