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Hu SY, Cao MM, Zhang YW, Shi L, Dai GC, Zhao YK, Xie T, Chen H, Rui YF. Dislocations deteriorate postoperative functional outcomes in supination-external rotation ankle fractures. Chin J Traumatol 2024:S1008-1275(24)00069-5. [PMID: 38937167 DOI: 10.1016/j.cjtee.2024.06.001] [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: 10/09/2023] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures. METHODS A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18-65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American orthopedic foot and ankle society score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. RESULTS During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, preoperative complications with diabetes, smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American orthopedic foot and ankle society score revealed no significant difference between dislocation and no-dislocation patients. CONCLUSION Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
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Affiliation(s)
- Sheng-Ye Hu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Mu-Min Cao
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yuan-Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Ya-Kuan Zhao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Tian Xie
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China; School of Medicine, Southeast University, Nanjing, 210009, China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
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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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Vosoughi AR, Afaridi E, Solooki S, Shayan Z, Rammelt S. Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures. Foot Ankle Int 2023; 44:825-833. [PMID: 37658714 DOI: 10.1177/10711007231175666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning. METHODS In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated. RESULTS In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%). CONCLUSION Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopaedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Afaridi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Solooki
- Bone and Joint Diseases Research Center, Department of Orthopaedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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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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Alamri WM, Aljeaan R, Almulhim AK, Saleh H. Traumatic Dislocation of Tibialis Posterior Tendon: A Case Report and Literature Review. Cureus 2020; 12:e10885. [PMID: 33178537 PMCID: PMC7652352 DOI: 10.7759/cureus.10885] [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] [Indexed: 12/02/2022] Open
Abstract
Traumatic dislocation of the tibialis posterior tendon is one of the significantly rare conditions that we might deal with in the emergency department. Approximately only 50 cases have been reported in the literature, and, usually, this condition is misdiagnosed as an ankle sprain in acute settings. It might be neglected in case of improper clinical examination and imaging techniques. We present a case of a 39-year-old patient diagnosed with traumatic dislocation of the tibialis posterior tendon as a result of twisting injury after falling from a 1-meter jump height while playing basketball; the patient was clinically diagnosed primarily as a case of simple ankle sprain in the emergency department and treated conservatively with cold compression. The patient was seen in the clinic after five days with the same complaint, which was medial ankle pain without any improvement. Proper examination and imaging techniques lead us to the accurate diagnoses. The patient was managed surgically and had an excellent outcome postoperatively with a full range of motion of the ankle joint and full weight-bearing without any complaint. Tibialis posterior dislocation should be one of the possible differential diagnoses while dealing with any ankle injury even with unremarkable X-rays. History and physical examination, if conducted correctly, are the keys to making an accurate diagnosis. Therefore, we recommend a proper history-taking and precise physical examination with a high index of suspicion for any possible diagnoses. Early surgical intervention for such cases is the preferable method of treatment to avoid further complications and promote early functional recovery.
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Affiliation(s)
| | - Razan Aljeaan
- Orthopedic Surgery, King Fahad Medical Military Complex, Dhahran, SAU
| | | | - Hosny Saleh
- Orthopedic Surgery, King Fahad Medical Military Complex, Dhahran, SAU
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