Achilles, peroneus longus and brevis ruptures with lateral malleolus fracture: A case report and review of literature.

BACKGROUND

Ankle fractures are well-documented in snow sports, but concomitant Achilles tendon and peroneal tendon ruptures are rare. This case report presents a previously unreported combination of Achilles tendon rupture, peroneal tendon rupture, and fibular fracture in a snowboarder, highlighting the complex nature of diagnosis, management, and rehabilitation.

CASE SUMMARY: A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash. Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture. Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons, along with a Weber A lateral malleolus fracture. Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking, open reduction and internal fixation of the distal fibula fracture, and primary repair of both peroneal tendons. Post-operatively, a modified Achilles repair protocol was implemented. At 16 weeks post-surgery, radiographs showed a well-healed fibular fracture, and physical examination confirmed intact Achilles and peroneal tendon repairs. By 6 months, the patient had regained full daily and work activities, including recreational pursuits.

CONCLUSION

This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports. Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.