Isolated Acute Dislocation of the Proximal Tibiofibular Joint

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Abstract

abstract

Isolated dislocation of the proximal tibiofibular joint is a rare injury and therefore can be easily overlooked in the emergency room. It is reported that there are many missed cases due to failure of diagnosis.

We present the case of an anterolateral dislocation of the proximal tibiofibular joint in a 35-year-old male professional soccer player. The comparative anteroposterior and lateral radiographs revealed the dislocation, and the computed tomography scan con-firmed the diagnosis. An unsuccessful closed reduction was attempted and an open reduction was followed. The reduced joint was transfixed with a smooth Kirschner wire that was removed 6 weeks later.

The treatment method is mostly dependent on the type of the joint instability and there is no agreement about the treatment options. It usually consists of closed reduction with casting. However, open reduction and stabilization may be required. In particular, for the symptomatic atraumatic subluxation of the proximal tibiofibular joint (type I /Ogden classification), nonsurgical management is usually successful. All the other types of acute dislocation (type II-anterolateral dislocation, type III-posteromedial dislocation, type IV-superior dislocation) have, in general, the same treatment principles. Initially, a closed reduction is attempted. If it is not successful, an open reduction should be performed. Temporary stabilization of the joint with K-wires or a screw fixation should be performed, as well as repair of the torn capsule and ligaments.

As proximal tibiofibular dislocation is an uncommon injury; the diagnosis requires awareness of this injury, good history of mechanism and symptoms, and adequate clinical and radiographic evaluation.

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