Rad Saber Barazandeh, Sadighi Mehrdad, Kafiabadi Meisam Jafari, Ebrahimpour Adel, Pourmahmoudian Mohammad, Karami Amin
Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2024 Nov;124:110388. doi: 10.1016/j.ijscr.2024.110388. Epub 2024 Sep 30.
Acute rupture of the tibialis anterior tendon and other tendons is an extremely rare injury. It is usually associated with minor trauma in older patients with medical comorbidity. Surgeons must be alert for rupture of these tendons which can complicate a closed tibial fracture.
A 19-year-old man was transferred to the emergency department with a segmental fracture at the lower third of his tibia. The patient could not actively dorsiflex his right ankle and first toe but was able to dorsiflex other toes actively. The tibialis anterior and extensor hallucis longus tendon were discovered torn at the same point, supposedly by a bone spike. The fracture was reduced and fixed and the tendons were repaired.
A traumatic rupture of the tibialis anterior and extensor hallucis longus tendons occurs rarely in conjunction with or as a consequence of a bony fracture in closed trauma, with only a few cases documented in the literature. They typically occur as a result of direct blunt or penetrating injury. In three papers, the tibial fracture caused a direct rupture in the tendon. We believe that the tendons rubbing against the fractured edges of the segmental bone of the tibia led to the tendons tearing gradually.
Further investigation is needed for an evaluation of ankle and first toe dorsiflexion to check for a palpable gap in the soft tissues of a lower third tibial fracture. The tibialis anterior and other tendons can be located between the segment of the tibial fracture and ruptured.
胫骨前肌腱及其他肌腱的急性断裂是一种极为罕见的损伤。它通常与患有内科合并症的老年患者的轻微创伤相关。外科医生必须警惕这些肌腱的断裂，因为这可能会使闭合性胫骨骨折复杂化。
一名19岁男性因胫骨下三分之一处的节段性骨折被转诊至急诊科。患者无法主动背屈右踝关节和第一趾，但能够主动背屈其他脚趾。发现胫骨前肌腱和拇长伸肌腱在同一点撕裂，推测是被骨尖所致。骨折得到复位和固定，肌腱也进行了修复。
胫骨前肌腱和拇长伸肌腱的创伤性断裂在闭合性创伤中很少与骨折同时发生或作为骨折的后果出现，文献中仅有少数病例记载。它们通常是直接钝性或穿透性损伤的结果。在三篇论文中，胫骨骨折导致了肌腱的直接断裂。我们认为，肌腱与胫骨节段性骨折的断端边缘摩擦导致肌腱逐渐撕裂。
对于胫骨下三分之一骨折，需要进一步检查踝关节和第一趾的背屈情况，以检查软组织中是否有可触及的间隙。胫骨前肌腱和其他肌腱可能位于胫骨骨折段之间并发生断裂。
