{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:27Z","timestamp":1783509267931,"version":"3.55.0"},"reference-count":17,"publisher":"MDPI AG","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Metastasis of the distal tibia is quite rare. In this article, we present the case of a 58-year-old woman with distal tibial metastasis located in the posterior malleous caused by breast cancer. She had left ankle pain and nonweightbearing status that had been ongoing for 2 months and showed progression. The patient's Mirels score was 10. Limb salvage surgery was performed by removing the metastatic lesion by posterior ankle incision followed by applying a double plate from the posterior and the medial side of the distal tibia, and the defect was reconstructed with methylmethacrylate. Consequently, good stability was achieved. Radiotherapy consisting of 10 fractions (2000 cGy total) was applied to the distal tibia at postoperative week 3. There were no complications after surgery. No recurrence was observed at the 18-month follow-up of the patient. The Musculoskeletal Tumor Society Score at the 18-month control of the patient was 86%. Use of curettage of the metastatic mass, double-plate application, and defect reconstruction with methylmethacrylate is an effective method for distal tibia metastases located in the posterior malleolus.<\/jats:p>","DOI":"10.7547\/20-142","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T01:47:23Z","timestamp":1618883243000},"source":"Crossref","is-referenced-by-count":0,"title":["Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization"],"prefix":"10.3390","volume":"111","author":[{"given":"Koray","family":"Ba\u015fdelio\u011flu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonca","family":"Civi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-111-2-Article_18-b01","series-title":"Nat Rev Cancer","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1038\/nrc867","article-title":"Metastasis to bone: causes, consequences and therapeutic opportunities","volume":"2","author":"Mundy","year":"2002","unstructured":"Mundy\n              GR:\n            \n          \n          Metastasis to bone: causes, consequences and therapeutic opportunities.\n\t\t\t\t\tNat Rev Cancer2: 584,\n\t\t\t\t\t2002.\n\t\t\t\t1215435110.1038\/nrc867"},{"key":"i8750-7315-111-2-Article_18-b02","series-title":"Oncol Rev","first-page":"321","article-title":"Bone metastasis; an overview","volume":"11","author":"Macedo","year":"2017","unstructured":"Macedo\n              F\n            \n            \n              Ladeira\n              K\n            \n            \n              Pinho\n              F\n            \n            :\n          \n          Bone metastasis; an overview.\n\t\t\t\t\tOncol Rev11: 321,\n\t\t\t\t\t2017.\n\t\t\t\t28584570"},{"issue":"(suppl)","key":"i8750-7315-111-2-Article_18-b03","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/01.blo0000093843.72468.3a","article-title":"Treatment of metastatic disease of the tibia","volume":"415","author":"Kelly","year":"2003","unstructured":"Kelly\n              CM\n            \n            \n              Wilkins\n              RM\n            \n            \n              Eckardt\n              JJ\n            \n            :\n          \n          Treatment of metastatic disease of the tibia.\n\t\t\t\t\tClin Orthop Relat Res415(suppl): 219,\n\t\t\t\t\t2003.\n\t\t\t\t10.1097\/01.blo0000093843.72468.3a"},{"key":"i8750-7315-111-2-Article_18-b04","series-title":"Injury","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1016\/j.injury.2010.08.015","article-title":"Surgical treatment of pathologic fractures of humerus","volume":"41","author":"Piccioli","year":"2010","unstructured":"Piccioli\n              A\n            \n            \n              Maccauro\n              G\n            \n            \n              Rossi\n              B\n            \n            :\n          \n          Surgical treatment of pathologic fractures of humerus.\n\t\t\t\t\tInjury41: 1112,\n\t\t\t\t\t2010.