Acute proximal tibiofibular joint dislocation: a sports related injury?—two different cases

Nunes, Jóni; Direito-Santos, Bruno; Costa, André; Tavares, Nuno; Varanda, Pedro; Duarte, Rui

doi:10.21037/aoj.2019.01.07

Cited by 4 publications

(4 citation statements)

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“…Proximal tibiofibular joint dislocation is relatively rare, as too is literature concerning operative management. Nunes et al published a 2019 case report detailing open fibular head reduction followed by temporary PTFJ fixation with a K-wire, which was later removed after a 5-week nonweightbearing period with full return to function after a 3-month period (Nunes et al 2019). Oksum et al described internal fixation of the PTFJ with open direct repair of the posterior ligamentous structures and syndesmotic stabilization with a dynamic suture button (Arthrex TightRope) (Oksum and Randsborg 2018), though this differed from this case report in that the fixation was not performed following tibial intramedullary nail (IMN) fixation.…”

Section: Discussionmentioning

confidence: 99%

Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing

Faerber,

Udal,

Corrado

2023

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction/Objective Proximal tibiofibular joint (PTFJ) dislocation is a rare acute injury of the knee that is often misdiagnosed or overlooked. The diagnosis should be considered as part of the differential in any patient presenting with acute-onset lateral knee pain after an aggressive torsion trauma to a flexed knee. This case report detailing surgical fixation of a PTFJ dislocation is unique in that surgical lateral collateral ligament (LCL) repair was necessary and performed, and PTFJ fixation occurred following recent open reduction internal fixation (ORIF) of the tibia. This paper details specific technique and orientation of fixation to best return the PTFJ to anatomic alignment, as failure to do so can lead to instances of chronic morbidity. Case Report This case report describes surgical fixation of a traumatic posteromedial (Type III) PTFJ dislocation. During ORIF of the ipsilateral tibia, significant PTFJ laxity and displacement was noted intraoperatively. This necessitated a return to the operating room for definitive PTFJ surgical fixation with two TightRope syndesmotic suture button fixation devices with simultaneous intraoperative LCL repair with #2 Fiberwire. Discussion/Conclusions While few case reports have documented the use of TightRope syndesmotic fixation of the PTFJ, these authors present a novel method of orienting the fixation from the posterolateral fibula to the anteromedial tibia with simultaneous caudal to cranial direction in order to create orthogonal fixation of the PTFJ. This creates an orientation of fixation perpendicular to the anatomic alignment of the native PTFJ.We believe that this orientation of syndesmotic PTFJ fixation most physiologically replicates that of the native PTFJ, and will lead to effective surgical results and improved patient outcomes. We also believe that publications on this topic will help bring awareness to an underrecognized and underdiagnosed joint pathology, with the hopes that future patients will benefit and receive more thorough and efficient care.

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Section: Discussionmentioning

confidence: 99%

Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing

Faerber,

Udal,

Corrado

2023

Journal of Orthopaedic Experience &Amp; Innovation

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“…16 However, despite the relative stability of PTFJ, its damage most frequently results from injury, and is often accompanied by its dislocation, 13,14,20 fibula fractures, 14 rupture of ligaments around the joints and muscle tendons. 21 This kind of problems occurs more frequently in young males, and usually is the result of sports activity, 11,13,22 but also was described in ballet dancers, soccer players, equestrian jumpers, 7 parachutists. 15 The clinical experience shows also that in the case of just PTFJ subluxations without visible joint dislocation, these damages often are less recognized, 14,20,23 remain undiagnosed due to difficulties with radiographic identification, 14,24 lack of emphasis in the literature and textbooks, 16 in polytrauma scenario, 10 or in children.…”

Section: Case Descriptionmentioning

confidence: 98%

“…9,10,13,14 This joint is quite stable articulation due to bony congruency and ligamentous and muscle support. 9,11 Pathology of PTFJ is relatively rare, 7,13,15 potentially it could be associated with a number of diseases such as osteoarthritis, 16,17 neoplasms, 18 ganglion, 19 pigmented villonodular synovitis, etc. 16 However, despite the relative stability of PTFJ, its damage most frequently results from injury, and is often accompanied by its dislocation, 13,14,20 fibula fractures, 14 rupture of ligaments around the joints and muscle tendons.…”

Section: Case Descriptionmentioning

confidence: 99%

“…Less common attention paid to this joint subluxation, could be associated with its low frequency, 7,8 or with uncommon misrecognition of this clinical pathology and therefore, with untimely assistance. [9][10][11] In this article, we present a case report about a relatively rare happening of PTFJ subluxation in a child that was found to cause lower leg pain and cramps in fact for at least two-years, and in whom we were able to successfully eliminate these symptoms and their cause by manipulation on these joints.…”

Section: Introductionmentioning

confidence: 99%

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High and Rapid Effectiveness of Manipulation in the Symptomatic Subluxation of the Proximal Tibiofibular Joint in a Child: A Case Report

Plotkina,

Bourdeinyi

2023

Osteol Rheumatol Open J

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In this article, a case of the lower leg and feet pain and cramps in a 5-year-old girl disturbing the child for two-years was described. These symptoms had been occurring just during the nights and lasted sometimes for 2-3-hours. There were no visible causes of this disorder. Previous examinations in a pediatric office and by a podiatrist did not reveal any pathology. In our office, both fibular heads were found to be subluxated postero-medially. We hypothesized that a causative factor of the pain and cramps was the involvement of the common peroneal nerve due to this subluxation. Manipulation of the fibular heads (a high-velocity, low-amplitude thrust) eliminated these symptoms after just two visits. In the future, these symptoms in the child occurred just a couple of times during the next eight-years of follow-up observations. Various types of treatment of the proximal tibiofibular joint pathology, the common peroneal nerve involvement, and the significance of manipulative therapy in this type of involvement that resulted in rapid and high effectiveness, are discussed in the article.

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Fracture Dislocations About the Knee

Rubinger

Gazendam

Ekhtiari

et al. 2021

Advances in Knee Ligament and Knee Preservation Surgery

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Acute proximal tibiofibular joint dislocation: a sports related injury?—two different cases

Cited by 4 publications

References 0 publications

Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing

Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing

High and Rapid Effectiveness of Manipulation in the Symptomatic Subluxation of the Proximal Tibiofibular Joint in a Child: A Case Report

Fracture Dislocations About the Knee

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