Milankov Miroslav, Kecojević Vaso, Gvozdenović Nemanja, Obradović Mirko
University of Novi Sad, Faculty of Medicine, Clinical Centre of Vojvodina, Novi Sad, Department of Orthopedic Surgery and Traumatology.
Med Pregl. 2013 Sep-Oct;66(9-10):387-91. doi: 10.2298/mpns1310387m.
Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far.
A 23-year-old male soccer player sustained an injury after he had joined the game without previous warming-up. He fell on his right side because of a sudden change of direction while his foot was fixed to the base. He felt a severe pain and had a sensation as if something had snapped in his right knee. Pain and swelling at the head of fibula were found by physical examination, which, however, did not reveal any pain, swelling and instability of the ankle or peroneal nerve palsy. The x-ray showed anterolateral dislocation of the proximal tibiofibular joint, Ogden type II. Since manual reposition in general anesthesia failed, open reduction internal fixation was performed and proximal tibiofibular joint was transfixed with a screw After the wound closure, the above-the-knee plaster cast was applied. The screw was extracted six weeks later, full weight bearing was allowed and he started with physical therapy. Four months after the injury he returned to sports activities. On the follow-up one year after the injury he had the full range of motion of the knee, no complains, and continued with active soccer playing. X-ray showed no signs of arthrosis of the proximal tibiofibular joint.
The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.
胫腓近端关节脱位是一种罕见的损伤。它发生在包括屈膝剧烈扭转动作的体育活动中。胫腓近端关节的作用是减轻踝关节的扭转负荷，分散胫骨外侧的弯矩，并在站立时传递垂直负荷。文献中没有大量病例报道；迄今为止，仅发表了几例采用不同方法治疗的胫腓近端关节脱位病例。
一名23岁男性足球运动员在未进行热身就参加比赛后受伤。他在脚固定在地面时因突然改变方向而右侧摔倒。他感到剧痛，感觉右膝好像有什么东西折断了。体格检查发现腓骨头处疼痛和肿胀，然而，未发现踝关节有任何疼痛、肿胀和不稳定或腓总神经麻痹。X线显示胫腓近端关节前外侧脱位，Ogden II型。由于全身麻醉下手法复位失败，遂行切开复位内固定，并用螺钉固定胫腓近端关节。伤口缝合后，应用膝上石膏托。六周后取出螺钉，允许完全负重，并开始物理治疗。受伤四个月后他恢复了体育活动。受伤一年后的随访显示，他的膝关节活动范围正常，无不适，继续积极参加足球比赛。X线显示胫腓近端关节无骨关节炎迹象。
胫腓近端关节脱位可能是膝关节慢性疼痛的原因，因此在对膝关节外侧疼痛进行鉴别诊断时必须予以考虑。准确诊断的关键是对受伤膝关节进行技术上正确的X线检查，并与对侧膝关节对比，显示腓骨头的移位情况。如果手法复位失败，胫腓近端关节切开复位内固定及螺钉固定可取得良好效果，并能快速恢复体育活动。
