Abstract
A patient with severe irreducible open fracture dislocation of the ankle was admitted
to our emergency department. After wound irrigation and debridement, skeletal traction
was applied to the calcaneus to minimize soft tissue injury and swelling. The patient
was followed in traction for 1 week, after which reduction and fixation of the fibula
was attempted but not achieved. We extended the incision distally, visualized the
ankle, and located the tibialis posterior tendon between the distal tibia and fibula,
thereby inhibiting the reduction. The tendon coursed into the tibiotalar joint anteriorly
and pushed the talus anterolaterally. After manipulation of the tendon to its anatomically
correct location, the ankle was easily reduced. The wound at the medial side was closed
with a fasciocutaneous rotational flap. The ankle was then immobilized for 6 weeks
postoperatively. The patient regained her full range of motion, and there were no
problems with the tibialis posterior tendon, such as rupture or insufficiency. Isolated
tibialis posterior tendon interposition between the distal tibiofibular and tibiotalar
joints has rarely been reported, and can inhibit anatomical reduction of the fractured
ankle.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: December 21, 2009
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
