Peronea Magna Artery Challenging Proximal Fibula Resection of Ewing’s Sarcoma, Report of a Case

Surgical resection of the fibula is commonly done for either to obtain structural bone graft or to respect the fibula if involved by bone tumor. The vascular anatomy around the popliteal fossa is complex and has to be studied prior to any attempt of surgical resection. We present a case of 11 years old female patient who was diagnosed as a Ewing’s sarcoma of the fibula and her pre-operative CT angiography showed a vascular anomaly of Peronea magna artery. Following adjuvant chemotherapy, the patient was treated by wide local resection and the surgical procedure has to be modified in order to save the dominant peroneal artery the vascularity of the limb.

Successful Outcome After Intralesional Curettage for Spindle Cell Hemangioma of Fibula in an Infant: A Case Report

Spindle cell hemangioma (SCH), a non-neoplastic reactive vascular lesion, rarely locates in bones. We herein report a successful case of intralesional curettage for an infant with SCH of fibula. An 11-month-old boy was admitted to our center with a painless mass in the right proximal calf. Preoperative digital radiograph demonstrated a massive vascular lesion with an irregular bone destruction of proximal fibula. The lesion was removed via the intralesional curettage approach and pathologically diagnosed as SCH. The patient gained bone structure recovery of right proximal fibula. Two years after the surgery, he experienced no local recurrence. For the management of SCH of fibula with partial bone destruction, we suggest early-stage intralesional curettage as its safety and effectiveness.

Tuberculous osteomyelitis of proximal fibula: An unusual presentation of tuberculosis

Tubercular involvement of the proximal fibula is rare. We present a case of tuberculosis of proximal fibula in an immunocompetent 22-year-old female. She was diagnosed clinically as a case of cellulitis. Radiological investigations, including magnetic resonance imaging revealed a destructive lesion in her right proximal fibula. Finally, by fine-needle aspiration cytology and GeneXpert polymerase chain reaction, a diagnosis of tuberculous osteomyelitis of proximal fibula was established. She was managed non-operatively with multidrug antitubercular chemotherapy. A high index of suspicion is required to make a diagnosis of musculoskeletal tuberculosis of such a rare site in the early stages.

Classification and Treatment Strategies of Concomitant Fibular Column Injuries in Tibial Plateau Fractures

Background. About 1/3 of tibial plateau fractures are associated with proximal fibula fractures, but most proximal fibula fractures are often ignored. The aim of this study was to precisely explain the classification and treatment strategies of six injury types of the fibular column associated with tibial plateau fractures. Methods. Patients with ipsilateral proximal fibula and tibial plateau fractures treated in our hospital were retrospectively reviewed from Aug 2007 to Mar 2020. Two experienced surgeons and two radiologists divided fibular column injury into 6 injury types according to the AO classification and four-column nine-segment classification. The treatment scheme (surgically treated or conservatively treated) was also recorded. Results. In total, 355 proximal fibula fractures were included. Type 2 fibular head fracture was the most common type of injury in 122, and the segregate of superior tibiofibular syndesmosis was the rarest type in 3. In avulsion injury proximal of fibular pattern, the proportion of patients who need surgical intervention is the highest. Conclusions. Six injury types in the four-column nine-segment classification covered all types of bony and soft tissue injuries of the fibular column and concisely explained the injury mechanism. The classification is helpful for the precise judgement and decision-making of the concomitant fibular column injuries in tibial plateau fractures.

Isolated proximal fibula hypertrophic non-union: a case Report

We report on a 59-year-old woman with an isolated, hypertrophic non-union of the proximal fibula. To our knowledge, there has been no previous literature documenting a symptomatic, isolated hypertrophic non-union of the proximal fibula. This injury may pose significant difficulty in surgical fixation due to the proximity of the peroneal nerve. In treating these patients, it is critical to consider the underlying factors that may contribute to its pathology, and to recognize alternative approaches that may lead to improved outcomes for the patient.

Novel ideas for the comprehensive evaluation of varus knee osteoarthritis: radiological measurements of the morphology of the lateral knee joint

BackgroundThe lateral anatomical and morphological characteristics of knees with varus knee osteoarthritis (OA) have not received sufficient attention. This study used several radiological parameters to describe the morphological characteristics of the lateral knee with OA to determine whether there are relationships between varus knee OA and parameters such as lateral plateau widening (LPW), proximal fibula curvature (PFC), and fibula height (FH).MethodsThe study retrospectively analyzed 1072 subjects [376 males, 696 females; mean age 66.84 ± 7.04 (range 46–83) years; mean body mass index (BMI) 26.98 ± 3.22 kg/m²] who underwent standard radiography for diagnosing or evaluating symptomatic knee joint disease. The 163 Kellgren and Lawrence (K-L) grades 0 and I knees were categorized into the no-knee-OA group, and the 909 K-L grades II–IV knees were classified into the knee-OA group. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and hip-knee-ankle angle (HKAA) were measured to investigate varus knee deformity. The LPW, PFC, and FH were measured. T-tests and chi-square tests were used to compare each index between the two groups. Binary logistic regression was performed to examine the correlation between indexes and knee OA occurrence. Principal component analysis was used to calculate the comprehensive principal component score of varus deformity, which was used to comprehensively evaluate the knee varus deformity degree by reducing the original data's dimension. Multiple logistic and linear regression analyses were performed to examine the correlations between the three parameters and K-L grades and the comprehensive principal component score of varus deformit.ResultsLPW and PFC were significantly greater and FH was significantly smaller in the knee-OA group than in the no-knee-OA group. LPW, PFC, and FH were correlated with knee OA occurrence. One principal component, named the comprehensive principal component score of varus deformity, was extracted from the three indexes, and the total variance of the principal component interpretation was 76.60%. Multivariate logistics and linear regression analysis showed that after adjusting for age and BMI, LPW and PFC were positively correlated with K-L grading and varus deformity. FH was significantly and negatively associatedwith K-L grading and varus deformity (all P < 0.05).ConclusionsRegular morphological changes take place in the lateral knee with varus OA, including lateral dislocation of the tibial plateau, proximal fibula bending, and upward movement of the fibular head. Changes in LPW, PFC, and FH could enable a more comprehensive assessment of varus knee OA occurrence, severity, and deformity.Level of EvidenceRetrospective Study Level III