Title: Radiography and US of os peroneum fractures and associated peroneal tendon injuries: Initial experience
Authors: Brigido MK, Fessel DP, Jacobson JA, Widman DS, Craig JG, Jamadar DA, van Holsbeek MT
Source: Radiology 237(1):235-41 2005.
PODIATRIC RELEVANCE:
Os peroneum fractures and associated peroneal tendon injuries are frequently encountered by the foot and ankle surgeon. This article investigates the imaging features of these injuries with use of radiography, ultrasonography and MRI to determine the correlation between radiographic findings of os peroneum fractures and the extent of peroneal tendon tears.
METHODS:
This was a retrospective review of 9 patients with post-injury lateral foot pain who demonstrated radiographic evidence of an os peroneum fracture. Os peroneum fragment separation and displacement relative to the calcaneocuboid joint were measured on plain radiographs. The fractured os peroneum and peroneus longus tendon injuries were then characterized using ultrasound and magnetic resonance imaging.
Thirty-six control subjects (43 feet) who were found to have an os peroneum present on radiographs but were asymptomatic in the area of the sesamoid were also reviewed. These control radiographs were used to provide standard measurements of the distance between the os peroneum and the calcaneocuboid joint and bipartite os peroneum fragment distraction.
RESULTS:
In the control subjects, os peroneum location measurements ranged from 7mm proximal to or 8mm distal to the calcaneocuboid joint on lateral radiographs, and from 9mm proximal to 8mm distal to the calcaneocuboid joint on oblique radiographs. Bipartite os peroneum fragment separation was noted to be 2mm or less in control subjects. Among the post-injury group, 7 of 7 patients (100%) who demonstrated os peroneum fragment separation of 6mm, displacement of the proximal fragment by 10mm or more on the lateral radiograph or 20mm or more displacement on an oblique radiograph exhibited a full thickness peroneus longus tendon tear on ultrasound and MRI. In contrast, os peroneum fragment separation of 2mm or less or proximal displacement of 8mm or less was associated with ultrasound/MRI findings of normal tendon substance, partial-thickness tears, or tendinosis.
COMMENTS:
Radiography, ultrasound and MR imaging are useful and important tools in the evaluation and diagnosis of os peroneum fracture peroneal tendon injuries. These findings provide the foot and ankle surgeon with radiographic parameters by which to gauge the extent of peroneal tendon involvement in the presence of an os peroneum fracture.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.