case_images: PMC6589228_01
case_images: Proximal tibiofibular joint synostosis. (a) AP X-ray of the left proximal tibia show the tibial nail in an acceptable position with visible TFJ synostosis. (b) Axial CT scan showing appropriate position of the implant and TFJ synostosis. (c) Axial CT scan showing appropriate position of interlocking screw without excessive prominence. (d) CT scan demonstrating a potential soft tissue damage from drilling through the TFJ space into the fibula. (e) 3D reconstruction showing TFJ synostosis.
case_images: CRIOR2019-2423010.001.jpg
case_images: PMC6589228_01_CRIOR2019-2423010.001.jpg
case_images: fig1
case_images: X-ray images taken during initial evaluation at our clinic showed no evidence of fractures, appropriate position of hardware, and presence of heterotopic bone at the proximal TFJ (Figure 1(a)). The CT scan demonstrated that the implant was properly positioned with no protruding or loosening screws (Figures 1(a)-1(d)). The scan also displayed no acute fracture consistent with the patient's reported level of pain (Figures 1(a)-1(e)). However, it showed that the drill for the proximal locking screw may have penetrated through the tibia and into the fibula (Figure 1(d)). It also revealed proximal tibiofibular synostosis immediately distal to the proximal TFJ joint (Figures 1(a)-1(e)) aligned with the bone reaming along the drill path (Figure 1(d)).