Rupture of the posterior tibial tendon associated with fractures of the ankle. A report of two cases.

Zwart, D.; Davidson, Jeff

doi:10.2106/00004623-198365020-00017

Cited by 34 publications

(22 citation statements)

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“…In the literature, few ruptures of the tibialis posterior tendon in association with ankle fractures have been reported [2][3][4][5][6][7][8][9]11]. Most papers report a trauma in abduction, eversion and extension of the foot, overcoming the strength of the tibialis posterior tendon fibres.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 99%

“…Fracture of the medial malleolus can also occur during a direct trauma of the ankle. Involvement of the tibialis posterior tendon, consisting of its displacement [2] or less frequently of its rupture [3][4][5][6][7][8][9], is very uncommon in association with an ankle fracture and has been reported only a few times in the literature.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…The associated soft tissue and occasionally neurovascular injuries underscore the violent forces that are responsible for the fracture. 1,2,6,7,11 Interestingly, there was no associated fibular fracture and the syndesmosis appeared intact on stress views when imaged intraoperatively. However, the possibility of subtle ligamentous injuries on the lateral column cannot be totally ruled out.…”

Section: Displacement Of the Tendon And Increases The Risk Of Interpomentioning

confidence: 95%

“…However, a high index of suspicion should be maintained; otherwise the injury could be easily missed. 2,4 Severe soft tissue swelling on the medial side of the ankle, difficult or failed reduction of the fracture should raise the suspicion of an underlying medial soft tissue injury demanding exploration. Primary surgical repair produces good functional outcomes and is the treatment of choice.…”

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confidence: 99%

Tibialis posterior tendon injury associated with a closed medial malleolus fracture—a case report

Madhusudhan

Rangan

2006

Injury Extra

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A 25-year-old healthy male solicitor was involved in a road traffic accident, being knocked off his motorbike by a car. He presented with an abrasion over the medial aspect of the right ankle and swelling of his right foot. The ankle was diffusely tender on the medial aspect and passive ankle movements were restricted and painful. There was no distal neurological deficit and posterior tibial and dorsalis pedis pulsations were palpable. Survey for associated skeletal injuries was negative.X-ray of the right ankle revealed a fracture of the medial malleolus with wide displacement of the fragments. The fibula and syndesmosis were intact ( Fig. 1).Urgent surgery was carried out for the medial malleolar fracture. The fracture was exposed through a medial longitudinal incision and the fragments were found to be widely displaced. The tibialis posterior tendon was found to be lacerated about 2 cm proximal to the fracture site and the distal stump was found interposed in the fracture site. The tendon appeared healthy otherwise. The incision was placed anterior in order to avoid the abrasion and had to be extended to retrieve the proximal end of the severed tendon. The frayed tendon edges were freshened and repaired after fixation of the medial malleolar fracture with two partially threaded cancellous screws. The screws were positioned a little anterior in order to protect the repair. The deltoid ligament was found to be intact and there was no osteochondral injury noted in the ankle joint on exploration. The ankle and foot were immobilised in a resting plaster for four weeks postoperatively, followed by progressive weight bearing as tolerated.Radiological union of the fracture had occurred by 14 weeks and return to full activities of daily living was possible by 6 months. At the time of last review 30 months following surgery, the foot arches were well maintained and he had achieved a full range of active ankle and foot movements, although the terminal 108 of inversion and eversion were associated with some discomfort (Fig. 2). DiscussionThe tibialis posterior tendon lies close to the medial malleolus and beneath the flexor retinaculum, which binds the tendon to the bone. This location of the tendon precludes it from direct laceration. 8 The anatomic arrangement at the ankle prevents

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“…Acute rupture of the PTT associated with closed fracture of the ankle has been reported previously (Table 1). 1,4,10,[13][14][15] This is the 10th report of a PTT rupture associated with ankle fracture and is unique in that the fracture was open and the rupture occurred at the fracture edge, probably as a combination of stretch and laceration rather than direct external wounding. This case, however, demonstrated factors common to the previous reported closed injuries and illustrates the difficulties in preoperative diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Acute Disruption of the Posterior Tibial Tendon Associated with Open-Fracture Dislocation of the Ankle

Bos

Lusskin

1997

Foot Ankle Int.

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A 27-year-old man with a high-energy, open-fracture dislocation of the ankle underwent debridement and open reduction of his injuries. During surgery a disruption-laceration of the posterior tibial tendon at the level of the fracture of the medial malleolus was found. Repair required location of the proximal muscle and tendon and controlled traction of the musculotendinous unit from its retracted position. Common aspects in the nine previously reported instances of this lesion include relatively high energy of the injury and the fracture type, a transverse fracture in the medial malleolus. Unique to this case was the open injury.

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Rupture of the posterior tibial tendon associated with fractures of the ankle. A report of two cases.

Cited by 34 publications

References 0 publications

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

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

Tibialis posterior tendon injury associated with a closed medial malleolus fracture—a case report

Acute Disruption of the Posterior Tibial Tendon Associated with Open-Fracture Dislocation of the Ankle

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