Elbahri Hassan Mohammed Hassan, Abd-Elmaged Hozifa Mohammed Ali, Abdulkarim Mohamed
International University of Africa, Department of Orthopedics, Sudan.
Alzaiem Alazhari University, Department of Orthopedics, Sudan.
Int J Surg Case Rep. 2022 Jul;96:107310. doi: 10.1016/j.ijscr.2022.107310. Epub 2022 Jun 14.
Osteosarcomas are malignant primary bone tumors of mesenchymal origin producing osteoid material and has peak incidence in adolescents. Distal lower limb tumors are rare and can negatively affect ankle joint stability.
A 24-year-old female who has newly graduated from college presented with distal fibular mass measuring around 5 × 15 cm located on the lateral aspect of the right ankle over a period of 2 months. The mass located on the lateral aspect of the right ankle that was hard, oval and measuring around 5 × 15 cm and originating from the fibula. The overlying skin was normal with no discharging sinuses. Distal neurovascular examination was normal with no lymphadenopathy. Imaging using X-rays and MRI as well as pathological examinations thereafter has proven the diagnosis. She was planned for wide surgical resection at distal fibula and ankle reconstruction after neoadjuvant chemotherapy, then for adjuvant chemotherapy. Ankle reconstruction using fibular autograft was used after its reversal and was then stabilization by syndesmotic screws. She has clinically good outcome.
Surgery with extensive and meticulous dissection remains the cornerstone for treating osteosarcomas affecting distal fibula. Neoadjuvant and adjuvant chemotherapy are important for managing micro-metastasis. Ankle reconstruction and be performed using different methods with good outcomes.
Lesson learnt is that ankle reconstruction using fibular autograft can be used after reversal and stabilization by screws with good outcome for managing distal fibular osteosarcomas. However, this finding needs to be strengthened with future reports.
骨肉瘤是间充质起源的原发性恶性骨肿瘤，可产生类骨质物质，在青少年中发病率最高。下肢远端肿瘤罕见，可对踝关节稳定性产生负面影响。
一名刚大学毕业的24岁女性，在2个月的时间里，右侧踝关节外侧出现一个约5×15厘米的腓骨远端肿块。肿块位于右侧踝关节外侧，质地坚硬，呈椭圆形，大小约5×15厘米，起源于腓骨。覆盖其上的皮肤正常，无窦道形成。远端神经血管检查正常，无淋巴结肿大。此后通过X线和MRI检查以及病理检查确诊。计划在新辅助化疗后对腓骨远端进行广泛手术切除并进行踝关节重建，然后进行辅助化疗。在翻转腓骨后使用腓骨自体移植进行踝关节重建，然后用下胫腓联合螺钉固定。她的临床效果良好。
广泛且细致的手术切除仍然是治疗累及腓骨远端骨肉瘤的基石。新辅助化疗和辅助化疗对于控制微转移很重要。踝关节重建可采用不同方法，效果良好。
经验教训是，在翻转腓骨并用螺钉固定后，使用腓骨自体移植进行踝关节重建，对于治疗腓骨远端骨肉瘤效果良好。然而，这一发现需要未来的报告加以强化。
