Acute traumatic fracture dislocation of proximal tibiofibular joint: case report and literature review

Neglected Proximal Tibiofibular Joint Dislocation Treated With a Cortical Button Suspension Device: A Case Report

Proximal tibiofibular joint dislocation is a rare knee injury. Hence, its diagnosis is often missed. Herein, we have reported a case of posterior lateral proximal tibiofibular joint dislocation that was initially missed because it was associated with a fibula diaphyseal fracture. Our patient was a 23-year-old male with a complaint of left lateral knee pain and a history of fall from a motorcycle. He was treated with a cortical button suspension device. The patient reported no symptoms or complications at the one-year follow-up. Proximal tibiofibular joint dislocation is easily neglected if not considered as a diagnosis during clinical assessment. Half of these cases present with symptoms such as chronic pain and peroneal nerve palsy that require surgical treatment. A detailed physical examination and close review of imaging findings are important to establish a definitive diagnosis. A cortical bone button suspension device could be the appropriate treatment for cases requiring surgical management.

Anterior Dislocation of the Tibiofibular Joint: A Case Report

Dislocation of the proximal tibiofibular joint (PTJ) is a knee injury that occurs infrequently. In this case, the dislocation of the PJT of the right knee was reported with subsequent pain and limitation in range of motion, caused by trauma during the practice of a soccer game. An intense pain was observed in the area where the head of the fibula is located without finding crepitation or deformity. Initially, comparative anteroposterior and lateral X-rays of the knees were requested, showing proximal tibiofibular joint incongruity with anterolateral displacement without evidence of fracture lines. For this reason, it was decided to take a tomography of the right knee that confirmed the presence of anterior dislocation of the proximal tibiofibular joint. Closed reduction under sedation was scheduled.

Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified. A 21-year-old patient, a leisure sportswoman, presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion. We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses. This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.

Lateral Collateral Ligament and Proximal Tibiofibular Joint Reconstruction for Tibiofibular Instability

Instability of the proximal tibiofibular joint (PTFJ) can be post-traumatic or due to accumulative injuries and may also be underdiagnosed pathology that can present with symptoms of lateral and/or medial knee pain. It can be associated with subtle instability and subluxation or frank dislocation of both the PTFJ and the native knee joint. Previously described techniques have been either nonanatomic, require secondary hardware removal, disrupt native anatomy, or fail to account for the inherent stabilizing effect of the lateral collateral ligament, which is likely additionally injured or lax in these patients. The purpose of this Technical Note is to present an open anatomic reconstruction of the PTFJ and lateral collateral ligament using a single semitendinosus allograft, thus restoring all anatomic constraints to the PTFJ and lateral knee.

Acute traumatic proximal tibiofibular dislocation: Treatment of three cases

Introduction:

Acute traumatic dislocation of the proximal fibula occurs in an anterolateral, posteromedial, or superior direction. The dislocation is seen both isolated and in combination with other injuries of the leg. A dislocation is an uncommon injury. We have recently treated three patients with this injury which we believe will illustrate some treatment aspects.

Case Reports:

Case 1: A 25-year-old man fell in a football match. He had pain in his leg especially proximally. There was a prominent fibular head on inspection. X-rays showed an anterolateral dislocation in the proximal tibiofibular joint. The dislocation was treated by closed reduction under spinal anesthesia. The joint was stable when tested subsequently. He avoided weight bearing for 2 weeks. At 6 months follow-up, the patient played football at the same level. Case 2: A 63-year-old man caught his right foot in a net and fell immediate pain and minimal swelling proximally on the leg. It was diagnosed as a tibiofibular dislocation. A computed tomography (CT) scan was conducted to confirm a dislocation in an anterolateral direction while waiting for surgery, the dislocation spontaneously reduced. The patient was treated with a cast, with non-weight bearing for 2 weeks. Six months after injury, the patient was without symptoms. Case 3: A 45-year-old woman got a large object on the proximal part of her right leg. She had an open wound over her proximal fibula. We found a posteromedial dislocation. Through the wound, the fibular head dislocation was reduced and temporarily (for 6 weeks) fixated with a screw. At 6 months follow-up, there was no restriction of movement in the knee and the proximal tibiofibular joint was stable. She still had occasional pain with full weight bearing.

Conclusions:

Anamnesis and clinical examination usually provide the diagnosis of proximal tibiofibular dislocation. X-ray (and CT scans) examination may be helpful. The treatment of acute traumatic dislocation is closed reduction. Open reposition and temporary fixation are required if closed reduction fails or if the joint is unstable (after reduction) and in the case of posteromedial dislocation. The prognosis is good if the joint is stable after closed reduction.

Proximal tibiofibular joint dislocation: a rare entity

A 37-year-old woman was diagnosed with an isolated proximal tibiofibular joint dislocation (PTJD) after an accident during gymnastic exercise. The dislocation has a low incidence rate and is often missed in the emergency department as physical and radiology signs are subtle. Treatment consists of closed or open reduction and immobilisation. When it is not recognised it is associated with significant peroneal nerve injury.

Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation

We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.

Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature

PURPOSE

To evaluate the treatment options, outcomes, and complications associated with proximal tibiofibular joint (PTFJ) instability, which will aim to improve surgical treatment of PTFJ instability and aid surgeons in their decision making and treatment selection.

METHODS

A systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Inclusion criteria were as follows: PTFJ instability treatment techniques, PTFJ surgical outcomes, English language, and human studies. Exclusion criteria were cadaveric studies, animal studies, basic science articles, editorial articles, review articles, and surveys. Furthermore, we excluded studies that did not report patient follow-up time and studies without any patient-reported, clinical or radiographic outcomes at the final follow-up.

RESULTS

The systematic review identified 44 studies (96 patients) after inclusion and exclusion criteria application. For the treatment of PTFJ instability, there were 18 studies (35 patients) describing nonoperative management, 3 studies (4 patients) reported on open reduction, 11 studies (25 patients) reported on fixation, 4 studies (10 patients) that described proximal fibula resection, 3 studies (11 patients) reported on adjustable cortical button repair, 2 studies (3 patients) reported on ligament reconstructions, and 5 (8 patients) studies reported on biceps femoris tendon rerouting. The most (77% to 90%) PTFJ dislocations and instability were anterolateral/unspecified anterior dislocation or instability. Improved outcomes after all forms of PTFJ instability treatment were reported; however, high complication rates were associated with both PTFJ fixation (28%) and fibular head resection (20%).

CONCLUSIONS

Improved outcomes can be expected after surgical treatment of PTFJ instability. Proximal tibiofibular ligament reconstruction, specifically biceps rerouting and anatomic graft reconstruction, leads to improved outcomes with low complication rates. Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates.

LEVEL OF EVIDENCE

Level IV, systematic review of level IV studies.

Proximal tibiofibular dislocation: a case report of this often overlooked injury

Tibiofibular dislocation is a condition that is a recognized cause of lateral knee pain in trauma patients and can occur in isolation or as a part of multiple injuries. There is usually prominence of the fibular head on clinical examination, with tenderness to palpation. Radiological investigation can confirm the diagnosis, and in the case or our patient, both plain radiographs and MRI were performed. MRI permitted pre-reduction assessment of the intrinsic knee ligaments, as well as the common peroneal nerve. The dislocated fibular head was successfully relocated under general anaesthesia as a closed reduction.