Cases of proximal tibial malignancies involving the fibula were retrospectively collected to discuss their limb-preserving techniques and to summarize oncologic outcomes, complications, and functional conditions. Methods From November 1998 to February 2010, a total of 32 patients with malignant tumors of the proximal tibia involving the fibula received limb-preserving treatment, including 21 males and 11 females, with a mean age of 23.4 years; including 23 cases of osteosarcoma, 5 cases of chondrosarcoma, 1 case of malignant giant cell tumor of bone, and 3 cases of soft tissue sarcoma. All cases received whole tumor resection including the upper fibula, 14 cases of ligation and severance of the anterior tibial vessels, 1 case of repair of the posterior tibial vessels, 2 cases of ligation and severance of the anterior tibial vessels and repair of the posterior tibial vessels, 3 cases of replacement; 4 cases of resection of the common peroneal nerve and 5 cases of the deep peroneal nerve; 25 cases of joint prosthesis replacement, 5 cases of prosthesis-tumor segment inactivation-reimplantation complex replacement, and 3 cases of tumor segment inactivation-reimplantation. The soft tissue was covered by medial cephalic flap transfer of gastrocnemius muscle in 14 cases and lateral cephalic flap transfer in 1 case. Results The follow-up period ranged from 11 to 159 months, with a mean of 39.4 months. 6 patients (18.8%) had local recurrence of the tumor. The overall 5-year survival rate was 51.2%, including 14 cases of death due to tumor metastasis, 2 cases of survival with tumor, and 16 cases of survival without tumor. 15 cases (46.9%) had complications, including 10 cases with one complication, 3 cases with two complications, and 2 cases with three complications: 4 cases of postoperative vascular crisis resulting in ischemia of the affected limb, 12 cases of common peroneal nerve palsy (including permanent palsy due to severance of the common peroneal nerve), 9 cases of postoperative vascular crisis resulting in ischemia of the affected limb, and 12 cases of common peroneal nerve palsy (including permanent palsy due to severance of the common peroneal nerve). The mean MSTS93 functional score was 21.6 (72%). Conclusion When malignant tumors of the proximal tibia involve the upper tibiofibular joint or fibula, strict indications and careful operation should be performed with the aim of obtaining adequate surgical borders; despite the occurrence of certain complications, most patients can achieve better postoperative function. Tibia; fibula; malignancy; artificial joint; limb-preserving treatment. Preoperative radiographs showed a malignant tumor involving the proximal tibia and the fibula. The tumor specimen image showed complete resection of the tumor along with the upper tibiofibular segment. Postoperative radiographs showed artificial joint prosthesis replacement.