Vlasak A, Orear C, Sakryd G, Metzl J. Achilles, peroneus longus and brevis ruptures with lateral malleolus fracture: A case report and review of literature. World J Orthop 2026; 17(1): 112222 [DOI: 10.5312/wjo.v17.i1.112222]
Corresponding Author of This Article
Alexander Vlasak, MD, Academic Fellow, Department of Orthopedics, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora Ct., 4th Floor, Aurora, CO 80045, United States. alexander.vlasak@cuanschutz.edu
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Orthopedics
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 18, 2026 (publication date) through Jan 9, 2026
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Vlasak A, Orear C, Sakryd G, Metzl J. Achilles, peroneus longus and brevis ruptures with lateral malleolus fracture: A case report and review of literature. World J Orthop 2026; 17(1): 112222 [DOI: 10.5312/wjo.v17.i1.112222]
World J Orthop. Jan 18, 2026; 17(1): 112222 Published online Jan 18, 2026. doi: 10.5312/wjo.v17.i1.112222
Achilles, peroneus longus and brevis ruptures with lateral malleolus fracture: A case report and review of literature
Alexander Vlasak, Christopher Orear, Gary Sakryd, Joshua Metzl
Alexander Vlasak, Christopher Orear, Gary Sakryd, Joshua Metzl, Department of Orthopedics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO 80045, United States
Co-corresponding authors: Alexander Vlasak and Joshua Metzl.
Author contributions: Vlasak A, Orear C, Sakryd G, Metzl J contributed to the writing and revising of all subsequent drafts of the manuscript prior to submission; Orear C revised the manuscript as requested by the journal and reviewers; Vlasak A and Metzl J evaluated the patient in clinic, reviewed the pertinent imaging, engaged in shared-decision making with the patient and performed the surgery; Vlasak A performed the literature search, obtained the relevant images for the figures, and wrote the majority of the initial draft of the manuscript; Orear C assisted in writing the initial draft of the manuscript and figure creation; All authors have reviewed and approve the final draft of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors have no conflicts of interest to declare in relation to this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander Vlasak, MD, Academic Fellow, Department of Orthopedics, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora Ct., 4th Floor, Aurora, CO 80045, United States. alexander.vlasak@cuanschutz.edu
Received: July 21, 2025 Revised: August 21, 2025 Accepted: November 28, 2025 Published online: January 18, 2026 Processing time: 172 Days and 12.7 Hours
Abstract
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.
Core Tip: Here, we present the case report of a previously unreported injury pattern: Concomitant Achilles tendon rupture, peroneal tendon ruptures, and Weber A lateral malleolus fracture sustained in a high energy snowboarding fall. Initially, peroneal tendon tears were missed and discovered intraoperatively, changing the course of clinical care. We discuss the mechanism of injury and review the literature around similar cases of high energy tendon rupture and concomitant ankle fracture. This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.
