Dislocation of superior tibio-fibular joint in association with fracture of the tibia: ‘Monteggia’ injury of the leg

Abstract

A 40-year-old female courier motorcyclist sustained a closed spiral fracture of the middle third of the tibia with posterosuperior dislocation of the superior tibiofibular joint, (Figure 1 and Figure 2). Whilst travelling at 40 miles per hour she skidded into the back of a car which suddenly and unexpectedly slowed in front of her. Both the fracture and the dislocation reduced easily with a closed manipulation; she was initially treated in an above knee plaster splint. However, screening under an image intensifier 2 days later showed redisplacement of the head of the fibula. Consequently an open plating was performed in order to obtain a perfect reduction of the fracture and dislocation. Again the fibula seemed to reduce satisfactorily, but further radiographs taken 2 days later showed that it was once again dislocated. A third procedure was required to hold the fibula with an extraarticular buttress screw (Figure 3 and Figure 4). Following this the patient made a satisfactory recovery.