Irreducible Tibial Pilon Fracture Secondary to Posterior Tibial Tendon Entrapment: A Case Report.

Abstract

The term pilon fracture was coined in 1911 after a description of this type of injury was published by the French radiologist Destot1. The complication rate from this fracture is high, ranging from 30% to 70%, and includes infection, wound breakdown, chronic ankle pain, and poor patient satisfaction2-6. At our institution, a recent patient with a pilon fracture had the posterior tibial tendon (PTT) trapped within the fracture site, lateral to the central axis of the tibial shaft, preventing reduction and leading to persistent deformity and soft-tissue complications. To the best of our knowledge, this is the first case report in the literature of a PTT that prevented reduction in this manner. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-nine-year-old man with a “closed but irreducible pilon fracture” was transferred to our hospital from a community center. At the time of presentation, the injury was sixteen days old. An external fixator was in place and intact. There was a 1 × 1-cm region of stage-2 skin breakdown caused by pressure necrosis from a splint near the medial malleolus. Imaging demonstrated a tibial pilon fracture as well as medial and lateral malleoli fractures and a lateral tibiotalar dislocation (Figs. 1-A and 1-B). The patient was brought to the operating room for open reduction and internal fixation. Fig. 1-A Anteroposterior radiograph sixteen …