Anterolateral Dislocation Research Articles

Traumatic proximal tibiofibular fracture and dislocation

BackgroundTraumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of severely traumatized knees. The purpose of this study was to retrospectively analyze the incidence and impact of PTFD in traumatized knees with vascular injury.MethodsPatients with knee trauma and vascular injury were included from January 2022 to October 2023. X-rays and CT scans of included patients were retrospectively analyzed to determine the presence of PTFD. Patients were further divided into PTFD group and non-PTFD group for further comparative analysis.ResultsA total of 27 patients (28 limbs) were included. Incidence of PTFD was 39.3% (11/28) in traumatic knee with vascular injury, including 8 anterolateral dislocations and 3 posteromedial dislocations. PTFD group had significantly more limbs with open injuries compared with non-PTFD group (10/11 VS 7/17, p<0.05). Amputation rate of PTFD group was as high as 40% (4/10), compared to 23.5% (4/17) in non-PTFD group. However, the difference between two groups was not statistically significant (p>0.05).ConclusionsPTFD was easily overlooked or missed. In traumatized knees with vascular injury, incidence of PTFD was high. The presence of PTFD might indicate severe knee trauma and the possibility of open injury. Although there was no significant difference compared with non-PTFD group, PTFD group had a relatively high amputation rate of 40%.

Closed anterolateral fracture dislocation of the talus: Challenges and solutions. A case report

Closed anterolateral fracture dislocation of the talus: Challenges and solutions. A case report

Closed isolated anterolateral calcaneal dislocation: a case report

BackgroundComplete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.Case presentationA 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.ConclusionPatients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.

Luxação completa do astrágalo associada a fratura do maléolo peronial no jovem desportista

Complete closed talus dislocation is a rare and serious injury, with a bad prognosis due to the risk of avascular necrosis. This article describes the clinical case of a young soccer player, who during sports competition suffered an injury in his right ankle, after bad positioning of his foot on the ground. On examination, an irreducible deformity in supination of the foot was evident, and the X-ray and the CT-scan showed a complete anterolateral talus dislocation associated with a peroneal malleolus fracture. An emergent open reduction was performed with osteosynthesis of the peroneal malleolus fracture. The teenager had a satisfactory functional recovery, with no evidence of progression to avascular necrosis, having resumed his sports practice after 6 months of follow-up.

Acute proximal tibiofibular joint dislocation: a sports related injury?—two different cases

Proximal tibiofibular joint (PTFJ) dislocation is a rare injury, accounting for less than 1% of all knee injuries. The mechanism of this injury is usually sports related. Diagnosis is largely clinical, but the findings may be subtle. This condition may be easily missed. There is no larger series described in the literature but only several cases of dislocation of the PTFJ treated by different methods. We present two different antero-lateral dislocation cases successfully treated with different approaches.

Open anterolateral fracture dislocation of ankle joint: a rare case report

&lt;p class="abstract"&gt;Anterior ankle dislocation with associated compound bi-malleolar fracture is a rare injury. Ankle fracture dislocations most frequently occurs in young males caused by high energy trauma. The direction of the joint dislocation is determined by the position of the foot and the direction of the force being applied. A middle aged male presented to us with history of road traffic accident and was diagnosed to have anterior dislocation of right ankle joint with compound bi-malleolar fracture. Patient was taken to emergency operation theatre for wound debridement and immediate ankle reduction done under sedation. Due to wound contamination fracture fixation was delayed, once the wound healed bi-malleolar fracture fixation was done.&lt;/p&gt;

Modified technique of the treatment for proximal tibiofibular joint dislocation

Introduction. Dislocation of the proximal tibiofibular joint (PTFJ) is a rare injury. The diagnosis requires an accurate history of the mechanism and symptoms of the injury, and adequate clinical and radiographic evaluation of both knees. In the literature there is no larger series, only several cases of PTFJ dislocation treated by different methods have been published so far. The aim of the study was to present a modified technique for the treatment of the unstable PTFJ that results in faster recovery of the patient. Case report. A 24-year-old football player was injured at the beginning of training; when tackling the ball he felt a sharp pain in his right knee. He was immediately brought to the Emergency Center of Vojvodina and diagnosed with anterolateral dislocation of the PTFJ. Close reduction in general anesthesia was tried but we failed and then open reduction and internal fixation (ORIF) were performed with a single three cortical screw. We preferred not to immobilise the knee after the procedure and immediately employed passive and active exercises in the knee, without bearing weight to the injured leg. After 6 weeks we removed the screw and gave full weight support to the leg and continued physical treatment. Conclusion. In case of acute PTFJ dislocation, the first method of choice is closed reduction in sedation or general anesthesia. If closed reduction fails, ORIF must be performed. ORIF without immobilization and early start of physical therapy lead to the rapid return to sports activities

