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Rev Bras Ortop. DOI: One of its variants includes a proximal tibiofibular dislocation, which is an even more unusual injury. This article reports the case of a year-old male patient admitted to the emergency room with left lower limb edema after a sports trauma.
A knee X-ray revealed an anterolateral subluxation of the proximal tibiofibular joint, with no signs of fracture. After limb evaluation, the diagnosis of Maisonneuve variant lesion with proximal tibiofibular dislocation was confirmed.
The authors describe this case, addressing the clinical, radiological and surgical features of such variant. Keywords: ankle injuries; joint dislocations; surgical procedures, operative. Ankle joint injuries associated with sports are often diagnosed in trauma centers, especially in the age group ranging from 15 to 35 years-old. In one variant, there is concomitant dislocation of the proximal tibiofibular joint and distal ankle syndesmosis in the absence of a proximal fibular fracture. Only four cases of this rare lesion have been reported up to this year.
A year-old patient was admitted to the emergency room after a left lower limb trauma during a football match. In addition to severe pain in his left ankle and knee, the patient was unable to walk. Clinical examination revealed edema in the left lateral malleolus region and the lateral aspect of the left knee. No neurological or vascular changes were observed. The patient underwent surgical anatomical reduction under spinal anesthesia.
The curvilinear lateral access to the knee was used, starting at the lateral femoral condyle, toward the anterior border of the proximal fibular portion. The common fibular nerve was identified and carefully retracted. The tibiofibular joint was identified, and, after hematoma drainage, reduction and fixation were performed. The ankle injury was percutaneously treated, taking care to maintain the divergence between screws. In this approach, two 3. Anatomical reduction and perfect stability were obtained, preserving the ankle and knee functional arc of motion, as well as their proper alignment and rotation.
Active and passive knee and ankle mobilization started immediately after surgery. In addition, loading was immediately allowed with the use of an axillary crutch for partial support.
Isometric thigh and leg strengthening exercises were started at the same time. Total load was allowed within a month. The patient returned to work in two months and resumed sports activities in 3 months. The stability of the proximal tibiofibular joint depends on the bony and muscle-ligamentous components. Despite the fragility of this complex, the fibular head displacement is very rare, and it is little described in the literature.
There are four possibilities for this displacement: anterolateral more frequent , posteromedial, superior and atraumatic subluxation. The distal tibiofibular syndesmosis is an injury frequently seen in the emergency room due to ankle torsional trauma. However, the isolated lesion of the ligament complex without fibular fracture is rare.
Thus, Maisonneuve variant lesion with proximal tibiofibular luxation is a rare disorder that requires a careful diagnostic approach. In this case report, the patient was treated with direct surgical reduction for proximal tibiofibular luxation and percutaneous ankle reduction and fixation. We also report the need to immediately allow active and passive movement in addition to partial load support to obtain good functional results in these patients' rehabilitation.
Anteroposterior radiographs of the ankle A and the leg B showing ankle syndesmosis disjunction and proximal tibiofibular subluxation, respectively. Axial computed tomography scan of the proximal tibiofibular joint A showing an anterolateral proximal tibiofibular subluxation.
Posterior view of computed tomography scan with 3D reconstruction of knee B showing the proximal tibiofibular anterolateral subluxation. Anteroposterior A and lateral B radiograph of the leg and anteroposterior C and lateral D radiograph of the ankle after surgery. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg ;46 02 — Dislocation of the proximal and distal tibiofibular syndesmotic complex without associated fracture: case report.
Foot Ankle Int ;32 10 : — Maisonneuve-hyperplantarflexion variant ankle fracture. Orthopedics ;37 11 :e—e Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: case report and literature review. J Foot Ankle Surg ;56 02 — Sreesobh KV, Cherian J. Traumatic dislocations of the proximal tibiofibular joint: a report of two cases. J Orthop Surg Hong Kong ;17 01 — Superior tibiofibular joint disruption - As a variant of Maisonneuve injury.
Foot Ankle Surg ;10 01 — Maisonneuve fracture equivalent with proximal tibiofibular dislocation. A case report and literature review. J Bone Joint SurgAm;88 05 —
FRATURA - LUXAÇÃO EXPOSTA DE TORNOZELO
One of its variants includes a proximal tibiofibular dislocation, which is an even more unusual injury. This article reports the case of a year-old male patient admitted to the emergency room with left lower limb edema after a sports trauma. A knee X-ray revealed an anterolateral subluxation of the proximal tibiofibular joint, with no signs of fracture. After limb evaluation, the diagnosis of Maisonneuve variant lesion with proximal tibiofibular dislocation was confirmed. The authors describe this case, addressing the clinical, radiological and surgical features of such variant.
Translation of "tornozelo" in English
Acute isolated anterolateral dislocation of the proximal tibiofibular joint. The isolated traumatic dislocation of the proximal tibiofibular joint is rare. The injury could go unrecognized or be misdiagnosed at the initial presentation. Lack of clinical suspicion can cause diagnostic problems. The diagnosis requires accurate history of the mechanism and symptoms of the injury, and adequate clinical and radiographic evaluation of the both knees. Overlooked injuries are a source of potentially chronic changes. The treatment is closed reduction and immobilization or, in case of a failed or unstable reduction, open reduction with temporary internal fixation.