Concomitant Achilles Tendon Rupture and Ankle Fracture in a Snowboarder Managed with Early Rehabilitation: A Case Report.
- 1Department of Medical Education, Idaho College of Osteopathic Medicine, Meridian, Idaho, USA.
- 2Department of Orthopedic Surgery, Valley Consortium for Medical Education, California, USA.
- 3Department of Orthopedic Surgery, Idaho Sports Medicine Institute, Boise, Idaho, USA.
Abstract
Achilles tendon rupture and ankle fracture are each common in isolation, but their simultaneous occurrence in the same limb is rare. Because the two injuries share overlapping signs of pain, swelling, and functional limitation, one is often missed on initial evaluation, and a low threshold for combined clinical and sonographic or magnetic resonance imaging assessment is warranted in high-energy ankle trauma. Furthermore, while early functional weight-bearing is increasingly favored for isolated Achilles ruptures, its safety and implementation in combined injuries remain poorly defined. A 34-year-old male sustained a closed Weber B bimalleolar ankle fracture and a complete Achilles tendon rupture during a high-energy snowboarding accident. Both injuries were identified preoperatively by clinical examination (palpable tendon defect, positive Thompson, and Matles tests) and ultrasonography. One week after injury, he underwent open reduction and internal fixation of the lateral malleolus with a lateral approach followed by repair of the Achilles using a Krackow-type suture-tape repair docked to the calcaneus with two SwiveLock anchors (Arthrex, Naples, FL). This was done through a separate posterior longitudinal incision. Intraoperative external rotation stress testing demonstrated no talar shift or medial malleolar fracture displacement, confirming stability and avoiding unnecessary medial fixation. At 1 week postoperatively, the patient was transitioned from a posterior splint to a boot with a heel wedge, and active range of motion was initiated. At 2 weeks, the patient was allowed to bear full weight in the boot with a heel wedge. Formal physical therapy began at 4 weeks. Concomitant Achilles tendon rupture and ankle fracture require a high index of suspicion for both injuries. Intraoperative stress testing after fibular fixation can guide the decision to forgo medial malleolar fixation. In addition, an early, protected rehabilitation protocol can be successfully implemented in patients with a combined Achilles rupture and malleolar fracture.
Related
- Commentary: Correlation analysis of metabolic parameters influencing postoperative tendon healing after Achilles tendon rupture repair
- Minimally Invasive Revision Surgery Combining Endoscopic Double-Row Reinsertion and Flexor Hallucis Longus Transfer for Insertional Achilles Tendon Re-Rupture in a Semi-Professional Rugby Player: A Case Report
- Fluoroquinolone Exposure and Other Factors Associated with Achilles Tendon Rupture: A Nationwide Nested Case–Control Study
- Management and Outcomes of Achilles Tendon Re-rupture: A Retrospective Cohort Study
- Nonoperative Management of an Acute Complete Achilles Tendon Rupture With Mesenchymal Stem Cells and Extracellular Vesicles: A Case Report.
BibTeX
@article{curran2026concomitant,
title = {{Concomitant Achilles Tendon Rupture and Ankle Fracture in a Snowboarder Managed with Early Rehabilitation: A Case Report.}},
author = {John A Curran and Michael W Pappas and Nathan L Grimm and Andrew R Curran},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8468},
url = {https://europepmc.org/article/MED/42997071},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Concomitant Achilles Tendon Rupture and Ankle Fracture in a Snowboarder Managed with Early Rehabilitation: A Case Report.
AU - John A Curran
AU - Michael W Pappas
AU - Nathan L Grimm
AU - Andrew R Curran
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8468
UR - https://europepmc.org/article/MED/42997071
AB - Achilles tendon rupture and ankle fracture are each common in isolation, but their simultaneous occurrence in the same limb is rare. Because the two injuries share overlapping signs of pain, swelling, and functional limitation, one is often missed on initial evaluation, and a low threshold for combined clinical and sonographic or magnetic resonance imaging assessment is warranted in high-energy ankle trauma. Furthermore, while early functional weight-bearing is increasingly favored for isolated Achilles ruptures, its safety and implementation in combined injuries remain poorly defined. A 34-year-old male sustained a closed Weber B bimalleolar ankle fracture and a complete Achilles tendon rupture during a high-energy snowboarding accident. Both injuries were identified preoperatively by clinical examination (palpable tendon defect, positive Thompson, and Matles tests) and ultrasonography. One week after injury, he underwent open reduction and internal fixation of the lateral malleolus with a lateral approach followed by repair of the Achilles using a Krackow-type suture-tape repair docked to the calcaneus with two SwiveLock anchors (Arthrex, Naples, FL). This was done through a separate posterior longitudinal incision. Intraoperative external rotation stress testing demonstrated no talar shift or medial malleolar fracture displacement, confirming stability and avoiding unnecessary medial fixation. At 1 week postoperatively, the patient was transitioned from a posterior splint to a boot with a heel wedge, and active range of motion was initiated. At 2 weeks, the patient was allowed to bear full weight in the boot with a heel wedge. Formal physical therapy began at 4 weeks. Concomitant Achilles tendon rupture and ankle fracture require a high index of suspicion for both injuries. Intraoperative stress testing after fibular fixation can guide the decision to forgo medial malleolar fixation. In addition, an early, protected rehabilitation protocol can be successfully implemented in patients with a combined Achilles rupture and malleolar fracture.
SN - 2250-0685
SN - 2321-3817
ER -