A Systematic Review of Tibialis Posterior Tendon Entrapment in Pilon and Trimalleolar Injuries

Abstract

Category: Ankle; Trauma Introduction/Purpose: The tibialis posterior tendon (TPT) entrapment is an uncommon complication associated with posterior malleolar and pilon fractures. If undiagnosed, TPT entrapment is associated with significant morbidity. Our aim was to perform a systematic review of all reported TPT entrapments in the literature to further understand its risks and outcomes. Methods: The electronic databases Scopus, PubMed, and Medline was utilised to identify the relevant publications regarding TPT entrapment in pilon and ankle fractures. Inclusion criteria: all adult studies published in English language reporting the outcome of TPT entrapment in patients with ankle injuries. To critically appraise the papers, CASP clinical appraisal tool was used. Results: Four retrospective studies and eight case reports were accepted in this review. Collectively there were, 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 Tri-malleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fracture at initial presentation. The diagnosis of TPT entrapment was made in the early period in 25% of cases and delayed diagnosis in 75% of cases reported. Utilising modified Clavien-Dindo complication classification, 67% of the injuries reported GRADE IIIA complications, and the rest GRADE IIIB complications. Conclusion: In conclusion, TPT tendon was the commonest tendon injury associated with Pilon and Tri-malleolar ankle fractures. Early identification, utilising a clinical suspicion and CT imaging, could lead to early management of TP entrapment in these injuries which could potentially lead to better patient outcomes and reduced morbidity.