Vol.5 No.3 (September 2015)
Clinical Treatment of Distal Fibular Tumours in Children
Objective: To study the clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. Method: Nine patients with distal fibular tumours were followed up and observed between June 2011 and September 2014. A PubMed search was per-formed using the terms “fibula”, “lower limb tumour (cancer)”, “sarcoma”, “Ewing”, “peroneal”, “fibular metastasis”. Result: All cases were followed-up for 3.6 ± 1.5 years. In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 patients. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40% - 100% in case of malignancies. Conclusion: Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain,, limping, and pathological fractures and malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.
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