Proximal fibula resection with tibial stabilization: a surgical challenge of proximal fibular tumors

Primary fibular bone tumors are rare, representing 2.5–4% of all. Most occur in the proximal third and are benign, however their proximity to neurovascular and ligament structures may cause morbidity period. Surgical management is challenging, requiring careful dissection and reconstruction to preserve knee stability and function. Three proximal fibular tumors were resected en bloc with neurovascular preservation. The lateral collateral ligament and biceps femoris tendon were reattached to the proximal tibia using anchors. Minimum follow-up was 12 months. Functional outcomes were assessed with the musculoskeletal tumor society score (MSTS) score. All patients underwent successful resection with preservation of common peroneal nerve and key stabilizing structures. Anchor-based reconstruction provided good knee stability. No recurrence occurred. Transient peroneal nerve (CPE) deficits occurred in two patients, with full recovery. MSTS scores ranged from 83.3% to 93.3%. Proximal fibular resections are technically challenging due to anatomical complexity and close relationship with CPE. Larger resections increase the risk of CPE palsy, highlighting the need for meticulous planning and careful nerve handling. Although the need of lateral collateral ligament reconstruction is debated, reattachment using tibial anchors provided stable knees and good function in all cases. With proper technique, both oncological control and excellent functional outcomes are achievable.