Syziu Anxhela, Aamir Junaid, Mason Lyndon William
Aintree University Hospital, Liverpool, UK.
University of Liverpool School of Medicine, Aintree University Hospital, Liverpool, UK.
Bone Jt Open. 2024 Mar 28;5(3):252-259. doi: 10.1302/2633-1462.53.BJO-2023-0139.
Posterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis.
The inclusion criteria applied in PubMed, Scopus, and Medline database searches were: all adult studies published between 2012 and 2022; and studies written in English. Outcome of TP entrapment in patients with ankle injuries was assessed by two reviewers independently.
Four retrospective studies and eight case reports were accepted in this systematic review. Collectively there were 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 trimalleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fractures at initial presentation. The diagnosis of TP entrapment was made in the early period in two (25%) cases, and delayed diagnosis in six (75%) cases reported. Using modified Clavien-Dindo complication classification, 60 (67%) of the injuries reported grade IIIa complications and 29 (33%) grade IIIb complications.
TP tendon was the commonest tendon injury associated with pilon fracture and, to a lesser extent, trimalleolar ankle fracture. Early identification using a clinical suspicion and CT imaging could lead to early management of TP entrapment in these injuries, which could lead to better patient outcomes and reduced morbidity.
后踝骨折常与踝关节骨折、pilon骨折相关，在较小程度上还与胫骨干骨折有关。胫后肌腱嵌顿是后踝骨折罕见的并发症。如果未被诊断出来，胫后肌腱嵌顿会引发一系列并发症，从踝关节活动范围减小到不稳定和平足畸形，这需要进一步手术，包括诸如关节融合术等根治性治疗。
在PubMed、Scopus和Medline数据库检索中应用的纳入标准为：2012年至2022年间发表的所有成人研究；以及用英文撰写的研究。由两名审阅者独立评估踝关节损伤患者胫后肌腱嵌顿的结果。
本系统评价纳入了四项回顾性研究和八篇病例报告。总共有489例pilon骨折，其中77例出现胫后肌腱嵌顿（15.75%）。有28例三踝骨折，其中12例出现胫后肌腱嵌顿（42.86%）。所有病例报告研究均报告初次就诊时骨折无法复位。胫后肌腱嵌顿的诊断在2例（25%）病例中为早期，在报告的6例（75%）病例中为延迟诊断。采用改良的Clavien-Dindo并发症分类法，报告的损伤中有60例（67%）为Ⅲa级并发症，29例（33%）为Ⅲb级并发症。
胫后肌腱是与pilon骨折相关的最常见肌腱损伤，在较小程度上也与三踝骨折相关。通过临床怀疑和CT成像进行早期识别可对这些损伤中的胫后肌腱嵌顿进行早期处理，这可能带来更好的患者预后并降低发病率。
