Selected Topics: Sports Medicine|Articles in Press

A Young Skier with Leg Pain



      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.


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