![]() The proximal shift of the inferiorly displaced fibular head was achieved by doing the biceps tenodesis. The lateral collateral ligament injury was compensated by doing a biceps tenodesis. Open reduction and stabilization with a cancellous screw b] was performed with screw purchase of three cortices. (Arrow) Note the slackness of the ligament and edemaĭelayed proximal tibiofibular syndesmosis was operated 2 weeks after the injury because the fasciotomy wound had exposed the area adjacent to the planned internal fixation of the proximal tibiofibular joint. (c) Sprain of the anterior tibiofibular ligament of the distal syndesmosis. ![]() (White arrows) (b) Disruption of the interosseus ligament. MRI of (Lt) knee showing (a) Complete disruption of the proximal tibiofibular ligament and the lateral collateral ligament. Subsequently, split skin grafting of the fasciotomy wounds was performed after 5 days. The limb was placed in an above knee slab in 15° of knee flexion. The artery was repaired using an interposition graft of saphenous vein with double incision fasciotomy of the leg. The arterial Doppler scan revealed the complete transection of the artery 2 cm proximal to the bifurcation. Plain radiographs of the knee, leg, and ankle b] showed diastasis of the proximal tibiofibular joint, with the head of fibula being displaced inferiorly and laterally with the fracture of the shaft of the fibula and an overlap of the fractured fragments, further corroborating the inferior displacement of the fibular head. The sensorimotor component of the tibial nerve appeared intact. Clinically, he also had foot drop and loss of sensation in the areas supplied by the superficial and deep peroneal nerves, suggestive of common peroneal nerve palsy. Crepitus and tenderness was felt in midleg laterally. There was no capillary filling and the limb was cold to touch. On examination he had lateral prominence of the fibular head with absent dorsalis pedis and posterior tibial artery pulsations. He had diffuse swelling, and tenderness of the left knee and leg. It was followed by immediate onset of pain in his left knee and leg. He was riding a two wheeler and was knocked down by a truck, leading to fall on the left knee in flexion. A 23-year-old male reported to the emergency services 1 hour following road traffic accident.
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