Malignant proximal fibular tumors: Surgical management of 112 cases

Matthew Abdel, Panayiotis J. Papagelopoulos, Mark E. Morrey, Carrie Y. Inwards, Doris E. Wenger, Peter S. Rose, Franklin H. Sim

Research output: Contribution to journalArticle

15 Citations (Scopus)

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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)e165(1)
JournalJournal of Bone and Joint Surgery - Series A
Volume94
Issue number22
DOIs
StatePublished - Nov 21 2012

Fingerprint

Case Management
Fibula
Neoplasms
Peroneal Nerve
Ankle Lateral Ligament
Osteosarcoma
Recurrence
Knee
Tibial Arteries
Sex Ratio
Amputation
Paralysis
Cause of Death
Thrombosis
Neoplasm Metastasis
Pain
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Abdel, M., Papagelopoulos, P. J., Morrey, M. E., Inwards, C. Y., Wenger, D. E., Rose, P. S., & Sim, F. H. (2012). Malignant proximal fibular tumors: Surgical management of 112 cases. Journal of Bone and Joint Surgery - Series A, 94(22), e165(1). https://doi.org/10.2106/JBJS.K.00953

Malignant proximal fibular tumors : Surgical management of 112 cases. / Abdel, Matthew; Papagelopoulos, Panayiotis J.; Morrey, Mark E.; Inwards, Carrie Y.; Wenger, Doris E.; Rose, Peter S.; Sim, Franklin H.

In: Journal of Bone and Joint Surgery - Series A, Vol. 94, No. 22, 21.11.2012, p. e165(1).

Research output: Contribution to journalArticle

Abdel, M, Papagelopoulos, PJ, Morrey, ME, Inwards, CY, Wenger, DE, Rose, PS & Sim, FH 2012, 'Malignant proximal fibular tumors: Surgical management of 112 cases', Journal of Bone and Joint Surgery - Series A, vol. 94, no. 22, pp. e165(1). https://doi.org/10.2106/JBJS.K.00953
Abdel, Matthew ; Papagelopoulos, Panayiotis J. ; Morrey, Mark E. ; Inwards, Carrie Y. ; Wenger, Doris E. ; Rose, Peter S. ; Sim, Franklin H. / Malignant proximal fibular tumors : Surgical management of 112 cases. In: Journal of Bone and Joint Surgery - Series A. 2012 ; Vol. 94, No. 22. pp. e165(1).
@article{7621dbfa8bf2482fa9e9de0dcb1409f0,
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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
author = "Matthew Abdel and Papagelopoulos, {Panayiotis J.} and Morrey, {Mark E.} and Inwards, {Carrie Y.} and Wenger, {Doris E.} and Rose, {Peter S.} and Sim, {Franklin H.}",
year = "2012",
month = "11",
day = "21",
doi = "10.2106/JBJS.K.00953",
language = "English (US)",
volume = "94",
pages = "e165(1)",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "22",

}

TY - JOUR

T1 - Malignant proximal fibular tumors

T2 - Surgical management of 112 cases

AU - Abdel, Matthew

AU - Papagelopoulos, Panayiotis J.

AU - Morrey, Mark E.

AU - Inwards, Carrie Y.

AU - Wenger, Doris E.

AU - Rose, Peter S.

AU - Sim, Franklin H.

PY - 2012/11/21

Y1 - 2012/11/21

N2 - 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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - 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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=84870220299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870220299&partnerID=8YFLogxK

U2 - 10.2106/JBJS.K.00953

DO - 10.2106/JBJS.K.00953

M3 - Article

C2 - 23172332

AN - SCOPUS:84870220299

VL - 94

SP - e165(1)

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 22

ER -