Irreducible Ankle Fracture Due to Incarceration of the Long Flexor Tendons Together With the Neurovascular Bundle in the Tibial Fibular Interosseous Space: A Case Report and Short Literature Review

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Abstract

Ankle fracture dislocations with frustrating attempts at closed reduction are a rare traumatic entity. We present a case of an irreducible ankle fracture due to incarceration of all the flexor tendons including the neurovascular bundle in the tibial fibular interosseous space; to date, only one such case has been published in the literature. A computed tomography scan in both bone and soft tissue windows was necessary to clarify the structures that were inhibiting repositioning. The decisive step for surgical treatment was removal of the trapped structures from the tibial fibular interosseous space by a dorsomedial approach. The malleolar joint was then reconstructed anatomically. After 12 weeks, the patient was fully mobile without restrictions in his daily professional activities.

Section snippets

Case Report

A 31-year-old man twisted his left foot while working as a roofer as he jumped off a platform. The primary treatment was carried out in an external hospital with a clinically and radiographically confirmed diagnosis of a bimalleolar ankle fracture dislocation of the left ankle (Arbeitsgemeinschaft für Osteosynthesefragen 44B3, pronation-external rotation trauma type III according to the Lauge-Hansen classification system) (26,28). There were 2 unsuccessful attempts at closed reduction performed

Discussion

As part of the primary care of ankle fractures, closed reduction and temporary immobilization (e.g., in a lower leg splint) are the first treatment measures performed by the trauma surgeon in the emergency room. Nevertheless, adequate reduction may not succeed, and an urgent search for the cause must be performed. While bony obstructions to reduction are usually detected rapidly by x-ray or computed tomography, the incarceration of soft tissue structures is initially hidden on radiographic

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