Proximal tibiofibular dislocation: a case report and review of literature

Abstract

An isolated dislocation of the proximal tibiofibular joint is uncommon. The mechanism of this injury is usually sports related. We present a case where initial X-rays did not show the tibiofibular joint dislocation conclusively. It was diagnosed after comparative bilateral AP X-rays of the knees were obtained. A closed reduction was performed and followed by unrestricted mobilization after 1 week of rest. A review of the literature was conducted on PubMed MEDLINE. Thirty cases of isolated acute proximal tibiofibular joint dislocations were identified in a search from 1974. The most common direction of the dislocation was anterolateral, and common causes were sports injury or high velocity accident related. More than 75 % of the cases were successfully treated by closed reduction. Complaints, if any, at the last follow-up (averaging 10 months, range 0-108) were, in the worst cases, pain during sporting activities. We advise comparative knee X-rays if there is a presentation of lateral knee pain after injury and diagnosis is uncertain. Closed reduction is usually successful if a dislocation of the proximal tibiofibular joint is diagnosed. There is no standard for after-care, but early mobilization appears safe if there are no other knee injuries.

Fig. 1

Clinical presentation on the A&E department. The knee could not be further flexed than shown on the picture because of pain. A swelling on the lateral side of the right knee is visible

Fig. 2

AP X-ray of the right knee. Based on this X-ray, the diagnosis of luxation of the fibula was not made

Fig. 3

Bilateral AP X-ray of the knees. The aberrant position of the proximal fibula on the right side is evident when compared to the left knee. The direction of the luxation is anterolateral

Fig. 4

Clinical presentation after closed reduction. The swelling has diminished, and the knee could be fully flexed without pain

Fig. 5

Bilateral post-reduction AP X-ray of the knees showing a reduced fibula on the right side