Traumatic Dislocation of the Proximal Tibiofibular Joint: A Systematic Review and 10-year Experience From a Level 1 Trauma Center

Abstract

Introduction:Traumatic proximal tibiofibular joint dislocations occur infrequently and are typically the result of high-energy trauma. These injuries can be a marker of limb injury severity because patients often sustain vascular injury and are at high risk of amputation. The purpose of this study was to present a systematic review of traumatic proximal tibiofibular joint dislocations and compare rates of associated injuries with a retrospective series of patients at a level 1 trauma center. The secondary objective was to report rates and clinical predictors of limb amputation.Methods:A systematic review was conducted, identifying three studies meeting eligibility criteria. A retrospective chart review was conducted identifying 17 skeletally mature patients with proximal tibiofibular dislocation treated from January 2010 to February 2021. A chart review extracted patient demographics, fracture patterns, open fracture, preoprative and postoperative peroneal nerve injury, vascular injury, and amputation. Binary logistic regression analysis was used to identify clinical predictors of outcomes.Results:Sixteen of 17 proximal tibiofibular injuries (94.1%) were associated with fracture, most commonly tibial shaft (n = 11, 68.75%). Twelve of 17 fractures (76.5%) were open. Five vascular injuries (29.4%) occurred requiring surgical intervention. Seven (41.2%) preoperative peroneal nerve deficits were noted; six had persistent deficits postoperatively or underwent amputation (average follow-up 31.3 ± 32.6 months). Two patients in the sample without preoperative peroneal nerve deficits were noted to exhibit them after fixation. Eight patients (47%) underwent an amputation, 7 (87.5%) of whom had an open fracture and 4 (50%) of whom had documented vascular injury.Discussion:Traumatic proximal tibiofibular fractures indicate severe injury to the lower extremity with high risk for nerve injury and possible amputation. Patients who present with vascular injury and open fracture in association with proximal tibiofibular joint disruption may be at elevated risk of amputation.

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

“…A significant amount of force is often necessary to cause a dislocation of the PTFJ, and as such, PTFJ dislocations are often associated with other potentially distracting injuries, which may contribute to the relatively low rate of recognition and diagnosis. A systemic review by Rajan et al found that PTFJ dislocation had a high rate of associated open fractures (70.6%) -similar to the 76.7% rate found by , and preoperative peroneal nerve deficit (41.2%) (Rajan, Ramski, and Romeo 2022;Herzog, Serrano-Riera, and Sagi 2015), all of which are characteristic of high-energy, limb-threatening injury. The PTFJ dislocation in this case was consistent with an Ogden Type III dislocation, which occur in 10% of PTFJ dislocations and as stated above, are most often the result of direct trauma to the fibular head (Aladin, Lam, and Szypryt 2002;Ogden 1974b).…”

“…This tension appeared to significantly relax after the PTFJ was manually reduced. Proper identification and protection of the nerve was done diligently, as there have been reports of postoperative common peroneal nerve palsy in patients preoperatively neurologically intact (Rajan, Ramski, and Romeo 2022).…”

Traumatic proximal tibiofibular fracture and dislocation

“…As a marker of severe limb trauma, the occurrence of PTFD may indicate the patient at higher risk of amputation [16]. However, reported amputation rate varies greatly in different studies [15,16,20].…”

“…As a marker of severe limb trauma, the occurrence of PTFD may indicate the patient at higher risk of amputation [16]. However, reported amputation rate varies greatly in different studies [15,16,20]. In a retrospective study of 30 patients with proximal tibiofibular dislocation by Herzog et al [15], only 2 patients underwent amputation due to a nonreconstructable extremity.…”

“…In recent years, research has begun to focus on traumatic PTFD. It is considered a marker of severely traumatized knees and may be associated with a higher risk of vascular injury and amputation [15,16]. The incidence of traumatic proximal tibiofibular dislocation among common tibial plateau and tibial shaft fractures has been reported to be only 1-2% [15].…”