Bilateral tripartite insertion of the fibularis (peroneus) brevis muscle: a case report / Inserción tripartita bilateral del músculo fibular corto: reporte de caso

SUMMARY: The fibularis brevis muscle typically inserts by a single long, robust, flat tendon upon the base of the fifth metatarsal. In this case report, we demonstrate two comparatively small accessory tendons of insertion in both the right and left limbs of an elderly cadaver. In each limb, the superior and inferior accessory tendons arose from the distal end of the main tendon of insertion to attach to, respectively, the shaft and neck of the fifth metatarsal. The bilateral presence of this comparatively rare condition is a new finding. Review of the literature reveals that these accessory tendons are most probably remnants of the inserting tendons of the atavistic muscle peroneus digiti minimi. The presence of this anomaly could affect reconstruction surgeries that utilize the inserting tendon of fibularis brevis, and treatment of avulsion fractures of the base of the fifth metatarsal.

RESUMEN: El músculo fibularis corto generalmente se inserta por un solo tendón largo, robusto y plano en la base del quinto metatarsiano. En este trabajo demostramos dos tendones accesorios de inserción comparativamente pequeños en ambos miembros inferiores de un cadáver de edad avanzada. En cada miembro inferior, los tendones accesorios superiores e inferiores surgieron de la porción distal del tendón principal de inserción para adherirse, respectivamente, al eje y al cuello del quinto metatarsiano. La presencia bilateral de éste músculo, comparativamente raro, es un nuevo hallazgo. La revisión de la literatura revela que estos tendones accesorios son probablemente remanentes de los tendones de inserción del músculo peroneus digiti minimi. La presencia de esta anomalía podría afectar las cirugías de reconstrucción que utilizan el tendón de inserción del músculo fibular corto, y el tratamiento de las fracturas por avulsión de la base del quinto hueso metatarsiano.

Distally based peroneus brevis muscle flap: A single centre experience / 中华创伤杂志(英文版)

PURPOSE@#Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects.@*METHODS@#This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery.@*RESULTS@#There were 21 males and 4 females with the mean age of 39 (5-76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4-50) cm. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting.@*CONCLUSION@#The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.

Single-stage reconstruction of achilles tendon and overlying skin defect with peroneus brevis tendon transfer and peroneal tendofascial flap / 中华显微外科杂志

Objective To explore the efficacy of peroneus brevis tendon transfer and peroneal tendofascial flap for repairing achilles tendon and overlying skin defect.Methods From April,2004 to May,2015,5 cases of achilles tendon and overlying skin defect were treated with peroneus brevis tendon transfer and peroneal tendofascial flap.In these cases,the length of the achilles tendon defect was from 3.0 cm to 8.0 cm,and the size of skin defect ranged from 2.0 cm × 3.0 cm to 3.0 cm × 5.0 cm.Using peroneus brevis tendon to reconstruct achilles tendon defect,and covered with peroneal tendofascial flap,and then skin graft.One of them combined with the gastrocnemius tendon V-Y advancement to promote the reconstruction of achilles tendon longer defect.The patients were followed-up regularly,and evaluated by the American Society of Ankle Arrhythmia (AOFAS) ankle-hindfoot scoring system.ResultsAll operations were successful and the grafted skin survived.All cases were followed-up from 6 months to 10 years with an average of 5.2 years.At the time of last followed-up,all wounds healed well without re-infection and ulceration.Not foot varus deformity and the strongth was back to the level before the injury.AOFAS ankle-hindfoot score was increased from (50.44 ± 12.05)(preoperative) to (90.02 ± 6.55)(the last follow-up) (P＜0.05).Conclusion There were some advantages in the method of the treatment of achilles tendon and overlying skin defect by using peroneus brevis tendon transfer and peroneal tendofascial flap,such as easy to cut,small damage to the donor area,and no significant deformity to the receptor area,etc.It is a good way to repair achilles tendon and overlying skin defects.

Augmented Repair of Degenerative Tears of Tendo Achilles Using Peroneus Brevis Tendon: Early Results

Reconstruction of degenerated ruptures of the tendoachilles is a challenge. Ruptured tendons and the remaining tendon ends are abnormal. A number of methods have been described in literature reconstruct the tendoachilles, but with variable results1. We used peroneus brevis tendon in 20 patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop as described by Teuffer et al2. All patients were followed up for atleast 18 months. At the last postoperative visit, 18 out of 20 patients were able to do a toe raise. Eighty-five per cent of patients had excellent or good results and 15% had fair or poor results using modified Rupp scoring. Advantages offered by this procedure are the use of a single incision and mini incision and use of a dispensable tendon such as the peroneus brevis without entirely depending on the damaged tendon for healing.

