Summary A proximal tib-fib dislocation is a disruption of the proximal tibia-fibula joint associated with high energy open fractures of the tibia and peroneal nerve injury. Diagnosis requires careful assessment of radiographs of the knee and tibia (often missed injury). Treatment is prompt closed reduction with unstable injuries requiring surgical pinning versus soft tissue reconstruction. Epidemiology Incidence rare injury even less common as an isolated injury Demographics most common in 2nd to 4th decades Etiology 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
QUESTIONS 1 of 1 1 Previous Next (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? QID: 1218 FIGURES: A B C Type & Select Correct Answer 1 Arthroscopy for repair or debridement of meniscal tear 44% (976/2240) 2 Reconstruction of anterior cruciate ligament 14% (303/2240) 3 Arthroscopy for repair or debridement of femoral condyle osteochondral lesion 9% (211/2240) 4 Closed reduction of dislocation 30% (681/2240) 5 Electromyography (EMG) for evaluation of anterior tarsal tunnel syndrome 2% (55/2240) L 5 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (0) Login to View Community Videos Login to View Community Videos Proximal Fibula Instability Reconstruction Knee & Sports - Proximal Tib-Fib Dislocation E 10/24/2012 417 views 0.0 (0)