case_images: PMC11761275_01
case_images: Plain radiographs of the ankle joint (A) at the time of injury and (B) after initial surgery. (A) A distal one-third of the fibular shaft fracture with a small third fragment, diastasis of the distal tibiofibular syndesmosis, and tibiotalar dislocation are shown. (B) A widening of the tibiofibular syndesmosis and medial clear space are shown.
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case_images: Plain radiographs of the ankle joint revealed a distal one-third of the fibular shaft fracture with a small third fragment, diastasis of the distal tibiofibular syndesmosis, and tibiotalar joint dislocation (Fig. 1A). An anteroposterior plain radiograph taken after the initial surgery showed widening of the tibiofibular syndesmosis and a medial clear space (Fig. 1B).
case_images: Plain radiographs of the ankle joint (A) after open reduction and fixation of the fibula and distal tibiofibular syndesmosis, and (B) 2 weeks after reduction and fixation. (A) The fibula is fixed using a conventional plate and screws and the distal tibiofibular syndesmosis is fixed using a screw. (B) A widening of the tibiofibular syndesmosis, medial clear space, and anterior subluxation of the talus are shown.
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case_images: Six days after the initial surgery, the fibula was fixed using a conventional plate and screws, and the distal tibiofibular syndesmosis was reduced and fixed using a screw (Fig. 2A). Two weeks after fixation of the fibula and distal tibiofibular syndesmosis, follow-up radiographs showed widening of the medial clear space and anterior subluxation of the talus; soft tissue interposition was suspected (Fig. 2B).
case_images: (A) Magnetic resonance image showing posterior tibialis tendon (PTT) interposition in the distal tibiofibular and tibiotalar joints. (B) Plain radiographs of the ankle joint after PTT reduction show reduced distal tibiofibular and tibiotalar joints.
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case_images: PMC11761275_01_gr3.jpg
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case_images: Magnetic resonance imaging (MRI) revealed entrapment of the PTT in the distal tibiofibular and tibiotalar joints (Fig. 3A). Two weeks after PTT involvement was evident, the subluxated talus was reduced by approaching the PTT from the medial open wound along the posterior aspect of the tibia and pulling it out of the distal tibiofibular joint, and the PTT was reduced to its original position (Fig. 3B).
case_images: (A) Weight-bearing plain radiographs of the ankle joint at 10-year follow-up show osteoarthritic changes of the tibiotalar joint. (B:D) Retrospectively reconstructed three-dimensional images of the tendon using volume rendering of the computed tomography show PTT interposition in the distal tibiofibular and tibiotalar joints (B) at initial injury, (C) after initial surgery, and (D) after reduction and fixation of the fibula and distal tibiofibular syndesmosis.
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case_images: PMC11761275_01_gr4.jpg
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case_images: Plain radiographs revealed a reduced but osteoarthritic tibiotalar joint without apparent diastasis of the distal tibiofibular syndesmosis (Fig. 4A).