Trapping of the Posterior Tibial Tendon and Interposition of Soft Tissue in Severe Fractures About the Ankle Joint

Coonrad, Ralph W.; Bugg, Everett I.

doi:10.2106/00004623-195436040-00005

Cited by 51 publications

(18 citation statements)

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“…The OTA/AO classification showed 26 fractures (65%) as 43-C3 injuries, 12 fractures (30%) as 43-C2, and 2 fractures (5%) as 43-C1 injuries. The Injury Severity Score for this cohort of patients averaged 15 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). 32% of the patients were considered multiply injured with an Injury Severity Score .17.…”

Section: Resultsmentioning

confidence: 99%

“…[19][20][21] The flexor digitorum longus tendon and the posteromedial neurovascular bundle have also been documented to impede reduction in complex ankle injuries. [22][23][24] Through our retrospective review of a large series of patients who sustained a pilon fracture, nearly 10% of the patients had posteromedial soft tissue structure interposition within the posteromedial fracture site. The tibialis posterior tendon was the most commonly interposed structure in our series, but any or even multiple posteromedial structures may be entrapped in one fracture.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Entrapped Posteromedial Structures in Pilon Fractures

Eastman

Firoozabadi

Benirschke

et al. 2014

Journal of Orthopaedic Trauma

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Entrapped Posteromedial Structures in Pilon Fractures

Eastman

Firoozabadi

Benirschke

et al. 2014

Journal of Orthopaedic Trauma

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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%

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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“…A 3 cm incision above the medial malleolus was made and a low profile anatomically pre-contoured 3.5/4.5 mm locking compression plate (LCP; Synthes®, Oberdorf, Switzerland) was subcutaneously inserted in a retro- ated with fracture reduction difficulties, non-operative treatment failure, injury to the incarcerated structure and compromised bone union [1,2,[9][10][11][15][16][17][18][19][20][21]. Experimental studies show that muscle interposition in an animal fracture model prevents callus formation by creating a gap at the fracture site and is a predictable way to obtain intentional non-union [1,2,20,21].…”

Section: Surgical Techniquementioning

confidence: 99%

Fixation of a Distal Diaphyseal Tibia Fracture with Neurovascular Tissue Incarceration: Surgical Technique Using a Lesser Invasive Approach

Belaieff¹

2017

Trauma Cases Rev

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Soft tissue incarceration in a distal diaphyseal tibia fracture may predispose to adverse fracture healing. Incarcerated soft tissue may include nerves and/or vessels, with the potential for neurovascular complications. Meticulous neurovascular examination of the extremity is mandatory, and, when in doubt, Doppler ultrasound of the fracture area should be obtained, in addition to computed tomography angiography if neurovascular structures are involved. In order to address this situation, a surgical technique combining the advantages of minimally invasive plate osteosynthesis and limited fracture line exposition is described, exemplified with the case of a 65 y/o male who sustained a low-energy right closed distal diaphyseal tibio-peroneal fracture (AO/ OTA type 42-B2) with anterior tibial artery and deep peroneal nerve entrapment.

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Trapping of the Posterior Tibial Tendon and Interposition of Soft Tissue in Severe Fractures About the Ankle Joint

Cited by 51 publications

References 0 publications

Entrapped Posteromedial Structures in Pilon Fractures

Entrapped Posteromedial Structures in Pilon Fractures

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

Fixation of a Distal Diaphyseal Tibia Fracture with Neurovascular Tissue Incarceration: Surgical Technique Using a Lesser Invasive Approach

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