![]() There is limited literature regarding PTFJ instability and there are no quality studies to support specific treatment options. Addressing PTFJ instability may reduce the progression of chronic dislocation, nerve palsy and pain requiring surgical management. Long-term disability or failure of treatment may result with a failure to identify and treat PTFJ instability. Dislocation of the PTFJ is often overlooked as it usually accompanies other lower extremity injuries. Proximal tibiofibular joint (PTFJ) dislocations are a relatively rare injury that occurs most commonly in sports injuries or high velocity accidents. PAGE BREAK Open left tibia and fibula fractures with proximal tibiofibular disruption CT images demonstrate subcutaneous air tracking to the knee joint. Sagittal view of the left lower extremity (a) and axial view at the level of the knee joint (b) are shown. AP (a), lateral (b) radiographs are shown demonstrating comminuted midshaft tibia and segmental fibula fractures. Deep subcutaneous air was noted at the fracture site, which tracked proximally to the knee joint (Figure 2). A CT scan of the left lower extremity demonstrated the comminuted midshaft tibia/fibula fractures with 1-cm overlap between the proximal and distal tibia. Post-reduction radiographs demonstrated improved alignment of the fracture. The left eyebrow laceration was managed with nylon sutures. The left lower extremity was then placed in a well-padded posterior mold splint. A reduction maneuver was performed with longitudinal traction to pull the tibia out to length. Initial orthopedic management in the trauma bay involved administration of cefazolin, gentamicin, tetanus and provisional irrigation of the left leg open wound. CT scan of the head was negative for any fracture or intracranial processes. Radiographs of the left femur and ankle were negative. There also appeared to be subcutaneous air at the knee joint. Radiographs revealed a comminuted midshaft tibia and fibula fracture (Figure 1). All four extremities were noted to be soft and compressible and the patient was neurovascularly intact. At the mid-tibia level anteriorly, there was a 0.5-cm open wound and no open wounds were discovered around the knee joint. Upon arrival, the patient was hemodynamically stable, and an advanced trauma life support protocol was initiated.Įxamination of the patient revealed a left eyebrow laceration, superficial abrasions on the lateral knee and a gross deformity of the left leg. The driver and the other construction worker expired at the scene. The vehicle struck him and another construction worker. The patient was working in a closed driving lane when a motor vehicle entered the lane at approximately 70 mph. If you continue to have this issue please contact to HealioĪ 46-year-old male construction worker presented to the ER complaining of midtibia pain after being struck by a vehicle.
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