title: Radiography and US of os peroneum fractures and associated peroneal tendon injuries: initial experience.
abstract: OBJECTIVE
  To retrospectively evaluate the imaging features of os peroneum fractures and associated peroneus longus tendon injuries at radiography and ultrasonography (US) and to retrospectively compare these imaging features with those of multipartite os peroneum.
  
  
  METHODS
  Institutional review board approval was obtained and informed consent was waived for this HIPAA-compliant study. Retrospective review of findings in nine patients (five men, four women; age range, 35-59 years) with os peroneum fracture at radiography and lateral foot pain after injury who had undergone US of the foot was performed. Three patients underwent magnetic resonance (MR) imaging, and two underwent surgery. Os peroneum fragment separation and displacement relative to the calcaneocuboid joint were measured on radiographs. Os peroneum fracture and peroneus longus tendon injuries were characterized with US and MR imaging. Review of 43 foot radiographs obtained in 36 control subjects (eight men, 28 women; age range, 18-84 years) who were found to have an os peroneum at radiography but were asymptomatic in that area was completed to measure os peroneum distance from the calcaneocuboid joint and bipartite os peroneum fragment distraction.
  
  
  RESULTS
  Os peroneum fragment separation of 6 mm or more or displacement of the proximal fragment by 10 mm or more on a lateral radiograph or 20 mm or more on an oblique radiograph was associated with full-thickness peroneus longus tendon tear in seven of seven patients (100%). Os peroneum fragment separation of 2 mm or less or proximal displacement of 8 mm or less was associated with normal tendons, partial-thickness tears, or tendinosis. In the control subjects, os peroneum location ranged from 7 mm proximal to 8 mm distal to the calcaneocuboid joint on lateral radiographs and from 9 mm proximal to 8 mm distal to the joint on oblique radiographs. Bipartite os peroneum fragment separation was 2 mm or less.
  
  
  CONCLUSIONS
  Os peroneum fragment separation of 6 mm or more suggests os peroneum fracture and associated full-thickness peroneus longus tendon tear. Separation of 2 mm or less may be seen with nondisplaced os peroneum fractures and bipartite os peroneum.
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2808, Ann Arbor, MI 48109-0326, USA. mbrigido@umich.edu
authors.forename: Monica K
authors.initials: MK
authors.lastname: Brigido
authors.forename: David P
authors.initials: DP
authors.lastname: Fessell
authors.forename: Jon A
authors.initials: JA
authors.lastname: Jacobson
authors.forename: David S
authors.initials: DS
authors.lastname: Widman
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Craig
authors.forename: David A
authors.initials: DA
authors.lastname: Jamadar
authors.forename: Marnix T
authors.initials: MT
authors.lastname: van Holsbeeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000293:injuries* / Q000601:surgery; D013708:Tendon Injuries / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography