Failure of Reduction for Ankle Fracture-Dislocation Caused by Tibialis Posterior Tendon Interposition: A Case Report

Dong-Jun Ha; Heui-Chul Gwak; Dong-Woo Jeong; Sang-Myung Roh

doi:10.14193/jkfas.2014.18.4.217

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Ha, Gwak, Jeong, and Roh: Failure of Reduction for Ankle Fracture-Dislocation Caused by Tibialis Posterior Tendon Interposition: A Case Report

Case Report

J Korean Foot Ankle Soc 2014;18(4):217-221.

Published online: 19 January 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.4.217

Failure of Reduction for Ankle Fracture-Dislocation Caused by Tibialis Posterior Tendon Interposition: A Case Report

Dong-Jun Ha^*, Heui-Chul Gwak, Dong-Woo Jeong, Sang-Myung Roh

Departments of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

^*Departments of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Maryknoll Medical Center, Busan, Korea

Corresponding Author: Heui-Chul Gwak Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6257, Fax: 82-51-892-6619, E-mail: ortho1@hanmail.net

Received 5 July 201431 October 2014 Accepted 31 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fracture and fracture-dislocation of the ankle may be caused by a variety of mechanisms. In addition to the fracture, injury of soft tissue such as ligaments, tendons, nerves, and muscles may occur. Among these, tibialis posterior tendon injury is difficult to identify due to swelling and pain at the fracture site. There is no clear finding in radiological examination, therefore, it is found during surgery. In this case, irreducible fracture-dislocation of the ankle due to tibialis posterior tendon interposition was observed after the primary operation. The authors obtained satisfactory results in performance of a secondary operation assisted with arthroscopy.

Keywords: Ankle fracture, Tibialis posterior tendon, Arthroscopy, Trauma

REFERENCES

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Figure 1.

Preoperative radiographs showed AO-OTA (Arbeitsgemeinschaft für osteosynthesefragen-Orthopedic Trauma Association) type C ankle fracture. Lateral subluxation of talus and widening of syn-demosis were observed. (A) Mortise view. (B) Lateral view.

Figure 2.

Postoperative radiographs after initial operation showed widening of syndesmosis. (A) Mortise view. (B) Lateral view.

Figure 3.

Three-dimensional computed tomography after initial operation showed widening of syndesmosis.

Figure 4.

Ankle arthroscopic findings during second operation. (A) Tibialis posterior tendon (TP) was found at intra-articular space of ankle. (B) Anatomical reduction was inhibited by interposition of tibialis posterior tendon.

Figure 5.

Schematic images of operative findings. Tibialis posterior tendon was passing from posterior to anterior between the distal tibia and fibula (A), and from lateral to medial across the anterior surface of talus (B).

Figure 6.

Postoperative radiographs after second operation. The syndesmosis and the tibiotalar joint seemed reduced. (A) Mortise view. (B) Lateral view.

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