Simultaneous fracture of the ankle and talus associated with ruptured tibialis posterior tendon.

A 45-year-old woman involved in a motor vehicle accident sustained a fracture of the medial malleolus and a fracture of the neck of the talus. Open reduction and internal fixation of the fractures were achieved through an anteromedial approach. Intraoperatively, the tibialis posterior tendon was found to be ruptured and retracted. The tendon was reapproximated and repaired. The patient developed an inversion deformity of the ankle, which required release of the tibialis posterior tendon and correction of the deformity using the Ilizarov fixation device. Twelve months after the injury, the patient had 45 degrees of plantar flexion and 15 degrees of dorsiflexion of the ankle; subtalar motion was 25 degrees of eversion and 35 degrees of inversion. Radiographs showed healing of all fractures with minimal degenerative changes of the ankle joint and absence of avascular necrosis of the talus.