Tibial shaft fracture with knee and proximal tibiofibular dislocation: Case report

Abstract

Tibial shaft fractures are the most common type of long bone fracture, frequently associated with high-energy traumas such as traffic accidents, which carry a high mortality rate in Colombia. The combination of an open tibial shaft fracture with knee and proximal tibiofibular joint dislocation is extremely rare. The presented case involves these injuries, which were managed surgically in a single-stage with a follow-up of six months and good functional outcomes. Intramedullary nailing of the tibia was performed using an extra-articular, extra-synovial, semi-extended technique, which optimized tibial alignment for reduction and mitigated one of the common complications of intramedullary nailing: anterior knee pain. The proximal tibiofibular dislocation was reduced and stabilized using two screws, followed by a bucket-handle suture of the lateral meniscus, single-bundle posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL) reconstructions. This injury combination has not been previously reported, highlighting its clinical and academic relevance in advancing medical knowledge and serving as a reference for similar cases. Furthermore, this case underscores the importance of a well-structured management approach for victims of high-energy trauma and the necessity for surgeons to be adept at addressing multifaceted surgical challenges. Finally, it emphasizes the benefits of a single-stage surgical approach in facilitating early rehabilitation and optimizing outcomes. LEVEL OF EVIDENCE: V.

Keywords: Knee dislocation; Proximal tibiofibular dislocation; Tibial shaft fracture; case report; open fracture.