A Young Skier with Leg Pain

Area of Science:

• Orthopedics
• Emergency Medicine
• Radiology

Background:

• Proximal tibiofibular joint (PTFJ) dislocation is an uncommon knee injury.
• Subtle radiographic abnormalities can make diagnosis challenging, necessitating a high index of suspicion.
• Lateral knee pain, especially after trauma, warrants careful evaluation for PTFJ disruption.

Observation:

• A 17-year-old male presented with acute lateral knee pain and gait difficulty after a skiing collision.
• Physical examination revealed ecchymosis and tenderness over the lateral proximal fibula.
• Initial X-rays were concerning for PTFJ dislocation, prompting orthopedic referral.

Findings:

• The patient underwent successful closed reduction of the PTFJ dislocation in the ED under moderate sedation.
• Reduction involved applying medial force to the fibular head with knee hyperflexion and foot manipulation.
• Post-reduction radiographs confirmed improved tibiofibular alignment without evidence of fracture.

Implications:

• Emergency physicians must maintain a high suspicion for PTFJ dislocations in patients with traumatic knee pain.
• Prompt diagnosis and closed reduction in the ED can prevent potential long-term complications.
• This rare injury highlights the importance of thorough knee examination and appropriate imaging interpretation.