Letter to the Editor: Is Stability of the Proximal Tibiofibular Joint Important in the Multiligament-injured Knee?
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- Cite this article as:
- Liu, Y. Clin Orthop Relat Res (2014) 472: 2550. doi:10.1007/s11999-014-3709-4
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To the editor,
Jabara and colleagues  performed an interesting study regarding proximal tibiofibular joint instability in the setting of the multiligament-injured knee. As we know, this is typically a high-energy injury, which is associated with other types of damage, namely complex tibial plateau fractures. Several years ago, we treated two patients using the same approach to fix the proximal tibiofibular joint as Jabara and colleagues. However, all of the single 4.5 mm screws broke after 1 year. We believe that the proximal tibiofibular joint is an example of a joint that demonstrates amphiarthrosis; that is a very slight, but still potentially important, movement during physiological activity. Because of that, the rigid fixation we achieved with the 4.5 mm screw resulted in screw breakage.
Since then, we have been treating this kind of injury with brace protection for 3 months. We have not observed any more broken screws using this method on two additional patients. However, because we only have a small number of cases and patients, we would like to know whether the authors believe screw fixation should be used for the proximal tibiofibular joint in patients with this injury pattern. Do the authors see broken screws in their patients treated this way?