Surgical management of aggressive and malignant tumors of the proximal fibula.

En bloc resection of tumors of the proximal fibula by a specified route allows safe exposure of the popliteal vessels and resection of the fibula, tibiofibular joint, and adjacent musculature. Type I (marginal excision) and Type II (wide intracompartmental resection) procedures performed in ten consecutive patients were evaluated. There were five male and five female patients; the average age was 18.9 years. The histologic diagnoses were osteosarcoma (2 patients), Ewing's sarcoma (3 patients), aggressive osteoblastoma (1 patient), giant cell tumor (3 patients), and "active" osteochondroma (1 patient). All resections achieved negative margins, with no local recurrences from 14 to 37 months after operation. Pathologic specimens showed a high incidence of direct muscle infiltration. Local complications included peroneal palsy (2 patients), flap necrosis (2 patients), and synovial fistula (1 patient). No secondary surgical procedures were required. At follow-up evaluation no knees showed ligamentous instability, and ankle function was good. Selected patients with aggressive (benign) and malignant tumors of the proximal fibula can be treated successfully by resection. A good functional outcome can be anticipated.