\n\t\t\t\t10.1016\/j.injury.2010.08.015http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000283537900004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f320828692"},{"key":"i8750-7315-111-2-Article_18-b05","series-title":"Clin Orthop Relat Res","first-page":"206","article-title":"Metastatic skeletal disease distal to the elbow and knee","volume":"94","author":"Leeson","year":"1986","unstructured":"Leeson\n              MC\n            \n            \n              Makley\n              JT\n            \n            \n              Carter\n              JR:\n            \n          \n          Metastatic skeletal disease distal to the elbow and knee.\n\t\t\t\t\tClin Orthop Relat Res94: 206,\n\t\t\t\t\t1986."},{"key":"i8750-7315-111-2-Article_18-b06","series-title":"J Orthop Sci","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1007\/s007760200044","article-title":"Successful limb salvage of pathological fracture of the distal tibia caused by cancer metastasis","volume":"7","author":"Futani","year":"2002","unstructured":"Futani\n              K\n            \n            \n              Kamae\n              S\n            \n            \n              Atsui\n              K\n            \n            :\n          \n          Successful limb salvage of pathological fracture of the distal tibia caused by cancer metastasis.\n\t\t\t\t\tJ Orthop Sci7: 262,\n\t\t\t\t\t2002.\n\t\t\t\t10.1007\/s00776020004411956990"},{"key":"i8750-7315-111-2-Article_18-b07","series-title":"Int Orthop","first-page":"105","article-title":"Metastatic fractures of long bone","volume":"15","author":"Korkala","year":"1991","unstructured":"Korkala\n              OL\n            \n            \n              Karaharju\n              EO:\n            \n          \n          Metastatic fractures of long bone.\n\t\t\t\t\tInt Orthop15: 105,\n\t\t\t\t\t1991.\n\t\t\t\t1917181"},{"key":"i8750-7315-111-2-Article_18-b08","series-title":"Curr Probl Cancer","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/S0147-0272(86)80005-8","article-title":"Surgical stabilization of pathological neoplastic fracture","volume":"10","author":"Colyer","year":"1986","unstructured":"Colyer\n              RA:\n            \n          \n          Surgical stabilization of pathological neoplastic fracture.\n\t\t\t\t\tCurr Probl Cancer10: 117,\n\t\t\t\t\t1986.\n\t\t\t\t351413010.1016\/S0147-0272(86)80005-8"},{"key":"i8750-7315-111-2-Article_18-b09","series-title":"Injury","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.injury.2013.04.001","article-title":"Surgical treatment of impending and pathological fractures of tibia","volume":"44","author":"Piccioli","year":"2013","unstructured":"Piccioli\n              A\n            \n            \n              Maccauro\n              G\n            \n            \n              Scaramuzzo\n              L\n            \n            :\n          \n          Surgical treatment of impending and pathological fractures of tibia.\n\t\t\t\t\tInjury44: 1092,\n\t\t\t\t\t2013.\n\t\t\t\t23648362http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000321496700015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016\/j.injury.2013.04.001"},{"key":"i8750-7315-111-2-Article_18-b10","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1302\/0301-620X.83B4.0830471","article-title":"The treatment of metastases in appendicular skeleton","volume":"83","author":"Capanna","year":"2001","unstructured":"Capanna\n              R\n            \n            \n              Campanacci\n              DA:\n            \n          \n          The treatment of metastases in appendicular skeleton.\n\t\t\t\t\tJ Bone Joint Surg Br83: 471,\n\t\t\t\t\t2001.\n\t\t\t\t1138011310.1302\/0301-620X.83B4.0830471"},{"key":"i8750-7315-111-2-Article_18-b11","series-title":"Injury","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1016\/j.injury.2010.09.018","article-title":"Protocol of surgical treatment of long bone pathological fractures","volume":"41","author":"Ruggieri","year":"2010","unstructured":"Ruggieri\n              P\n            \n            \n              Mavrogenis\n              AF\n            \n            \n              Casadei\n              R\n            \n            :\n          \n          Protocol of surgical treatment of long bone pathological fractures.\n\t\t\t\t\tInjury41: 1161,\n\t\t\t\t\t2010.