Tibialis posterior tendon entrapment in posterior malleolar and pilon injuries of the ankle: a retrospective analysis.

BackgroundThe 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.AimOur aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF).MethodsA 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 ResultsA 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 ConclusionIn 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

Posterior tibialis tendon entrapment as a complication of posterior malleolar fractures in complex ankle fractures.

AimsPosterior 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.MethodsThe 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.ResultsFour 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.ConclusionTP 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

A Systematic Review of Tibialis Posterior Tendon Entrapment in Pilon and Trimalleolar Injuries

Category: Ankle; Trauma Introduction/Purpose: The tibialis posterior tendon (TPT) entrapment is an uncommon complication associated with posterior malleolar and pilon fractures. If undiagnosed, TPT entrapment is associated with significant morbidity. Our aim was to perform a systematic review of all reported TPT entrapments in the literature to further understand its risks and outcomes. Methods: The electronic databases Scopus, PubMed, and Medline was utilised to identify the relevant publications regarding TPT entrapment in pilon and ankle fractures. Inclusion criteria: all adult studies published in English language reporting the outcome of TPT entrapment in patients with ankle injuries. To critically appraise the papers, CASP clinical appraisal tool was used. Results: Four retrospective studies and eight case reports were accepted in this review. Collectively there were, 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 Tri-malleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fracture at initial presentation. The diagnosis of TPT entrapment was made in the early period in 25% of cases and delayed diagnosis in 75% of cases reported. Utilising modified Clavien-Dindo complication classification, 67% of the injuries reported GRADE IIIA complications, and the rest GRADE IIIB complications. Conclusion: In conclusion, TPT tendon was the commonest tendon injury associated with Pilon and Tri-malleolar ankle fractures. Early identification, utilising a clinical suspicion and CT imaging, could lead to early management of TP entrapment in these injuries which could potentially lead to better patient outcomes and reduced morbidity

Tibialis Posterior Tendon Entrapment in Posterior Malleolar and Pilon Injuries of the Ankle: A Retrospective Analysis

Category: Ankle; Trauma Introduction/Purpose: The Tibialis Posterior tendon (TPT) is the only tendon to come into contact with 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. Aim 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). Methods: 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. Results: A total of 363 patients were identified for further analysis, 220 who had a PMF and posterior 143 with Pilon injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture entered the TPT sheath, there was a 45% (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). Conclusion: In our assessment, 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 care pre-operative imaging and seek to identify the TPT intraoperatively where entrapment does occur