Abstract
Peroneal tendon instability associated with an intraarticular calcaneal fracture is
a common injury that still often passes undiscovered by both radiologists and orthopedic
surgeons. Timely identification of this injury will guide the choice of surgical technique
used and treatment of patients. Using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines, several databases were searched through June
2017 for any observational or experimental studies that reported the prevalence/incidence
of peroneal tendon subluxation/dislocation with a calcaneus fracture with regard to
fracture classifications and the significance of the fleck sign. Nine studies were
included, with 1027 patients and 1050 calcaneus fractures. The overall prevalence
of peroneal instability (PI) in association with a calcaneus fracture was 29.3%. An
increasing prevalence of PI increased the severity of the calcaneus fractures, 5.4%
in Sanders I, 19% in Sanders II, 39.4% in Sanders III, and 49.5% in Sanders IV. The
presence of a fleck sign is a strong indicator of PI, with a prevalence of 54.7%.
The computed tomography findings can overestimate the presence of PI compared with
the intraoperative findings. The global reported prevalence of peroneal tendon instability
associated with intraarticular calcaneal fractures is high and increases with increasing
severity of the calcaneus fracture.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: March 14, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
