Author(s): Herzog GA, SerranoRiera R, Sagi HC
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Abstract 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.
This article was published in J Orthop Trauma
and referenced in Journal of Trauma & Treatment