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Nguyen Van L, Nguyen Nang G. Ankle fracture-dislocation with the interposition of the tibialis posterior tendon in the ankle syndesmosis and tibiotalar joint - A case report and systematic literature review. Int J Surg Case Rep 2023; 110:108710. [PMID: 37625231 PMCID: PMC10470289 DOI: 10.1016/j.ijscr.2023.108710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE In rare cases of ankle fracture dislocation, PTT can be incarcerated in the ankle syndesmosis. We report a case of a patient who had a fracture-dislocation of the ankle with the interposition of PTT in the ankle syndesmosis and discuss a systematic review of injury mechanics, pathology, diagnosis, management, and outcomes of this injury. CASE PRESENTATION I reported a 43-year-old patient presented with an irreducible lateral displacement of the talus after ORIF of the malleolar ankle fractures and fixation of ankle syndesmosis. Subsequent open reduction and surgical management revealed an interposition of PTT in the syndesmosis 1- month post-operative. A systematic review was completed afterward with the following terms: "ankle fracture" OR "ankle dislocation" AND "tibialis posterior tendon interposition" OR "tibialis posterior tendon entrapment" OR "tibialis posterior tendon incarceration" on Medline, ScienceDirect, and Ovid for articles between 1970 and 2022. CLINICAL DISCUSSION 5 months postoperative, the patient reported no pain and became capable of walking without a steppage gait. The systematic review showed that the entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. It usually occurs in patients with pronation/eversion injury, Weber C ankle fracture with a valgus deformity and a syndesmosis diastasis. CONCLUSION The PTT entrapment usually occurs in patients with pronation/eversion injury, Weber C ankle fracture, a valgus deformity, a syndesmosis diastasis. The entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. The tibiofibular syndesmosis and retromalleolar groove should be explored intraoperatively with suspicion of irreducible ankle fracture-dislocations.
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Affiliation(s)
- Luong Nguyen Van
- Institute of Trauma and Orthopaedics, 108 Central Military Hospital, No. 01 Tran Hung Dao Street, Hanoi, Viet Nam.
| | - Gioi Nguyen Nang
- Institute of Trauma and Orthopaedics, 108 Central Military Hospital, No. 01 Tran Hung Dao Street, Hanoi, Viet Nam.
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Shon HC, Lim EJ, Yang JY. Irreducible Ankle Fracture Dislocation Because of Tibialis Posterior and Flexor Digitorum Longus Tendon Entrapment in the Interosseous Membrane: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00011. [PMID: 37478312 DOI: 10.2106/jbjs.cc.23.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
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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Affiliation(s)
- Hyun-Chul Shon
- Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, South Korea
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Hikichi T, Matsubara H, Kanu S, Watanabe K, Tsuchiya H. Equinus foot deformity and malunion of the medial malleolus caused by tibialis posterior tendon interposition following irreducible fracture dislocation of the ankle: A case report and literature review. Trauma Case Rep 2022; 38:100618. [PMID: 35141390 PMCID: PMC8816712 DOI: 10.1016/j.tcr.2022.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
We report a case of equinus foot deformity and malunion of the medial malleolus caused due to tibialis posterior tendon interposition following irreducible fracture-dislocation of the ankle. A 19-year-old female patient was referred to our hospital with the chief complaint of persistent ankle pain and restricted ankle dorsiflexion. Her medical history revealed a fracture-dislocation of the ankle in the left tibia at the age of 18 years. Open reduction and osteosynthesis were performed 3 days after injury. One year after the operation, ankle pain and restricted ankle dorsiflexion persisted. Computed tomography revealed malunion of the medial malleolus and an irregular groove in the interosseous space between the tibia and fibula. Magnetic resonance imaging revealed entrapment of the tibialis posterior tendon within the posterior talocrural joint and syndesmosis, preventing posterior translation of the talus back to its normal position and forcing the fibula to remain anteriorly displaced in the syndesmosis. We performed several procedures, including reduction of the tibialis posterior tendon interposition and dislocation of the talus, augmentation of the tibio-fibular ligament, and recession of the gastrocnemius. Finally, the patient achieved plantigrade stance and improvement in her Japanese Society for Surgery of the foot ankle/hindfoot scale from 42 to 82 points, after a 2-year follow-up. Anterior impingement caused the patient to experience severe osteoarthritis. Early reduction of the tibialis posterior tendon should have been achieved for this case. Age, fracture type, and severely restricted range of motion should raise suspicion of this adverse event. Level of Clinical Evidence: 4.