Long-term effects of chronic achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer, on sports activities / Efectos a largo plazo del tratamiento de la ruptura crónica del tendón de aquiles mediante reconstrucción con transferencia del peroneo corto en las actividades deportivas

OBJECTIVE: This study reports long-term effects of chronic Achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer (PBT), on sports activities based on an approximate 10-year follow-up study. METHODS: Twenty patients (6 women and 14 men; mean age, 43 ± 12.85 years at the time of operation) underwent chronic Achilles tendon repair with an average follow-up of 164.05 ± 5.07 months. Seven were involved in competitive sports, 10 participated in recreational activities and three were not involved in any sporting activities. All patients were Asians. Results were assessed using Cybex strength testing and the American Othopaedic Foot and Ankle Society (AOFAS) Score, the muscle manual test (MMT), sports activities and comprehensive satisfaction assessment. RESULTS: Cybex strength testing resulted in an average gain of 87.05 ± 14.83% in dorsiflexion strength (range 65-110%) and 98.05 ± 9.02% in plantar flexion strength (range 85%-120%). The AOFAS score average was 86.9 ± 7.27. There were no postoperative re-ruptures, no recurrences and no wound complications. Plantar flexion strength and the AOFAS score were negatively correlated with the age at the time of operation (r = "0.566, r = -0.669, respectively). Seventeen patients (85%) were level five of MMT in eversion strength. Following treatment, six patients (30%) returned to competitive sports, while 10 (50%) who, prior to the injury and surgery, were involved in recreational activities, returned to similar activities. The relatively younger group tended to continue sport activities as competitive athletes (p < 0.05). Significant differences were observed in age at the operation between non-satisfaction group and excellent group (p < 0.05). The under 40-year age group tended to show a poor value. CONCLUSION: Recreational athletes and non-athletes could return to their sports activities satisfactorily, while young competitive athletes found difficulties in certain actions, especially related to eversion.

OBJETIVO: Este estudio reporta efectos a largo plazo del tratamiento de la ruptura crónica del tendón de Aquiles mediante reconstrucción con transferencia del peroneo corto (TPC) en actividades deportivas, sobre la base de un estudio de seguimiento de aproximadamente 10 años. MÉTODOS: Veinte pacientes (6 mujeres y 14 hombres; edad promedio, 43 ± 12.85 años en el momento de la operación) fueron sometidos a una reparación de ruptura crónica del tendón de Aquiles con un seguimiento promedio de 164.05 ± 5.07 meses. Siete estaban en medio de competencias deportivas, 10 participaban en actividades recreativas, y tres estaban fuera de toda actividad deportiva. Todos los pacientes eran los asiáticos. Los resultados se evaluaron usando la prueba de Cybex para medir la fuerza, la puntuación de la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) para la valoración quirúrgica, la prueba muscular manual (PMM), y la evaluación integral de la satisfacción y las actividades deportivas. RESULTADOS: La prueba de Cybex indicó una ganancia promedio de 87.05 ± 14.83% en fuerza de dorsiflexión (rango 65-110%) y 98.05 ± 9.02% en fuerza de flexión plantar (rango 85%-120%). El promedio de la puntuación de la escala de AOFAS fue 86.9 ± 7.27. No se produjeron re-rupturas post-operatorias, ni recurrencias, ni complicaciones de heridas. La fuerza de flexión plantar y la puntuación de la escala AOFAS fueron puestas en correlación negativa con la edad al momento de la operación (r = "0.566, r = -0.669, respectivamente). Diecisiete pacientes (85%) alcanzaron el nivel cinco de la PMM en fuerza de eversión. Tras el tratamiento, seis pacientes (30%) se reintegraron a las competencias deportivas, mientras que 10 (50%) que antes de la lesión y la cirugía participaban en actividades recreativas, se reincorporaron a actividades similares. El grupo relativamente más joven tiende a continuar las actividades deportivas como atletas de competencia (p < 0.05). Se observaron diferencias significativas en edad en la operación entre el grupo sin satisfacción y el grupo excelente (p < 0.05). El grupo por debajo de los 40 años de edad mostró valores más pobres como tendencia. CONCLUSIÓN: Tanto los atletas de actividades recreativas como los no atletas, pudieron regresar a sus actividades deportivas satisfactoriamente, mientras que los competidores jóvenes encontraron dificultades en ciertas acciones, en particular las relacionadas con la eversión.

Stenosing Peroneus Brevis Tendinitis Caused by Peroneus Quartus Tendon / 대한정형외과학회잡지

Peroneus quartus tendon is one of a group of accessory peroneal tendons present in humans. Associated pathologies include an attritional tear in the peroneus tendon, stenosing tendinitis, and peroneal tendon subluxation or dislocation. A 22-year old female patient, who presented suffering with lateral ankle pain and instability after ankle sprain, visited this hospital. The physical examination and MRI indicated a longitudinal tear of peroneus brevis tendon or chronic stenosing tendinitis caused by peroneus quartus tendon. Tenosynovectomy and an excision of the peroneus quartus tendon were performed. Satisfactory results were obtained at the 1 year follow-up after surgery. Orthopedic surgeons should consider the possible presence of the peroneus quartus tendon in a differential diagnosis of chronic lateral ankle pain.

Applied distally based peroneus brevis muscle flaps for coverage of the soft tissue defects over the lower one-third of the leg, ankle and foot / 中华显微外科杂志

Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The largest area of the soft tissue defect was 5 cm?7 cm. The smallest was 3 cm?4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion This technigue is a simple and complications are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue defect especially.

Rupture of Peroneus Brevis Combined with Bimaileolar Fracture: A case Report / 대한정형외과학회잡지

Combined injury of peroneus brevis rupture and bimalleolar fracture is very rare. The avulsion of peroneus brevis tendon from insertion maybe neglected and may prevent anatomic reduction of lateral malleolar fracture. We have treated open bimalleolar fracture with avulsion of peroneus brevis tendon from its insertion.