Proximal fibula resection with tibial stabilization: a surgical challenge of proximal fibular tumors

Overview

Primary tumors of the fibula represent a small proportion of bone neoplasms, with most cases occurring in the proximal third. Although the majority are benign, surgical resection carries significant technical complexity owing to the anatomical proximity of neurovascular structures and ligamentous attachments critical for knee stability. This report evaluates en bloc resection of three proximal fibular tumors with intraoperative neurovascular preservation and tibial-based reconstruction of lateral stabilizing structures.

Methods and approach

Three patients underwent surgical resection of proximal fibular tumors via en bloc dissection with intentional preservation of the common peroneal nerve. The lateral collateral ligament and biceps femoris tendon were reattached to the proximal tibia using anchor-based fixation. Functional assessment was performed using the Musculoskeletal Tumor Society score at minimum 12-month follow-up. Clinical examination evaluated knee stability, motor function, and sensory deficits.

Key Findings

All three tumors were successfully resected without compromise to common peroneal nerve integrity. Anchor-based reconstruction of the lateral collateral ligament and biceps femoris achieved stable knee articulation in all cases. Two patients experienced transient peroneal sensory or motor deficits that resolved completely during follow-up. Musculoskeletal Tumor Society scores ranged from 83.3% to 93.3%, indicating good functional preservation. No local recurrence was documented during the follow-up period.

Implications

Proximal fibular resection requires meticulous surgical planning and careful tissue handling to minimize morbidity associated with common peroneal nerve involvement. Larger resection margins correlate with increased risk of peroneal nerve dysfunction, necessitating individualized intraoperative decision-making regarding extent of dissection and nerve manipulation. The findings support comprehensive preoperative imaging and anatomical assessment to optimize surgical strategy.