Optimizing proximal fibula tumor resection: “The open door technique” for better surgical access and outcomes - A case series

Abstract

Objective

Proximal fibula tumors pose significant surgical challenges due to their proximity to vital neurovascular structures, including the common peroneal nerve. Traditional resection techniques often require extensive tissue manipulation, which can lead to complications such as peroneal nerve injury and knee instability. This study introduces and evaluates the “open door technique,” designed to enhance surgical visualization and access, thereby reducing complications while achieving oncologic control.

Methods

We conducted a retrospective cohort study of 31 patients who underwent proximal fibula tumor resection using the “open door technique” from 2015 to 2022. Patient demographics, tumor characteristics, and functional outcomes were documented. Preoperative imaging and a standardized surgical approach were employed, with follow-up assessments including the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Descriptive statistics and comparative analyses were applied to evaluate surgical and functional outcomes.

Results

The “open door technique” achieved negative resection margins in 93.5 % of cases, with a recurrence rate of 6.5 % over a mean follow-up period of 36 months. Postoperative complications included permanent peroneal nerve injury in 12.9 % of patients and transient nerve injury in 9.7 %, both lower than rates typically associated with traditional techniques. Functional outcomes were favorable, with 87.1 % of patients achieving good to excellent MSTS and TESS scores, indicating practical neurovascular and ligamentous structure preservation.

Conclusion

The “open door technique” provides an effective, function-sparing approach for proximal fibula tumor resection, balancing oncologic control with reduced neurovascular complications and improved functional outcomes. These findings support its potential as a valuable addition to orthopedic oncology practices. Further studies are recommended to confirm its applicability across a broader patient population.