Elmajee Mohammed, Rafee Asan, Williams Tolupe
Senior Registrar, Oldham General Hospital, Manchester, United Kingdom.
Senior Specialist Doctor, Department of Trauma and Orthopaedics, Salford Royal Hospital, Manchester, United Kingdom.
J Foot Ankle Surg. 2017 Nov-Dec;56(6):1320-1322. doi: 10.1053/j.jfas.2017.05.043.
Solitary ankle fracture or Achilles Tendon (AT) rupture might not be an uncommon injury. However, concomitant ipsilateral ankle fracture with AT rupture is rare. The present report discusses this rare combination. A 30-year-old female had fallen while rock climbing and sustained a closed fracture of the medial malleolus with an ipsilateral complete AT rupture. Most of the reported cases had similar patterns, not only in terms of history, but also in terms of a similar fracture pattern. This rare combination of orthopedic injuries tends to occur when an abrupt excessive force is applied to the forefoot, with subsequent ankle hyperextension or hindfoot inversion. Imaging studies are useful both for confirming the injuries and for medicolegal and research purposes. Definitive treatment of the AT rupture is usually surgical in young active patients. Concomitant malleolar fractures can be managed conservatively or surgically, depending on the fracture configuration and degree of displacement. The importance of a thorough clinical examination in assessing the musculoskeletal and neurovascular structures in ankle injuries cannot be overemphasized. Knowledge of these injury patterns is crucial to reducing the incidence of residual morbidity such as ankle and foot weakness and loss of motion.
孤立性踝关节骨折或跟腱断裂可能并非罕见损伤。然而,同侧踝关节骨折合并跟腱断裂则较为少见。本报告讨论了这种罕见的组合情况。一名30岁女性在攀岩时摔倒,导致内踝闭合性骨折并同侧跟腱完全断裂。大多数已报道的病例不仅在病史方面,而且在骨折模式上都有相似之处。这种罕见的骨科损伤组合往往在突然对前足施加过度力,随后踝关节过度伸展或后足内翻时发生。影像学检查对于确诊损伤以及法医学和研究目的都很有用。对于年轻活跃的患者,跟腱断裂的确定性治疗通常是手术治疗。合并的踝部骨折可根据骨折形态和移位程度进行保守或手术治疗。在评估踝关节损伤中的肌肉骨骼和神经血管结构时,全面临床检查的重要性再怎么强调也不为过。了解这些损伤模式对于降低诸如踝关节和足部无力以及活动丧失等残留发病率的发生率至关重要。