Clin Orthop Surg.  2017 Jun;9(2):249-254. 10.4055/cios.2017.9.2.249.

Secondary Chondrosarcoma from an Osteochondroma of the Proximal Tibia Involving the Fibula

• Cho HS
• Han I
• Kim HS

• KMID: 2412296
• DOI: http://doi.org/10.4055/cios.2017.9.2.249

Abstract

There are few reports on the surgical treatment of secondary malignancy arising from an osteochondroma on the lateral side of the proximal tibia. From March 2008 to December 2011, 3 patients were treated for a secondary chondrosarcoma from an osteochondroma of the proximal tibia involving the fibula. The operative procedure can be summed up as follows: (1) resection of the tumor including the fibula; (2) preservation of the peroneal nerve and the fibular head; and (3) arthrodesis of the proximal tibiofibular joint. Serial radiological studies showed successful fusion in the proximal tibiofibular joint in all patients. The Musculoskeletal Tumor Society functional scores were excellent in all 3 patients. No patients showed instability of the ipsilateral knee joint in any direction. All 3 patients could return to sports activities. Until the last follow-up, there was no evidence of disease recurrence. We suggest that the operative procedure described in this article would provide satisfactory oncological and functional outcomes.

Keyword

Tibia; Fibula; Osteochondroma; Chondrosarcoma

MeSH Terms

Adult
*Bone Neoplasms/diagnostic imaging/secondary/surgery
*Chondrosarcoma/diagnostic imaging/secondary/surgery
*Fibula/diagnostic imaging/surgery
Humans
Male
*Neoplasm Recurrence, Local/diagnostic imaging/surgery
Osteochondroma/*pathology
*Tibia/diagnostic imaging/surgery
Young Adult

Figure

• 

  Fig. 1 Schematic drawings of the operative procedure. (A) Isolation of the peroneal nerve. (B) Arthrodesis of the proximal tibiofibular joint using a cannulated screw after en bloc resection of the tumor including segmental resection of the fibula.

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  Fig. 2 23-year-old man was diagnosed with secondary chondrosarcoma in the proximal tibia. (A) Plain radiographs taken 3 years before the surgery showing a benign osteochondroma in the proximal tibia. (B) Plain radiographs showing destruction of the fibula. (C) T2-weighted axial magnetic resonance imaging showing a thick cartilage cap with high signal intensity and bone scan showing increased uptake. (D) Plain radiographs taken in the immediate postoperative period and after removal of the cannulated screw. Yellow arrow: cartilage cap.

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  Fig. 3 Schematic drawings showing varus stress transfer in the normal knee (A), after resection of the proximal fibula (B), and after arthrodesis of the proximal tibiofibular joint (C). Red arrow: strain, green arrow: varus stress.

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