Peroneal Tendons Rupture in a Closed Talar Body Fracture: A Rare Injury

Open Talar Body Fracture With Dislocation of the Ankle and Subtalar Joint Accompanying Acute Rupture of the Peroneal Tendons in an Elite Female Gymnast: A Case Report

CASE

A 20-year-old elite female gymnast injured her right ankle on landing during a vaulting attempt. Diagnosis revealed an open fracture of the talar body, prompting referral to our center after wound flushing and closure. Peroneal tendon and lateral ligament ruptures were observed during surgery, necessitating one-stage repair. The patient successfully resumed competitive gymnastics 9 months postoperatively.

CONCLUSION

This case underscores the importance of preventing muscle atrophy and contracture of ankle and hindfoot motion in athletes during the extended postoperative period of talar unloading.

Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures

BACKGROUND

We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning.

METHODS

In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.

RESULTS

In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).

CONCLUSION

Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures.

LEVEL OF EVIDENCE

Level III, retrospective case control study.

EFFECTS OF NEUROMUSCULAR TREATMENT ON POSTURAL BALANCE IN ATHLETES RECOVERING FROM THE ANKLE INJURY

ABSTRACT Introduction: Posture is directly related to body balance, and both have great importance in movement. Body posture is affected by several human body factors in space, and neuromuscular athletes’ rehabilitation methods should be designed for an optimal return of postural stability. Objective: Explore the effects of neuromuscular treatment on postural balance rehabilitation of athletes’ ankle injuries. Methods: 20 athletes with functional ankle instability were randomized into experimental and control groups. The experimental group received neuromuscular treatment. The control group maintained standard muscle strength and joint activity rehabilitation exercises. The effects of two rehabilitative procedures were compared by Cumberland ankle instability assessment questionnaire, T-type agility test, and Sargent vertical jump test. Results: Agility after exercise was significantly lower than those before exercise by 0.8 versus 1s; there was no significant difference between the two groups before the experiment. Agility test results of the experimental group were significantly lower than those of the control group (2s). Sargent's vertical jump test results were significantly different from those before the exercise (P < 0.01). Conclusion: The postural balance showed good recovery with the neuromuscular treatment and the rehabilitation method of the athletes after the ankle injury. Evidence Level II; Therapeutic Studies - Investigating the result.

Different patterns and characteristics of Talar injuries at two main orthopedic trauma centers in Shiraz, south of Iran

BACKGROUND

Categorizing different injury patterns of the talus, describing demographic data, mechanisms of injury and associated fractures are important issues in orthopedic trauma surgeries. Injuries of the talus require careful attention with appropriate treatment approaches in order to reduce possible complications.

METHODS

In a cross-sectional study, the demographic characteristics, mechanism of injury, fracture type, and associated fractures were compiled from all patients' files and operation notes with diagnosis of talar injuries from January 2014 to December 2019.

RESULTS

Among 367 patients, 317 (86.4%) males and 50 (13.6%) females with mean age of 31.8 ± 11.6 years were identified. There were three (0.8%) patients with bilateral talar fractures. The most common mechanism of injury was motor vehicle accident (MVA) (46.1%), followed by falls (43.3%), direct trauma (6.2%) and sport injuries (4.4%). About half of the patients injured in MVAs were motorcyclists. Isolated talar body fractures (21.9%) were more common than isolated talar neck (19.2%) or combined body & neck fractures (14.6%). Isolated lateral process fracture is the most frequent fractured process of the talus (14.3%). Hawkin type IIA (39.2%) was the most common type of talar neck, followed by Hawkin type III (22.3%), type I (21.5%), type IIB (14.6%) and type IV (2.3%). Medial malleolus, fibula and calcaneus were the most common associated fractures, respectively.

CONCLUSIONS

The population that is most affected by talar injury are active young men who are involved in motor vehicle accidents, especially motorcycle crashes, with fracture of body and/or neck of talus being the most common type.