Two surgical stabilization strategies for irreducible proximal tibiofibular joint dislocations: case report

Proximal tibiofibular joint (PTFJ) dislocation is a rare and frequently underdiagnosed injury that may occur following both sports-related trauma and high-energy mechanisms. Irreducible dislocations represent a particular challenge because they often reflect complex injury patterns requiring surgical management. We report two cases of irreducible PTFJ dislocation with distinct displacement patterns: an anterolateral dislocation following a sports injury and a posteromedial dislocation associated with high-energy trauma and common fibular nerve palsy. In both cases, closed reduction was unsuccessful, necessitating open reduction. Surgical stabilization was tailored to the specific injury characteristics and intraoperative findings, using suture anchor-based ligament repair in the anterolateral dislocation and adjustable cortical button fixation in the posteromedial dislocation. The latter case additionally required repair of associated posterolateral soft-tissue injuries. At 12-month follow-up, both patients demonstrated maintenance of reduction, restoration of joint stability, substantial functional improvement, and no persistent neurological deficits or recurrent instability. These cases highlight the importance of recognizing irreducible PTFJ dislocations and addressing associated lesions when closed reduction fails. Rather than supporting a single fixation method, they illustrate a pattern-based surgical approach in which satisfactory short-term outcomes were achieved through anatomic reduction, restoration of soft-tissue stability, and protection of the common fibular nerve. LEVEL OF EVIDENCE: Level V.