Bernstein Derek T, Harris Joshua D, Cosculluela Pedro E, Varner Kevin E
Orthopedics. 2016 Sep 1;39(5):e970-5. doi: 10.3928/01477447-20160526-04. Epub 2016 Jun 1.
Tibialis posterior tendon rupture in the setting of pronation-type ankle fractures can lead to long-term debility as a result of chronic tendon dysfunction. This rare injury pattern presents a diagnostic challenge because thorough preoperative examination of the function of the tendon is limited by pain, swelling, and inherent instability of the fracture. As such, a high index of suspicion is necessary in ankle fractures with radiographs showing a medial malleolus fracture with an associated suprasyndesmotic fibula fracture. This report describes 3 cases of tibialis posterior tendon rupture associated with pronation-type ankle fractures treated acutely with open reduction and internal fixation and primary tendon repair. Additionally, common features of this injury pattern are discussed based on the current literature. In accordance with this report, the typical mechanism of injury is high energy and includes forced pronation, external rotation, and dorsiflexion of the ankle, which places maximal stress on the tibialis posterior tendon. Rupture most commonly occurs in a relatively hypovascular area of the tendon located at the posteromedial extent of the medial malleolus fracture. In the operative treatment of pronation-type ankle fractures, direct inspection of the tibialis posterior tendon allows for timely diagnosis and treatment of associated ruptures. [Orthopedics.2016; 39(5):e970-e975.].
旋前型踝关节骨折合并胫后肌腱断裂可因慢性肌腱功能障碍导致长期功能障碍。这种罕见的损伤模式带来了诊断挑战，因为术前对肌腱功能的全面检查受到疼痛、肿胀和骨折固有不稳定性的限制。因此，对于X线片显示内踝骨折合并腓骨联合上骨折的踝关节骨折，必须保持高度怀疑。本报告描述了3例旋前型踝关节骨折合并胫后肌腱断裂的病例，这些病例均接受了切开复位内固定和一期肌腱修复的急性治疗。此外，根据当前文献讨论了这种损伤模式的共同特征。根据本报告，典型的损伤机制为高能量损伤，包括踝关节的强迫旋前、外旋和背屈，这会使胫后肌腱承受最大应力。断裂最常发生在位于内踝骨折后内侧范围的肌腱相对血供不足的区域。在旋前型踝关节骨折的手术治疗中，直接检查胫后肌腱有助于及时诊断和治疗相关断裂。[《骨科》.2016; 39(5):e970-e975.]
