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01.11.2010 | Symposium: Highlights of the ISOLS/MSTS 2009 Meeting | Ausgabe 11/2010

Clinical Orthopaedics and Related Research® 11/2010

Surgical Management of 121 Benign Proximal Fibula Tumors

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 11/2010
Autoren:
MD Matthew P. Abdel, MD, Dsc Panayiotis J. Papagelopoulos, MD Mark E. Morrey, MD Doris E. Wenger, MD Peter S. Rose, MD Franklin H. Sim
Wichtige Hinweise
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that waiver of informed consent was obtained from our Institutional Review Board given the minimal risk.
This investigation was performed at the Mayo Clinic, Rochester, MN, USA.

Abstract

Background

Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports.

Questions/purposes

We therefore analyzed the incidence of peroneal nerve palsy, knee stability, and local recurrence following surgical treatment of benign proximal fibula tumors.

Methods

We retrospectively reviewed the charts of 120 patients (121 tumors) with histologically confirmed aggressive benign tumors of the proximal fibula. There were 56 males and 64 females with an average age of 24 years (range, 2–64 years). The most common diagnosis was osteochondroma (38%) followed by giant cell tumor (19%). Pain (94%), palpable mass (39%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. Of the 121 tumors, 56 (46%) underwent en bloc resection. The minimum followup was 2 years (mean, 9 years; range 2 to 49 years; median, 7.4 years).

Results

Postoperative complications included nine peroneal nerve palsies (six transient, three permanent), one deep venous thrombosis, and one wound dehiscence. No long-term knee instability was seen with repair of the lateral collateral ligament. Ten patients had recurrences, with 70% of local recurrences occurring in patients who underwent intralesional excision.

Conclusions

Given the higher recurrence rate with curettage, patients with aggressive proximal fibula tumors benefit from en bloc resection. The overall morbidity is low, but postoperative permanent peroneal palsy remains a concern (3%).

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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