Joint Injuries Which Can Go Unnoticed: Fibular Head Dislocation

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Approximately 65% of the emergency cases are major and minor traumas. 35% of the unnoticed traumatic injuries are seen in the Emergency Departments. Unnoticed traumatic injuries adversely affects the patient’s prognosis, as well as tarnishing the reliability and reputation of the related clinician and institution. Dislocation of the Proximal Tibiofibular Joint (PTFJ) is among the injuries that can go unnoticed. While dislocation of the PTFJ is usually described with accompanying bone fractures in the literature, isolated dislocation of the PTFJ is very rare. This study aims to report an isolated PTFJ dislocation case presenting to our Emergency Department with the complaint of knee pain due to falling while walking.

A twenty eight year-old male patient presented to our Emergency Department with the complaint of knee pain due to a slip and fall accident on the accident. Physical examination revealed tenderness to palpation in the lateral aspect of the right knee. He was totally capable of passive movements of the joint; however, he felt increasing pain with the flexion of the knee and ankle. The patient could walk with support. His pulse palpations and neurological examination revealed normal results. Direct imaging suggested dislocation of the PTFJ (Figure 1). Then, computed tomography (CT) scan of the knee was performed. 

posterior radiograph of left lower extremity with normal findings; C. the lateral x-ray of right lower extremity demonstrate proximal tibiofibular joint dislocation; D. the lateral roentgenogram of left lower extremity with normal findings. CT scan revealed anterolateral dislocation (Figure 2). Closed reduction was performed in the sedated patient using the conventional method with the collaboration of an orthopedic consultant in the Emergency Department, and long leg cast was applied. The patient was hospitalized in the Orthopedics Inpatient Clinic for monitoring and treatment. Magnetic resonance imaging (MRI) scan of the knee was performed to evaluate the ligament structures on Day 2 of hospitalization. Injury of the tibiofibular ligament was detected (Figure 3). Due to the absence of problems in his monitoring and follow-up results, the patient was discharged with recommendations on Day 5 of hospitalization.