A Rare But not Uncommon Intraosseous Lipoma of Fibula Treated Surgically

Intraosseous lipoma is a rare benign tumor composed of mature adipose tissue, representing <0.1% of all primary bone tumors. Although it can occur in various bones, the fibula is an uncommon site. Patients may present with pain, swelling, or incidental findings on imaging. Surgery is indicated for symptomatic lesions or those at risk of fracture, typically managed by curettage and bone grafting. A 43-year-old female presented with lateral ankle pain and swelling persisting for 3 months. Imaging revealed a well-defined lytic lesion in the distal fibula. Magnetic resonance imaging findings were suggestive of an intraosseous lipoma. The patient underwent extended curettage, fibular strut grafting, and fixation with a reconstruction plate. Histopathology confirmed a Milgram Stage I intraosseous lipoma. At 6 months follow-up, she remained pain-free with radiological evidence of union and no recurrence. Intraosseous lipoma in the fibula is extremely rare. While many cases are asymptomatic, lesions causing cortical thinning or pain require surgical management. Imaging guides diagnosis, but histological confirmation is essential due to overlap with other lytic bone lesions. Extended curettage with bone grafting and fixation is an effective treatment for symptomatic intraosseous lipoma, ensuring lesion clearance, structural stability, and excellent outcomes.