Irreducible Fracture Dislocation of the Ankle Caused by Tibialis Posterior Tendon Interposition

A patient with severe irreducible open fracture dislocation of the ankle was admitted to our emergency department. After wound irrigation and debridement, skeletal traction was applied to the calcaneus to minimize soft tissue injury and swelling. The patient was followed in traction for 1 week, after which reduction and fixation of the fibula was attempted but not achieved. We extended the incision distally, visualized the ankle, and located the tibialis posterior tendon between the distal tibia and fibula, thereby inhibiting the reduction. The tendon coursed into the tibiotalar joint anteriorly and pushed the talus anterolaterally. After manipulation of the tendon to its anatomically correct location, the ankle was easily reduced. The wound at the medial side was closed with a fasciocutaneous rotational flap. The ankle was then immobilized for 6 weeks postoperatively. The patient regained her full range of motion, and there were no problems with the tibialis posterior tendon, such as rupture or insufficiency. Isolated tibialis posterior tendon interposition between the distal tibiofibular and tibiotalar joints has rarely been reported, and can inhibit anatomical reduction of the fractured ankle.     

Talus Fracture of the Medial Tubercle of the Posterior Process: Interposition of the Flexor Hallucis Longus Tendon

Talus fracture of the medial tubercle of the posterior process is rare. This type of fracture can be easily missed, because it is difficult to identify on plain radiographs of the ankle. Oblique radiographs with external rotation, computed tomography, and magnetic resonance imaging (MRI) of the ankle are useful for making an accurate diagnosis. However, even with an early diagnosis, the treatment guidelines for talus fractures of the posterior medial tubercle have not yet been established. The flexor hallucis longus (FHL) tendon, which passes through the groove between the medial and lateral tubercles of the posterior process of the talus, can interpose between the fracture sites and interrupt fracture reduction. MRI might be the best imaging modality for the identification of the interposed FHL tendon. We report a case in which talus fracture of the posterior medial tubercle was treated by open reduction and internal fixation owing to an interposed FHL tendon that was confirmed by MRI. MRI is the recommended imaging study of choice for talus fractures of the posterior medial tubercle owing to the possibility of an interposed FHL tendon.     

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.     

Concomitant Talar Neck Fracture and Achilles Tendon Rupture

A 56-year-old man fell down 1 m from a ladder and sustained a forced dorsiflexion injury to his right ankle when his foot contacted a lower rung, which resulted in the rare combination of a Hawkins II fracture of the neck of the talus and a concomitant rupture of the Achilles tendon. Clinical examination and diagnostic imaging confirmed the injuries, and surgical fixation of the fracture and repair of the Achilles tendon were achieved by means of a posterior approach. Healing proceeded unremarkably, and, at 18 months postoperatively, the patient had regained full function despite a 5 degrees limitation of subtalar joint range of motion.     

Checkrein deformity--an unusual complication associated with a closed Salter-Harris Type II ankle fracture: a case report.

This article presents a case of tethering of the flexor hallucis longus (FHL) tendon (checkrein deformity) and rupture of the posterior tibialis tendon after a closed Salter-Harris Type II ankle fracture. Delayed repair was affected by tenolysis of the FHL and flexor digitorum longus tendons and tenodesis of the posterior tibialis to the flexor digitorum longus tendon. This case represents the first such report of concomitant entrapment of the FHL tendon and rupture of the posterior tibialis tendon after a closed ankle fracture.     

Tibialis Posterior Tendon Rupture Associated with a Closed Medial Malleolar Fracture: A Case Report and Review of the Literature

We report an acute rupture of a macroscopically normal tibialis posterior tendon in the setting of an acute closed ankle fracture. This injury is considered to be rare, although it is probably frequently overlooked preoperatively because of limitations of the clinical examination secondary to pain. The tibialis posterior tendon rupture was identified at the time of operative repair of the ankle fracture, and direct suture repair of the tendon was undertaken. After primary suture and osteosynthesis, the patient’s progress was favorable and a satisfactory outcome was achieved. A clear history of the mechanism of injury as well as a high index of suspicion should be maintained, because failure to repair rupture of the tibialis posterior tendon, in the presence of an ankle fracture, is likely to lead to long-term patient disability and a planovalgus foot.     

Acute rupture of the lateral ligaments of the ankle joint, diagnosis and surgical treatment.

A useful method for the diagnosis of acute rupture of the lateral ligament of the ankle joint is presented. Twenty-three patients with ruptures of the lateral ligament of the ankle joint were treated surgically with suture of the lateral ligaments of the ankle. Accurate preoperative diagnosis with stress films and arthrography under local anesthesia of the ankle joint is imperative. No instances of infection or other complications were observed. All patients achieved a normal range of ankle function within three to six months. Radiograhs of the injured ankle in the forced inversion position following operation showed full stability of the ankle joint. In our opinion, all ankle injuries should be examined roentgenographically with forced inversion of the foot. Tilting of the talus of at least 10 degrees must be followed by arthrography of the ankle joint under local anesthesia. If there is leakage of contrast material along the peroneal tendon sheaths and around the joint cavity, the lateral ligament of the ankle must be sutured immediately in order to regain stability of the ankle joint.     

Achilles tendon rupture. Occurrence with a closed ankle fracture

A 61-year-old man, involved in an automobile accident, sustained a complete Achilles tendon rupture with an ipsilateral, closed slightly displaced medial malleolus ankle fracture. The tendon rupture was not diagnosed before operation but was recognized at the time of open reduction of the ankle. This rare combination of injuries was apparently secondary to hyperdorsiflexion of the foot. The tendon rupture would have been missed had surgical treatment not been required. Unrecognized tendon ruptures associated with closed ankle fractures may be a cause of residual ankle-foot weakness, pain, loss of motion, or a combination thereof.     

