Abstract
Background
Proximal tibiofibular joint (PTFJ) dislocation is a rare injury that can disrupt the
proximal tibia-fibula joint. The abnormalities in knee X-ray imaging can be subtle
and difficult to detect, requiring careful assessment. This rare cause of lateral
knee pain requires a high level of suspicion for diagnosis. Treatment is closed reduction
with unstable PTFJ dislocations often requiring surgical intervention.
Case Report
A 17-year-old male presented to the Emergency Department (ED) with right lateral knee
pain and difficulty walking after colliding with another skier two days prior. The
exam showed right lateral ecchymosis and tenderness over the lateral proximal fibula.
He remained neurovascularly intact with a full passive and active range of motion.
X-rays were obtained (Figure 1). The patient was referred by his outpatient orthopedic
surgeon after the initial knee X-ray was concerning for proximal tibiofibular joint
(PTFJ) dislocation (Figure 2B) and unsuccessful reduction. In the ED, the patient
underwent moderate sedation and successful orthopedic guided reduction via medial
force on the lateral fibular head while hyper-flexing the knee and holding the foot
dorsiflexed and everted. Post-reduction radiographs showed improved proximal tibiofibular
alignment without fracture (Figure 2B).
Why should an emergency physician be aware of this?
PTFJ dislocation is a rare injury that can easily be missed and requires a high level
of suspicion when presented with an acute traumatic knee pain. Closed reduction of
PTFJ dislocation can be achieved in the ED and early identification can prevent long
term sequelae.
KEYWORDS
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Article info
Publication history
Accepted:
March 7,
2023
Received in revised form:
February 1,
2023
Received:
November 21,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
