Krukhaug Yngvar, Schrama Johannes Cornelis
Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lie Vei, 5021 Bergen, Norway.
J Orthop Case Rep. 2019 Jan-Feb;9(1):98-101. doi: 10.13107/jocr.2250-0685.1328.
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 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.
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.
腓骨近端急性创伤性脱位可向前外侧、后内侧或上方发生。这种脱位既可单独出现，也可与小腿的其他损伤合并存在。脱位是一种不常见的损伤。我们最近治疗了3例这种损伤的患者，我们认为这将说明一些治疗方面的问题。
病例1：一名25岁男性在一场足球比赛中摔倒。他的腿部疼痛，尤其是近端。检查时可触及突出的腓骨头。X线显示胫腓近端关节前外侧脱位。在脊髓麻醉下进行了闭合复位治疗。随后检查时关节稳定。他避免负重2周。在6个月的随访中，该患者能以相同水平参加足球比赛。病例2：一名63岁男性右脚被网缠住并摔倒，腿部近端立即疼痛且肿胀轻微。诊断为胫腓关节脱位。在等待手术期间进行了计算机断层扫描（CT）以确认前外侧脱位，脱位自行复位。该患者用石膏固定，非负重2周。受伤6个月后，患者无症状。病例3：一名45岁女性右大腿近端被一个大物体砸伤。她的腓骨近端有开放性伤口。我们发现是后内侧脱位。通过伤口对腓骨头脱位进行了复位，并用一枚螺钉临时（6周）固定。在6个月的随访中，膝关节活动无受限，胫腓近端关节稳定。她在完全负重时仍偶尔有疼痛。
病史和临床检查通常可诊断胫腓近端脱位。X线（及CT扫描）检查可能有帮助。急性创伤性脱位治疗为闭合复位。如果闭合复位失败、关节（复位后）不稳定或存在后内侧脱位，则需要切开复位和临时固定。如果闭合复位后关节稳定，预后良好。
