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Proximal Tibiofibular Joint Injury and Proximal Fibula Fracture
Donna G. Blankenbaker, MD, FACR; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Proximal tibiofibular joint (PTFJ)
          • Synonyms

            • Proximal syndesmosis injury of leg
          • Definitions

            • Injury to proximal tibiofibular articulation including dislocation, fracture, or ligament disruption

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      PATHOLOGY

                      • Staging, Grading, & Classification

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Cunningham NJ et al: Review article: Isolated proximal tibiofibular joint dislocation. Emerg Med Australas. 31(2):156-62, 2019
                                    2. Liu Y et al: Relative incidence of proximal fibula fractures with tibial plateau fractures: an investigation of 354 cases. J Knee Surg. 31(2):156-62, 2019
                                    3. Zheng ZL et al: Establishment of classification of tibial plateau fracture associated with proximal fibular fracture. Orthop Surg. 11(1):97-101, 2019
                                    4. Cohen BH et al: The arcuate fracture: A descriptive radiographic study. Injury. 49(10):1871-7, 2018
                                    5. Bissuel T et al: Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: Case Report and Literature Review. J Foot Ankle Surg. 56(2):404-7, 2017
                                    6. Kruckeberg BM et al: Proximal tibiofibular joint instability and treatment approaches: A systematic review of the literature. Arthroscopy. 33(9):1743-51, 2017
                                    7. Devitt BM et al: Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthrosc. 23(1):10-6, 2015
                                    8. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                    9. Milankov M et al: Dislocation of the proximal tibiofibular joint. Med Pregl. 66(9-10):387-91, 2013
                                    10. Park S et al: Compartment syndrome in tibial fractures. J Orthop Trauma. 23(7):514-8, 2009
                                    11. Dirim B et al: Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. AJR Am J Roentgenol. 191(2):W44-51, 2008
                                    12. Stuermer EK et al: Tibial shaft fracture and ankle joint injury. J Orthop Trauma. 22(2):107-12, 2008
                                    13. Al-Kashmiri A et al: Case report: Fatigue fracture of the proximal fibula with secondary common peroneal nerve injury. Clin Orthop Relat Res. 463:225-8, 2007
                                    14. Nikolaides AP et al: Inferior dislocation of the proximal tibiofibular joint: a new type of dislocation with poor prognosis. Arch Orthop Trauma Surg. 127(10):933-6, 2007
                                    15. Bozkurt M et al: The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification. Knee Surg Sports Traumatol Arthrosc. 13(4):323-8, 2005
                                    16. Lee J et al: Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol. 32(11):619-27, 2003
                                    17. Sekiya JK et al: Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg. 11(2):120-8, 2003
                                    18. Aladin A et al: The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee. 9(3):233-6, 2002
                                    19. Juhng SK et al: MR evaluation of the "arcuate" sign of posterolateral knee instability. AJR Am J Roentgenol. 178(3):583-8, 2002
                                    20. Roy N et al: Superior dislocation of the superior tibiofibular joint associated with fracture of the tibial shaft. Injury. 29(6):486-8, 1998
                                    21. Morris JR et al: Magnetic resonance imaging of acute Maisonneuve fractures. Foot Ankle Int. 17(5):259-63, 1996
                                    22. Semonian RH et al: Proximal tibiofibular subluxation relationship to lateral knee pain: a review of proximal tibiofibular joint pathologies. J Orthop Sports Phys Ther. 21(5):248-57, 1995
                                    23. Harvey GP et al: Anterolateral dislocation of the proximal tibiofibular joint: case report and literature review. Todays OR Nurse. 14(3):23-7, 1992
                                    24. Veth RP et al: The abnormal proximal tibiofibular joint. Arch Orthop Trauma Surg. 102(3):167-71, 1984
                                    25. Veth RP et al: Traumatic instability of the proximal tibiofibular joint. Injury. 13(2):159-64, 1981
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Proximal tibiofibular joint (PTFJ)
                                            • Synonyms