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Tschudi S, Wittauer M, Hirschmann A, Eckardt H. Avoiding pitfalls in ankle fracture-dislocations: A case report of a dislocated tibialis posterior tendon causing persistent ankle subluxation. Foot Ankle Surg 2021; 27:700-709. [PMID: 33011101 DOI: 10.1016/j.fas.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/28/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
Tibialis posterior tendon dislocation, a rare complication in ankle fracture-dislocations, can impede anatomical reduction of the ankle mortise. We report on a 59-year-old healthy male with an open fracture-dislocation of the right ankle. Despite multiple attempts under direct vision of the anterior syndesmosis, anatomical reduction of the ankle mortise was not possible. Soft tissue windows in a computed tomography (CT) scan revealed the dislocated tibialis posterior tendon to be the impeding structure. At the level of the fibula fracture the tendon passed through the interosseous membrane anterior to the distal tibia and was then incarcerated in the medial talocrural joint before returning to the flexor retinaculum and its insertion on the navicular bone. Understanding the trauma mechanism and the course of the dislocated tendon as well as correct interpretation of CT and magnetic resonance images of the ankle enable surgeons to early diagnose and correctly treat this condition.
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Affiliation(s)
- Samuel Tschudi
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Matthias Wittauer
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4051 Basel, Switzerland.
| | - Anna Hirschmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Henrik Eckardt
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; University of Basel, Petersplatz 1, 4051 Basel, Switzerland
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Heinecke M, Hofmann GO, Mendel T. Irreducible Ankle Fracture Due to Incarceration of the Long Flexor Tendons Together With the Neurovascular Bundle in the Tibial Fibular Interosseous Space: A Case Report and Short Literature Review. J Foot Ankle Surg 2021; 59:849-852. [PMID: 32345508 DOI: 10.1053/j.jfas.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 08/31/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Abstract
Ankle fracture dislocations with frustrating attempts at closed reduction are a rare traumatic entity. We present a case of an irreducible ankle fracture due to incarceration of all the flexor tendons including the neurovascular bundle in the tibial fibular interosseous space; to date, only one such case has been published in the literature. A computed tomography scan in both bone and soft tissue windows was necessary to clarify the structures that were inhibiting repositioning. The decisive step for surgical treatment was removal of the trapped structures from the tibial fibular interosseous space by a dorsomedial approach. The malleolar joint was then reconstructed anatomically. After 12 weeks, the patient was fully mobile without restrictions in his daily professional activities.
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Affiliation(s)
- Markus Heinecke
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany.
| | - Gunther O Hofmann
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany; Professor, Hospital for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Thomas Mendel
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany; Senior Physician, Hospital for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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Colomb E, Muscatelli S, Morash JG, Crawford EA, Holmes JR, Walton DM. 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. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211000297. [PMID: 35097438 PMCID: PMC8564945 DOI: 10.1177/24730114211000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Level of Evidence: Level IV, case series.
