Abstract：Objective To explore surgical modalities, postoperative complications and management strategies of proximal fibula osteosarcoma (PFOS).Methods Eighteen patients of PFOS admitted in our center between January 2007 to January 2016 were retrospective analyzed, including 11 male patients and 7 female patients with a median age of 17 (range 8-38) years. All the 18 patients reported pain as the chief complaint, including 8 patients with accompanying symptoms of common peroneal nerve paralysis,and 3 patients with masses. The median duration of disease was 1-24 weeks. According to Enneking surgical classification,there were 17 cases in stage ⅡB and one case in stage Ⅲ.Fifteen patients underwent neoadjuvant chemotherapy for proximal humeral osteosarcoma resection, including 13 cases of Malawer type Ⅰ resection and 2 cases of type Ⅱ resection. There were 2 patients with incomplete resection in other hospitals who were amputation after admission. One patient (stage Ⅲ) had lung metastasis at the time of admission. After two courses of chemotherapy, the primary tumor continued to grow, and the pain was not relieved. Amputation was performed. The knee joint function of 15 patients with limb salvage was evaluated using the Musculo Skeletal Tumor Society(MSTS) scoring system in 3 months after operation.Results All the 18 PFOS patients were followed up successfully for a mean of 59 (range 7-120) months, during which lung metastasis occurred in 8 patients, and death occurred in 5 patients(including 3 cases of amputation). Of the 15 patients with limb salvage, recurrence occurred in 4 patients; postoperative wound infection occurred in one patient which was cured after positive and intensified dressing change. Common peroneal nerve injury occurred in 5 patients, and two of them recovered spontaneously in 3 and 7 months after operation. One patient had mild lameness and two patients had perforation of the perforation. No knee joint instability occurred in all these 15 patients. MSTS function scores in 3 months after operation were good in 11 cases, moderate in 2 cases, and poor in 2 cases.Conclusions Correct selection of the initial surgical modality for the treatment of PFOS is critical. Surgical procedures are determined according to the extent of tumor invasion,and postoperative complications of proximal fibular osteosarcoma are acceptable. Knee joint stability can be achieved by simple in situ suturing of the knee joint lateral collateral ligament and the lateral head of the biceps femoris muscle.
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2019, Vol. 24 
