Jornal de Trauma e Tratamento

Lower Limb Thrombosis after Tibialis Tendon Tenorrhaphy: Case Report and Literature Review

Abstract

Gustavo Constantino de Campos

Background: Rupture of the tibialis anterior tendon is a rare lesion and only few reports are found in the literature. Another not so rare condition is a thromboembolic event following a lower limb surgical procedure or immobilization period. Although there is general agreement that patients undergoing major hip or knee surgery benefit from prophylactic anti-thrombotic therapy, currently there are no unanimously accepted recommendations for thromboprophylaxis in patients with isolated lower limb injury or surgery.

Purpose: The aim of this study is to provide a case report and a critical review of publications on the matter. Case Report: We herein report a case of a 38-year-old man, otherwise well, who sustained a small open wound anterior to the tibiotarsal joint caused by the tip of a knife. Ultrasound confirmed a complete anterior tibialis tendon rupture. Patient underwent to acute repair and was discharged with an ankle cast, with the guidance of full-time use. There was no recommendation of any type of mechanical or pharmacological thromboprophylaxis. Five days later he presented deep venous thrombosis. Treatment was conducted with enoxaparin (20 mg daily) for 3 months.

Discussion: Rupture of the tibialis anterior tendon is decidedly rare and often neglected. Acute repair may be attempted, since delayed tendon reconstruction has had less favorable functional results. Deep venous thrombosis is a potentially life threatening condition that can occur after lower limb injury or immobilization period. We performed a literature review but we cannot draw definite conclusions, given the paucity of high quality studies. In conclusion, there is a need for further research with deeper assessment of thromboprophylaxis indications and contraindications.