Abstract
Background
Ankle fractures represent an increasing workload, particularly in the elderly female population. The posterior tibial tendon is exposed to injury during displaced medial malleolar fractures. Posterior tibial tendon dysfunction delays rehabilitation and results in significant morbidity and is most prevalent in women over 40.
Objective
To ascertain whether posterior tibial tendon should be routinely explored in displaced medial malleolar fractures and consequently should post-operative rehabilitation of ankle fractures be modified. Intra-operative assessment of the tendon may help with this diagnosis and consequently alter post-operative rehabilitation.
Method
We performed a prospective case series of 25 patients with displaced medial malleolar ankle fractures admitted to the Royal Victoria Hospital Belfast between August and November 2009. The admission notes were then checked for any previous injuries and the initial reduction was assessed radiologically. At the time of surgery the primary operator explored the posterior tibial tendon and assessed the tendon for damage using the following scale: nil, bruising, superficial, partial tear, complete tear.
Results
The average age was 58. The majority of injuries were Weber B (20/25), bimalleolar (19/25), had an initial satisfactory reduction (19/25) and had the surgery performed by SPR/STR (22/25). The mechanism of injury was reported as mainly supination-external rotation (13/25). Eight patients were reported as having superficial damage and one with a partial rupture. Of note all patients included under the age of forty were reported as having no damage to posterior tibial tendon.
Conclusion
This study does not support the routine exploration of the posterior tibial tendon in displaced medial malleolar fractures. However, the study would advocate an altered post-op regime for at risk groups for posterior tibial dysfunction.
