title: Incidence and recognition of peroneal tendon dislocation associated with calcaneal fractures.
abstract: BACKGROUND
  Questions abound regarding natural history and medicolegal implications of untreated peroneal tendon dislocation (PTD) associated with calcaneal fractures.
  
  
  METHODS
  We retrospectively analyzed CT scans and anteroposterior ankle radiographs of 79 consecutive calcaneal fractures presenting over 4 years at a single institution.
  
  
  RESULTS
  Nineteen patients (24%) had associated PTD, which was initially missed in 10 (53%). Bony fleck was present in 11 (13.75%). Soft tissue swelling at lateral malleolar level, present on radiographs of 18 tendon dislocators (95%), raises likelihood of PTD with increasing specificity the greater the swelling. In 6 patients, surgeons failed to identify on CT spontaneously relocated tendons that then peeped around the posterolateral fibula, a finding not appreciable on 3-dimensional volume-rendering.
  
  
  CONCLUSIONS
  Despite a significant association of PTD with calcaneal fractures, it still passes unrecognized all too frequently. Anatomical fracture fixation does not guarantee stable tendon reposition. Further studies are required to elucidate functional outcome of untreated PTD.
authors.affiliation: Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK. Electronic address: johnwong@doctors.org.uk.
authors.forename: John
authors.initials: J
authors.lastname: Wong-Chung
authors.affiliation: Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: William Dominic
authors.initials: WD
authors.lastname: Marley
authors.affiliation: Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Tucker
authors.affiliation: Department of Radiology, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: Diarmaid S
authors.initials: DS
authors.lastname: O'Longain
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Ankle; Calcaneal fracture; Diagnosis; Natural history; Peroneal tendon dislocation