Proximal Tibiofibular Dislocation Repaired with Syndesmotic Suture Buttons: A Case Report

Abstract

Introduction: Dislocations of the proximal tibiofibular joint (PTFJ) are a relatively rare orthopedic injury. They are often repaired with open reduction internal fixation utilizing a transfixation screw. Limited data are available concerning alternative repair methods.

Case report: This report details a 46-year-old male who presented with an open Type IIIA comminuted mid-shaft tibia and segmental fibula fractures after being struck by a car traveling 70mph. Computed tomography confirmed comminuted and displaced tibia and fibula fractures with PTFJ dislocation as well as air tracking through the anterior compartment of the leg communicating with the knee joint. He underwent open reduction internal fixation with intramedullary nailing of his tibial shaft fracture and PTFJ syndesmosis repair with two suture buttons. X-ray at post-operative follow-up 2 years later showed complete healing without evidence of failure or hardware loosening.

Conclusion: This case illustrates a patient treated with suture buttons, which provides an alternative option in treating PTFJ dislocations with a reported decreased likelihood of hardware removal and faster return to work.

Keywords: Proximal tibiofibular; surgery; suture button; trauma.

Figure 1

Initial X-rays. Anteroposterior(a), Lateral (b) of the tibia and lateral of the knee (c) demonstrating comminuted mid-shaft tibia and segmental fibula fractures with significant shortening and angulation. Subcutaneous air is seen at the level of the knee joint.

Figure 2

Sagittal (a), coronal (b), and axial (c) computed tomography images of the left lower extremity showing left tibia/fibula fractures with shortening and subcutaneous air tracking to the knee joint.

Figure 3

Post-operative anteroposterior (a) and lateral (b) of the left lower extremity demonstrating adequate reduction and stabilization of the left tibia fracture and proximal tibiofibular joint utilizing an intramedullary nail and two suture buttons.

Figure 4

2-year post-operative X-rays demonstrating complete healing of the left tibial and fibular mid-diaphysis with well-seated IM nail and two buttons without complication.