What Are the Different Types of Peroneal Tendon Injury?

Fibula Shortbone: An important part of the fibula. The fibula is one of the long bones of the lower leg and lower leg. Thinner on the outside of the calf. The upper end is called the fibula head, and the joint surface is connected with the fibula joint surface of the tibia. The lower end is called the lateral malleolus, and the medial side has a flat lateral malleolus joint surface that participates in the formation of the ankle joint. This bone is slender, supporting and supporting. This bone injury is more common, and simple fibula fractures have less effect on the weight bearing of the lower limbs. However, there are many nerves and blood vessels in the tibia and fibula, which are easy to be damaged at the same time, so it should be treated with great care.

Fibula Shortbone: An important part of the fibula. The fibula is one of the long bones of the lower leg and lower leg. Thinner on the outside of the calf. The upper end is called the fibula head, and the joint surface is connected with the fibula joint surface of the tibia. The lower end is called the lateral malleolus, and the medial side has a flat lateral malleolus joint surface that participates in the formation of the ankle joint. This bone is slender, supporting and supporting. This bone injury is more common, and simple fibula fractures have less effect on the weight bearing of the lower limbs. However, there are many nerves and blood vessels in the tibia and fibula, which are easy to be damaged at the same time, so it should be treated with great care.

Chinese name

Short fibula

Foreign name

Fibula short bone

Fibula Short Bone Overview

1. Fibula short bone: An important part of the fibula.

2. Fibula tendon: The fibula tendon exists in the bone-fiber tube behind the ankle joint fibula level. The front of the fibula tendon is bordered with the posterior lateral malleolus, the medial is the posterior peroneal ligament, and the posterior inferior is the tibiofibular ligament and the calcaneal fibula ligament. There is a fibula support band on the outside. The fibula tendon is wrapped by a synovial sheath extending from the lower edge of the fibula muscle to 1 cm below the tip of the fibula. The fibula tendon sheath and fibrous band 2cm distal to the fibula tip constitute the suprafibula support band. The support band extends from the posterior fibula to the posterior upper part and ends at the fibula periosteum.

Fibula short bone anatomy

Fibula: Fibula is an elongated long bone on the side of the calf near the little toe. Split the two ends. The proximal end swells into a round fibula head. The distal end is triangular in shape and extends downward to form a lateral malleolus. It has a lateral malleolus joint on its inner surface, which together with the subtibia joint and medial malleolus joint surfaces form the socket of the ankle joint.

Fibula short tibia fracture nonunion anastomosis vascular free fibula transplantation

Indications : Non-union of tibia fracture, long sclerotic end, and large tibia defect.

Preoperative preparation : microsurgical instruments, vascular anastomosis.

Anesthesia : continuous epidural anesthesia or spinal anesthesia or general endotracheal intubation.

Posture : prone position.

Operation steps :

1. Incision: A long and longitudinal snake incision on the outer posterior edge of the fibula, which does not exceed 1/4 of the lower fibula, and can extend upward to the popliteal fossa (transplant the fibula).

2. Reveal vascular nerves: Cut open the skin, subcutaneous tissue and deep fascia, sharply cut the gap between the soleus muscle and the fibula muscle, cut off the long flexor muscle 1.0 cm away from the fibula, and expose and protect the peroneal artery and fibula nutrition under this muscle For arteries, the posterior tibialis muscle is separated and cut off at 1.0 cm from the medial edge of the peroneal artery. The posterior tibialis muscle and toe flexor muscle are peeled inwardly from the periosteum until the posterior aspect of the tibial bone is exposed, including the fractured end of the tibial.

3, repair the tibial fracture end: remove the hardened tibia, and cut out a layer of cortical bone on the back side of each end of the tibia, resulting in a fresh surface.

