Primitive malignant neoplasms affecting the distal third of the tibia are altogether rare. The authors describe the diagnostic procedure and surgical strategy of limb salvage in a case of malignant fibrous histiocytoma in this region, in a 50-year-old male. In this anatomic region, considering the limb salvage surgery, there are different reconstructive possibilities, as ankle prosthesis and arthrodesis with or without vascolarized fibula. The Authors underline the infective and mechanic problems of these surgical solutions, proposing a different arthrodesis. The surgical treatment consisted in resection of the distal third of the tibia and fibula. The restoration of the skeletal continuity has been obtained by a locked nail. The mechanical resistance of the system has been obtained by acrylic cement. A vascularized myocutaneous flap allowed the cover of the resection area. About 28 months after surgical intervention, the patient is now able to walk without the aid of the knee stabilizer nor the sticks; without signs of local recurrence of the disease, metastases, with no implant failure, nor of the cement. The very favourable outcome of the clinical case previously described should make this method be looked at as one of the available surgical options in treating these lesions.