Proximal tibiofibular dislocation: a case report of this often overlooked injury

Abstract

Tibiofibular dislocation is a condition that is a recognized cause of lateral knee pain in trauma patients and can occur in isolation or as a part of multiple injuries. There is usually prominence of the fibular head on clinical examination, with tenderness to palpation. Radiological investigation can confirm the diagnosis, and in the case or our patient, both plain radiographs and MRI were performed. MRI permitted pre-reduction assessment of the intrinsic knee ligaments, as well as the common peroneal nerve. The dislocated fibular head was successfully relocated under general anaesthesia as a closed reduction.

Figure 1.

Anteroposterior radiograph of the patient’s left knee showing lateral tibiofibular dislocation. The arrow highlights the lack of tibiofibular overlap. “Red dot” indicates an abnormality identified by the radiographer

Figure 2.

Lateral radiograph of the patient’s left knee showing anterior tibiofibular dislocation. The arrow indicates the direction of dislocation in this view.

Figure 3.

Coronal proton density fat saturation MRI [repetition time (TR) = 4500/echo time (TE) = 32.18] of the left knee showing high signal around the tibiofibular ligament complex (thin arrow) and lateral translation of the fibular head (thick arrow).

Figure 4.

Axial proton density fat saturation MRI [repetition time(TR) = 3480/echo time (TE) = 31.87] of the left knee showing high signal around the tibiofibular ligament complex (thin arrow) and anterolateral translation of the fibular head (thick arrow).

Figure 5.

Anteroposterior post-reduction image intensifier image of the left knee showing normal tibiofibular overlap. Arrow indicates the area of tibio-fibular overlap.

Figure 6.

The two different tibiofibular joint structures. Reproduced from Ogden 1974 with permission from Rockwater Inc.

Figure 7.

Anteroposterior radiographs of the knee showing the injury (left) and post-reduction normal configuration (right). “Red dot” shows that the abnormality was detected by the attending radiographer.

Figure 8.

Lateral radiographs of the knee showing the injury (left) and post-reduction normal configuration (right).