\n\t\t\t\t20947077http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000283537900013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016\/j.injury.2010.09.018"},{"key":"i8750-7315-111-2-Article_18-b12","series-title":"J Manipulative Physiol Ther","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.jmpt.2004.02.007","article-title":"Bilaterral acrometastasis secondary to breast cancer","volume":"27","author":"Osterhouse","year":"2004","unstructured":"Osterhouse\n              MD\n            \n            \n              Guebert\n              GM:\n            \n          \n          Bilaterral acrometastasis secondary to breast cancer.\n\t\t\t\t\tJ Manipulative Physiol Ther27: 275,\n\t\t\t\t\t2004.\n\t\t\t\t10.1016\/j.jmpt.2004.02.007"},{"key":"i8750-7315-111-2-Article_18-b13","series-title":"Foot Ankle","first-page":"243","article-title":"Metastatic tumors of the foot and ankle","volume":"8","author":"Hattrup","year":"1998","unstructured":"Hattrup\n              SJ\n            \n            \n              Amadio\n              PC\n            \n            \n              Sim\n              FH\n            \n            :\n          \n          Metastatic tumors of the foot and ankle.\n\t\t\t\t\tFoot Ankle8: 243,\n\t\t\t\t\t1998."},{"key":"i8750-7315-111-2-Article_18-b14","series-title":"Orthop Traumatol Surg Res","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/j.otsr.2019.07.017","article-title":"Surgical treatment of tibial metastases: retrospective, multicenter, observational study of 25 patients","volume":"106","author":"Bonnevialle","year":"2020","unstructured":"Bonnevialle\n              P\n            \n            \n              Descamps\n              J\n            \n            \n              Niglis\n              L\n            \n            :\n          \n          Surgical treatment of tibial metastases: retrospective, multicenter, observational study of 25 patients.\n\t\t\t\t\tOrthop Traumatol Surg Res106: 1039,\n\t\t\t\t\t2020.\n\t\t\t\t3162403210.1016\/j.otsr.2019.07.017http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000577437900007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-111-2-Article_18-b15","series-title":"Foot Ankle Spec","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1177\/1938640017733098","article-title":"Management of a tibial plafond lung cancer metastasis using an intramedullary hindfoot fusion nail","volume":"11","author":"Hsu","year":"2018","unstructured":"Hsu\n              AR\n            \n            \n              Lindsay\n              AD:\n            \n          \n          Management of a tibial plafond lung cancer metastasis using an intramedullary hindfoot fusion nail.\n\t\t\t\t\tFoot Ankle Spec11: 82,\n\t\t\t\t\t2018.\n\t\t\t\t2895279410.1177\/1938640017733098"},{"key":"i8750-7315-111-2-Article_18-b16","series-title":"Beijing Da Xue Xue Bao Yi Xue Ban","first-page":"752","article-title":"Surgical managements for bone metastases in tibia of 16 cases [in Chinese]","volume":"45","author":"Huang","year":"2013","unstructured":"Huang\n              L\n            \n            \n              Guo\n              W\n            \n            \n              Li-Yang\n              R\n            \n            :\n          \n          Surgical managements for bone metastases in tibia of 16 cases [in Chinese].\n\t\t\t\t\tBeijing Da Xue Xue Bao Yi Xue Ban45: 752,\n\t\t\t\t\t2013.\n\t\t\t\t24136272"},{"key":"i8750-7315-111-2-Article_18-b17","series-title":"Sci Rep","doi-asserted-by":"publisher","first-page":"11325","DOI":"10.1038\/s41598-017-11700-4","article-title":"Clinical characteristics and risk factors for developing bone metastases in patients with breast cancer","volume":"7","author":"Chen","year":"2017","unstructured":"Chen\n              WZ\n            \n            \n              Shen\n              SF\n            \n            \n              Zhou\n              Y\n            \n            :\n          \n          Clinical characteristics and risk factors for developing bone metastases in patients with breast cancer.\n\t\t\t\t\tSci Rep7: 11325,\n\t\t\t\t\t2017.\n\t\t\t\t28900285http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000410297900039&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1038\/s41598-017-11700-4"}],"container-title":["Journal of the American Podiatric Medical 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