Correction: Rupture of the Tibialis Posterior Tendon With Associated Bimalleolar Ankle Fracture.

[This corrects the article DOI: 10.7759/cureus.31886.].

Rupture of the Tibialis Posterior Tendon With Associated Bimalleolar Ankle Fracture.

The acute traumatic rupture of the tibialis posterior tendon in association with closed ankle fractures is rare and often under-recognised. If recognised early, outcomes can be excellent. There are 28 known cases in the literature, and we report two further cases associated with bimalleolar ankle fracture dislocation. A 49-year-old presented with valgus deformity at the ankle joint and global tenderness following a work injury as a mechanic. A plain radiograph showed a displaced oblique comminuted fracture of the lateral malleolus with valgus angulation at a syndesmosis, with significant talar shift. The patient underwent open reduction and internal fixation with a seven-hole, one-third tubular plate and screws. A 35-year-old involved in a motorcycle collision with a car presented with swollen left ankle and valgus deformity. Plain radiographs revealed bimalleolar fracture subluxation. Closed reduction was unsuccessful and hence direct medial approach demonstrated a complete rupture of the posterior tendon. The medial malleolus was fixed using lag screws and washers. The tendon was repaired using the modified Kessler technique in both cases. The tibialis posterior plays a significant role in foot and ankle biomechanics due to its broad tendinous insertion. Acute traumatic rupture is rare, as it is protected due to its deep-seated anatomic location within the deep posterior compartment of the leg. Preoperative diagnosis of this injury is challenging and hence this diagnosis is often made intraoperatively. In both cases, there was a retraction of the proximal end beyond incision margins, and this can make tendon rupture difficult to identify intraoperatively as well. Upon identification, assessment of the tendon for degenerative changes was key to deciding upon suitability for primary repair. Despite its rarity, a high index of suspicion should be maintained in fracture dislocation of the ankle joint, especially when the mechanism is known to be pronation-external rotation.

Well leg compartment syndrome.

Well leg compartment syndrome refers to the occurrence of compartment syndrome in an uninjured limb in the absence of an underlying systemic predisposing cause. It is a rare phenomenon with devastating clinical consequences resulting from commonly utilized operative positions and requires a high index of suspicion for diagnoses. There are only a few reports in the literature and a lack of awareness of the condition. Identifying patients with at risk predisposition and increasing surveillance in these patients may allow for early detection and decrease the morbidity and potential mortality associated with well-leg compartment syndrome.

Trevor's Disease: Management Difficulties and Proposed Classification.

Dysplasia epiphysealis hemimelica, also known as Trevor's disease, is a rare developmental disorder with osteocartilagenous overgrowth of the epiphysis or epiphyseal equivalent. The condition bears similarities to osteochondroma in terms of its radiographic appearance, but differs in its pathobiology and geographic occurrence. Unlike the metaphyseal occurrence of osteochondromata, it arises from the epiphysis. The clinical presentation is wide and varied, but mechanical symptoms and deformities predominate. Early reports of the condition suggested involvement of the lower limbs only. However, since then, numerous reports have indicated a more generalized distribution. Difficulties in management and recurrence rates seem to hinge on whether its origin is intra-articular or extra-articular. A new classification system to include these parameters is discussed. [Orthopedics.2016; 39(5):e967-e969.].

Avulsion Fracture of the Tibial Tubercle Associated With Patellar Tendon Avulsion.

Avulsion fractures of the tibial tubercle in adolescent athletes are uncommon injuries, believed to be a result of forceful extension of the knee against a fixed leg. Concomitant injury to the ipsilateral patella tendon is even more rare, with few cases reported in the literature. The mechanisms responsible for this association are not well understood. The significance of this double insult to the knee extensor mechanism is the potential deleterious effect of misdiagnosis and/or mismanagement. In this case report, the pathophysiology, mechanism of injury, classification, diagnosis, and management of concomitant injury are reviewed. [Orthopedics. 2016; 39(3):e561-e564.].