Isolated Traumatic Proximal Tibio-Fibular Joint Dislocation: Case Report of a Rare Injury

We report a rare case of isolated traumatic anterolateral dislocation of proximal tibiofibular joint dislocation in a 41 year old female patient who was admitted in our institution following a twisting injury to knee. Initial clinical examination and plain radiographs were equivocal needing bilateral axial Computed Tomography (CT) scan for definite diagnosis. We discuss the various aspects of this rare injury including the current management options and clinical outcome.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12066Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 37-40

Closed anterolateral total talar dislocation: a case report and technical notes

Closed anterolateral total talar dislocation: a case report and technical notes Yousef A Alrashidi,1 Zubair A Wali,2 Khalid I Khoshhal11Department of Orthopedic Surgery, College of Medicine, Taibah University, 2Department of Orthopedic Surgery, King Fahd Hospital, Almadinah Almunawwarah, Saudi ArabiaBackground: Standard treatment of closed total talar dislocations (TTDs) is a controversial issue due to the rarity of the injury.Case presentation: We report a case of closed anterolateral TTD in a 30-year-old male treated successfully by a closed reduction technique with no radiological evidence of avascular necrosis on 1 year follow-up.Conclusion: Closed reduction has become the preferred modality of management of closed anterolateral TTD. This case supports, as found in recent literature, that closed reduction if possible in similar cases may yield a better outcome, although there is a need for high-level studies to prove the superiority of such a modality.Keywords: closed reduction, closed talar dislocation, complete talar dislocation, pantalar dislocation, talus, total talar dislocation

Closed Talar Dislocation without Associated Fracture a Very Rare Injury, a Case Report.

Introduction:Total talar dislocations are uncommon injuries and usually seen following high velocity injuries. Total talar dislocations (missing talus) without fractures around the ankle are extremely rare. There are no consensuses on the best treatment of such injuries. To best of our knowledge very few cases have been reported in literature. We hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle. He was managed with emergency closed reduction and below knee splint. At one year follow up there were no complications.Case Report:A 25 year old male presented to orthopaedic causality with injury to right ankle following a road traffic accident. Patient complained of severe pain and deformity of ankle following injury. On examination ankle was deformed and swollen. Plain radiographs of right ankle joint revealed total anterolateral dislocation of talus without any accompanying ankle fracture. CT scan with 3D reconstruction also confirmed our radiographic findings. Under spinal anaesthesia and fluoroscopic guidance closed reduction was performed. To maintain reduction a 3mm K-wire was passed from calcaneum to tibia through talus. A posterior below knee splint was applied. Patient was followed every three months till one year. At one year follow up patient had good range of motion at ankle and subtalar joint.Conclusion:Total talar dislocations are very rare injuries and should be treated as impending open fractures. There is no consensus on treatment of such complex injuries as very few cases have been reported in literature.

Total Dislocation of the Talus

Total talar dislocation is a rare injury that is usually open. We report a case of closed anterolateral dislocation in a 19 year old, following a fall from a bicycle. He was treated with prompt closed reduction. A magnetic resonance imaging scan 6 months later showed no signs of avascular necrosis. At 2 years follow-up, the patient had a full, pain free, range of motion at the ankle and subtalar joints.

Dislocation of the proximal tibiofibular joint

Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far. A 23-year-old male soccer player sustained an injury after he had joined the game without previous warming-up. He fell on his right side because of a sudden change of direction while his foot was fixed to the base. He felt a severe pain and had a sensation as if something had snapped in his right knee. Pain and swelling at the head of fibula were found by physical examination, which, however, did not reveal any pain, swelling and instability of the ankle or peroneal nerve palsy. The x-ray showed anterolateral dislocation of the proximal tibiofibular joint, Ogden type II. Since manual reposition in general anesthesia failed, open reduction internal fixation was performed and proximal tibiofibular joint was transfixed with a screw After the wound closure, the above-the-knee plaster cast was applied. The screw was extracted six weeks later, full weight bearing was allowed and he started with physical therapy. Four months after the injury he returned to sports activities. On the follow-up one year after the injury he had the full range of motion of the knee, no complains, and continued with active soccer playing. X-ray showed no signs of arthrosis of the proximal tibiofibular joint. The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.

