title: Peroneal tendon displacement accompanying intra-articular calcaneal fractures.
abstract: BACKGROUND
  Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate.
  
  
  METHODS
  A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated.
  
  
  RESULTS
  Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p < 0.001). Only twelve (10.2%) of the 118 cases of peroneal tendon displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases.
  
  
  CONCLUSIONS
  Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, YAW 3F, Boston, MA 02114.
authors.forename: Rull James
authors.initials: RJ
authors.lastname: Toussaint
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, YAW 3F, Boston, MA 02114.
authors.forename: Darius
authors.initials: D
authors.lastname: Lin
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, YAW 3F, Boston, MA 02114.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Ehrlichman
authors.affiliation: Foot and Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200 B, Charlotte, NC 28207.
authors.forename: J Kent
authors.initials: JK
authors.lastname: Ellington
authors.affiliation: Foot and Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200 B, Charlotte, NC 28207.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Strasser
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, YAW 3F, Boston, MA 02114.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries*; D018409:Foot Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D004204:Joint Dislocations / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery