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Skeletal Radiology
Published in: Skeletal Radiology 7/2016

01-07-2016 | Scientific Article

Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

Authors: Jonathan Tresley, Ty K. Subhawong, Adam D. Singer, Paul D. Clifford

Published in: Skeletal Radiology | Issue 7/2016

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Abstract

Objective

To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation.

Materials and methods

After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher’s exact test was used for statistical analysis with significance at p < 0.05.

Results

A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001).

Conclusions

Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures.
Appendix
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Literature
1.
Eastman JG, Firoozabadi R, Benirschke SK, Barei DP, Dunbar RP. Entrapped posteromedial structures in pilon fractures. J Orthop Trauma. 2013.
2.
Rak V, Ira D, Masek M. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications. Ind J Orthop. 2009;43(3):271–80.CrossRef
3.
Ho RT, Smith D, Escobedo E. Peroneal tendon dislocation: CT diagnosis and clinical importance. AJR Am J Roentgenol. 2001;177(5):1193.CrossRefPubMed
4.
Ehrlichman LK, Toussaint RJ, Kwon JY. Surgical relocation of peroneal tendon dislocation with calcaneal open reduction and internal fixation: technique tip. Foot Ankle Int. 2014.
5.
Mak MF, Tay GT, Stern R, Assal M. Dual-incision approach for repair of peroneal tendon dislocation associated with fractures of the calcaneus. Orthopedics. 2014;37(2):96–100.CrossRefPubMed
6.
Ebraheim NA, Elgafy H, Sabry FF, Tao S. Calcaneus fractures with subluxation of the posterior facet. A surgical indication. Clin Orthop Relat Res. 2000;377:210–6.CrossRefPubMed
7.
Wright DG, Sangeorzan BJ. Calcaneal fracture with peroneal impingement and tendon dysfunction. Foot Ankle Int. 1996;17(10):650.CrossRefPubMed
8.
Ebraheim NA, Zeiss J, Skie MC, Jackson WT. Radiological evaluation of peroneal tendon pathology associated with calcaneal fractures. J Orthop Trauma. 1991;5(3):365–9.CrossRefPubMed
9.
Rosenberg ZS, Feldman F, Singson RD. Intra-articular calcaneal fractures: computed tomographic analysis. Skelet Radiol. 1987;16(2):105–13.CrossRef
10.
Guyer BH, Levinsohn EM, Fredrickson BE, Bailey GL, Formikell M. Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance. AJR Am J Roentgenol. 1985;145(5):911–9.CrossRefPubMed
11.
Bradley SA, Davies AM. Computed tomographic assessment of old calcaneal fractures. Br J Radiol. 1990;63(756):926–33.CrossRefPubMed
12.
Jarvis HC, Cannada LK. Acute tibialis posterior tendon rupture associated with a distal tibial fracture. Orthopedics. 2012;35(4):e595–7.CrossRefPubMed
13.
Rosenberg ZS, Feldman F, Singson RD, Price GJ. Peroneal tendon injury associated with calcaneal fractures: CT findings. AJR Am J Roentgenol. 1987;149(1):125–9.CrossRefPubMed
14.
Crim J, Enslow M, Smith J. CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skelet Radiol. 2013;42(4):487–92.CrossRef
15.
Toussaint RJ, Lin D, Ehrlichman LK, Ellington JK, Strasser N, Kwon JY. Peroneal tendon displacement accompanying intra-articular calcaneal fractures. J Bone Joint Surg Am. 2014;96(4):310–5.CrossRefPubMed
16.
Coonrad RW, Bugg Jr EI. Trapping of the posterior tibial tendon and interposition of soft tissue in severe fractures about the ankle joint. J Bone Joint Surg Am. 1954;36-A(4):744–50.PubMed
17.
Ermis MN, Yagmurlu MF, Kilinc AS, Karakas ES. Irreducible fracture dislocation of the ankle caused by tibialis posterior tendon interposition. J Foot Ankle Surg. 2010;49(2):166–71.CrossRefPubMed
18.
Pankovich AM. Fracture-dislocation of the ankle. Trapping of the postero-medical ankle tendons and neurovascular bundle in the tibiofibular interosseous space: a case report. J Trauma. 1976;16(11):927–9.CrossRefPubMed
19.
Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br Vol. 2005;87(5):692–7.CrossRef
20.
Resnick D, Goergen TG. Peroneal tenography in previous calcaneal fractures. Radiology. 1975;115(1):211–3.CrossRefPubMed
21.
Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg. 2007;127(1):55–60.CrossRefPubMed
22.
Henry PDG, McKee MD. Irreducible tibial pilon fracture secondary to posterior tibial tendon entrapment. J Bone Joint Surg Case Connect. 2012;2(4), e69.CrossRef
23.
Parrish TF. Fracture-dislocation of the ankle; an unusual cause of failure of reduction; a case report. J Bone Joint Surg Am. 1959;41-A(4):749–51.PubMed
Metadata
Title
Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination
Authors
Jonathan Tresley
Ty K. Subhawong
Adam D. Singer
Paul D. Clifford
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 7/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-016-2380-0

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