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

Table 1 Table comparing details of presented case to similar cases documented in the literature

Ref.	Patient	Mechanism	Key injuries	Management	Outcome
Present case	50-year-old male, snowboarder	High-energy tumbling fall; immediate “pop”, unable to bear weight	Achilles rupture; complete peroneus longus and brevis ruptures; nondisplaced Weber A distal lateral malleolus fracture; additional bone marrow contusions on MRI	Achilles Kraków repair with calcaneal docking using two 4.0 mm knotless PEEK anchors; primary repair of both peroneal tendons; ORIF distal fibula; cast/boot with staged heel lifts; early PT with DF limited to neutral initially	16 weeks: Fracture healed, repairs intact; 6 months: Single-leg heel rise, full activities; approximately 1.5 years: High-level athletics without pain/Limits
Bowers et al[26], 2021	35-year-old male, snowboarder	Jump landing on rock causing hyperdorsiflexion and eversion	Midsubstance Achilles rupture; medial malleolus fracture (posterior colliculus avulsion) with deep deltoid injury; SPR avulsion with peroneal dislocation; CFL avulsion; distal fibular cortical avulsion	Percutaneous Achilles tendon-to-bone fixation with two 4.75 mm × 15 mm anchors; indirect fibular groove deepening; CFL repair; SPR repair with knotless anchors; deep deltoid anchor repair; staged heel lifts; PT progression with DF past neutral only after 8 weeks	4 months: Wounds healed, normal gait; 9 months: Returned to all activities, no limitations
Jadib et al[18], 2024	44-year-old male, snowboarder	High-energy ankle trauma; initially casted, surgery at 2 weeks	Subcutaneous Achilles rupture 4 cm from insertion with approximately 5 cm gap; trimalleolar fracture without syndesmotic opening; traumatic peroneal dislocation with SPR bony avulsion; distal fibular avulsion	Open end-to-end Achilles Krakow repair with absorbable sutures; excision small avulsed fibular fragment; SPR reinsertion via bone tunnels; medial/posterior malleoli left unfixed after satisfactory reduction; splint/cast in approximately 10 PF; staged rehab and PT	12 months: MRI confirmed healed Achilles/SPR and fractures; 18 months: Full ROM, returned to all activities; fractures healed radiographically

DF: Dorsiflexion; ORIF: Open reduction internal fixation; PT: Physical therapy; PF: Plantarflexion; SPR: Superior peroneal retinaculum; CFL: Calcaneofibular ligament; DF: Dorsiflexion; ROM: Range of motion; MRI: Magnetic resonance imaging.