The aim of this study was to establish whether the proximity of significant neurovascular structures around the surgical excision results in higher rates of recurrence and poorer survival outcomes. A retrospective study of all patients treated at a regional bone tumour unit for proximal fibula Ewing's tumours and osteosarcomas was conducted, and in total 17 patients were identified. The recurrence rate of all cases was 29.4% and the overall 5 year survival was 70.5%. The recurrence rate just for osteosarcoma was 50%, which compared poorly to published recurrence rates throughout the appendicular skeleton. The 5-year survival for proximal fibula osteosarcoma of 50% was also worse than generalised survivorship data reported in non-metastatic osteosarcoma. This series demonstrates that malignant proximal fibula tumours are a difficult entity to manage and recurrence rates and patient survival are poor for osteosarcoma.