Incidence and clinical results of tendinous injuries in calcaneus and pilon fractures

Sousa, Arnaldo; Carvalho, João; Amorim, Joana; Rodrigues-Pinto, Ricardo

doi:10.1007/s00402-022-04343-2

Cited by 4 publications

(9 citation statements)

References 18 publications

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“…However, they did not investigate the outcomes, revision surgeries, or definitive management. 14 , 15 …”

Section: Resultsmentioning

confidence: 99%

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Syziu,

Aamir,

Mason

2024

Bone Jt Open

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AimsPosterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis.MethodsThe inclusion criteria applied in PubMed, Scopus, and Medline database searches were: all adult studies published between 2012 and 2022; and studies written in English. Outcome of TP entrapment in patients with ankle injuries was assessed by two reviewers independently.ResultsFour retrospective studies and eight case reports were accepted in this systematic review. Collectively there were 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 trimalleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fractures at initial presentation. The diagnosis of TP entrapment was made in the early period in two (25%) cases, and delayed diagnosis in six (75%) cases reported. Using modified Clavien-Dindo complication classification, 60 (67%) of the injuries reported grade IIIa complications and 29 (33%) grade IIIb complications.ConclusionTP tendon was the commonest tendon injury associated with pilon fracture and, to a lesser extent, trimalleolar ankle fracture. Early identification using a clinical suspicion and CT imaging could lead to early management of TP entrapment in these injuries, which could lead to better patient outcomes and reduced morbidity.Cite this article: Bone Jt Open 2024;5(3):252–259.

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“…However, they did not investigate the outcomes, revision surgeries, or definitive management. 14 , 15 …”

Section: Resultsmentioning

confidence: 99%

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Syziu,

Aamir,

Mason

2024

Bone Jt Open

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“…7 Although this injury mainly happens during sports activities such as skiing and soccer, it occasionally occurs in neurologic paralytic disorders like poliomyelitis 4 or ankle and hindfoot fractures. 19,22 PTI may be misdiagnosed in about 40% of cases referred for acute trauma. 4,7,19 In the present study, we found an overall prevalence of PTI of 16.7% in association with 400 operatively treated calcaneal fractures, which lies at the lower end of the previously reported range of 11.6% to 29.3%, [8][9][10]13,20,28 most likely because many of these studies relied on CT-based analysis that tends to overread the prevalence of true mechanical instability.…”

Section: Discussionmentioning

confidence: 99%

“…19,22 PTI may be misdiagnosed in about 40% of cases referred for acute trauma. 4,7,19 In the present study, we found an overall prevalence of PTI of 16.7% in association with 400 operatively treated calcaneal fractures, which lies at the lower end of the previously reported range of 11.6% to 29.3%, [8][9][10]13,20,28 most likely because many of these studies relied on CT-based analysis that tends to overread the prevalence of true mechanical instability. 8 Although Kwaadu et al, 9 by reviewing 97 calcaneal fractures, found a Sanders type II fracture in 11 of 13 PTIs accompanying these injuries, others speculated that the rate of PTI would be increasing with an increasing severity of the calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

“…1,14,15 The overall reported prevalence of PTI in calcaneal fractures varies considerably from 11.6% to 29.3%. [8][9][10]13,19,20,28 A 40% rate of peroneal tendon dislocation in calcaneal fractures has been reported when using volume-rendered computed tomography (CT) imaging. 12 Most previous studies rely on preoperative CT findings that may overestimate the true prevalence of mechanical instability, which can only be assessed intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures

Vosoughi,

Afaridi,

Solooki

et al. 2023

Foot Ankle Int.

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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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“…In addition to soft tissue issues, achieving anatomic reduction and fixation of the articular surface is still the key to treatment. Some studies have shown that the quality of fracture reduction may be significantly correlated with long-term functional prognosis [ 26 , 27 ]. The present study determined that fibular fixation was pivotal in treating pilon fractures, particularly those with severe metaphyseal comminution and joint involvement.…”

Section: Discussionmentioning

confidence: 99%

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures

Gao

Zhu

Guo

et al. 2023

JPM

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Staged treatment for pilon fractures is widely accepted. It remains to be discussed how to reduce and fix posterior column fractures while avoiding clinical complications. We provided a staged treatment protocol with detailed surgical techniques for closed AO Foundation/Orthopaedic Trauma Association (AO/OTA) C3 tibial pilon fractures with fibular fractures. In the first stage, the internal fixation of the fibula and distal tibial posterior column is accompanied by an external fixator. After swelling, the medial and anterior columns were fixed via the posteromedial approach in the second stage. We advocate early reduction and fixation of the posterior column and lateral column. The right timing of surgery can ensure well-reduced articular surface and alignment while minimizing soft tissue complications.

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Incidence and clinical results of tendinous injuries in calcaneus and pilon fractures

Cited by 4 publications

References 18 publications

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures

Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures

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