                                              • Proximal syndesmosis injury of leg
                                            • Definitions

                                              • Injury to proximal tibiofibular articulation including dislocation, fracture, or ligament disruption

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        PATHOLOGY

                                                        • Staging, Grading, & Classification

                                                          • Gross Pathologic & Surgical Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Cunningham NJ et al: Review article: Isolated proximal tibiofibular joint dislocation. Emerg Med Australas. 31(2):156-62, 2019
                                                                      2. Liu Y et al: Relative incidence of proximal fibula fractures with tibial plateau fractures: an investigation of 354 cases. J Knee Surg. 31(2):156-62, 2019
                                                                      3. Zheng ZL et al: Establishment of classification of tibial plateau fracture associated with proximal fibular fracture. Orthop Surg. 11(1):97-101, 2019
                                                                      4. Cohen BH et al: The arcuate fracture: A descriptive radiographic study. Injury. 49(10):1871-7, 2018
                                                                      5. Bissuel T et al: Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: Case Report and Literature Review. J Foot Ankle Surg. 56(2):404-7, 2017
                                                                      6. Kruckeberg BM et al: Proximal tibiofibular joint instability and treatment approaches: A systematic review of the literature. Arthroscopy. 33(9):1743-51, 2017
                                                                      7. Devitt BM et al: Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthrosc. 23(1):10-6, 2015
                                                                      8. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                                                      9. Milankov M et al: Dislocation of the proximal tibiofibular joint. Med Pregl. 66(9-10):387-91, 2013
                                                                      10. Park S et al: Compartment syndrome in tibial fractures. J Orthop Trauma. 23(7):514-8, 2009
                                                                      11. Dirim B et al: Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. AJR Am J Roentgenol. 191(2):W44-51, 2008
                                                                      12. Stuermer EK et al: Tibial shaft fracture and ankle joint injury. J Orthop Trauma. 22(2):107-12, 2008
                                                                      13. Al-Kashmiri A et al: Case report: Fatigue fracture of the proximal fibula with secondary common peroneal nerve injury. Clin Orthop Relat Res. 463:225-8, 2007
                                                                      14. Nikolaides AP et al: Inferior dislocation of the proximal tibiofibular joint: a new type of dislocation with poor prognosis. Arch Orthop Trauma Surg. 127(10):933-6, 2007
                                                                      15. Bozkurt M et al: The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification. Knee Surg Sports Traumatol Arthrosc. 13(4):323-8, 2005
                                                                      16. Lee J et al: Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol. 32(11):619-27, 2003
                                                                      17. Sekiya JK et al: Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg. 11(2):120-8, 2003
                                                                      18. Aladin A et al: The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee. 9(3):233-6, 2002
                                                                      19. Juhng SK et al: MR evaluation of the "arcuate" sign of posterolateral knee instability. AJR Am J Roentgenol. 178(3):583-8, 2002
                                                                      20. Roy N et al: Superior dislocation of the superior tibiofibular joint associated with fracture of the tibial shaft. Injury. 29(6):486-8, 1998
                                                                      21. Morris JR et al: Magnetic resonance imaging of acute Maisonneuve fractures. Foot Ankle Int. 17(5):259-63, 1996
                                                                      22. Semonian RH et al: Proximal tibiofibular subluxation relationship to lateral knee pain: a review of proximal tibiofibular joint pathologies. J Orthop Sports Phys Ther. 21(5):248-57, 1995
                                                                      23. Harvey GP et al: Anterolateral dislocation of the proximal tibiofibular joint: case report and literature review. Todays OR Nurse. 14(3):23-7, 1992
                                                                      24. Veth RP et al: The abnormal proximal tibiofibular joint. Arch Orthop Trauma Surg. 102(3):167-71, 1984
                                                                      25. Veth RP et al: Traumatic instability of the proximal tibiofibular joint. Injury. 13(2):159-64, 1981