Proximal tibiafibular joint dislocation with total syndesmotic rupture

Dislocation in the proximal tibiafibular joint is a rare but perhaps underreported injury, which also can include peroneal nerve affection with its relation close to the head of the fibula, especially with posterior and superior dislocation. Ogden’s classification describes four types of dislocations: subluxation, anterolateral dislocation, posteromedial dislocation and superior dislocation. The anterolateral dislocation is the most common, accounting for 85% of proximal tibiafibular dislocations and is frequently associated with sports. The mechanism of injury is typically a sudden plantarflexion and inversion of the foot combined with a flexion in the knee and external rotation of the leg. Objective findings usually include a prominent capitulum fibulae, local pain and swelling and lateral knee pain associated with movement in the ankle. Antero-posterior and lateral X-rays are usually diagnostic for the injury but computed tomography (CT) can often supplement with valuable information, especially in determining the position of the luxation. X-rays of the ankle should always be included to estimate the position of the ankle joint, and if needed comparative X-rays of the opposite ankle joint should be made or a CT of the injured side. The importance of a thorough anamnesis and objective findings, to prevent the progression towards chronical symptoms, must be stressed, as the acute injury could be misdiagnosed as it resembles the symptoms of a knee distortion or meniscus injury. The injury can include both syndesmotic rupture and ankle fracture, particularly along the medial malleolus and should therefore always be considered when there are symptoms from the ankle and a relevant anamnesis.

Closed anterolateral ankle dislocation without fractures: Case report

Ankle dislocation without concomitant fracture is a rare phenomenon with only a few cases reported in literature.Our case report presents a male who sustained a closed anterolateral ankle dislocation without fractures following a road traffic accident. The patho-anatomy, principles of management and probable complications of this injury have been discussed.

A severe case of paediatric group A streptococcal osteomyelitis in varicella

We here report an unusual paediatric case of streptococcal osteomyelitis with a severe outcome as a complication of varicella. A 15-month-old girl with a 3-day history of varicella rash was admitted to our Paediatric Department because of high fever, pain and joint immobility of her right elbow and left ankle. Upon admission the patient presented pustules with highly infected lesions on her back, trunk, arms and face. Physical examination revealed marked swelling with diffused tenderness and local warmth at both the right elbow and the left ankle. The patient at admission had a leukocyte count (WBC) of 17,940 ll, C-reactive protein (CRP) of 17.15 mg/dl (normal value \0.5 mg/dl) and erythrocyte sedimentation rate (ERS) of 50 mm/h (normal value \20 mm/h). The humoral immune response was normal [immunoglobulin A (IgA) 107 mg/dl, IgG 925 mg/dl, IgM 182 mg/dl) as were the Tand B-cell subsets (CD3? 74%, CD4? 44%, CD8? 23%, CD19? 18%). Empirical antibiotic therapy with ceftriaxone and amikacin was prescribed. Conventional X-ray revealed swelling at the right elbow, left wrist and feet as well as a fragmented and irregular profile of the right ulna distal metaphysic and the left fibula. Magnetic resonance imaging (MRI) of the elbow revealed massive inflammation of the joint on the left side, with involvement of the surrounding soft tissues (Fig. 1). Bone scintigraphy showed increased activity in the right elbow, left fibula and tibia, consistent with osteomyelitis. Three days after admission, ceftriaxone and amikacin were replaced by ampicillin, owing to a positive blood culture for Group A beta-hemolytic streptococcus(GABSH). Two weeks following the initiation of the ampicillin treatment, laboratory tests revealed the WBC count to be 11,000 ll, CRP 4.63 and ERS 100 mm/h. Due to the lack of improvement in the patient’s clinical condition, ampicillin therapy was changed to treatment with linezolid on the basis of the susceptibility testing. This led to pain relief and a decrease in the swelling. Four weeks after the initiation of linezolid therapy, the patient was discharged with oral administration of linezolid. However, 15 days later, the patient was readmitted due to right elbow pain and swelling. At admission, the WBC was 11,200 ll, CRP 0.08 mg/dl and ERS 10 mm/h. Radiological examinations (X-ray and MRI) revealed bone destruction of the ulna distal metaphysic, compatible with destructive osteomyelitis. The residual proximal stump was diverted externally, and both the lamellar and diaphyseal distal stumps were fragmented (Fig. 2). The orthopaedic physician intraoperatively reduced the anterolateral dislocation of the right radius and put it into a cast. No cultures or other microbiological tests were performed during surgery. One month following the surgery, X-ray examinations showed severe right ulna destructive outcomes, with just a minimal residual proximal and distal fragments. Six months later, an X-ray showed no further radiological modifications. Varicella complications are rare, but in some patients they may be severe, requiring hospitalization [1–3]. The frequency of varicella infection complicated by invasive GABSH disease in children has been documented to be 6–17% [3–5]. Recently, numerous studies have documented an increasing incidence and severity of GABSHS infections [2, 6, 7]. E. Bozzola (&) A. Krzystofiak L. Lancella A. Quondamcarlo A. Villani Department of Paediatrics, Paediatric and Infectious Disease Unit, Children Hospital Bambino Gesu, Rome, Italy e-mail: elenabozzola@libero.it

