Case: A 78-year-old man with type 2 diabetes and spinal stenosis complicated by chronic neuropathy suffered an open medial malleolus fracture with proximal tendon rupture after fall from height. Fracture fixation was achieved with cannulated screws. Meticulous repair of the proximal tibialis posterior and flexor digitorum longus tendon avulsions required tunneling into the deep posterior compartment. Postoperatively, the patient was non–weight bearing, responsive to therapy, and discharged home. Conclusion: This unique case illustrates the importance of maintaining a high index of suspicion for tendinous injury. A careful physical examination, understanding of injury mechanisms, and a high index of suspicion for these associated injuries should be maintained to maximize patient outcomes.
Halkias et al. (2026) studied this question.