Dislocation of the proximal tibiofibular joint

Abstract

Introduction. Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far. Case Report. A 23-year-old male soccer player sustained an injury after he had joined the game without previous warming-up. He fell on his right side because of a sudden change of direction while his foot was fixed to the base. He felt a severe pain and had a sensation as if something had snapped in his right knee. Pain and swelling at the head of fibula were found by physical examination, which, however, did not reveal any pain, swelling and instability of the ankle or peroneal nerve palsy. The x-ray showed anterolateral dislocation of the proximal tibiofibular joint, Ogden type II. Since manual reposition in general anesthesia failed, open reduction internal fixation was performed and proximal tibiofibular joint was transfixed with a screw. After the wound closure, the above-the-knee plaster cast was applied. The screw was extracted six weeks later, full weight bearing was allowed and he started with physical therapy. Four months after the injury he returned to sports activities. On the follow- up one year after the injury he had the full range of motion of the knee, no complains, and continued with active soccer playing. X-ray showed no signs of arthrosis of the proximal tibiofibular joint. Conclusion. The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.