Amir Reza Vosoughi, Ehsan Afaridi, Saeed Solooki, Zahra Shayan, Stefan Rammelt
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The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.</p><p><strong>Results: </strong>In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (<i>P</i> = .03), dislocated peroneal tendons (<i>P</i> < .001), calcaneal fracture-dislocation (<i>P</i> < .001), SPR avulsion fracture (<i>P</i> < .001), and Sanders type IV of calcaneal fracture (<i>P</i> = .02). There was no statistically significant relationship between PTI and the mechanism of injury (<i>P</i> = .98), side of fracture (<i>P</i> = .30), uni- or bilateral calcaneal fractures (<i>P</i> = .27), a fracture at the tip of lateral malleolus (<i>P</i> = .69), shape of the retromalleolar groove (<i>P</i> = .78), or excessive displacement of the lateral calcaneal wall (<i>P</i> = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).</p><p><strong>Conclusion: </strong>Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"825-833"},"PeriodicalIF":2.4000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures.\",\"authors\":\"Amir Reza Vosoughi, Ehsan Afaridi, Saeed Solooki, Zahra Shayan, Stefan Rammelt\",\"doi\":\"10.1177/10711007231175666\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning.</p><p><strong>Methods: </strong>In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.</p><p><strong>Results: </strong>In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (<i>P</i> = .03), dislocated peroneal tendons (<i>P</i> < .001), calcaneal fracture-dislocation (<i>P</i> < .001), SPR avulsion fracture (<i>P</i> < .001), and Sanders type IV of calcaneal fracture (<i>P</i> = .02). There was no statistically significant relationship between PTI and the mechanism of injury (<i>P</i> = .98), side of fracture (<i>P</i> = .30), uni- or bilateral calcaneal fractures (<i>P</i> = .27), a fracture at the tip of lateral malleolus (<i>P</i> = .69), shape of the retromalleolar groove (<i>P</i> = .78), or excessive displacement of the lateral calcaneal wall (<i>P</i> = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).</p><p><strong>Conclusion: </strong>Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. 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引用次数: 1
摘要
背景：我们旨在了解不同类型跟骨骨折伴腓肌腱不稳定（PTI）的发生率，并根据术前CT扫描确定PTI的预测因素。方法：在一项回顾性横断面研究中，回顾了400例连续手术的跟骨骨折的术前CT扫描，包括踝外侧沟粉碎性碎片、外踝尖骨折、腓肌腱脱位、跟骨外侧壁过度移位、跟骨骨折脱位，腓上支持带（SPR）撕脱骨折（斑点征）和踝后沟的形状。评估了这些变量与术中SPR应力测试（定义为跟骨骨折PTI的诊断标准）的相关性。结果：总共有369名患者（平均年龄39岁） ± 13；范围，11-72 年龄），其中男性321例（87.0%）。在所有跟骨骨折中，67例（16.7%）在术中通过SPR应力测试证实有相关的PTI。跟骨骨折的PTI与踝外侧沟粉碎性碎片的相关性有统计学意义（P = .03）、腓肌腱脱臼（P P P P = .02）。PTI与损伤机制无统计学意义（P = .98），骨折侧（P = .30）、单侧或双侧跟骨骨折（P = .27）、外踝尖端骨折（P = .69）、踝后沟的形状（P = .78）或跟骨外侧壁过度移位（P = .06）。预测跟骨骨折伴发PTI最具体的CT表现是跟骨骨折脱位（99.1%）。结论：跟骨骨折固定后，术中SPR应力测试证实PTI的病例占六分之一。除了跟骨骨折脱位外，术前CT扫描和跟骨骨折病理解剖结果不足以诊断伴有跟骨骨折的PTI。证据级别：三级，回顾性病例对照研究。
Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures.
Background: We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning.
Methods: In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.
Results: In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).
Conclusion: Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures.
Level of evidence: Level III, retrospective case control study.
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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