# Primary Malignant Tumours of the Proximal Third of the Fibula, from Epidemiology to Treatment: A Systematic Review

## TL;DR

This systematic review summarizes the current understanding of rare malignant tumors in the proximal fibula, covering their presentation, diagnosis, treatment, and outcomes.

## Contribution

A comprehensive synthesis of clinicopathological features and treatment outcomes for primary malignant proximal fibula tumors.

## Key findings

- Osteosarcoma and Ewing’s sarcoma are the most common histological types in proximal fibula tumors.
- Limb-sparing surgeries are preferred, but 16 patients required amputation.
- Local recurrence and lung metastases are common, with 38 patient deaths due to disease progression.

## Abstract

Background: Primary fibula tumours are rare, representing approximately 0.25% of all primary bone tumours. While benign lesions are often asymptomatic, malignant ones typically present with pain and functional impairment. Most tumours arise in the proximal third of the fibula, yet the literature regarding their epidemiology and clinicopathological features remains limited. This systematic review aims to synthesise current evidence on presentation, diagnosis, management, and prognosis of primary malignant tumours of the proximal fibula. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and the Cochrane Register were searched on 28 October 2025 for English-language case reports and case series on primary malignant tumors of the proximal fibula. Two reviewers independently performed study selection and data extraction, collecting information on demographics, tumor characteristics, diagnostic approaches, treatments, and outcomes, with disagreements resolved by a third reviewer. Results: Thirty-three papers involving 228 patients (78 females, 128 males, 22 unknown) were included. The mean age at diagnosis was 22.8 years (range 4–79). The most common symptoms were painful mass and neurological complaints. Osteosarcoma and Ewing’s sarcoma were predominant histological types. Limb-sparing surgeries were most common, although 16 patients underwent amputation. At mean follow-up of 48.9 months, local recurrence occurred in 44 cases, and 12 developed distant metastases, most commonly in the lungs. Overall, 38 patients died, 37 due to disease progression. Conclusions: Primary malignant tumours of the proximal fibula, while rare, pose significant therapeutic challenges. Accurate diagnosis, appropriate multimodal treatment, and careful surgical planning are crucial to optimise oncological control and functional outcomes.