4. Transplantation of the fibula: Select the osteotomy plane above and below the fibula and cut off the fibula. If the bone segment includes the fibula head, the fibula head should also be sawn off from the tibial articular surface. In order to ensure the vascular supply of the transplanted fibula segment, it is best to ensure the periosteum and the peroneus longus muscles, part of the peroneus shortis muscle attached to the small head and outer side of the fibula, attached to the peroneus longus muscle of the anterior side of the fibula, and about 0.5 parts of the toe longus flexor muscles behind ~ 1.0cm thick, forming a layer of muscle sheath. If the transplant includes the fibula head, the biceps femoris tendon attached should be severed. After the fibula is free, ligate and cut off the peroneal blood vessel at the osteotomy plane of the lower end of the fibula, while the upper end of the peroneal blood vessel is temporarily reserved, and cut off after the cross is ready. You can observe whether the peroneal muscle and periosteum of the peroneal bone are cut before the blood vessel is cut There is no bleeding in the cavity to observe the blood circulation of the peroneal artery. The two ends of the fibula were trimmed, and the trimmed bone segment formed a trapezoidal anastomosis with the tibial fracture end, and each was fixed with 2 screws (Figure 16-3-10). End-to-side anastomosis of the fibula bone vessels with the posterior tibial artery.

5. Suture and external fixation: rinse to stop bleeding, place drainage tube, and suture layer by layer. After bandaging, the long leg cast was fixed.

Key points during the operation:

1. Separate the common peroneal nerve and protect the common peroneal nerve when cutting off the peroneal long muscle of the lateral fibula head.

2. Do not damage the anterior tibial arteries and veins.

3. The distal 1/4 of the lower end of the fibula must be stored to avoid affecting the stability of the ankle joint.

Postoperative management:

Long leg plaster was fixed for 3 months, and then wearing a patellar tendon weight-bearing walking exercise, gradually thickened after walking.

X X-ray diagnosis of fibula short fibula

1. The fibula is in the right position. On the fibula orthotopic film, the fibula head partially overlaps with the lower part of the lateral tibial condyle. The upper end of the small head of the fibula protrudes upward, which is called the fibula styloid process. The cancellous texture of the fibula's small head is relatively sparse, and sometimes a local density reduction zone may appear.

The fibula shaft is particularly slender, showing a typical tubular bone shadow, with a thicker outer cortex and a thinner medial cortex, and sometimes a lighter density edge appears as an interosseous epiphysis.

The lower end of the fibula constitutes the lateral malleolus, which has a triangular shape with the tip facing downwards, and its inner surface corresponds to the talar block and participates in the formation of the ankle joint. At the lower end of the lateral malleolus, a lighter sulcus is sometimes seen as the lateral malleolus sulcus. Above the lateral malleolus, the fibula overlaps or corresponds to the lower end of the tibia with a gap.

2, lateral fibula. The anterior part of the fibula head overlaps with the tibia, and the fibula backbone is a typical long tubular bone. The lateral malleolus goes down through the ankle joint into the talar pulley shadow. In the shadow that overlaps the talar tackle, the medial malleolus is anterior and the lateral malleolus is posterior.

Fibula short and fibula-related diseases

Fibula tendon spondylolisthesis: Fibula tendon spondylolisthesis refers to a syndrome in which the fibula tendon slips out of the fibula sulcus at the distal end of the fibula, loses the pivot point, and produces a series of clinical symptoms such as pain and instability of the lateral ankle. Although the total or total dislocation of the fibular tendon is not clinically high, it is often missed or misdiagnosed as a lateral ankle sprain and delayed treatment. Eventually, the ankle joint function is severely restricted and surgery is caused.

Most acute fibula tendon injuries occur after sports injuries such as alpine skiing, tennis, football, rugby, ice skating and running. Earle et al. Slipped fibular tendon slip accounted for about 0.5% of all ski injuries.

Hassani et al. Retrospectively analyzed 265 cases of sports injuries, and the results showed that 71% of them were related to alpine skiing. The second largest cause of injuries was rugby sports injuries. Acute fibular tendon spondylolisthesis is also more common after high-energy trauma such as fractures of the fibula, talus and calcaneus. In clinical situations, it is generally the first thing to think of bone and joint damage, and tendon dislocation is easily missed. Title et al. Reported 23 cases of refractory chronic fibular tendon spondylolisthesis with an average delay of several months.