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Affiliation(s)
- Eric Colomb
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Stefano Muscatelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joel G. Morash
- Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eileen A. Crawford
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James R. Holmes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David M. Walton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Sato R, Tsuchida Y, Murakami H, Shirakawa T, Futamura K, Hasegawa M, Suzuki T, Tsuihiji K. Fracture dislocation of the ankle with posterior tibial tendon entrapment within the tibiofibular interosseous space: A case report. Trauma Case Rep 2019; 23:100235. [PMID: 31417954 PMCID: PMC6690664 DOI: 10.1016/j.tcr.2019.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 12/02/2022] Open
Abstract
In rare cases of ankle fracture dislocation, the posterior tibial muscle tendon (TP tendon) is incarcerated between the tibia and fibula, thereby impeding reduction. Here we describe a case that presented with such a condition, in which ankle reduction was achieved and surgical repair of the incarcerated TP was delayed. The subject was a 30-year-old male who sustained a fracture dislocation of the left ankle (AO:44-C1.3) in a motorbike accident. After repairing the ankle dislocation, external fixation was performed and osteosynthesis was conducted 10 days after the injury. Plate fixation for the fibula fracture and tight rope fixation for the separation between the tibia and fibula were performed; however, internal fixation for the medial malleolus fracture was delayed because the skin on the medial side of the ankle was in poor condition. One month after the injury, osteosynthesis of the medial malleolus was performed, and the TP tendon was identified in the fracture site. After removing the incarcerated tendon, good reduction of the medial malleolus was achieved, and thus, internal fixation and wound closure could be performed. Re-examination revealed that the TP tendon had an abnormal course. After 3 months, upon re-exposing the entire length of the TP tendon, the TP tendon was incarcerated between the tibia and fibula. To date, although several cases have been reported regarding TP tendon incarceration caused by fracture dislocation of the ankle, no study has reported the anatomical repair of the ankle, regardless of tendon incarceration. In our case, rotational displacement of the medial malleolus fracture remained when the second surgery was completed; however, the presence of some type of incarcerated tissue was suspected. Because leaving the incarcerated TP tendon untreated can cause irreversible long-term complications, early anatomical repair is recommended.
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Affiliation(s)
- Ryo Sato
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Hiroko Murakami
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Tetsuya Shirakawa
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Kentaro Futamura
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Masayuki Hasegawa
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Takafumi Suzuki
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
| | - Kanako Tsuihiji
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan
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8
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Irreducible ankle fracture dislocation due to posterior tibialis tendon interposition: Diagnostic and clues for early management – A case report. Trauma Case Rep 2019; 20:100175. [PMID: 30906840 PMCID: PMC6403444 DOI: 10.1016/j.tcr.2019.100175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/30/2022] Open
Abstract
Irreducible fracture dislocation of the ankle is a rare condition. Multiple cases have been described throughout the literature. Different known etiologies involve the distal fibula, deltoïd ligament and tendons of the posteromedial malleolar region. More specifically, trapping of the Posterior tibialis tendon has been described at several levels from the inside of the ankle joint, through the syndesmosis and in some cases in the fibula tibial interosseous space depending on the energy of trauma. We hereafter propose a case report and a review of previous cases of posterior tibialis tendon dislocation proximally in the interosseous space of the lower leg. The aim of this review is to point out common features and clues for early management in order to avoid overlooking these rare lesions as they may lead to major functional impairment of the ankle joint.
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9
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Karim A, So E, Taylor BC, Degenova D, Nace WC. Ankle Fracture Fixation: Medial or Lateral First? J Foot Ankle Surg 2019; 58:75-79. [PMID: 30448377 DOI: 10.1053/j.jfas.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 02/03/2023]
Abstract
In unstable ankle fractures, the importance of reducing the lateral malleolus first to obtain an anatomic reduction of the talus is well established. Although this is a time-tested and common surgical approach, current surgical practice does not always follow the established dogma. Medial-first fixation may be a worthwhile alternative to lateral-first fixation in select instances. We performed a retrospective, cohort study in an urban level I trauma center to compare medial malleolus-first fixation of unstable ankle fractures with lateral malleolus-first fixation. Patient demographics, injury characteristics, and radiographic metrics including pre-, intra-, and final postoperative talocrural angles, medial clear space, and tibiofibular overlap were assessed. Complications were also reviewed. A total of 280 adult patients with operative bimalleolar ankle fractures from January 2010 to January 2015 met inclusion criteria. There were more open fractures (23.2% vs 9.4%, p = .01) and less isolated injuries in the medial-first group (59.2% vs 71.0%, p = .02). There were less isolated operative procedures (80.3% vs 89.1%, p = .04) and more intramedullary screw placement of the lateral malleolus (11.2% vs 4.3% p = .02) in the medial-first fixation group. There was also a strong trend in identifying more posterior tibial tendon injuries in the medial-first group compared with the lateral-first group (3.5% vs 0%, p = .06). There were no significant differences in fluoroscopy times or radiographic variables in the preoperative, intraoperative, or most recent postoperative images between either group. This approach demonstrates equivalent radiographic outcomes to lateral-first fixation and may be appropriate in select cases.
