Osteonecrosis of the Distal Tibia after a Pronation External Rotation Ankle Fracture: Literature Review and Management

Osteonecrosis of distal tibia in open dislocation fractures of the ankle

“…Therefore Weber C ankle fracture has to be considered as a major risk factor in development of PON in patients suffering from ankle dislocation. Moreover, open fracture with soft tissue damage seems to be an important prognostic factor in the development of tibial PON [2,6]. An observation underlined within present study.…”

“…This is in consistency with the literature. Rajagopalan et al [6] and Chakravarty et al [4] described a subluxation of the ankle joint in the patients with PON. Assal et al [2] showed a tibiotalar dislocation within his group as well.…”

“…PON is associated with open and dislocation fractures of the ankle [1][2][3][4]6]. However, in a few cases PON has been seen after closed ankle fracture or isolated syndesmotic instabilities [2,5].…”

“…Some cases of severe tibiotalar joint destruction after open dislocation fractures of the ankle have been reported [1]. Within the majority of these cases a posttraumatic osteonecrosis (PON) of the distal tibial epiphysis leading to a progressive collapse and a loss of joint function was described [2][3][4][5][6]. Most patients ended up with an ankle arthrodesis.…”

“…Up to now the aetiology of the necrosis of the distal tibia in dislocated ankle fractures even after meticulous osteosynthesis remains unclear. Therefore evaluation of potential risk factors is requested, because early detection of the necrosis and subsequent therapeutic management seem to be important [6][7][8].…”