Reconstruction after wide resection of the entire distal fibula in malignant bone tumours

Dieckmann, Ralf; Ahrens, H.; Streitbürger, Arne; Budny, Tymoteusz; Henrichs, Marcel-Philipp; Vieth, Volker; Gebert, Carsten; Hardes, Jendrik

doi:10.1007/s00264-009-0931-x

Cited by 33 publications

(58 citation statements)

References 25 publications

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“…Type II resection is performed for high-grade malignant tumors, Erler et al (11) modified Malawer classification by adding two more detailed types of resection. Dieckman et al (4) claimed that previous classification systems were dependent on the tumour differentiation but not on the tumour size or extension (12). Thus, they reported new classification system.…”

Section: Discussionmentioning

confidence: 99%

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Clinical, Radiological and Surgical Pitfalls in Fibular Tumors

Göçer¹,

Çıraklı²,

Atmaca³

et al. 2016

Acta Oncol Tur.

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Section: Discussionmentioning

confidence: 99%

“…In distal fibula, ligament reconstruction or arthrodesis methods are applied to increase ankle stability (3,4). However, since fibula tumors are rare and since it is not possible to get ideal resection all the time, it may cause some complications such as instability in joints and local relapse in tumor.…”

Section: Introductionmentioning

confidence: 99%

Clinical, Radiological and Surgical Pitfalls in Fibular Tumors

Göçer¹,

Çıraklı²,

Atmaca³

et al. 2016

Acta Oncol Tur.

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“…It thus prompted us to explore the plausibility of a peroneus brevis tenodesis directly to the lateral distal tibia as described in this article. Because of the relative rarity of distal fibula tumors, surgeons disagree about the best way to manage the ankle after distal fibulectomy [1,7,9,12]. Options available for the treating surgeon include: resection of the distal fibula without reconstruction of the lateral ankle, especially if there is no lateral talar subluxation [3,19,20], repairing the residual lateral ankle ligaments to the distal tibia [8,26], reconstruction of the lateral ankle using the patient's fibula head mobilized distally [4,6,12], use of a fibula allograft or iliac crest graft to reconstruct the ankle [9,17], or tibiotalar arthrodesis with or without inclusion of the subtalar joint [7].…”

Section: Discussionmentioning

confidence: 99%

“…Complications from these reports range from progressive valgus deformity [15,20], gait abnormalities from ankle contractures and abnormal talar tilt [1,14], lateral knee instability with peroneal nerve injury [2,10], ankle and subtalar arthritis [7,18], growth plate injury of the immature distal tibia, to absolutely no effect at all on the functional outcome of the limb [3,19,20,26].…”

Section: Introductionmentioning

confidence: 99%

“…When surgeons perform it, the most typical indications include tumor surgery (where limb salvage is preferred to below-knee amputation), traumatic loss of the distal fibula, correction of posttraumatic deformities of the lower extremity, and situations in which the distal fibula is used as a donor graft [3][4][5][6]. Lateral ankle stabilization and soft tissue coverage after distal fibulectomy is recommended to prevent ankle instability and subsequent progression to ankle arthritis with accompanying disability [7].…”

Section: Introductionmentioning

confidence: 99%

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Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

Monson

Vojdani

Dean

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background After tumor resection involving the distal fibula, the method for recreating stability of the lateral ankle remains controversial. Many reconstructive options exist, including allograft reconstruction and arthrodesis; however, each of these approaches has significant potential disadvantages. Description of Technique The distal fibula is resected as necessary to obtain negative margins for local control of the neoplasm. Reconstruction of the lateral ankle ligamentous complex is performed using the peroneus brevis tendon to reestablish lateral and anterior stability of the tibiotalar joint. The peroneus brevis tendon is transected proximally at it myotendinous junction and then sutured to the calcaneofibular and anterior talofibular ligaments in sequence and then tenodesed to the lateral distal tibia with suture anchors and a staple. Methods We present three patients who underwent distal fibulectomy for tumors originating in the distal fibula. All patients who have undergone the reconstruction being described are included within this cohort study. The patients were assessed clinically and radiographically at a range of 14 months to 9.5 years (average, 4.8 years) for functional recovery, return of range of motion, stability of the ankle, and imaging evidence of arthrosis and instability. Results There were no episodes of instability or early progression to arthrosis. In addition, all patients obtained excellent ankle stability and range of motion on examination, but two had complications. One sustained a traumatic fracture to the base of the fifth metatarsal that healed with nonsurgical treatment and another who underwent further fibular shortening and bursectomy at the tip of the residual fibula with complete relief of his symptoms. Conclusions Reconstruction of the lateral ankle after distal fibular resection is possible using the peroneus brevis tenodesed to the distal tibia and sutured to the remnants of the calcaneofibular and anterior talofibular ligaments as described in this surgical technique. In this small group, we found that patients were able to return to normal daily activities without instability or progression to tibiotalar arthrosis at short term; however, longer followup and larger series of patients are called for to confirm these findings.

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Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

et al. 2022

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The tibiofibular joint can be reconstructed after distal fibular sarcoma salvage surgery to maintain ankle stability and achieve early gait. Classical reconstructive options include ligamentoplasties, arthrodesis, prosthetic replacement, bone grafts, and pedicled ipsilateral or free contralateral fibular bone flaps. We present a novel strategy for reconstruction of the ankle in an elderly patient and a literature review. A 68-year-old man presented with a high-grade myxofibrosarcoma to his distal fibula.Wide resection of the tumor and adjacent structures left a 12 Â 12 Â 8 cm defect including the distal fibula (10 cm), a 2 cm fragment of the lateral cortex of the tibia, the lateral anterior and superficial posterior compartments, and the lateral compartment. A 3 cm distal fibula remnant was left in the ankle mortice. Reconstruction was performed using a free ipsilateral 13-cm diaphyseal osteocutaneous fibular flap telescoped into the distal fibula remnant and anastomosed to the anterior tibial artery. A pre-bent L-shaped locking plate was used to reconstruct a syndesmotic joint. A 21 Â 13 cm suprafascial ALT flap was anastomosed to the proximal stump of the peroneal artery to cover the soft tissue defect. The patient had no complications and was ambulating with full weight bearing by postoperative week 11. He received postoperative chemo and radiotherapy. Three years postoperatively, he is tumor free, has complete ankle ROM and stability, and ambulates with no restrictions. Limb sparing surgery with a functional tibiofibular joint reconstruction should be considered to attain an early functional recovery after distal fibula sarcomas resection.

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Reconstruction after wide resection of the entire distal fibula in malignant bone tumours

Cited by 33 publications

References 25 publications

Clinical, Radiological and Surgical Pitfalls in Fibular Tumors

Clinical, Radiological and Surgical Pitfalls in Fibular Tumors

Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

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