Srimongkolpitak Surasak, Manop Pratchaya, Chernchujit Bancha
Department of Orthopaedics, Faculty of Medicine, Queen Savang Vadhana Memorial Hospital, Chon Buri, Thailand.
Department of Orthopaedics, Pranangaklao Hospital, Mueang Nonthaburi, Nonthaburi, Thailand.
Arthrosc Tech. 2024 Aug 26;14(1):103182. doi: 10.1016/j.eats.2024.103182. eCollection 2025 Jan.
The fibular head is attached to posterolateral corner structures, which are responsible for stabilization of the varus knee, external rotation, and posterior translation stability. The arcuate sign is a large piece of the fibular head that has avulsed longitudinally from the posterolateral corner. If the fixation system is not sufficient to secure the various stabilities of the knee, it will fail and cause significant knee instability. Concomitant involvement of the proximal tibiofibular joint (PTFJ) may also occur. Many patients, even after fixation, continue to experience persistent proximal knee pain and instability. PTFJ instability is often ignored and misdiagnosed, especially in cases involving the arcuate sign. Numerous fixation systems have been invented and reported in the literature, but they tend to focus solely on the fracture site and anatomic reduction, neglecting PTFJ instability. Suture repair and suspensory button fixation of an avulsion fracture of the fibular styloid (arcuate fracture) aims to establish fixation stability, provide a robust system, minimize the rate of fixation failure, reduce the incidence of implant irritation, and address PTFJ instability.
腓骨头附着于后外侧角结构，这些结构负责维持膝关节内翻、外旋及后向平移稳定性。弓形征是指腓骨头的一大块从后外侧角纵向撕脱。如果固定系统不足以确保膝关节的各种稳定性，则固定会失败并导致严重的膝关节不稳定。近端胫腓关节（PTFJ）也可能同时受累。许多患者即使在固定后仍持续存在膝关节近端疼痛和不稳定。PTFJ不稳定常被忽视和误诊，尤其是在涉及弓形征的病例中。文献中已报道了许多固定系统，但它们往往仅关注骨折部位和解剖复位，而忽略了PTFJ不稳定。腓骨茎突撕脱骨折（弓形骨折）的缝线修复和悬吊纽扣固定旨在建立固定稳定性，提供一个坚固的系统，降低固定失败率，减少植入物刺激的发生率，并解决PTFJ不稳定问题。
