IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS)

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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

Russian Federation

V. 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

Russian Federation

E. 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

Russian Federation

S. 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

Russian Federation

V. 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

Russian Federation

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