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IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS)
- Authors: Konovalchuk N.S.1, Rumakin V.P.1, Sorokin E.P.1, Lasunskii S.A.1, Fomichev V.A.1
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Affiliations:
- Vreden Russian Research Institute of Traumatology and Orthopedics
- Issue: Vol 23, No 4 (2017)
- Pages: 83-91
- Section: METHODS OF EXAMINATIONS
- Submitted: 26.12.2017
- Accepted: 26.12.2017
- Published: 26.12.2017
- URL: https://journal.rniito.org/jour/article/view/835
- DOI: https://doi.org/10.21823/2311-2905-2017-23-4-83-91
- ID: 835
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Abstract
Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.
Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.
Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.
Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of mechanical damage of bundles and inflammation. In prolonged impingement the intensity of inflammation decreases, but the connective tissue degeneration of the tendon continues with lipoid infiltration.About the authors
N. S. Konovalchuk
Vreden Russian Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: konovalchuk91@yandex.ru
Nikita S. Konovalchuk — Graduate Student.
8, ul. Akad. Baykova, St. Petersburg, 195427
РоссияV. P. Rumakin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Vasilii P. Rumakin — Cand. Sci. (Med.), head of the pathomorphological department.
8, ul. Akad. Baykova, St. Petersburg, 195427
РоссияE. P. Sorokin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Evgenii P. Sorokin — Cand. Sci. (Med.), researcher, orthopaedic surgeon, trauma and orthopaedic department N 7.
8, ul. Akad. Baykova, St. Petersburg, 195427
РоссияS. A. Lasunskii
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Sergei A. Lasunskii — Cand. Sci. (Med.), head of the trauma and orthopedic department N 7.
8, ul. Akad. Baykova, St. Petersburg, 195427
РоссияV. A. Fomichev
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Viktor A. Fomichev — orthopaedic surgeon, trauma and orthopaedic department N 7.
8, ul. Akad. Baykova, St. Petersburg, 195427
РоссияReferences
- Ахтямов И.Ф., Кривошапко С.В., Иванов П.В., Кривошапко Г.М. Послеоперационная реабилитация больных с переломами пяточной кости при чрескостном остеосинтезе по Илизарову. Гений ортопедии. 2003;(4):76-79. Akhtyamov I.F., Krivoshapko S.V., Ivanov P.V., Krivoshapko G.M. [Postoperative rehabilitation of patients with calcaneal fractures in the transosseous osteosynthesis according to Ilizarov]. Genij ortopedii [Orthopaedic Genius]. 2003;(4):76-79. (in Russian).
- Stephens H.M., Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int. 1996;17(7):395-401.
- Romash M.M. Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures. Clin Orthop Relat Res. 1993;(290):157-167.
- Young K.W., Lee K.T., Lee Y.K., Jang M.S., Yoon J.H., Kim J.H. Calcaneal reconstruction for the late complication of calcaneus fracture. Orthopedics. 2011;e634-638. doi: 10.3928/01477447-20110826-03.
- Clare M.P., Lee W.E., Sanders R.W. Intermediate to longterm results of a treatment protocol for calcaneal fracture malunions. J Bone Joint Surg Am. 2005;87(5):963-973. doi: 10.2106/JBJS.C.01603.
- Atkins R.M. The treatment of calcaneal malunion. Foot Ankle Clin. 2014;19(3):521-540.
- Yavuz U., Sökücü S., Demir B., Özer D., Özcan Ç., Kabukçuoğlu Y.S. Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthop Traumatol Turc. 2014;48(5):541-545. doi: 10.3944/AOTT.2014.13.0144.
- Coughlin M.J., Saltzman C.L., Anderson R.B. Mann’s surgery of the foot and ankle. 9th ed. Elsevier; 2014. pp. 1905-2186.
- Title C.I., Jung H.-G., Parks B.G., Schon L.C. The peroneal groove deepening procedure: a biomechanical study of pressure reduction. Foot Ankle Int. 2005;26(6):442-448. doi: 10.1177/107110070502600603.
- Sobel M., DiCarlo E.F., Bohne W.H., Collins L. Longitudinal splitting of the peroneus brevis tendon: an anatomic and histologic study of cadaveric material. Foot Ankle. 1991;12(3):165-170.
- Petersen W., Bobka T., Stein V., Tillmann B. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand. 2000;71(2):168-174. doi: 10.1080/000164700317413148.
- Toussaint R.J., Lin D., Ehrlichman L.K., Ellington J.K., Strasser N., Kwon J.Y. Peroneal tendon displacement accompanying intra-articular calcaneal fractures. J Bone Joint Surg Am. 2014;96(4):310-315. doi: 10.2106/JBJS.L.01378.
- Uhthoff H.K., Lohr J.F. The Pathogenesis of Rotator Cuff Tears. Proceedings of the Third International Conference on Surgery of the Shoulder Fukuoka, Japan. 1986. pp. 211-212.
- Longo U.G., Berton A., Khan W.S., Maffulli N., Denaro V. Histopathology of rotator cuff tears. Sport Med Arthrosc. 2011;19(1):227-236. doi: 10.1097/JSA.0b013e318213bccb.
- Hashimoto T., Nobuhara K., Hamada T. Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res. 2003;(415):111-120. doi: 10.1097/01.blo.0000092974.12414.22.
- Maffulli N., Ewen S.W., Waterston S.W., Reaper J., Barrass V. Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons. Am J Sports Med. 2000;28(4):499-505.
- Goncalves-Neto J., Witzel S.S., Teodoro W.R., Carvalho-Júnior A.E., Fernandes T.D., Yoshinari H.H. Changes in collagen matrix composition in human posterior tibial tendon dysfunction. Joint Bone Spine. 2002;69:189-194. doi: 10.1016/S1297-319X(02)00369-X.
- Guelfi M., Pantalone A., Mirapeix R.M., Vanni D., Usuelli F.G., Guelfi M., Salini V. Anatomy, pathophysiology and classification of posterior tibial tendon dysfunction. Eur Rev Med Pharmacol Sci. 2017;21(1):13-19.
- Maffulli N., Longo U.G., Maffulli G.D., Rabitti C., Khanna A., Denaro V. Marked pathological changes proximal and distal to the site of rupture in acute Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):680-687. doi: 10.1007/s00167-010-1193-2.
- Chen T.M., Rozen W.M., Pan W.-R., Ashton M.W., Richardson M.D., Taylor G.I. The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications. Clin Anat. 2009;22(3):377-385. doi: 10.1002/ca.20758.
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