Updated: 8/15/2019

Proximal Tib-Fib Dislocation

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https://upload.orthobullets.com/topic/3014/images/tibia fib proximal dislocation_moved.jpg
https://upload.orthobullets.com/topic/3014/images/proximal tibiofibular joint.jpg
https://upload.orthobullets.com/topic/3014/images/proximal tibiofibular joint anterior ligament.jpg
https://upload.orthobullets.com/topic/3014/images/proximal tibiofibular joint posterior ligament.jpg
https://upload.orthobullets.com/topic/3014/images/common peroneal nerve illustration anterior and posterior views.jpg
https://upload.orthobullets.com/topic/3014/images/common peroneal nerve.jpg
Introduction
  • Often a missed diagnosis
  • Epidemiology
    • incidence
      • rare injury
      • even less common as an isolated injury
    • demographics
      • most common in 2nd to 4th decades
  • Pathophysiology
    • mechanism
      • high-energy trauma
        • more common with horseback riding and parachuting
      • fall onto a flexed and adducted knee
  • Associated conditions
    • posterior hip dislocation (flexed knee and hip)
    • open tibia-fibula fractures
    • other fractures about the knee and ankle
Anatomy
  • Arthrology  
    • proximal fibula articulates with a facet of the lateral cortex of the tibia
      • distinct from the articulation of the knee
    • joint is strengthened by anterior and posterior ligaments of the fibular head  
  • Nerves
    • common peroneal nerve lies distal to the proximal tibiofibular joint on the posterolateral aspect of the fibular neck  
Classification
  • Ogden classification  
    • subluxation and 3 types of dislocation
      • anterolateral - most common  
      • posteromedial  
      • superior  
Presentation
  • Symptoms
    • lateral knee pain
      • symptoms can mimic a lateral meniscal tear
    • instability
  • Physical exam
    • tenderness about the fibular head
    • comparison of bilateral knees with palpation of normal anatomic landmarks and their relative positions can clarify the diagnosis
Imaging
  • Radiographs 
    • recommended views
      • AP and lateral of both knees  
        • comparison views of the contralateral knee are essential
  • CT scan  
    • clearly identifies the presence or absence of dislocation
Treatment
  • Nonoperative
    • closed reduction  
      • indications
        • acute dislocations
      • technique
        • flex knee 80°-110° and apply pressure over the fibular head opposite to the direction of dislocation
        • post-reduction immobilization in extension vs. early range of motion (controversial)
      • outcomes
        • commonly successful with minimal disadvantages
  • Operative
    • surgical soft tissue stabilization vs. open reduction and pinning vs. arthrodesis vs. fibular head resection  
      • indications
        • chronic dislocation with chronic pain and symptomatic instability
Complications
  • Recurrence
  • Common peroneal nerve injury
    • usually seen with posterior dislocations
  • Arthritis
    • rarely occurs and is usually minimally symptomatic
 

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Questions (1)

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(OBQ04.113) A 34-year-old male was playing rugby 2 weeks ago when an opposing player fell on the lateral aspect of his left knee. He felt an immediate pop and was unable to bear weight on the extremity initially. He has had recurrent popping and catching in the knee since the initial injury and intermittent numbness on the top of his foot. Radiograph and MRI images of the left knee are shown in Figures A-C. What is the most appropriate next step in management? Review Topic

QID: 1218
FIGURES:
1

Arthroscopy for repair or debridement of meniscal tear

42%

(674/1600)

2

Reconstruction of anterior cruciate ligament

13%

(211/1600)

3

Arthroscopy for repair or debridement of femoral condyle osteochondral lesion

9%

(150/1600)

4

Closed reduction of dislocation

32%

(518/1600)

5

Electromyography (EMG) for evaluation of anterior tarsal tunnel syndrome

2%

(38/1600)

L 5

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