0:00

<v ->Here, it's a beautiful case, of course.

0:06

Of a fracture, of the os peroneal fracture.

0:11

So this, let's go to the history.

0:15

It's a 61 year old male with lateral ankle pain

0:20

after trauma and ankle sprain four weeks ago.

0:24

So here, we have a case of os peroneal fracture

0:29

with a complete tear of the peroneus longus.

0:32

So the peroneus longus tendon is here,

0:34

and here is one piece of the os peroneal.

0:38

And here's the other piece of the os peroneal.

0:41

And here we can see the area of discontinuation between

0:45

the two fragments, and the discontinuation of the tendon.

0:50

And one interesting thing that I found in the literature,

0:54

is when this gap is greater than six millimeter,

1:00

it's probably a sign of a complete tear

1:02

of the peroneus longus tendon.

1:07

So that's important like, important point to make here.

1:14

And when you have a gap more than six millimeter

1:17

this is a sign of complete tear

1:18

of the peroneus longus tendon.

1:21

And another nice thing about this case

1:25

is that we can see that the fragments here,

1:27

this fragment, the proximal fragment,

1:29

is generally bigger than the distal fragment.

1:34

Sometimes we have trouble to find the distal fragment

1:37

but the proximal fragment is easier to find.

1:40

And sometimes we cannot see that on the MRI,

1:42

but we find this fragment doing ultrasound, or maybe CT,

1:47

or even an x-ray can find this fragment.

1:51

And there is some papers dealing with the position

1:56

of this proximal fragment, because this fragment here,

1:59

it is located above the peroneal tubercle here.

2:04

So it's the inferior peroneal retinaculum.

2:12

It's okay because the fragment is above this level.

2:17

If the fragment was, it's below this fragment.

2:21

If the fragment was above the peroneal tubercle,

2:26

probably the inferior peroneal retinaculum would be damaged.

2:30

And if the fragment is above the lateral malleolus,

2:37

probably the superior peroneal retinaculum is damaged

2:42

because of the high

2:48

retraction of the proximal retraction of the peroneal bone.

2:53

Let me see.

2:54

I did a lot of, I did my homework here,

2:58

but I couldn't read that.

3:01

I'm just talking by heart here.

3:03

Let me see if I have something else to add here.

3:08

Yeah, I think that's it.

3:12

<v ->Well, you did your homework very, very well.

3:16

The only other point I would make on this

3:18

is that one of the things,

3:19

when you study the peroneus longus tendon,

3:23

there's a tendency not to follow it

3:26

all the way along the plantar aspect of the foot

3:29

but you have to remember it goes all the way

3:31

to the medial cuneiform and base of the first

3:35

and pathology does lurk down there

3:37

and you can get complete tears distally

3:40

that can the displace the aspernium

3:43

but that's a beautiful, beautiful case.

3:47

<v ->I have just,

3:49

I have something to add up that I think that's nice.

3:53

<v ->Yeah.

3:53

<v ->That one of the mechanisms of lesion

3:58

of the fracture of the aspernium

4:00

is that it's actually the sprain of the ankle,

4:04

because when it occurs plantar flexion inversion

4:08

of the foot, the peroneal ossicle, the os peroneal,

4:14

its compressed against the cuboid bone

4:17

because of the contraction of the the peroneus longus,

4:21

and it can fracture the ossicle.

4:27

<v ->Sounds good.

4:28

<v ->It can happens after ankle sprain.

4:33

<v ->Good.