Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography.

Abstract

The purpose of this study was to assess the incidence of tendon entrapments and tendon dislocations associated with ankle and hindfoot fractures in patients studied by multidetector computed tomography (MDCT). Additionally, we describe particular tendon injuries associated with specific fractures. This was a retrospective review of all individuals with a trauma-protocol CT for suspected ankle and/or hindfoot fractures during a consecutive 41-month time period at a single Level I Trauma Center. Each patient's images were evaluated by two radiologists and an orthopedic surgeon for tendon entrapment, tendon dislocation, and bone(s) fractured or dislocated. There were 398 patients with ankle and/or hindfoot fractures that showed tendon entrapment or dislocation in 64 (16.1%) patients. There were 30 (46.9%) patients with 40 tendon entrapments, 31 (48.4%) patients with 59 tendon dislocations, and three (4.7%) patients with both tendon entrapment and dislocation. All patients with tendon entrapments were seen with either pilon fractures and/or a combination of posterior, medial, or lateral malleolar fractures. The most frequently entrapped tendon was the posterior tibialis tendon (PTT) in 27 patients (27/30, 90.0%). The peroneal tendons were the most frequently dislocated, representing 27 (87.1%) of patients with tendon dislocation; all resulted from a talar or calcaneal fracture or subluxation. This study demonstrates that tendon entrapments and tendon dislocations are commonly seen in complex fractures of the ankle and hindfoot. Pilon fractures were associated with the majority of tendon entrapments, whereas calcaneus fractures were associated with the majority of tendon dislocations.