Traumatic Proximal Tibiofibular Dislocation

Herzog, Greg A; Serrano-Riera, Rafael; Sagi, H. Claude

doi:10.1097/bot.0000000000000348

Cited by 18 publications

(24 citation statements)

References 18 publications

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“…Outcomes of this particular injury pattern are largely unknown. PTFJ dislocations in the setting of tibia fracture have high rates of neurovascular injury and increased risk for complications, but these are typically associated with high-energy trauma and likely represent a different injury than that in our report 10 .…”

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confidence: 60%

Treatment and Outcome of a “Floating Fibula” Injury

Joseph

Morgan

Mutty

2023

JBJS Case Connector

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Case:We report a case of a rare “floating fibula” ankle injury characterized by dislocation of the proximal tibiofibular joint (PTFJ), syndesmosis disruption, complete deltoid disruption, and tibiotalar dislocation without fibula fracture in a 44-year-old man. Imaging includes preoperative and postoperative radiographs and CT scans. Treatment involved reduction and screw fixation of the syndesmosis and PTFJ with planned screw removal. A successful clinical and radiographic outcome was achieved at the 15-month follow-up.Conclusion:This case highlights the unique features of the “floating fibula” injury and shows that reduction and intraoperative assessment may be more challenging than a typical Maisonneuve injury.

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confidence: 60%

Treatment and Outcome of a “Floating Fibula” Injury

Joseph

Morgan

Mutty

2023

JBJS Case Connector

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“…A recent review 3 notes that PTFD occurs in 1–2% of tibial shaft/plateau fractures, and is a marker of severe lower limb trauma. 31 cases of isolated PTFD have been published since 1974, 4 , 5 which have occurred following a wide range of mechanisms, 6 , 7 ranging from football 8 to long jump, 9 falling from a height 10 to snowboarding.…”

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confidence: 99%

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

et al. 2016

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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.

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“…13 Superior and inferior dislocations are frequently associated with tibial shaft and plateau fractures, but superior dislocations can also occur with high-energy ankle injuries. 9,12,15 Herzog et al 16 reported an incidence of 1.5% and 1.9% of PTFJ dislocation in all tibial shaft and tibial plateau fractures, respectively. These results were supported by Haupt et al 17 who found an incidence of PTFJ dislocation in tibial shaft fractures of 1.06%.…”

Section: Patient Presentationmentioning

confidence: 99%

Proximal Tibiofibular Joint Instability: An Underrecognized Cause of Lateral Knee Pain and Mechanical Symptoms

Miller

Curatolo

2023

J Am Acad Orthop Surg

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Instability of the proximal tibiofibular joint is an uncommon and often unrecognized cause of lateral knee pain, mechanical symptoms, and instability. The condition results from one of three etiologies: acute traumatic dislocation, chronic or recurrent dislocations, and atraumatic subluxations. Generalized ligamentous laxity is a key predisposing factor for atraumatic subluxation. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Anterolateral instability is the most common type (80% to 85%) frequently occurring with hyperflexion of the knee with the ankle plantarflexed and inverted. Patients with chronic instability report lateral knee pain with snapping or catching often leading to a misdiagnosis of lateral meniscal pathology. Subluxations may be treated conservatively with activity modification, supportive straps, and knee-strengthening physical therapy. Chronic pain or instability is an indication for surgical treatment including arthrodesis, fibular head resection, or soft-tissue ligamentous reconstruction. Newly developed implants and soft-tissue graft reconstruction techniques provide secure fixation and stability with less invasive procedures and without the need for arthrodesis. Instability of the proximal tibiofibular joint (PTFJ) is an often overlooked cause of lateral-sided knee pain and mechanical symptoms. The differential diagnosis for lateral-sided knee pain and "snapping" is vast and includes meniscal injury, discoid meniscus, lateral collateral ligament (LCL) rupture, chondral injury, posterolateral rotatory instability, iliotibial band (IT) syndrome, and biceps tendinopathy. However, clinicians fail to appreciate PTFJ pathology when considering differential diagnoses for lateral knee complaints. PTFJ instability can be divided into three common etiologies: atraumatic subluxations, traumatic dislocations, and chronic dislocations. 1 Instability can be multidirectional, and its injury pattern can guide surgical and nonsurgical management options.

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Traumatic Proximal Tibiofibular Dislocation

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 18 publications

References 18 publications

Treatment and Outcome of a “Floating Fibula” Injury

Treatment and Outcome of a “Floating Fibula” Injury

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

Proximal Tibiofibular Joint Instability: An Underrecognized Cause of Lateral Knee Pain and Mechanical Symptoms

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