Incidence of peroneal tendon dislocation with talus fracture

Traumatic peroneal tendon dislocation (PTD) is known to occur with pilon and calcaneus fractures, however, literature describing PTD in concurrence with injury to the talus remains limited.

This was a retrospective review of adult patients with operatively treated talus fractures treated at a level I academic trauma center between 2007 and 2021. Charts, radiographs, and advanced imaging, when available, were reviewed for patient demographics, injury characteristics, and complications.

126 patients with 128 talus fractures were included. Incidence of PTD after talus fracture was 21.1 % (n = 27). Among isolated talus fractures only (n = 60), incidence of PTD was 16.7 % (n = 10). Peroneal rupture was separately found in 3 instances (2.3 %). PTD was significantly associated with lateral process fractures, making up one-third of total cases of PTD (p = 0.02), with 39 % of lateral process fractures demonstrating PTD. PTD was also associated with presence of fleck sign on injury radiographs (p < 0.00001). Among 27 cases of PTD, 14 (51.9 %) were diagnosed based on advanced imaging only (13 via CT scan and 1 by MRI), 4 (14.8 %) by operative report only, and 9 (33.3 %) based on both imaging and the operative report. Diagnosis was made acutely for 25 (89.3 %) PTDs, whereas 2 (7.4 %) were diagnosed in a delayed fashion. Three PTDs underwent delayed surgical intervention due to delayed diagnosis (n = 1), or missed dislocation by the surgeon although evident on injury scans (n = 2). Fractures with PTD developed higher rates of avascular necrosis (30.4 % versus 12.7 % among fractures without PTD, p = 0.044).

PTD with talus fracture is relatively common and was identified in one out of five fractures within the studied cohort. Surgeons and radiologists should be cognizant of this injury, especially in the setting of a lateral process fracture and a positive fleck sign.

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