Reconstruction of Ankle Mortise following Resection of Giant Cell Tumor of Distal Fibula

Vol 3 | Issue 2 |  July-Dec 2018 | Page 51-53 | Dinesh Chidambaram, Prakash Sengottaiyan, Karthikeyan Chinnaswami.

Authors: Dinesh Chidambaram [1], Prakash Sengottaiyan [2], Karthikeyan Chinnaswami [1].

[1] Dept of Orthopaedic Surgery, Royal Care Superspeciality Hospital, Neelambur, Coimbatore, Tamilnadu, India
[2] Dept of Plastic Surgery, Royal Care Superspeciality Hospital, Coimbatore, India

Address of Correspondence
Dr. Dinesh Chidambaram,
Royal Care Superspeciality Hospital, Neelambur, Coimbatore, Tamilnadu, India


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.
Keywords: GCT, Distal Fibula, Resection and Reconstruction with Proximal Fibula


1. Puri A, Agarwal MG. Current concepts in bone and soft tissue tumours.Chapter 6 page 53 – 54.
2. Mirra JM. Giant Cell Tumours. Mirra JM (Ed), Bone Tumours.Clinical Radiologic and Pathologic correlations, Vol 2. Philadelphia: Lea and Febiger; 1989, pp 942.
3. Jones RB, Ishikawa SN, Richardson EG, Murphy GA. Effect of distal fibular resection on ankle laxity. Foot and Ankle International 2001;22:590–3.
4. Zhao S-C, Zhang C-Q, Zhang C-L. Reconstruction of lateral knee joint stability following resection of proximal fibula tumors. Experimental and Therapeutic Medicine. 2014;7(2):405-410. doi:10.3892/etm.2013.1429.
5. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstruction procedures after surgical treatment of tumors of the musculoskeletal system. Clinical Orthopaedics and Related Research 1993;286(1):241–6.
6. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am. 1982;64:755–61
7. Campanacci M. Giant cell tumor. In: Gaggi A, editor. Bone and soft-tissue tumors. Bologna, Italy: Springer-Verlag; 1990. pp. 17–53.
8. Vaishya R, Kapoor C, Golwala P, Agarwal AK, Vijay V. A Rare Giant Cell Tumor of the Distal Fibula and its Management. Muacevic A, Adler JR, eds. Cureus. 2016;8(7):e666. doi:10.7759/cureus.666.
9. Leibner ED, Ad-El D, Liebergali M, Ofiram E, London E, Peyser A. Lateral malleolar reconstruction after distal fibular resection. A case report. Journal of Bone and Joint Surgery American Volume 2005;87:878–82.
10. Capanna R, van Horn JR, Biagini R, Ruggieri P, Bettelli G, Campanacci M. Reconstruction after resection of the distal fibula for bone tumor. Acta Ortho-paedica Scandinavica 1986;57:290–4.
11. Khodamorad Jamshidi, Farid Najd Mazhar, Zahra Masdari. Reconstruction of distal fibula with osteoarticular allograft after tumor resection.official journal of the European society of foot and ankle surgeons 2013 19;1: 31 – 35.
12. Carrell WB. Transplantation of the fibula in the same leg. Journal of Bone and Joint Surgery 1938;20:627–34.
13. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clinical Orthopaedics and Related Research 1984;186:172–81.

How to Cite this article: Dinesh C, Sengottaiyan P, Chinnaswami K. Reconstruction of ankle mortise following resection of giant cell tumor of distal fibula. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):51-53.

(Abstract    Full Text HTML)      (Download PDF)