Horan J, Quin G
Emergency Department, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland.
Emerg Med J. 2006 May;23(5):e33. doi: 10.1136/emj.2005.032144.
Proximal tibiofibular joint dislocation is an uncommon injury, which may be easily missed on plain radiography. If recognised, it can be treated in the emergency department, avoiding surgery and long term problems. The case is presented of a 22 year old male rugby player who was tackled from the left hand side while turning to the left. He heard a "pop" from his knee as he fell to the ground. Clinical examination revealed a prominence in the area of the fibular head. There was no evidence of peroneal nerve injury. Plain x rays confirmed a clinical suspicion for anterior dislocation of the proximal tibiofibular joint. Proximal tibiofibular joint dislocation typically occurs when the knee is slightly flexed and the foot is rotated and plantar flexed. Antero lateral dislocation is the most common pattern. Diagnosis is largely clinical, but the findings may be subtle. Plain films may not show any abnormality and computed tomography is the investigation of choice if there is clinical suspicion for the injury. The dislocation should be reduced in the emergency department, but controversy exists whether early mobilisation or casting is the most appropriate course of action.
胫腓近端关节脱位是一种罕见的损伤，在X线平片上可能很容易被漏诊。如果能够识别，可在急诊科进行治疗，避免手术及长期问题。本文介绍了一名22岁男性橄榄球运动员的病例，他在向左转身时被从左侧绊倒。倒地时他听到膝盖处有“啪”的一声。临床检查发现腓骨头区域有隆起。没有腓总神经损伤的迹象。X线平片证实了临床对胫腓近端关节前脱位的怀疑。胫腓近端关节脱位通常发生在膝关节轻度屈曲、足部旋转并跖屈时。前外侧脱位是最常见的类型。诊断主要依靠临床，但表现可能很细微。X线平片可能未显示任何异常，若临床怀疑有该损伤，计算机断层扫描是首选的检查方法。脱位应在急诊科进行复位，但对于早期活动还是石膏固定哪种是最合适的治疗方法仍存在争议。
