[Fibular tendon dislocations associated with calcaneal fractures: four case reports]

We report four cases of traumatic dislocation of the fibular tendons associated with calcaneal fractures. There are few reports of this type of association in the literature. We analyzed the diagnostic and therapeutic features. Two patients with a history of calcaneal fracture presented old, unrecognized, symptomatic dislocations of the fibular tendons. After CT confirmation, the tendons were repositioned surgically. During the last two years, CT scans performed systematically in patients with calcaneal fracture led to the discovery of two recent dislocations associated with calcaneal fractures. In these patients the fibular tendon dislocation was treated during the osteosynthesis procedure by relocating the tendon in the gutter and reinsertion of the retinaculum. The two older cases illustrated the serious functional consequences of neglecting displaced fibular tendons. We also detailed the characteristic CT signs observed with the two recent cases. The association of calcaneal fracture with fibular tendon displacement is rarely reported in the literature, but is not exceptional. Physical examination is limited during the acute phase. Imaging, particularly CT is required to demonstrate the tendon displacement. The objective results of surgical treatment were good. Orthopedic treatment is almost always unsuccessful. The association of fibular tendon displacement with calcaneal fracture is not exceptional. We have instituted a standardized CT protocol for all cases of calcaneal fracture in order to recognize disinsertion of the retinaculum and enable treatment at the same time as the osteosynthesis.