Peroneus brevis tendon in proximal 5th metatarsal fractures: Anatomical considerations for safe hook plate placement

The peroneus brevis tendon (PBT) inserts into the proximal aspect of the 5th metatarsal. Metatarsal bone fractures are encountered to be the most common fractures in the foot with predominantly fractures at the base of the fifth metatarsal bone. Mechanism of injury and treatment of the proximal 5th metatarsal fractures vary due to the complex anatomy and diverse biomechanical properties. The purpose of this study was to analyze the footprint of the PBT with regards to the proximal 5th metatarsal fractures and to define a "safe zone" for hook plate placement.

Forty-one (41) fixed human lower leg specimens were dissected to expose the PBT insertion. The following footprint characteristics were evaluated: area of insertion (AOI) (mm²), length (mm), width (mm), shape and insertional variations. The position of the main PBT footprint was localized according to the Lawrence and Botte classification for the proximal 5th metatarsal fractures (Zone I-III). A "safe zone" was defined for the fracture-specific hook plate placement.

In 25 (61%) feet the PBT footprint was situated in Zone I and in 16 feet (39%) in Zone I&II. The mean AOI, length and width measured 54.5 mm² (SD 16.5), 16.0 mm (SD 5.1) and 4.7 mm (SD 1.4), respectively. Analysis of the footprint shapes revealed four different shape types: kidney (29.3%), diamond (22.0%), crescent (31.7%) and oval (17.0%). A "safe zone" for hook plate placement without or minimal interference of the PBT at its insertion could be defined at the lateral aspect of the 5th metatarsal.

The majority of the PBT footprints were found in Zone I. Hook plate placement demonstrated to be safe when placed strictly laterally at the proximal aspect of the 5th metatarsal. Precise knowledge of the peroneus brevis anatomy may help to better understand the biomechanical aspects of the proximal 5th metatarsal fractures.