FUNCTIONAL OUTCOME FOLLOWING LIMB SALVAGE SURGERY FOR MALIGNANT TUMORS OF FIBULA

Abstract

Introduction: Extent of fibular resection dramatically alters limb function. Aim of our study was to evaluate the functional outcome following resections for 23 malignant tumors of fibula.

Methods: 23 biopsy proven malignant tumors of fibula were included in the study. There were 11 cases of Ewings sarcoma (PNET), 8 osteosarcomas, 2 malignant fibrous histiocytoma and 1 each of synovial sarcoma and chondrosarcoma. Following chemotherapy (wherever indicated) limb salvage surgery was done in all cases. There were 9 proximal, 6 middle and 9 cases of distal third of fibula. Type I resection was done in all proximal and 4 tumors of middle third fibula. Type II fibular resection with reconstruction of ankle joint was done in 10 cases. Reversal of contralateral fibula to reconstruct the ankle was done in 7 cases. Allograft was used in 3 patients.

Results: Average follow up was for 4.5 years (2 to 7 years). 17 patients (68%) were alive after 4 years of surgery. Local recurrence was seen in 3 cases and these were treated by above knee amputation. 3 patients died within 1 year of surgery. 82% of survivors had a good to excellent functional outcome according to the MSTS functional evaluation criteria and 65% were able to bear full weight and had unlimited activity. Recurrence was commonest in patients with PNET. All patients undergoing reversed fibular grafting showed good functional outcome.

Discussion and Conclusion: Results of limb salvage in malignant fibular lesions is infrequently reported. Site of fibular lesion is critical in salvage surgery and need for further reconstruction. Good results are obtained with reversed contralateral fibular reconstruction of the ankle.