Posterior tibial tendon entrapment after fracture dislocation of the ankle

Abstract

In rare cases of ankle fracture dislocation, the posterior tibial muscle tendon can be incarcerated in the tibio-fibular space impeding reduction. We report two cases, a 58-year-old male and a 64-year-old female who sustained a right ankle fracture-dislocation. The patients were submitted to open reduction and internal fixation. In the first case the diagnosis was made during pre-operative planning and suspected according to the fracture pattern. Arthroscopic identification and reduction of the posterior tibial tendon entrapment on the tibio-fibular space was achieved during the first surgery. In the second case, after initial fixation, post-operative radiographs showed a lateral malleolus fixation failure with a bent plate and incomplete reduction of the ankle tibio-fibular space. During revision surgery, during the arthroscopic examination, the tibialis posterior tendon was visualized between the tibia and fibula. The tendon was manipulated into its anatomical position behind the medial malleolus from a medial incision. Two years after surgery, the patient was submitted to arthroscopic ankle arthrodesis due to symptomatic ankle osteoarthritis changes. These cases show that unsatisfactory reduction of an ankle fracture may occur due tibialis posterior interposition, and that successful outcomes depends on early recognition.