Subluxation of the posterior tibial tendon into the tibiofibular syndesmosis secondary to high-level ankle fracture or dislocation: Surgical reduction technique guide and case study

Ankle fractures with associated dislocation of the ankle joint are a common injury presenting to emergency rooms. The first step in successful management of these injuries is with closed reduction of the dislocation and splinting in as close to anatomic alignment as possible. Infrequently, closed reduction cannot be obtained due to interposed soft tissues. In the case of ankle dislocations, subluxation of the posterior tibial tendon into the tibiofibular syndesmosis is a rare associated injury that may prevent proper reduction of the ankle mortise and, if not identified and corrected, results in a poor long-term outcome. We present a rare case of a young, healthy male college athlete who sustained a closed ankle dislocation injury with subluxation of the posterior tibial (PT) tendon through the ankle joint and into the tibiofibular syndesmosis. Additionally, we present a brief literature review and technique guide on the reduction and relocation of the posterior tibial tendon to hopefully serve as a reference for management of this rare injury type.