Traumatic Proximal Tibiofibular Dislocation: A Marker of Severely Traumatized Extremities.

OBJECTIVE

The purpose of this analysis is to report on the epidemiology and clinical implications of traumatic proximal tibiofibular dislocation (PTFD).

DESIGN

Retrospective chart and radiographic review.

SETTING

Level 1 regional trauma center.

PATIENTS: Skeletally mature patients with a traumatic PTFD between July 1, 2006, and December 31, 2013.

INTERVENTION: Open reduction internal fixation of the proximal tibiofibular joint.

MAIN OUTCOME MEASUREMENTS: Patient demographics and associated musculoskeletal and neurovascular injuries were recorded as data points.

RESULTS

There were a total of 30 PTFDs in 30 patients during the course of the defined study period. The incidence of PTFD was 1.5% (15 of 1013) of operative tibial shaft fractures and 1.9% (15 of 803) of operative tibial plateau fractures (P = 0.5810). Fifty percent (15 of 30) of PTFD were associated with a tibial shaft fracture, and 50% (15 of 30) with tibial plateau fractures. PTFD was associated with an open fracture in 63% (19 of 30) of cases. Two patients (6.7%) presented with a vascular injury who underwent a successful repair without vascular sequelae. Two different patients (6.7%) ultimately underwent an amputation (one above the knee and one below the knee) for a nonreconstructable extremity. In the remaining 28 patients without amputation, the incidence of compartment syndrome was 29% (8 of 28) and the incidence of peroneal nerve palsy was 36% (10 of 28). Only 30% (3 of 10) of the peroneal nerve palsies recovered clinically within the follow-up period, which averaged 11 months (range: 6 months to 4 years).

CONCLUSIONS

Traumatic proximal tibiofibular joint dislocations can be found in approximately 1%-2% of both tibial plateau and shaft fractures. PTFD is associated with a high rate of compartment syndrome (29%), open fracture (63%), and peroneal nerve palsy (36%). The majority (70%) of peroneal nerve palsies do not recover. Proximal tibiofibular joint dislocation is a marker for a severely traumatized limb.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.