Tibiofibular Joint Fractures / Fibular Head Pain

Tibial plateau fractures, femoral fractures, fractured patella
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wyeth
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Tibiofibular Joint Fractures / Fibular Head Pain

Post by wyeth »

Need some advice on my posterior lateral corner injury!

On Dec. 9, 2023, I was in a ski accident and suffered nondisplaced fractures in my tibial plateau and fibular head, along with a minor sprain of my LCL. By all accounts, I was VERY lucky that it wasn't worse and didn't require surgery. However, my doctor REALLY undersold just how bad the injury was, and it derailed my recovery as a result. At the time of injury, he told me it would be 4-6 weeks until I was running/skiing again and that the fractures were very minor.

However, my fractures were BAD—something I didn't understand the full scale of until I got a second opinion. The fibular head had 3 fractures, two of which went through the tibiofibular joint, and the tibia looked like a bomb went off inside it. My LCL was a grade 2 sprain, and the knee was loose as a result.

I was weight-bearing immediately in a hinged brace (with a limp/pain, which gradually improved) and was immediately thrown into pretty aggressive physical therapy. At first, it responded well. My pain was low, I was able to work out with it in the gym, and I felt my whole joint/leg progressing and getting stronger.

However, the moment I tried to re-introduce impact and more exercises in a non-linear plan in early February (side-to-side exercises, anything where my foot/ankle/knee was at an angle), everything fell apart. My pain jumped from manageable to what has been the worst pain I've ever experienced. Even now, it's a near-constant stabbing, grinding pain around the fibular head that keeps me up and night and makes it near impossible to complete daily tasks. I can't walk on it without feeling sick. There's also a horrible clicking in there whenever I flex my ankle up, and sometimes I feel/hear a loud pop when I make a sudden lateral move. Exercise, movement, and mobilizing the fibula make it worse, but honestly, nothing makes it feel better.

What's weird is that there wasn't a singular injury moment where symptoms popped up like this - the pain just gradually started getting worse, until it reached a crescendo. An MRI revealed that the bones are healed, and nothing abnormal seems to be going on around the joint. I don't have nerve pain and I don't have foot drop, so it seems like something else around the TF joint. I NEED to figure out what is going on—it's quite literally ruining my life.

My doctor is being very unhelpful and dismissive. They gave me a Kenalog -40 steroid injection into the tibiofibular joint, which did absolutely nothing, and the only thing that gave me any relief was an oral methylprednisolone dose pack, which provided temporary pain relief for about 48 hours before the pain came roaring back once the pack was done. My doctors are recommending a diagnostic scope if I really want to push the next steps (there could be a small meniscal tear or a bone fragment that's floating / not showing up on scans or something weird), but having had prior issues with arthrofibrosis in that knee, I want to avoid surgery at all costs.

So my question for the group... has anyone seen anything like this before? What would cause this level of debilitating fibular head pain? I can't help but feel my fibula is out of place or something is keeping it from behaving normally, because it just feels wonky in there, but wouldn't that show up in scans and/or during manual manipulation? I don't *think* my fibula is dislocating. Everyone tells me it feels stable in tests, but it does move a little more than my other leg, so it could be that...? Who the hell knows...

Feeling so lost with this one. After struggling with AF for so long, it feels brutal to be back in a pain cycle like this. If anyone has doctors or physical therapists they'd recommend I reach out to on this, I'd love to know who you recommend. I've been seeing folks at the Steadman Clinic (I'm based in Colorado), and it's been impossible to get help or a straight answer. The amount of advocating I'm having to go through just to be told to try Advil, taping and some Voltaren gel makes me want to throw a book through the window.

Thank you!!!!
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Re: Tibiofibular Joint Fractures / Fibular Head Pain

Post by The_KNEEguru »

So sorry you have suffered this terrible injury. It is not a common problem, which accounts for the lack of responses you have had so far.

Even the experts say
finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge.
Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419800/ - Posterolateral corner knee injuries: a narrative review.

I also read in the same article that
....only 26% of patients with PLC injuries can be diagnosed when an MRI is taken after 12 weeks post injury....
and
a standardized algorithm for the diagnosis and treatment of the PLC is still lacking and much controversy remains
You will be able to read the rest yourself as it is well-illustrated.
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