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