A novel technique of extracorporeal irradiated autograft reconstruction following distal fibula sarcoma resection: A case report

Abstract

Introduction: Primary malignancies of fibula are very rare accounting for approximately 2.4–5.6% of all primary bone sarcomas, with proximal fibula commonly involved than the distal. Wide resection of distal fibula is advocated for malignant lesions, in turn disturbing the foot and ankle biomechanics leading to chronic pain, valgus instability and early arthritis. Therefore, some form of reconstruction is necessary to provide a stable ankle. Due to rarity of the disease, multiple reconstructive techniques have been described. We present a novel technique of distal fibula reconstruction with promising outcome. Case report: We report the case of a 21 years old male, presenting to our oncology clinic with complaints of pain and swelling over the left ankle of 2 months duration. Xray and MRI showed an intramedullary lytic lesion with periosteal reaction over the metaphysis of left distal fibula, 1.7 cm proximal to the tip of lateral malleolus. Needle biopsy revealed Ewing Sarcoma of distal fibula. He was confirmed non metastatic after whole body PET CT scan. Neoadjuvant chemotherapy was started for 3 months, followed by surgery and adjuvant chemotherapy. At 18 months follow up, he has returned to his routine activities without any activity restriction or clinical-radiological evidence of disease recurrence. Conclusion: Reconstruction following total distal fibula resection is a challenge, with multiple reconstructive techniques described with variable results. Our technique of reconstruction with extracorporeally irradiated distal fibula autograft has resulted in an anatomical ankle with good stability, function and bony union, making it a feasible alternative method of reconstruction following distal fibula resection for malignancy.

Keywords

• Distal fibula
• Sarcoma
• Extracorporeal irradiation
• Autograft