The Unexpected With Ankle Fracture: Traumatic Tibialis Posterior Tendon Dislocation

Abstract

Traumatic dislocation of tibialis posterior is infrequently reported in the literature. It is rare but potential cause of persistent pain that can be easily missed. Concomitant ankle fracture may obscure the clinical picture and if unsuspected, consequences such as iatrogenic injury to tibialis posterior tendon while fixing the medial malleolus may occur. We report our experience in the management of a tibialis posterior tendon dislocation associated with ankle fracture. A review of all English literature had been carried with a focus on treatment options.

Irreducible Ankle Fracture Dislocation Due to Tibialis Posterior Tendon Interposition: A Case Report

“…(A and B) Postoperative radiographs displaying excellent triplane correction and restoration of the normal anatomic alignment. (6) reported tibialis posterior tendon interposition with an associated ankle fracture after a high-velocity injury sustained in a motor vehicle accident. Posterior tibialis dislocation was suspected by the clinical diagnosis preoperatively, primarily because of a finding of localized swelling with a palpable mass anterior to the medial malleolus.…”

Early surgical management of traumatic dislocation of the tibialis posterior tendon: a case report and review of the literature

“…Upon a patient’s initial visit, a dislocated tibialis posterior tendon is often impalpable owing to marked swelling. Therefore, tibialis posterior tendon dislocation tends to be misdiagnosed as a deltoid ligament injury of the ankle [3–5]; thus, its correct diagnosis will still take several months [6, 7]. Traumatic tibialis posterior tendon dislocation is caused by (a) plantar flexion and inversion, (b) falling while the foot is in varus, (c) repeated forced inversion, or (d) twisting injuries and motor vehicle accidents [7, 8].…”

“…Standard radiographs are necessary to rule out associated bone fractures. An internal rotation view is useful to detect a cortical avulsion at the insertion of the retinaculum [5, 6]. Computed tomography (CT) can also be helpful in detecting hypoplasia of the retromalleolar groove [4].…”

“…[10] described seven patients who had to undergo surgical treatment after a failed conservative treatment with casting, brace immobilization, and physical therapy. Surgical treatment should be considered even in an acute phase, because chronic dysfunction may cause potential complications, such as chronic pain, rupture of the tibialis posterior tendon, recurrent dislocation, and valgus deformity of the ankle [6]. …”

Closed Fracture of the Medial Malleolus Accompanied by A Rupture of the Tibialis Anterior Tendon: An Unusual Case Report

“…Isolated medial malleolus fractures comprise two-thirds of all ankle fractures (4) and are rarely accompanied by tendon ruptures. Medial malleolus fractures accompanied by a posterior tibial tendon rupture and dislocation have been reported (5,6), however, a medial malleolus fracture accompanied by an anterior tibial tendon rupture is unusual, and has not yet been reported. In this paper, a medial malleolus fracture accompanied by a tibialis anterior tendon rupture is presented and discussed.…”