Closed Rupture of Anterior Tibialis Tendon after Minor Injury without Medical History: A Surgical Repair.

INTRODUCTION: Closed rupture of the anterior tibial tendon is uncommon, with only a few cases being documented in literature. It usually happens in the forceful plantar flexion of the foot while in eversion and the simultaneous contraction of the anterior tibialis muscle. CARE REPORT: We present the case of a 65-year-old man with closed rupture of the tibialis anterior tendon after injury who was treated by primary surgical repair. The surgical technique as well as the rehabilitation protocol are described in detail. CONCLUSION: Primary surgical reconstruction repair is indicated in younger, active individuals. It appears that early diagnosis and treatment provides the best clinical results, while delayed treatment usually requires the use of a tendon graft in combination with tendon transfers, giving inferior results compared to primary tendon repair.

The effect of proximal tibial fractures on the limb axis in children.

Between 1985 and 2002 we treated 38 children with 39 fractures of the proximal tibia. Fractures affecting the proximal tibial physis were excluded from this study. Mean age at the time of injury was 7.1 years (range: 2.5 to 14). Conservative treatment was followed in 34 cases and four patients underwent surgery. We examined 31 children with 32 fractures followed up for an average of 4.8 years (range: 16 months to 15 years). Twenty eight (90.3%) patients developed post-traumatic tibia valga. Deformities were observed at an average 5.3 months after injury. All the cases with fractures of the medial cortex developed valgus angulation. The mean valgus angular deformity was 5.5 degrees. There was also an average of 5.31 mm limb lengthening in 27 patients. Eleven patients with an angulation >5 degrees were reevaluated at an average of 7.4 years from the initial injury. Partial remodelling was observed in 6 patients (54.5%) and total remodelling in 3 (25%). We recommend that children with proximal metaphyseal tibial fractures should be initially treated conservatively and followed up during skeletal development, because valgus deformity tends to remodel with age.