# Proximal Fibulectomy for Giant Cell Tumours: What Works!

## TL;DR

This study examines the outcomes of proximal fibulectomy for treating giant cell tumors of the proximal fibula, finding it to be oncologically safe with manageable functional outcomes.

## Contribution

The study provides insights into the functional and oncological outcomes of proximal fibulectomy for GCTB, emphasizing nerve sacrifice and reconstruction considerations.

## Key findings

- Proximal fibulectomy for GCTB is oncologically safe with no local or distant recurrences.
- Sacrificing the common peroneal nerve leads to compromised functional outcomes in nearly half of the patients.
- Knee instability was not observed in patients, even without reconstructing the LCL attachment.

## Abstract

Giant cell tumor of bone (GCTB) is the most common primary tumor of proximal fibula. Because of its close proximity to vascular structures, common peroneal nerve (CPN) and attachment of lateral collateral ligament (LCL), proximal fibulectomy poses unique challenges. We analyzed oncological and functional outcome of patients who underwent proximal fibulectomy for GCTB of proximal fibula.

Between January 2006 and December 2020, 23 patients underwent proximal fibulectomy for GCTB of proximal fibula, four were recurrent tumors. Mean resection length was 9 cm (5 to 15 cm). The LCL and biceps tendon were not reconstructed in 22 cases. The common peroneal nerve was sacrificed in seven patients including three recurrent cases. Functional status was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system.

There were two vascular complications and one infection. With 4 patients lost to follow up, mean follow up was 90 months (12 to 197). No patient had local or distant recurrence. Mean MSTS score was 26 (21 to 30). Eleven of 23 patients (48%) had loss of common peroneal nerve function with poorer functional outcome. No patient had symptoms suggestive of knee instability.

Proximal fibulectomy is oncologically safe. Reconstruction of the LCL attachment is not mandatory and patients do not have symptomatic knee instability. Functional outcomes are compromised after sacrifice of common peroneal nerve and may be potentially improved with tendon transfers at index surgery.