#DISTAL FIBULA SKIN#
#DISTAL FIBULA PLUS#
#DISTAL FIBULA FREE#

However, the dimensions of this area of altered signal intensity are decreased as compared to previous MRI. The last MRI done for the patient showed there is altered signal intensity of the soft tissue with post-contrast enhancement. VAC dressing was also applied as standard care management in Oncology cases at KFMC and backs lab was applied ( Figure 9). K-wires were used to do temporary arthrodesis ( Figure 8). The tendons of the peroneus longus, peroneus brevis, and flexor halluces longus were sacrificed and the ruminants were used to reconstruct for the lateral aspect of the left ankle using suture anchors ( Figure 7). Dissection of lateral compartment of the left leg up to 16cm proximal to the lateral malleolus and distally, until the distal physis ( Figure 6). Subcutaneous tissue was dissected and isolation of superficial peroneal nerve was done. We did a wide surgical resection of the tumor in the left leg. After 6 months of chemotherapy, we recommend to her family to do a surgery. Patient was put on neoadjuvant chemotherapy which included vincristine, cyclophosphamide, doxorubicin and etoposide, and if osfamide 3 times weekly. She treated as per Ewing sarcoma protocol in our hospital. She was electively admitted to the hospital for staging and central line insertion to start chemotherapy. ( Figure 5) The patient was referred from us to pediatric oncology clinic for further evaluation.

#DISTAL FIBULA FREE#

According to the histopathology department, they reported that there is no evidence of residual tumor i.e free resection margins. Excisional biopsy was taken from the proximal and distal margin of the lesion in the left fibula which confirmed Ewing's Sarcoma. This was followed by technetium-99m MDP scintigraphy ( Figure 4), it showed an increased tracer uptake in the distal left fibula, extending to the left ankle and the left foot. It is associated with aggressive periosteal reaction along with a large soft tissue mass that appears of high signal intensity in T2 and intermediate to low signal intensity in T1 sequences. This lesion does not cross the growth plate. Also, MRI of the lower limb ( Figure 3) showed there is a large destructive bone lesion involving the distal diaphysis of the left fibula. She was admitted under us in pediatric surgical ward for open biopsy of the distal fibular lesion and CT of the lower limb ( Figure 2) showed destructive bone lesion involving the distal end of the fibula associated with extensive destruction and aggressive periosteal reaction associated with large soft tissue mass 4.5 x 5 cm in maximum axial dimension.

#DISTAL FIBULA PLUS#

Thence patient was investigated with basic lab works plus systemic and local staging for further diagnosis. X-ray of the left leg ( Figure 1) showed aggressive lytic lesion of the distal fibula.

#DISTAL FIBULA SKIN#

The patient was examined clinically and there was a swelling in the lateral aspect of the distal leg tender firm too hard with intact skin over it, 4x3 cm, no other systemic clinical finding of note. She had visited many clinics for her pain and swelling with no relief to her symptoms. 1, 6 Case No 1Ī girl, 11yearsold Saudi presented to us with progressive swelling of the left lower limb, localized above the left ankle with complaints of pain and limping gait. The lateral side off the ankle has three major ligamentous structures namely 1)anterior talofibular 2)posterior talofibular 3) calcaneofibular, resection of which during surgery might result in ankle collapse into valgus if not reconstructed. static stabilizers and muscular structures i.e. The medial and lateral sides are strengthened by well-defined ligamentous structures i.e. The ankle joint is surrounded by fibrous capsule yet it is weak anteriorly and posteriorly. The distal projection of the lateral malleolus acts to limit the amount of eversion thus acting as a lateral buttress. In adults the fibula lateral malleolus is located 2cm posteroinferior to the medial malleolus tip, and is mobile up and down during stance phase. The embryological aspect of the ankle joint reflects a mild Varus alignment and becomes parallel to the knee joint after 12. In 1971, lambert 5using cadaveric ankles reported one sixth of the static load of the leg was carried by the fibula. The fibula is longer than the tibia and contributes partially to weight bearing.

Distal fibula