Traumatic Proximal Tibiofibular Dislocation: A Marker of Severely Traumatized Extremities

Abstract

Objective: The purpose of this analysis is to report on the epidemiology and clinical implications of traumatic proximal tibiofibular dislocation (PTFD).

Design: Retrospective chart and radiographic review.

Setting: Level 1 regional trauma center.

Patients: Skeletally mature patients with a traumatic PTFD between July 1, 2006, and December 31, 2013.

Intervention: Open reduction internal fixation of the proximal tibiofibular joint.

Main outcome measurements: Patient demographics and associated musculoskeletal and neurovascular injuries were recorded as data points.

Results: There were a total of 30 PTFDs in 30 patients during the course of the defined study period. The incidence of PTFD was 1.5% (15 of 1013) of operative tibial shaft fractures and 1.9% (15 of 803) of operative tibial plateau fractures (P = 0.5810). Fifty percent (15 of 30) of PTFD were associated with a tibial shaft fracture, and 50% (15 of 30) with tibial plateau fractures. PTFD was associated with an open fracture in 63% (19 of 30) of cases. Two patients (6.7%) presented with a vascular injury who underwent a successful repair without vascular sequelae. Two different patients (6.7%) ultimately underwent an amputation (one above the knee and one below the knee) for a nonreconstructable extremity. In the remaining 28 patients without amputation, the incidence of compartment syndrome was 29% (8 of 28) and the incidence of peroneal nerve palsy was 36% (10 of 28). Only 30% (3 of 10) of the peroneal nerve palsies recovered clinically within the follow-up period, which averaged 11 months (range: 6 months to 4 years).

Conclusions: Traumatic proximal tibiofibular joint dislocations can be found in approximately 1%-2% of both tibial plateau and shaft fractures. PTFD is associated with a high rate of compartment syndrome (29%), open fracture (63%), and peroneal nerve palsy (36%). The majority (70%) of peroneal nerve palsies do not recover. Proximal tibiofibular joint dislocation is a marker for a severely traumatized limb.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.