Anatomic reconstruction or temporary screw stabilization of chronic symptomatic anterolateral proximal tibiofibular joint instability

Dear Editors, We read with great interest the recent article of Horst and Laprade “Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability” [2]. The authors are to be complemented on a well-written and well-illustrated report of an operative technique with good results in two cases. The authors conclude that an anatomic reconstruction of the proximal posterior tibiofibular joint may be considered for patients with chronic, symptomatic proximal tibiofibular joint anterolateral subluxation. We would like to place some remarks that we feel should be discussed before accepting the above-mentioned conclusion. We will emphasize as already mentioned by the authors that there are 4 different types of instability, and the most frequent type (67%) is the anterolateral dislocation [4]. This type is mostly caused by a hyperflexion trauma of the knee with plantar flexion and inversion of the foot. In this type of injury, there is a rupture of the posterior and anterior capsular ligament and there could also be an injury of the lateral collateral ligament. These are the main stabilizers of the tibiofibular joint. Ogden identified two variants of the proximal tibiofibular joint, horizontal (coronal plane) and oblique configurations [4, 5]. The horizontal proximal tibiofibular joint lies in the coronal plane and, with a larger articular surface and greater mobility, is more flexible and theoretically more resistant to rotational forces tending to cause fibular dislocation [4, 5]. Peroneal nerve and ankle injuries can occur concomitantly with anterolateral proximal tibiofibular dislocation [10]. Evaluation of the distal syndesmotic ligaments and the interosseous membrane is advisable because the mechanism of trauma can cause a disruption of the distal tibiofibular syndesmosis [3, 10]. In cases of syndesmotic instability, prompt stabilization of the distal tibiofibular joint is advocated [10]. An associated transient peroneal palsy is commonly seen in types II, III, and IV [7, 10]. In more rare cases, disorders at the proximal tibiofibular joint can be a possible cause of referred pain proximally [9]. In the two cases described, 3 months of physical therapy with an emphasis on knee strengthening was ineffective. We would suggest that 6 months is a more appropriate duration of non-operative treatment. We also think there are more non-operative options for patients with chronic instability which can be considered like modifications of a patient’s activity level and training programs, utilization of a supportive strap, lower leg strengthening, and modifications in the lower kinetic chain biomechanics [6]. A supportive strap placed 1 cm below the fibular head can offer relief in many cases. Care should be taken not to apply the strap too tightly or for too long, as this could cause peroneal nerve palsy. The strap should be worn during activities that cause the symptoms [6–8]. Strengthening exercises should consist of: Strengthening of lateral and rotational stability and coordination on a balancing disk or a trampoline. Stretching exercises for m. biceps femoris, m. soleus, and m. gastrocnemius. Strengthening exercises of the peroneal muscles with a dynaband. The affected foot is moved in eversion against the resistance of the band. It is important to avoid activities involving hyperflexion of the knee [1, 6]. We agree with the authors that the ideal treatment for patients requiring surgical intervention has not been well defined. As this is a rare problem, there is a lack of data and no large series are available concerning the outcome of the different treatment possibilities [5]. The reader should also be aware of the technique described in our previous article using screw fixation [8]. The advantage of this technique is that it is much less invasive and less extensive and requires only a minimal incision compared to the technique of the Horst and LaPrade [2] and other ligament reconstructions. For all techniques described, the preliminary results are good, but the surgery is technically demanding, with large incisions and extensive soft tissue dissection and the risk of damaging the common peroneal nerve [10]. We performed a temporary screw fixation (3–6 months) of the proximal tibiofibular joint and a release of the peroneal nerve. In general, the results in our series (>10 athletes) performing this “more simple” technique are good. The disadvantage of this technique is the need for screw removal as it is known that arthrodesis of the proximal tibiofibular joint causes increased rotational forces in the ankle and often leads to pain and instability of the ankle joint [4, 5]. In summary, we agree with Horst and Laprade that an anatomic reconstruction of the proximal posterior tibiofibular joint may be considered for patients with chronic, symptomatic proximal tibiofibular joint anterolateral subluxation, but we think there are other less extensive alternative surgical options. A comparative study should answer this last question. We would be interested to further discuss this with the authors.

