Osteosarcoma of the distal fibula and reconstruction of the ankle using inverted fibula, a case report

INTRODUCTION AND IMPORTANCE: 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. CASE PRESENTATION: 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. CLINICAL DISCUSSION: 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. CONCLUSION: 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.