Concomitant peroneal tendon dislocation and medial malleolus fracture. A case report

Abstract

Introduction: The concomitant occurrence of peroneal tendon dislocation (PTD) and medial malleolus fracture (MMF) is rare. Its timely identification is important to prevent long-term complications.

Case presentation: A 21-year-old male was admitted to the emergency department of a tertiary care hospital in Medellín (Colombia) after suffering a motorcycle accident (as a passenger). Physical examination revealed left hip internally rotated and painful; complete functional limitation and severe pain in the left leg; wound on the medial aspect of the left knee without bone exposure; and edema, pain, functional limitation, and ecchymosis in the left ankle. Admission imaging tests (X-rays of the pelvis and ankle and CT scan of the pelvis) showed posterior hip dislocation with fracture of the posterior rim of the left acetabulum and MMF with slight displacement of the bone fragment. Hip dislocation was initially treated with closed reduction, but given its instability, open reduction and acetabular osteosynthesis were performed. However, during routine preoperative assessment (physical and radiological assessment) of the MMF, concomitant PTD was identified, so open reduction and medial malleolus osteosynthesis and repair of the superior peroneal retinaculum with anchor suture were performed. At 6 months of follow-up, functionality and mobility had been completely restored, and adequate bone consolidation of the medial malleolus was observed.

Conclusion: The concomitant occurrence of PTD and MMF is rare and may go unnoticed on initial assessment, so patients with MMF should undergo careful and routine clinical evaluation of ligament stability and ankle ligament complexes.