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Affiliation(s)
- Ammar Karim
- Orthopaedic Trauma Surgeon, Department of Orthopedic Surgery, Doctors Hospital, Columbus, OH
| | - Eric So
- Podiatric Surgeon, Department of Orthopedic Surgery, Doctors Hospital, Columbus, OH
| | - Benjamin C Taylor
- Fellowship Director, Orthopaedic Trauma and Reconstructive Surgery, Department of Orthopedic Surgery, Grant Medical Center, Columbus, OH.
| | - Daniel Degenova
- Medical Student, Department of Orthopedic Surgery, Doctors Hospital, Columbus, OH
| | - William C Nace
- Medical Student, Department of Orthopedic Surgery, Doctors Hospital, Columbus, OH
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Bae BJY, Baker JF, Orec RJ, Hadlow AT. Open Ankle Dislocation Without Fractures With Tibialis Posterior Tendon Interposition Through the Interosseous Space. J Foot Ankle Surg 2018; 56:1109-1113. [PMID: 28558998 DOI: 10.1053/j.jfas.2017.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Indexed: 02/03/2023]
Abstract
Open ankle dislocations without fracture are rare injuries. Dislocation or interposition of adjacent tendons are a rare associated feature of ankle fracture-dislocation. We report an extremely unusual case of open ankle dislocation without fracture with concurrent tibialis posterior tendon interposition through the interosseous space that was detected incidentally on computed tomography. We highlight the clinical, radiologic, and intraoperative features to avoid missing similar diagnoses.
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Affiliation(s)
- Bryan J Y Bae
- Junior Registrar, Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand.
| | - Joseph F Baker
- Orthopaedic Surgeon, Department of Orthopaedics, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Orec
- Orthopaedic Surgeon, Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | - Alastair T Hadlow
- Orthopaedic Surgeon, Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
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Lavini F, Maluta T, Carpeggiani G, Dall'Oca C, Samaila E, Marconato G, Magnan B. A new approach to local DCO in ankle fracture dislocations: external fixation with diaphyseal unicortical screws applied by local anaesthesia. Musculoskelet Surg 2017; 101:229-235. [PMID: 28429173 DOI: 10.1007/s12306-017-0472-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Ankle fracture dislocations represent a great threat for soft tissue viability and articular instability. The use of a temporary ankle bridging ExFix plays a fundamental role in the local damage control orthopaedics while waiting for definitive synthesis. METHODS For this prospective research, we have developed a full application protocol of innovative diaphyseal monocortical screws fixator (Unyco-OrthofixTM) exclusively under local anaesthesia. Rigid selection criteria allowed us to collect nine patients during a period of almost 2 years. VAS score was analysed for the feasibility of the procedure, and a thorough radiologic evaluation was performed. RESULTS Results pointed out that the calcaneus pin insertion (VAS: 3.44) followed by the local anaesthetics injection (VAS: 3.22) was the most painful, without precluding to continue the procedure; fracture temporary stability was achieved in all the cases. CONCLUSIONS The procedure of monocortical diaphyseal application in bridging external fixation is comparable to the conventional transcalcaneal traction maintaining the advantage in terms of speediness, independence from anaesthetists and feasibility within few minutes from hospital admittance even in patients under anticoagulants therapy, but increasing the stability of the reduction and improving the quality of nursing (so-called portable traction).
