J Korean Foot Ankle Soc.  2017 Jun;21(2):70-74. 10.14193/jkfas.2017.21.2.70.

A Irreducible Ankle Fracture and Dislocation Due to Injured Tibialis Posterior Tendon Interposition: A Case Report

Affiliations
  • 1Department of Orthopaedic Surgery, Chosun University School of Medicine, Gwangju, Korea. leejy88@chosun.ac.kr

Abstract

Fractures and fracture-dislocations of the ankle are caused by a variety of mechanisms. In addition to fractures, injuries of soft tissue, such as ligaments, tendons, nerves, and muscles may also occur. Among these, a tibialis posterior tendon injury is difficult to be identified due to swelling and pain at the fracture site. It is difficult to observe tibialis posterior tendon injury on a simple radiograph; it is usually found during surgery by accident. There are some studies regarding irreducible ankle fracture-dislocations due to interposition of the tibialis posterior tendon; however, to the best of our knowledge, there has not been any report about interposition of injured tibialis posterior tendon. Herein, we report a case of an irreducible fracture-dislocation of the ankle due to injured tibialis posterior tendon interposition that was observed intraoperatively, interrupting the reduction of ankle fracture-dislocation. We obtained satisfactory clinical result after reduction of the trapped tendon, fracture reduction, and internal fixation; therefore, we are willing to report this case with the consent of the patient. This study was conducted with an approval from the local Institutional Ethics Review Board.

Keyword

Ankle; Fracture and dislocation; Tibialis posterior tendon

MeSH Terms

Ankle Fractures*
Ankle*
Dislocations*
Ethics, Institutional
Humans
Ligaments
Muscles
Tendon Injuries
Tendons*

Figure

  • Figure 1. Preoperative radiographs showed AO-OTA (Arbeitsgemein-schaft für osteosynthesefragen-Orthopedic Trauma Association) type 44-B2, ankle fracture. Lateral subluxation of talus and widening of syndemosis were observed. (A) Mortise view. (B) Lateral view.

  • Figure 2. Irreducible ankle fracture and dislocation after manual reduction. (A) Mortise view. (B) Lateral view.

  • Figure 3. Intraoperative fluoroscopic image showed that the reduction was satisfactory and ankle joint congruency was well maintained.

  • Figure 4. Intraoperative fluoroscopic image showed that the reduction of medial malleolar fracture was not satisfactory and ankle mortise was not maintained.

  • Figure 6. Three-dimensional reconstruction images of operative findings. Tibialis posterior tendon (arrows) was passing by posterior surface of talus between the distal tibia and fibula and from lateral to medial.

  • Figure 5. Ankle joint findings during operation. (A) Tibialis posterior tendon was found at intra-articular space of ankle. (B) Anatomical reduction was inhibited by interposition of tibialis posterior tendon. (C) Partially ruptured tibialis posterior tendon was observed.

  • Figure 7. Postoperative radiographs after operation showed well, satisfactory reduction. (A) Mortise view. (B) Lateral view.

  • Figure 8. Postoperative radiographs after removal of syndesmosis screw. (A) Mortise view. (B) Lateral view.

  • Figure 9. The simple radiograph showed the complete bone union. (A) Mortise view. (B) Lateral view.

  • Figure 10. Postoperative radiographs after removal of implant. (A) Mortise view. (B) Lateral view.

  • Figure 11. The magnetic resonance imaging showed the interposition of tibialis posterior tendon in ankle joint (arrows). (A) Axial view. (B) Coronal view.


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