Dear Editor,
We read with interest the study entitled “Saving the ankle in distal fibular giant cell tumour. A case report” by Kaushik Bhowmick et al.1 We congratulate the authors for reporting such rare case of GCT with use of ipsilateral fibula for reconstruction and preservation of ankle joint. However, we came across some errors in the article.
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1)
The authors have commented on the preoperative restriction of subtalar and ankle movements, but subtalar movements have not been mentioned in the follow-up. The hind foot movements need to be mentioned as they are important part of the American Orthopaedic Foot and Ankle Society (AOFAS) score2 which is reported to be 97/100 in the article.
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2)
The authors have mentioned three transsyndesmotic screws were inserted, but in Fig 3a and b we can see only 2 screws passing through fibula into tibia. The screws which authors reported to be transyndesmotic are actually way above the syndesmosis.3 The transsyndesmotic screws can be seen in Fig 6 (distal 2 screws) of similar case of distal fibula GCT managed with tricortical iliac graft.4
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3)
The authors have mentioned that at final follow up, radiological assessment with a plain radiograph and CT scans were done. The authors have cited [Fig. 4a and b, 5a-b] for radiograph and CT scan respectively. However, Fig. 5a–b shows a clinical picture rather than CT scan.1
The purpose of reporting this case of ankle preservation in distal fibula GCT is well justified even with these errors.
Source(s) of support
None.
Declaration of competing interest
The authors declare that there are no conflicts of interest.
Acknowledgement
Nil.
Contributor Information
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References
- 1.Bhowmick K, Boopalan PR. Saving the ankle in distal fibular giant cell tumour–A case report. J Clin Orthop Traum. 2019 Mar 19 doi: 10.1016/j.jcot.2019.03.010. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kitaoka H.B., Alexander I.J., Adelaar R.S., Nunley J.A., Myerson M.S., Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994 Jul;15(7):349–353. doi: 10.1177/107110079401500701. [DOI] [PubMed] [Google Scholar]
- 3.Hermans J.J., Beumer A., De Jong T.A., Kleinrensink G.J. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat. 2010 Dec;217(6):633–645. doi: 10.1111/j.1469-7580.2010.01302.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Vaishya R., Kapoor C., Golwala P., Agarwal A.K., Vijay V. A rare giant cell tumor of the distal fibula and its management. Cureus. 2016 Jul;8(7) doi: 10.7759/cureus.666. [DOI] [PMC free article] [PubMed] [Google Scholar]