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Affiliation(s)
- F Lavini
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
| | - T Maluta
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy.
| | - G Carpeggiani
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
| | - C Dall'Oca
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
| | - E Samaila
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
| | - G Marconato
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
| | - B Magnan
- Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy
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Stevens NM, Wasterlain AS, Konda SR. Case Report: Irreducible Ankle Fracture With Posterior Tibialis Tendon and Retinaculum, Deltoid Ligament, and Anteromedial Joint Capsule Entrapment. J Foot Ankle Surg 2017. [PMID: 28633798 DOI: 10.1053/j.jfas.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Irreducible ankle fractures are a relatively rare phenomenon. We present a case of a pronation abduction-type ankle fracture that was irreducible in the emergency room despite sedation. The patient was taken to the operating room, where the posterior tibialis tendon and retinaculum, deltoid ligament, and anteromedial capsule were found to be trapped within the joint. After removal of the tissue, alignment was restored. The patient did well clinically and was advanced to full weightbearing at 6 weeks. This is, to the best of our knowledge, the first report of entrapment of all 4 anatomic structures, preventing closed reduction.
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Affiliation(s)
- Nicole M Stevens
- Resident Physician, Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY; Resident Physician, Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY.
| | - Amy S Wasterlain
- Resident Physician, Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY; Resident Physician, Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
| | - Sanjit R Konda
- Assistant Professor, Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY; Assistant Professor, Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
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13
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Vosoughi AR, Glazebrook M. Interposition of Tibialis Posterior and Flexor Digitorum Longus Tendons Resulted in Irreducible Ankle Fracture-Dislocation. J Foot Ankle Surg 2017; 56:697-701. [PMID: 28476402 DOI: 10.1053/j.jfas.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 02/03/2023]
Abstract
Irreducible ankle fracture-dislocations are very rare entities. The present case report demonstrates an unusual finding of tibialis posterior and flexor digitorum longus tendons interposed in the tibiofibular joint impairing successful closed reduction of ankle fracture-dislocation. A 45-year-old patient presented with a bimalleolar pronation-external rotation ankle fracture-dislocation after a motorcycle accident. Attempts to perform closed reduction before surgery were unsuccessful. Subsequent urgent open reduction and internal fixation surgical management revealed interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint. In irreducible fracture-dislocation of the ankle with severe lateral displacement of the talus, one should be aware of the possibility of soft tissue interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint.
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Affiliation(s)
- Amir Reza Vosoughi
- Assistant Professor, Foot and Ankle Surgeon, Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mark Glazebrook
- Professor of Surgery, Orthopedic Foot & Ankle and Sports Medicine, Dalhousie University & Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
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14
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Lee C, Douglas TJ. Irreducible Ankle Fracture from an Interposed Chaput Fragment: A Case Report. JBJS Case Connect 2017; 7:e42. [PMID: 29244680 DOI: 10.2106/jbjs.cc.16.00176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 23-year-old active-duty military service member sustained an unusual irreducible fracture-dislocation of the ankle joint. Preoperative computed tomography showed an anterolateral tibial (Chaput) fragment entrapped within the distal syndesmosis, preventing adequate reduction. An open reduction of the fragment was performed in the operating room, which allowed near-anatomic reduction and internal fixation of the tibiotalar joint. At the 21-month follow-up visit, the patient remained on active duty in the Navy without limitations. CONCLUSION To our knowledge, this rare injury pattern, an interposed Chaput fragment preventing closed reduction of the syndesmosis in a skeletally mature patient, has not previously been described in the literature. An open reduction and internal fixation of the Chaput fragment allowed near-anatomic reduction of the tibiotalar joint.
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Affiliation(s)
- Chihua Lee
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
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