Reconstruction of Ankle Mortise following Resection of Giant Cell Tumor of Distal Fibula
Journal Title: Journal of Clinical Orthopaedics - Year 2018, Vol 0, Issue 0
Abstract
Introduction: Giant cell tumor commonly occurs in the age group of 20-40 years with the commonest predilection around the knee joint. This case is presented here for its rare occurence in the distal fibula and its unique management. Case report: 25 year old male patient presented with complaints of pain and swelling over the outer aspect of left ankle for one year. On examination there was a diffuse swelling over distal third fibula with classical egg shell cracking consistency. Imaging with X ray, Computed tomography (CT) and Magnetic resonance imaging (MRI) revealed eccentric, expansile, lytic lesion with cortical breech. Thus a preoperative diagnosis of Giant Cell tumor(GCT) was made. Chest X ray and CT Chest were normal. Trucut Biopsy revealed features suggestive of Giant Cell Tumor. Locally aggressive tumor in an expendable bone warrants resection of distal fibula to prevent recurrence, which compromises ankle stability. So we did wide resection of the distal fibula and reconstruction of the ankle mortise with ipsilateral proximal fibula. Biceps femoris tendon and fibular collateral ligament were secured with suture anchor to lateral proximal tibia to avoid knee instability. Excision biopsy revealed giant cell tumor with margins free of tumor invasion. At one year follow up, there is no recurrence locally and patient walks without any support with normal knee and ankle range of movements . There is no lateral opening of knee joint on varus stress test with knee in 30 degree flexion. Mean musculoskeletal tumor society (MSTS) score was 100%. Conclusion: Giant cell tumor involving distal fibula is very rare. Owing to high recurrence rate, resection of tumour in toto and to enable the patient with good ankle stability, reconstruction of ankle mortise with ipsilateral proximal fibula is an appropriate mode of management especially in young patients.
Authors and Affiliations
Dinesh Chidambaram, Prakash Sengottaiyan, Karthikeyan Chinnaswami
Keywords
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