Acute traumatic proximal tibiofibular dislocation: Treatment of three cases

INTRODUCTION: Acute traumatic dislocation of the proximal fibula occurs in an anterolateral, posteromedial, or superior direction. The dislocation is seen both isolated and in combination with other injuries of the leg. A dislocation is an uncommon injury. We have recently treated three patients with this injury which we believe will illustrate some treatment aspects. CASE REPORTS: Case 1: A 25-year-old man fell in a football match. He had pain in his leg especially proximally. There was a prominent fibular head on inspection. X-rays showed an anterolateral dislocation in the proximal tibiofibular joint. The dislocation was treated by closed reduction under spinal anesthesia. The joint was stable when tested subsequently. He avoided weight bearing for 2 weeks. At 6 months follow-up, the patient played football at the same level. Case 2: A 63-year-old man caught his right foot in a net and fell immediate pain and minimal swelling proximally on the leg. It was diagnosed as a tibiofibular dislocation. A computed tomography (CT) scan was conducted to confirm a dislocation in an anterolateral direction while waiting for surgery, the dislocation spontaneously reduced. The patient was treated with a cast, with non-weight bearing for 2 weeks. Six months after injury, the patient was without symptoms. Case 3: A 45-year-old woman got a large object on the proximal part of her right leg. She had an open wound over her proximal fibula. We found a posteromedial dislocation. Through the wound, the fibular head dislocation was reduced and temporarily (for 6 weeks) fixated with a screw. At 6 months follow-up, there was no restriction of movement in the knee and the proximal tibiofibular joint was stable. She still had occasional pain with full weight bearing. CONCLUSIONS: Anamnesis and clinical examination usually provide the diagnosis of proximal tibiofibular dislocation. X-ray (and CT scans) examination may be helpful. The treatment of acute traumatic dislocation is closed reduction. Open reposition and temporary fixation are required if closed reduction fails or if the joint is unstable (after reduction) and in the case of posteromedial dislocation. The prognosis is good if the joint is stable after closed reduction.