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Updated: Jun 19 2023

Proximal Tib-Fib Dislocation

Images fib proximal dislocation_moved.jpg tibiofibular joint anterolateral dislocation.jpg tibiofibular joint superior dislocation.jpg right tibiofibular joint dislocation.jpg tibiofibular joint dislocation ct.jpg
  • 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
      • occurs at higher rate (>35%) with concomitant proximal tibia fracture 
    • Arthritis
      • rarely occurs and is usually minimally symptomatic
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