Irreducible Fractures and Dislocations of the Ankle Associated With Entrapment of the Posterior Tibial Tendon Within the Tibiofibular Interosseous Space: A Case Series and Literature Review

Colomb, Eric; Muscatelli, Stefano; Morash, Joel; Crawford, Eileen A.; Holmes, James R.; Walton, David M.

doi:10.1177/24730114211000297

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…PTT tendon displacement, interposition, and rupture are relatively well reported within the orthopaedic literature in the setting of traumatic ankle and hindfoot injuries [2][3][4][5][6][7] but remains less commonly highlighted in the literature regarding pilons fractures. 8,9 Although this lesion is relatively uncommon, its coincidence with pilon fracture is not insignificant.…”

Section: Discussionmentioning

confidence: 99%

Injury Pattern Recognition and Surgical Technique of Pilon Fracture Reduction With Posterior Tibial Tendon Incarceration

Labrum

Gallagher

Boyce

2023

Journal of Orthopaedic Trauma

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Pilon fractures occur over a broad spectrum of injury severity and soft-tissue compromise. This article will review a distinct pilon injury variant characterized by posterior tibial tendon incarceration in posteromedial pilon fracture propagation. This injury pattern is vital to recognize preoperatively because failure to mobilize the entrapped posterior tibial tendon (PTT) will result in fracture malreduction and postoperative loss of PTT excursion. In addition, the authors' preferred surgical technique for PTT mobilization and anatomic fracture reduction is described.

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Section: Discussionmentioning

confidence: 99%

Injury Pattern Recognition and Surgical Technique of Pilon Fracture Reduction With Posterior Tibial Tendon Incarceration

Labrum

Gallagher

Boyce

2023

Journal of Orthopaedic Trauma

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“…The TP tendon is often entrapped in the joint space or medial malleolus fragment [12][13][14] . Only 7 cases of the TP tendon entrapped in the interosseous membrane that interfered with reduction have been reported 4,[6][7][8][9][10][11] . All cases were high-energy injuries and presented with common features, including syndesmosis widening, Weber type C fractures, Lauge-Hansen pronation-external rotation-type fractures, and irreducible fractures using manual closed reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Bosworth fracture is a fracture in which the proximal fibular fragment is trapped behind the posterolateral tibial tubercle and interferes with reduction 3 . The deltoid ligament entrapped in the medial articular surface often interferes with reduction 4,5 . Some cases of tibialis posterior (TP) tendon entrapment in the ankle joint or tibiofibular interosseous membrane interference with reduction have been reported [4][5][6][7][8][9][10][11][12][13][14] .…”

mentioning

confidence: 99%

“…The deltoid ligament entrapped in the medial articular surface often interferes with reduction 4,5 . Some cases of tibialis posterior (TP) tendon entrapment in the ankle joint or tibiofibular interosseous membrane interference with reduction have been reported [4][5][6][7][8][9][10][11][12][13][14] . However, to our knowledge, no cases of TP and flexor digitorum longus (FDL) tendons entrapped in the interosseous membrane that interfere with reduction have been reported.…”

mentioning

confidence: 99%

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Irreducible Ankle Fracture Dislocation Because of Tibialis Posterior and Flexor Digitorum Longus Tendon Entrapment in the Interosseous Membrane

Shon

Lim

Yang

2023

JBJS Case Connector

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Case: We describe the case of a 63-year-old man with anterior ankle dislocation and fracture confirmed by x-ray. Postreduction x-ray and computed tomography (CT) revealed Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 44C3 and Lauge-Hansen pronation-external rotation–type ankle fractures. Conclusion: This was a rare case of ankle fracture dislocation because of entrapment of the tibialis posterior and flexor digitorum longus tendons in the interosseous membrane. Tendon entrapment should be suspected in cases of high-energy injuries, Weber type C fractures, Lauge-Hansen pronation-external rotation fractures, syndesmosis widening, and irreducible fractures using manual closed reduction. Fractures and soft tissues should be evaluated by changing the CT settings.

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“…A fracture-dislocation of the ankle is a rare injury produced by severe trauma that includes the bone and soft tissues surrounding the ankle or in any other combination [ 4 , 5 ]. Immediate closed reduction in ankle dislocation and temporary immobilization with an external fixator or bivalved cast to maintain stabilization post-reduction is a crucial step in the initial management of these severe injuries while awaiting definitive synthesis that involves open reduction and internal fixation as the procedure of choice [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

Hosin

Vermeşan

Prejbeanu

et al. 2022

JCM

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There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave.

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Irreducible Fractures and Dislocations of the Ankle Associated With Entrapment of the Posterior Tibial Tendon Within the Tibiofibular Interosseous Space: A Case Series and Literature Review

Abstract: Level of Evidence: Level IV, case series.

Cited by 5 publications

References 19 publications

Injury Pattern Recognition and Surgical Technique of Pilon Fracture Reduction With Posterior Tibial Tendon Incarceration

Injury Pattern Recognition and Surgical Technique of Pilon Fracture Reduction With Posterior Tibial Tendon Incarceration

Irreducible Ankle Fracture Dislocation Because of Tibialis Posterior and Flexor Digitorum Longus Tendon Entrapment in the Interosseous Membrane

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

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