Traumatic rupture of the tibialis anterior tendon associated with chronic tibialis posterior dysfunction

Isolated rupture of the tibialis anterior and tibialis posterior tendon is uncommon with approximately 25 cases reported in the English literature. Rupture of the tibialis anterior in the presence of chronic tibialis posterior dysfunction has not been reported to date. We present a patient with a closed traumatic rupture of the tibialis anterior tendon which occurred on a background of a pre-existing tibialis posterior dysfunction which was being treated non-operatively and discuss the successful operative management that was performed to reconstruct both tendons.     

Ruptured tibialis posterior tendon associated with a closed medial malleolar fracture

Interposition of a ruptured tibialis posterior tendon in a closed fracture of the medial malleolus leading to a failed closed reduction has not yet been described. The following is a report of such a case.     

Cobb repair for tibialis posterior tendon rupture

The tibialis posterior is the main dynamic stabilizer of the hindfoot against a valgus deformity. Its rupture results in hindfoot valgus with a considerable biomechanical disturbance and functional loss in the affected foot. A new method of reconstruction of this tendon is described which involves the use of half the tendon of tibialis anterior.     

Traumatic rupture of the tibialis posterior tendon after ankle fracture: a case report

Degenerative tears of the posterior tibial tendon associated with chronic disease are well documented in the literature. Traumatic ruptures of this tendon, however, are much less common and consequently have received little attention. An association has been shown between pronation-external rotation ankle fractures and tears of the tendons that cross the medial aspect of the ankle, most commonly the posterior tibial tendon. In the present case report, we share our unique experience of an open-ankle fracture associated with the traumatic rupture of the posterior tibial tendon. This injury illustrates that soft-tissue injury must always be suspected concomitantly in the treatment of certain fractures on the basis of both mechanism of injury and fracture pattern.     

Split tibialis posterior tendon transfer with concomitant distal tibial derotational osteotomy in children with cerebral palsy

Fifteen lower extremities with a spastic equinovarus foot deformity associated with internal tibial torsion were identified. Each lower extremity underwent a split tibialis posterior tendon transfer combined with a distal tibial derotational osteotomy. The medical record of each patient was reviewed retrospectively. We paid particular attention to clinic visits, gait analyses, and surgical procedures performed. These patients were followed up for an average of 4 years and 5 months after surgery. Twenty-seven percent had an excellent result, 13% developed a rigid equinovarus deformity, and 40% developed a severe planovalgus deformity. Eight of the 15 lower extremities required further corrective surgery because their resultant deformities limited their ambulation, was painful, or both. The combination of a split tibialis posterior tendon transfer with a distal tibial derotational osteotomy increases the difficulty of balancing the muscle forces across the spastic equinovarus foot, increasing the likelihood that overcorrection and a planovalgus deformity will develop.     

Stage IV posterior tibial tendon rupture

Adult acquired flatfoot deformity progresses through well defined stages as set out by Johnson and Strom. Myerson modified this classification system with the addition of a fourth, more advanced stage of the disease. This stage describes the involvement of the tibiotalar joint in addition to the hindfoot malalignment seen in stages II and III. This most advanced stage is comprised of a hindfoot valgus deformity, resulting from degeneration of the posterior tibial tendon, with associated valgus tilting of the talus within the mortise. The deformity at the tibiotalar joint may or may not be rigid. Although rigid deformities are still best treated with fusions of the ankle and hindfoot, supple tibiotalar deformity may be treated with joint sparing procedures involving reconstructive procedures of the foot and deltoid ligaments.     

Ruptured tibialis posterior tendon in a closed ankle fracture

Interposition of a ruptured tibialis posterior tendon between the medial malleolar fracture fragments in a closed pronation-eversion ankle fracture occurred in a 21-year-old woman. The tendon rupture was not diagnosed before surgery but was recognized at the time of open reduction. the tendon was repaired and the fracture internally fixed. Twelve months after the operation, the patient had a nearly full range of pain-free ankle movements and a normal longitudinal arch.     

Simultaneous rupture of the tibialis posterior and flexor digitorum longus tendons in a closed tibial fracture

An interposition of ruptured tendons of the tibialis posterior and flexor digitorum longus occurred between the lower third tibial fracture fragments in a closed tibial fracture in a 26-year-old man. The tendon ruptures were not diagnosed preoperatively but were recognized at the time of open reduction. The tendons were repaired and the fracture internally fixed. Six months postoperatively, the patient had a 10 degree dorsal extension deficit in the ankle joint, the motion was painless, and the strength of the posterior tibial compartment muscles was grade 5.     

Achilles tendon rupture associated with ankle fracture

The case of a 40-year-old man who sustained a medial malleolar fracture with extension of the fracture into the tibial plafond is discussed. Before surgery, the physical examination revealed an Achilles tendon rupture. Surgical treatment to repair the bone and tendon injury was performed. Achilles tendon rupture is not an uncommon injury, but it is rarely associated with a fracture. When a fracture is present, the Achilles tendon injury can be overlooked, which may result in a delay of treatment or residual morbidity.     

Traumatic rupture of the tibialis posterior tendon after ankle fracture: three cases and a review of the literature

We report three cases of complete traumatic tibialis posterior tendon rupture which occurred after ankle fracture. Diagnosis was established at surgery. Repair of the non-degenerative tendon was achieved during the procedure for osteosynthesis of the malleolar fracture. Fractures healed a few months after surgery. The posterior tibialis muscle tendon functioned plantar arch was normal, except in one patient with multiple injuries who died in intensive care thirteen days after the accident. Although exceptional, injury of the tibialis posterior tendon should not be overlooked after ankle fracture. These injuries become apparent only at surgery for the malleolar fracture since pain hinders clinical examination. Primary suture best guarantees a good functional outcome. Residual pain, deficit in active inversion of the foot, modified medial longitudinal arch, or progression to planovalgus are retrospective diagnostic signs.     

