Traumatic proximal tibiofibular joint dislocation treated by open reduction and temporary fixation: a case report

Abstract

Isolated dislocations of the proximal tibiofibular joint are a rare condition. Missed diagnosis can lead to chronic knee pain and disability. Early recognition should be followed by immediate closed reduction or open reduction and joint transfixation. We present a young athlete with this injury which was treated successfully by open reduction.

Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation

“…Most dislocations can be treated through closed reduction; however, open reduction may be required in some cases due to an anterior muscle tension and/or interposition of disrupted capsular ligaments that may resist reduction 9. MacGiobain et al 8 and Robinson et al 10 also reported a case of open reduction and internal fixation after an initial attempt with closed reduction failed. MacGiobain et al 8 reported the removal of the K wire 6 weeks after the surgery.…”

Dislocation of the proximal tibiofibular joint

“…The rotational movements of PTFJ happen during the ankle movements, while the knee flexion fibular head moves forward [2,22]. According to the literature, a traumatic dislocation of PTFJ most frequently occurs during playing soccer [23], rarely volleyball [16], skiing [23], basketball [24], trampoline jumping [25], or it results from high-energy trauma as usually seen in polytraumatised patients [26], while it is an extremely rare traumatic dislocation as a result of congenital connective tissue weakness [27]. The ligament reinforcement produces stability in the extended knee, so the injuries of this joint generally occur during knee flexion.…”

An isolated proximal tibiofibular joint dislocation in a young male playing soccer: a case report

“…Most dislocations can be reduced closed; however, open reduction may be necessary as anterior muscle tension and/or interposition of disrupted capsular ligaments may resist reduction. Acute dislocations undergoing open reduction require temporary joint stabilisation with either Kirschner wires [11] or screw fixation [6,12] combined with primary repair of the torn capsule and injured ligaments. Removal of the transfixing wire or screw is necessary to avoid fatigue fracture of the material.…”

“…They recommended full weight bearing but avoiding knee flexion beyond 90°. Robinson et al [6] recommended an above knee plaster for 6 weeks non-weight bearing whilst Rajkumar and Schmitgen [5] recommended a cylinder cast for 3 weeks partial weight bearing followed by a knee brace for 3 weeks. Removal of the temporary fixation in these cases was performed between 6 and 12 weeks from the index procedure [6,11,12].…”