SLR - December 2017 - Riddhi M. Shah
Reference: Sadamasu, A., Yamaguchi, S., Nakagawa, R., Kimura, S., Endo, J., Akagi, R., Sasha, T. The Recognition and Incidence of Peroneal Tendon Dislocation Associated with a Fracture of the Talus. Bone Joint J. 2017. 99-B(4), 489–493.Scientific Literature Review
Reviewed By: Riddhi M. Shah, DPM
Residency Program: UPMC Pinnacle Health System, Harrisburg, PA
Podiatric Relevance: Peroneal tendon dislocations are rare injuries that are often overlooked. Additionally, talar fractures injuries make up a low percentage of foot fractures. Together, there is limited information regarding peroneal tendon dislocation with a talar fracture. In this study, the authors determine the incidence of peroneal tendon dislocations with associated factors in 30 patients with ORIF of a talar fracture.
Methods: A level V retrospective study was performed on 30 ankles with an ORIF of talar fractures, with exclusion of nonoperative and subtalar arthrodesis of talar fractures. Patient characteristics collected were age, sex and mechanism of injury. The outcome measures were age, low versus high injury mechanism, body versus neck fracture site, Marti-Weber classification, presence of concurrent fracture and presence of fleck sign for which the patients were divided into two groups. Peroneal tendon dislocations were assessed by two independent examiners using preoperative CT images.
Results: Total incidence of peroneal tendon dislocation was nine of the 30 patients as seen on preoperative CT images and physical examination. The fleck sign had a statistically significant association with peroneal tendon dislocation. Even though there are greater number of dislocations in severe fractures of Marti-Weber classifications, concurrent fractures, high-energy injury and neck fractures, it was not statistically significant.
Conclusion: Peroneal tendon dislocations are frequently associated with talar fractures with a statistically signification incidence of fleck sign. Dislocations can be missed on CT images and on physical examination in high-energy trauma with pain. MRI and ultrasound can be an adjunctive for diagnosis. In terms of limitations, there might be a decreased incidence of peroneal tendon dislocations in nonoperative talar fractures that were excluded from the study. In addition, CT images are not able to capture all dislocations. Considering this, the main message is to have an increased height of suspicion for peroneal tendon dislocations in patients who present with talar fractures.