A rare type of ankle fracture: Syndesmotic rupture combined with a high fibular fracture without medial injury

High fibular spiral fractures are usually caused by pronation-external rotation mechanism. The foot is in pronation and the talus externally rotates, causing a rupture of the medial ligaments or a fracture of the medial malleolus. With continued rotation the anterior and posterior tibiofibular ligament will rupture, and finally, the energy leaves the fibula by creating a spiral fracture from anterior superior to posterior inferior.In this article we demonstrate a type of ankle fracture with syndesmotic injury and high fibular spiral fractures without a medial component. This type of ankle fractures cannot be explained by the Lauge-Hansen classification, since it lacks injury on the medial side of the ankle, but it does have the fibular fracture pattern matching the pronation external rotation injury (anterior superior to posterior inferior fracture). We investigated the mechanism of this injury illustrated by 3 cases and postulate a theory explaining the biomechanics behind this type of injury.     

Peroneal Tendons Rupture in a Closed Talar Body Fracture: A Rare Injury

The combination of tendon and ligament ruptures with fracture of the talus is very rare. We demonstrate our experience in the acceptable management of a 34-year-old male referred with a closed comminuted fracture of the talar body after falling 7 meters. During the surgery, complete rupture of the peroneus brevis tendon, partial rupture of the peroneus longus tendon, and an avulsed superficial deltoid ligament from medial malleolus were found. Twelve months after open reduction and internal fixation of the talar body fracture and repair of the peroneal tendons and superficial deltoid ligament, the patient was satisfied, without any talar dome collapse, sclerosis, or arthritic changes. It is recommended to take care of possible tendon or ligament ruptures during fixation of talar fractures in cases of high-energy trauma.     

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.     

Acute Calcaneus Tendon Rupture Associated with Ipsilateral Malleolar Fracture: Case Report and Literature Review

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.     

Posterior tibial tendon rupture in pronation-external rotation ankle fractures

We have recently treated two patients with closed pronation-external rotation bimalleolar ankle fractures. During the surgical explorations, an avulsion type rupture of the posterior tibial tendon was observed. Open reduction and internal fixation of the fracture in conjunction with primary tendon repair has produced excellent clinical results. We wish to report these two cases of this uncommon injury. More important, we wish to point out the association of the tendon rupture in conjunction with a particular type of fracture pattern.     

Fracture of the ankle associated with rupture of the Achilles tendon: case report and review of the literature

SUMMARY: A thirty-five-year-old man fell two meters from a ladder and sustained a closed fracture of the medial malleolus with an ipsilateral complete Achilles tendon rupture. The Achilles tendon rupture was diagnosed by means of the patient's complaints and physical findings. The ankle fracture was diagnosed incidentally on routine radiographs. Such a combination of injuries has been reported infrequently in the literature, and striking similarities have been described in the mechanism of injury and fracture pattern. Remarkably, in three of four reports the combined injury was initially misdiagnosed.     

Gradual Reduction of Chronic Fracture Dislocation of the Ankle Using Ilizarov/Taylor Spatial Frame

With the advances in trauma care, chronic fracture dislocation of the ankle is not a condition commonly seen in modern clinical practice. When encountered, it can be difficult to preserve the ankle joint. We present a case of a 65-year-old female, with a chronic fracture dislocation of the ankle. The ankle joint was subluxated with posterior translation of the talus, displacement of the posterior malleolus fragment, and a distal fibula fracture. A minimally traumatic approach was devised to treat this complex fracture dislocation which included gradual reduction of the ankle with a Taylor spatial frame, followed by stabilization with internal fixation and removal of the frame. Bony union and restoration of the ankle joint congruency was achieved.     

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.     

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.     

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.     

Posterior Tibial Tendon Rupture Associated With Anterolateral Distal Tibial and Medial Malleolar Fracture and a Novel Pattern of Tibiofibular Syndesmotic Injury: A Case Report and Review of the Literature

A posterior tibial tendon (PTT) rupture associated with ankle fractures is a very rare condition. Ankle pronation and external rotation (PER) movement are the typical traumatic mechanism. This injury is frequently overlooked preoperatively. Early diagnosis and treatment are very important to prevent the serious consequences related to functional PTT insufficiency on biomechanics of the foot. Few cases have been described in the literature that highlight the relationship between PTT rupture and PER type ankle fracture with a medial malleolar fracture. We present a case of a complete PTT rupture in a closed atypical ankle fracture in which a medial malleolar fracture was associated with a very large fragment from the anterolateral distal tibia (Tillaux-Chaput fragment) and a concomitant avulsion fracture from the anteromedial portion of the fibula (Lefort-Wagstaffe fragment), with a novel pattern never described before.     

Fracture of the os peroneum with rupture of the peroneus longus tendon. A case report and review of the literature

Subcutaneous rupture of the peroneus longus tendon occurring through a fracture of the os peroneum sesamoid in the foot, confirmed at surgery, is a rare injury, possibly with only one previously reported case. In the present case, the patient fell from a curb with the foot and ankle in supination; to prevent the fall, the patient forcibly everted the foot and ankle. Differential diagnosis of the injury includes chronic ankle ligament sprains, avulsion of the bony insertion of the peroneus brevis tendon, peroneal tendon subluxation, trauma to a congenitally multipartite os peroneum, and calcific tendonitis of the peroneus longus tendon. Primary repair with surgical approximation of the fractured os peroneum was performed with a satisfactory outcome.