Fibular Nonunion and Equinovarus Deformity Secondary to Posterior Tibial Tendon Incarceration in the Syndesmosis: A Case Report After a Bimalleolar Fracture-Dislocation

Abstract

A 39-year-old woman sustained a grade II open bimalleolar fracture-dislocation of the left ankle. Six months after an ORIF of these fractures was performed, she presented with a nonunion of the distal fibula fracture and with a fixed hindfoot equinovarus and forefoot adduction deformity. At surgery for repair of the fibular nonunion, the posterior tibial tendon (PTT) was found to be entrapped in the posterior tibiotalar joint, with a portion of the tendon interposed between the tibia and the fibula in the area of the posterior syndesmosis. After extrication of the PTT, the hindfoot varus and forefoot adduction deformity were corrected. To our knowledge, this is the first case report in the English literature of a missed PTT syndesmotic entrapment that resulted in a fibular nonunion and in a fixed foot deformity after an open bimalleolar ankle fracture dislocation.

Posterior tibial tendon subluxation in trimalleolar ankle fracture

“…Numerous complications were evident upon follow-up, including findings such as fracture nonunion, forefoot and hindfoot deformity and claw toe secondary to ischemic contracture. 11,12 Comparatively, the present case did not exhibit complications likely as a result of timely characterization of injury and subsequent repair.…”

Hallux flexus deformity due to entrapment of the flexor hallucis longus tendon after an open fracture of the tibia and fibula

“…The pathology of the flexor hallucis longus tendon has been described in many clinical situations and many anatomic locations. This pathology includes: entrapment in the calcaneus [1] and ankle fractures [2, 3], acute traumatic tears [4], partial atraumatic tears in ballet dancers [5], triggering of the great toe due to entrapment of the tendon in the fibro‐osseous sheath behind the talus and below the sustentaculum talli [6, 7], but a review of the English‐language literature did not reveal any prior publications regarding entrapment related to fractures of the tibia. In our patient, the entrapment probably occurred as a result of scarring of the soft tissues which were damaged during the displacement of bone fragments in the open fractures.…”

Postoperative magnetic resonance imaging of the foot and ankle

“…Occasionally, the hardware will impinge on a regional tendon or nerve that can be identified with high‐resolution MRI. Alternatively, fracture reduction may fail due to the presence of interposed tendon or periosteum (33–42).…”