Laceration of tibialis anterior tendon complicating a closed tibial fracture: a case report

Mind the Anterior Tibial Tendon in Oblique Distal Third Tibial Fractures with Anterior Inferior Proximal Spike: A Case Report

CASE

An oblique fracture of the distal third of the tibia, treated nonoperatively in a 14-year-old adolescent boy, did not unite because of ensnarement of the anterior tibial tendon (ATT) around an anterior inferior bony spike from the proximal tibial fragment. Computed tomography scan with 3-dimensional volume rendering aided in preoperative diagnosis. Surgical extraction of the tendon from within the fracture site and internal fixation led to successful union and full painless function.

CONCLUSION

Beware of possible ATT entrapment as a cause of irreducibility of oblique distal third tibial fractures with an anterior inferior bony spike of the proximal fragment.

Management of tibialis anterior tendon rupture: Recommendations based on the literature review

Tibialis anterior tendon (TAT) rupture is a rare injury that commonly diagnosed late due to mild clinical signs and symptoms. Management of TAT rupture is a topic without a clear consensus in the literature. This current concept review tries to shed some light on the data and treatment. Our extensive literature review identified 81 case reports and case series from 1905 to 2018. Several reported management techniques with their advantages and disadvantages were analyzed and our treatment recommendations are given based on current available evidences. LEVELS OF EVIDENCE: IV.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report

A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation. Revisiting the mechanism of injury it was evident that the jagged fracture ends ruptured the tibialis anterior tendon while she was hanging upside down on the strapping with the foot in forced equinus. This is the first case of such complication associated with a talar fracture and signifies the importance of tibialis anterior examination in such fractures.

Ipsilateral Rupture of Quadriceps Tendon with Distal Tibia Fracture: A Case Report and Review of the Literature

Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes.

Irreducible ankle fracture-dislocation due to tibialis anterior subluxation: a case report

Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the tibialis posterior tendon, deltoid ligament, or extensor digitorum longus tendon blocking the reduction. We report a case of irreducible ankle fracture-dislocation resulting from posteromedial subluxation of the tibialis anterior tendon around a medial malleolar fracture fragment. Ultimately, the ankle required open reduction of the incarcerated tendon to reduce the joint and proceed with internal fixation of the associated fracture. The patient's postoperative course was uncomplicated, and the tibialis anterior tendon was functioning at 10 months postoperatively, after which he did not return for follow-up examinations. To our knowledge, this is the first reported case of the tibialis anterior tendon blocking closed reduction of an ankle fracture-dislocation.

Tibialis anterior partial rupture mimicking muscle hernia: a rare case report

Rupture of tibialis anterior tendons is infrequently described in literature, and those described were around the ankle, either at the origin or in the tendon substance. To our known knowledge only very few cases of rupture of the tibialis anterior at musculotendinous junction were reported. We highlight the occurrence of rupture at the musculotendinous junction in tibialis anterior muscle after trauma, presenting as a soft tissue mass, the need to differentiate it from traumatic muscle hernia, mechanism of injury and its ultrasound and MRI findings.

Repair of lacerated anterior tibial tendon with acellular tissue graft augmentation

In the present case report, we describe the surgical repair of a complete laceration of the anterior tibial tendon using acellular human dermal tissue matrix. A 17-year-old, elite league hockey player was injured in the locker room when a teammate still clad in ice skates stepped on his bare left foot. After evaluation at a local emergency department, the patient presented to our office the next day for additional evaluation. It was determined that surgery would be performed using acellular tissue graft augmentation, followed by physical therapy. Within 7 weeks of the injury, the athlete returned to his original level of activity. At 3 years of follow-up, he was playing Division 1 hockey at the university level. We believe that augmentation of the tendon repair with the grafting material enhanced the tendon tensile strength and promoted ingrowth through vascular channels. This, combined with the patient's dedication to physical therapy, led to excellent recovery in less time than anticipated.

Closed tibial fracture associated with laceration of tibialis anterior tendon

Traumatic laceration of the tibialis anterior tendon is a rare finding. To the best of our knowledge, 4 such cases have been reported in the surgical literature, and 3 of these were missed upon initial clinical examination. We present the case of a 26-year-old male motorcyclist who sustained an acute laceration of the tibialis anterior tendon in association with closed fractures of the tibia and fibula. The laceration was initially not included in the diagnosis, because weak ankle dorsiflexion was attributed to antalgic guarding. The primary aim of this report is to emphasize the possibility of tibialis anterior tendon laceration in association with closed fracture of the tibia, and to encourage surgeons to maintain a high index of suspicion for this particular defect. Furthermore, we encourage surgeons to undertake a meticulous physical examination and, if warranted, obtain ancillary diagnostic images, such as magnetic resonance images, in order to accurately diagnose and determine the optimal course of treatment.