Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
School and Medicine, University of Liverpool, Liverpool, UK.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):781-787. doi: 10.1007/s00590-023-03714-8. Epub 2023 Sep 12.
The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late.
Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF).
A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major.
A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353).
In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.
胫骨后肌腱（TPT）是唯一遇到远端胫骨的肌腱，因此在远端胫骨骨折中受伤的风险最大。尽管 TPT 损伤在踝关节周围损伤中很少见，但它们经常被忽视并出现延迟。
我们的目的是分析涉及后胫骨的骨折中 TPT 嵌顿的发生率，即 Pilon（PLM）和后踝骨折（PMF）。
对 8 年来的 PMF 和 Pilon 骨折进行回顾性分析。使用我们前瞻性收集的数据库，从 2014 年至 2022 年确定接受 PMF 或 PLM 手术固定的患者。纳入所有接受术前 CT 的骨折。利用术前 CT 影像学分析来确定 TPT 嵌顿，如果 TPT 横截面积的<50%出现在骨折部位，则表示为轻度嵌顿，如果 TPT 横截面积的≥50%出现在骨折部位，则表示为重度嵌顿。
共确定 363 例患者进行进一步分析，其中 220 例为 PMF，143 例为 PLM 损伤。TPT 嵌顿的发生率为 22%（n=79），其中 64 例为轻度嵌顿，15 例为重度嵌顿。如果骨折线进入 TPT 鞘，嵌顿率为 45%（72/172），而骨折线不进入鞘的嵌顿率为 3.7%（7/190）（p<0.001）。PMF 和 PLM 之间 TPT 嵌顿率无显著差异（p=0.353）。
在我们的评估中，我们发现涉及后胫骨的骨折中 TPT 嵌顿的发生率高达 22%。PMF 和 PLF 之间 TPT 嵌顿率无统计学差异。此外，我们发现当 CT 图像显示骨折线进入肌腱鞘时，TPT 嵌顿的风险显著增加。我们建议外科医生在术前评估时注意评估影像学，以识别 TPT，并在出现嵌顿时进行术中评估。
