Abstract
Introduction: Young active patients with malignant tumours arising in the distal fibula, requiring bone and soft tissue excision, present a challenge to the treating surgeon. Wide local excision is advocated, to achieve clearance, however, disruption of the ankle mortise results and fusion is often required to restore stability. The loss of movement is poorly tolerated in the younger patient and leads to progressive degenerative changes in surrounding joints.
Method: Excision of the distal fibula lesion followed by rotation of the proximal fibula on its vascular pedicle recreates the ankle mortise with consequent restoration of ankle stability and retaining ankle movement.
Results: Between 2000 and 2008, we have performed this technique on four patients, (2F, 2M) mean age 21 (13–33). Diagnoses were that of chondrosarcoma, parosteal osteosarcoma, Ewings sarcoma and osteofibrodysplasia. Follow up at 5 years (18m-8 year) with no evidence of local or distant recurrence. One case was complicated by deep infection requiring surgical debridement and antibiotic therapy. In all cases the fibula grafts survived. Good to excellent functional results were achieved (Toronto Extremity Salvage Scores, mean 88 range 82–94).
Discussion: We will present the technical aspects of this procedure with particular reference to the most recent case, performed on a young female patient with parosteal osteosarcoma.
We believe this technique provides good oncological and functional results and recommend this treatment option is considered in young active patients required distal fibula excisions for sarcoma.
Correspondence should be addressed to BOOS c/o British Orthopaedic Association, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, England
