Abstract
Abstract
Background
The 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.
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 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 < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353).
Conclusion
In 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.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference23 articles.
1. Korkmaz A, Ciftdemir M, Ozcan M, Copuroğlu C, Sarıdoğan K (2013) The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury 44:1270–1274. https://doi.org/10.1016/j.injury.2013.06.016
2. van der Vliet QMJ, Ochen Y, McTague MF, Weaver MJ, Hietbrink F, Houwert RM, Leenen LPH, Heng M (2019) Long-term outcomes after operative treatment for tibial pilon fractures. OTA Int 2:e043. https://doi.org/10.1097/OI9.0000000000000043
3. Tarkin IS, Clare MP, Marcantonio A, Pape HC (2008) An update on the management of high-energy pilon fractures. Injury 39:142–154. https://doi.org/10.1016/j.injury.2007.07.024
4. Sajjadi MM, Ebrahimpour A, Okhovatpour MA, Karimi A, Sharifzadeh A (2018) The outcomes of pilon fracture treatment: primary open reduction and internal fixation versus two-stage approach. Arch Bone Jt Surg 6:412–419
5. van den Bekerom MPJ, Haverkamp D, Kloen P (2009) Biomechanical and clinical evaluation of posterior malleolar fractures a systematic review of the literature. J Trauma Acute Care Surg 66:279. https://doi.org/10.1097/TA.0b013e318187eb16