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;
unstable PTFJ dislocations often require surgical intervention.
Case Report
A 17-year-old young man presented to the emergency department (ED) with right lateral
knee pain and difficulty walking after colliding with another skier 2 days prior.
The examination 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-ray studies were obtained. The patient was referred by his outpatient orthopedic
surgeon after the initial knee x-ray study was concerning for PTFJ dislocation 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. Why Should an Emergency
Physician Be Aware of This? PTFJ dislocation is a rare injury that can be missed easily
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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Dislocation of the proximal tibiofibular joint, do not miss it.Bmj Case Rep. 2015; 2015bcr2014207875https://doi.org/10.1136/bcr-2014-207875
- Kinematics of the proximal tibiofibular joint is influenced by ligament integrity, knee and ankle mobility: an exploratory cadaver study.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 405-411
- The forgotten joint: quantifying the anatomy of the proximal tibiofibular joint.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1096-1103
- Review article: Isolated proximal tibiofibular joint dislocation.Emerg Med Australas. 2019; 31: 156-162
- Subluxation and dislocation of the proximal tibiofibular joint.J Bone Jt Surg. 1974; 56: 145-154
- Acute traumatic proximal tibiofibular dislocation: treatment of three cases.J Orthop Case Rep. 2019; 9: 98-101
- Proximal tibiofibular dislocation.Emerg Med J. 2006; 23: e33https://doi.org/10.1136/emj.2005.032144
- Proximal tibiofibular joint dislocation: a rare entity.Bmj Case Rep. 2019; 12e227953https://doi.org/10.1136/bcr-2018-227953
- An isolated proximal tibiofibular joint dislocation in a young male playing soccer: a case report.Cases J. 2009; 2: 7261
- Dislocation of the fibular head in an unusual sports injury: a case report.J Med Case Rep. 2008; 2: 158https://doi.org/10.1186/1752-1947-2-158
- Dislocation of the proximal tibiofibular joint.Medicinski Pregled. 2013; 66: 387-391
- Proximal tibiofibular dislocation: a case report and review of literature.Strategies Trauma Limb Reconstr. 2014; 9: 185-189
Article info
Publication history
Published online: March 14, 2023
Accepted:
March 7,
2023
Received in revised form:
February 1,
2023
Received:
November 21,
2022
Publication stage
In Press Uncorrected ProofFootnotes
RECEIVED: 21 November 2022; FINAL SUBMISSION RECEIVED: 1 February 2023; ACCEPTED: 7 March 2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