Anterior hip subluxation following fixation of a T-shaped acetabular fracture through an extended iliofemoral approach

We report the case of a 34-year-old female patient who, six week following her acetabular fracture ORIF through an extended iliofemoral approach, presented with anterolateral incomplete dislocation of the femoral head. In the absence of joint incongruence as demonstrated on radiographs and CT images, a capsular tightening was performed via the anterior Hueter approach. This capsular plasty stabilized the hip for 2 years, but gradual osteoarthritis deterioration resulted in the need for arthroplasty. At the 2-year follow-up, this secondary arthroplasty showed satisfactory result. The substantial muscle exposure of the lateral aspect of the acetabulum and the circumferential capsulotomy related to the use of the iliofemoral approach were retained as factors promoting this complication. In case early postoperative mobilization is impossible, temporarily maintaining the limb in abduction and flexion can be recommended after an extended iliofemoral approach with circumferential capsulotomy.

Recurrent idiopathic anterolateral dislocation of the proximal tibiofibular joint: case report and literature review

We present a case of recurring dislocation of the proximal tibiofibular joint without trauma. This problem is rarely noted in the paediatric surgery literature and clinically frequently missed. Pathbreaking are anamnesis and accurate physical examination, argumentative are conventional radiography, CT and MRI. The Ogden classification describes four types of dislocations, whereas the anterolateral dislocation is the most common type. Initial management consists of closed reduction and is often successful if tried immediately. Open reduction and stabilization by posterior soft-tissue reconstruction or temporary fixation of the joint are occasionally required to prevent or combat chronic instability. The aim of this study was to increase the awareness of this unusual lesion, based on an own case report of a recurring proximal tibiofibular joint dislocation and a review of the literature.

Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

Objective To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients. Methods The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures (19 cases of Garden type III, 23 cases of Garden type IV) treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years (range: 65–89 years). They were divided into anterolateral mini-invasive group (22 cases) and posterior group (20 cases). The mean time of follow-up was 13 months (range: 6–36 months). The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore (Southern incision) goes through the insertions of short external rotation muscles, reaching the femoral neck from posterior capsule. The related variables under observation were length of incision, operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate. Results The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15–22 cm in the conventional procedure. It took less time (average 15 minutes) to complete the anterolateral minimally invasive approach (72 min± 15 min), compared with the conventional approach (87 min ±10 min). The average Harris hip score was 91.23±10.20 in anterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was (6.4±2.2) days (range: 4–9 days), while that in posterior approach was (9.2 ±3.1) days (range: 6–13 days). The average length of bed stay was (3.4±1.1) days (range: 2–5 days) in anterolateral group and (6.2±2.8) days (range: 3–10 days) in posterior group. No patients in anterolateral group experienced dislocation. One (5%) hip in posterior approach had dislocation. Conclusions Anterolateral mini-invasive approach can decrease trauma, operation time, length of hospital stay and bed stay and rehabilitation time. The stability and minimal muscular damage permit the acceleration of postoperative rehabilitation, which can subsequently reduce the perioperative risk in the treatment of femoral neck fractures in the elderly undergoing total hip replacement.

Luxação aguda isolada da articulação tibiofibular proximal

A luxacao traumatica isolada da articulacao tibiofibular proximal e rara. Esta lesao pode nao ser reconhecida ou diagnosticada no atendimento inicial. A ausencia de suspeita clinica pode causar problemas para o diagnostico. O diagnostico necessita de historia precisa do mecanismo e sintomas da lesao, avaliacao clinica e radiografica adequada de ambos joelhos. Casos nao reconhecidos sao fonte de alteracoes cronicas. O tratamento e feito por reducao fechada e imobilizacao ou, em casos irredutiveis ou instaveis, reducao aberta com fixacao interna temporaria. Um caso raro de luxacao tibiofibular proximal isolada em um jogador de basquetebol e relatado para ilustrar essa lesao.