A 14-year-old girl has Ewing's sarcoma of the proximal fibula with no detectable metastasis. The most appropriate definitive local treatment is:
- A Amputation of the lower limb
- B Surgical resection (wide excision) alone without adjuvant radiation
- C Wide local excision with negative margins — the proximal fibula is an expendable bone ✓
- D Definitive radiation therapy to 54 Gy as the fibula cannot be excised
Correct answer: C. Wide local excision with negative margins — the proximal fibula is an expendable bone
Explanation
The proximal fibula is classified as an expendable bone; wide local excision with adequate oncological margins can be performed without significant functional deficit because the peroneal nerve is carefully identified and the ankle is stabilised by the remaining fibula and interosseous membrane. This avoids the morbidity of amputation and the risks of radiation-induced secondary sarcoma in a young patient. Radiation is reserved for unresectable lesions or positive margins.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.