Fracture of the neck of the talus associated with a trimalleolar ankle fracture and ruptured tibialis posterior tendon.

A rare case of a fracture through the neck of the talus with a trimalleolar ankle fracture and ruptured tibialis posterior tendon is presented and the literature reviewed. Management consisted of open-reduction internal fixation of the fractures and repair of the tibialis posterior tendon. At 40 months after injury, the patient had tibiotalar range of motion at 5 degrees of dorsiflexion and 38 degrees of plantar flexion. While avascular necrosis of the talus did not occur, significant degenerative arthritis of the ankle was noted.     

Achilles tendon rupture with open distal tibia and fibula fracture

The authors present a previously unreported case of an open fracture of the distal tibia and fibula with associated Achilles tendon rupture in a 27-year-old motorcyclist. Management followed established trauma principles of wound exploration, debridement, and stabilization of the fracture with reamed locked intramedullary nailing of the tibia. The injury to the Achilles tendon was not identified until surgical exploration for fixation of the fracture. This required a 2-stage operative approach, involving initial debridement and fracture fixation followed by Achilles tendon repair during the second-look wound review procedure. The authors believe this to be the first reported case of Achilles tendon rupture in association with an open transverse distal tibia fracture. Prior to surgical exploration of the wound, Achilles tendon rupture was not suspected, emphasizing the need for clinical suspicion, thorough examination, and adequate wound exploration at operation for fracture fixation.     

Laceration of tibialis anterior tendon complicating a closed tibial fracture: A case report

Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented. The tendon laceration was suspected preoperatively because of the patient's inability to actively dorsiflex his ankle joint and the existence of a palpable gap in the soft tissues over the anterolateral aspect of his tibia. Tibialis anterior tendon repair was performed simultaneously with fracture fixation. The role of careful physical examination is stressed so that this rare injury combination will not be missed.     

手术治疗胫骨中下段骨折合并后踝骨折

正2011年1月~2014年1月,我科手术治疗20例胫骨中下段骨折合并后踝骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组20例,男14例,女6例,年龄20~65岁。左下肢8例,右下肢12例。致伤原因:摔伤10例,扭伤4例,车祸伤6例。螺旋形骨折15     

Recurrent dislocation of tibialis posterior tendon

We successfully treated two patients with recurrent dislocation of the tibialis posterior tendon by creating a bone block. Sudden resistive contraction of the tibialis posterior muscle is considered to be the mechanical cause of the initial traumatic injury, and a shallow tibialis posterior tendon sulcus may be the predisposing factor. Once the flexor retinaculum is torn during the initial trauma, recurrent dislocation is inevitable, and surgical treatment is mandatory. When treating patients with a complaint of long-standing pain around the medial malleolus, we must bear in mind the possible diagnosis of recurrent dislocation of the tibialis posterior tendon. If the patient can voluntarily dislocate the tendon by active plantar flexion and inversion of the ankle, the diagnosis is definitive. Received: 1 April 1997     

Rupture of the tibialis posterior tendon in a closed ankle fracture: a case report

Rupture of the tibialis posterior tendon may occur during a trauma in pronation-external rotation of the foot or, less commonly, during a direct trauma of the ankle. When an isolated fracture of the medial malleolus is present, it is more likely that a direct trauma has occurred. A 36-year-old man with a non-displaced medial malleolar fracture was evaluated. Repair of the tendon and reduction of the fracture were performed. Twenty-four months after the operation, the fracture was completely healed, the patient was asymptomatic, he had a normal ankle range of motion, and the function and strength of the tibialis posterior tendon were equal to those on the contralateral side. Early surgical repair of the tibialis posterior tendon combined with malleolar fracture reduction is recommended to avoid progression to a plano-valgus foot.     

Surgical treatment of tibialis anterior tendon rupture

BackgroundRuptures of the anterior tibial tendon can be both acute and chronic. The acute lesion can be caused by a sharp cutting trauma or by blunt or hyperplantarflexion trauma.Spontaneous ruptures are rare, and most ruptures are due to degenerative changes mainly affecting the distal avascular 5?30 mm of the tendon. Surgical repair is the preferred treatment for physically active patients.Overall, the literature shows that operative repair results in a very good outcome in most patients.This study compares the clinical outcome in patients with anterior tibial tendon rupture, treated with different surgical techniques.MethodsThis multicenter cohort study was conducted at four different Foot and Ankle specialized clinics. The study was approved by the local ethical committee. A total of 48 patients with surgically treated tibialis anterior rupture was included. The study protocol included the demographic and clinical data of each patient and the surgical treatment. The VAS-FA PROM was recorded pre- and postoperative in all patients. The mean follow-up were 30 (20.8–48.5) months.ResultsA significant difference was found in age between patients who stated “good” versus “fair” (p = 0.002) and “very good” versus “fair”, i.e. younger age for “fair” p = 0.036, thus showing that younger patients do worse than older patient after surgery when rating the results. However there was no significant difference for older versus younger age looking at the results “poor”, “fair, good and very good”.The group with chronic tendon ruptures had a significantly higher preoperative VAS-FA than the group sustaining non-traumatic rupture (p = 0.048). There was no significant linear relation between age, postoperative VAS-FA and VAS-FA improvement. Also, we did not find a significant linear relation between age and outcome. Please see Tables 2–4 for results.ConclusionThe tibialis anterior tendon rupture can be both acute and chronic. We could not identify any significant differences in clinical outcome or PROM between acute and delayed suture of the tibialis anterior tendon rupture.Level of Evidence: Level II. Prospective controlled cohort study.