The peroneus brevis tendon at its insertion site on fifth metatarsal bone

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Abstract

Background

The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site.

Methods

The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides.

Results

The length of PB tendon was measured 79.57 ± 15.40 mm on the right side; 81.48 ± 14.31 mm on the left. The width of PB tendon at the mid-point was 4.46 ± 0.80 mm on the right side; 4.42 ± 0.94 mm on the left. The width of the tendon at its insertion point was measured 14.85 ± 3.40 mm and 15.16 ± 3.42 mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe.

Conclusions

Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.

Introduction

The anatomy of the PB tendon at its insertion site on the base of fifth metatarsal bone (MB) is important in terms of surgeries involving lateral side of the foot [1], [2]. Peroneal (fibular) muscles are the ones running in the evertion motion of the foot. Peroneus brevis (PB) has its insertion on the base of the fifth MB. It is known that intensive contractions of the muscles and sudden and severe motions of the extremities may lead to avulsion fractures at the attachment sites of tendons. Avulsion fractures of the base of fifth MB are among the frequently encountered fractures in orthopedic practice.

Here, we aimed to study the detailed anatomy of the PB tendon at its insertion area on the base of fifth MB in cadavers and we aimed to discuss its clinical importance for to determine the possible etiological factors of avulsion fracture. The PB tendon has also been analyzed on MR imaging in a limited number of patients with fractures located at the base of fifth MB to evaluate which the tendon type is more likely to be associated with these fractures.

Section snippets

Anatomy

A total of 45 lower extremities of the cadavers fixed by 10% formalin were included in the study. Both sides of lower extremities of 17 cadavers (male 15, female 2; years of 64–78; mean age 67) and 11 isolated lower extremities of with an unknown age and sex were included in the study.

There was no recorded history of trauma at the time of the death of the cadavers. No structural impairment or pathology related to the bones or soft tissues were observed. An incision was made from the level of

Imaging

For five patients (three males, two females; years of 32–55; mean age 45) of whom the base of fifth MB fractures was identified on their radiographies, magnetic resonance (MR) imaging (1,5 T, Siemens, Sonata) was planned. The images were obtained with T2-weighted (TR/TE = 3573/70) fast spin-echo and T1-weighted (TR/TE = 500/17) fast spin-echo sequences for to evaluate the integration of the PB tendons and their structure at the attachment site on the bone.

Results

The measurements related to the PB which were taken on the cadavers were shown in Table 1, Table 2. The mean values of the measurements, the classification related to the attachment of the tendon and the cases with slips were displayed in Table 3, Table 4, Table 5.

We have classified the tendon insertion characteristics of the PB as shown in Table 4a (Fig. 1, Fig. 2).

In 13 of 45 lower extremities (8 right, 5 left) a single slip and in five of 45 lower extremities (2 right, 3 left) a double slip

Discussion

In previous studies it was reported that the length of the PB tendon was important in tendon transplantations and the rotational grafts needed in orthopedic surgical procedures [1], [2]. In our study, the mean tendon length of the PB tendon was found to be 79.57 ± 15.40 mm on the right and 81.48 ± 14.31 mm on the left side.

Teng et al. [4] measured the width of the PB tendon as 2.8–6 mm (mean 4 ± 0.9 mm). In our study, the mean values for the width of the PB tendon was found to be 4.46 ± 0.80 mm on the right

Conclusion

Our study is the detailed study to establish the detailed distal anatomy of the PB at its insertion site. Knowing the differences at the attachment site of the PB tendon on the base of fifth metatarsal bone is important in surgical procedures when this tendon is needed in transplantation or rotational grafting. We suggest that a narrowly inserted tendon may apply more stress since the internal force applied on per unit area will increase when compared with a wider insertion area. Increased

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

The authors thank to Associate Professor Selim Kılıç, Gulhane Military Medical Academy Department of Public Health, Turkey, Associate Professor Yüksel Yurttas, Gulhane Military Medical Academy Department of Orthopedic Surgery, Associate Professor Ayhan Comert, Ankara University Department of Anatomy, Turkey, for their help in statistical analysis and the suggestions for the used data in this manuscript.

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