What is Proximal Tibiofibular Joint Dislocation

Proximal tibiofibular joint dislocation is a type of knee injury. The two bones of the lower leg connect at a joint on the outside of the knee. The thinner, outside bone is the fibula. The larger bone is the tibia.

This condition occurs when the top (head) of the fibula separates from the tibia. This type of dislocation happens when a lot of force is applied to a bent knee. There are four types of proximal tibiofibular joint dislocation:

• Type I is an incomplete dislocation (subluxation).
• Type II is dislocation of the tibia in a forward and outward direction. This is the most common type.
• Type III is dislocation in a backward and inward direction.
• Type IV is dislocation in an upward direction.

What are the causes?

This condition may be caused by:

• Severely twisting your knee.
• Falling and landing hard on a bent knee.
• A motor vehicle accident.

What increases the risk?

This condition is more likely to develop in people who participate in sports that involve jumping and landing with force. These sports include:

• Soccer.
• Ballet.
• Horseback riding.

What are the signs or symptoms?

Symptoms of this condition may include:

• Pain in the outside of the knee. The pain may get worse when turning the foot outward.
• Inability to put weight on the knee.
• Pain when pressing on the outside of the knee (tenderness).
• A deformity or lump on the outside of the knee.
• A wobbly (unstable) knee.
• A popping sensation when moving the knee.

How is this diagnosed?

This condition is diagnosed based on a physical exam, medical history, and X-rays. You may have X-rays of both knees for comparison. Sometimes other imaging tests may be done to confirm the diagnosis and rule out other injuries.

How is this treated?

Treatment depends on the type of dislocation you have. Treatment usually involves moving the bone back into place without surgery (closed reduction). You may have to wear a cast for 2–3 weeks or an elastic knee support (compression bandage) for up to 6 weeks. You may also need to use crutches for a few weeks to avoid putting weight on your knee.

In some cases, the bone may need to be repositioned with surgery done through an incision (open reduction). You may need surgery if your injury does not respond to closed reduction after several weeks or if you have a fracture. Surgery may include using a screw or wire to stabilize the joint.

Follow these instructions at home:

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

If You Have a Compression Bandage:

• Wear the bandage as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the bandage if your leg or toes tingle, become numb, or turn cold and blue.
• Keep the bandage clean and dry.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast or compression bandage is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a cast or compression bandage on your leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If physical therapy was prescribed, do exercises daily as told by your health care provider or physical therapist.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have a cast, do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain or swelling that gets worse.
• Your toenails turn a dark color, such as blue or gray.
• Your cast or compression bandage becomes loose or damaged.
• You develop new symptoms.
• You have numbness, coldness, or weakness in your foot.