Hyperglycemia associated with type 2 diabetes genetic,the genetic basis of type 2 diabetes,what is type 2 diabetes statistics,m. pectoralis major (gro?er brustmuskel) - Reviews

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We report a case of plantar left peroneus longus tendon rupture associated with os peroneum fracture and treated with partial excision of os peroneum fracture and side-to-side suture of the peroneal tendon and fibularis tertius enhancement. 44 year old male patient presented to the emergency department after a left ankle sprain. Because of persistent pain in his left foot and functional dysfunction he was referred to our unit 2 weeks after the accident.
A lateral and oblique foot radiographs showed a displaced fracture of the left os peroneum.
The peroneus longus tendon rupture was identified with the proximal stump retracted with a biggest part of the os peroneum. The patient was then immobilized in a below knee cast for two weeks with partial weight bearing.
The fibular longus muscle originates proximally from the lateral condyle of the tibia and head of the fibula, turns sharply at the cuboid groove and inserts into the plantar-lateral aspect of the first metatarsal and medial cuneiform. The primary action of the fibular longus is eversion and plantar flexion of the foot. Both the fibular brevis and the fibular longus muscles are innervated by the superficial peroneal nerve and receive their blood supply from the posterior peroneal artery and branches of the medial tarsal artery. Brandes and Smith [5] categorized three zones along the peronei longus tendon. Avulsion fractures and tendon ruptures at the musculotendinous junction occur much more frequently than midsubstance tendon ruptures [8].
Physical examination, starting with inspection may disclose swelling posterior to the lateral malleolus.
The os peroneum is an accessory ossicle located within the substance of the peroneus longus tendon and its location, size, and appearance are varied [10].
In the present case, we used MRI to evaluate the tendon pathology and to rule out any associated ligamentous injury to the left ankle. Brandes CB, Smith RW (2000) Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases.
Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR (2003) Peroneal tendon tears: a retrospective review.
Blitz NM, Nemes KK (2007) Bilateral peroneus longus tendon rupture through a bipartite os peroneum. Choplin RH, Buckwalter KA, Rydberg J, Farber JM (2004) CT with 3D rendering of the tendons of the foot and ankle: technique, normal anatomy, and disease.
MacDonald BD, Wertheimer SJ (1997) Bilateral os peroneum fractures: comparison of conservative and surgical treatment and outcomes. Peterson DA, Stinson W (1992) Excision of the fractured os peroneum: a report on five patients and review of the literature.
Peacock KC, Resnick EJ, Thoder JJ (1986) Fracture of the os peroneum with rupture of the peroneus longus tendon. Diabetes complicationsConditions or pathological processes associated with the disease of diabetes mellitus. Send Home Our method Usage examples Index Statistics Advertise with us ContactWe do not evaluate or guarantee the accuracy of any content in this site. Hyperinsulinemia - What is Hyperinsulinemia?Hyperinsulinemia, or hyperinsulinaemia is a condition in which there are excess levels of circulating insulin in the blood. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This is a rare pathology and several treatment optionshave been proposed in the literature. Usually tears of the peroneal tendons are partial ruptures called longitudinal tears.
His pain was mainly on the lateral malleolus and on the plantar aspect of the lateral left foot. Physical examination showed tenderness on the plantar lateral aspect of the left foot just behind the base of the fifth metatarsal. The large proximal fragment of the fractured osperoneum was located at the cuboid notch and the thin distal fragment was displaced distally.
The distal part was detected with the small cartilaginous part of the os peroneum at the level of the base of the fifth metatarsal. At two weeks we changed the cast to a dynamic Vacoped for an additional 4 weeks with full weight bearing.
The musculotendinous junctions of both tendons are usually located proximal to the superior peroneal retinaculum [1]. Together with the peroneus brevis, it provides supplemental lateral ankle stability, especially during the midstance and heel rise of the gait cycle [4].
Zone A extends from the tip of the malleolus to the peroneal tubercle, Zone B from the lateral trochlear process to the inferior retinaculum, and Zone C from the inferior retinaculum to the cuboid notch.
The first type is peroneal tendinopathy without subluxation of the fibular tendons, with or without attritional rupture. Fibular longus tears typically occur in 3 distinct anatomic zones: the lateral malleolus, the peroneal tubercle of the calcaneus, and the cuboid notch [8,9]. Palpation along the peroneal trajectory may identify areas of tenderness with the tendon palpable and painful. Because of variable ossification centers, the ossicle may present bipartite and multipartite which may mimic fracture lines on the radiographs. Also known as pre-diabetes, insulin resistance, and syndrome X, it is commonly associated with PCOS (Polycystic Ovarian Syndrome) in females.
Partial and complete rupture of peroneus longus tendon do occur but are far less common than injuries seen in peroneus brevis. Physical examination showed some tenderness in the lateral retromalleaolar area with no neurovascular disturbance. Pain was evoked with first ray plantar flexion against resistance with some weakness detected in the lateral eversion against resistance of the left foot with the ankle in plantar flexion.
We completed the exam with an MRI and confirmed the diagnosis of plantar rupture of the left peroneus longus tendon with fracture of the os peroneum (Figure 3 and 4). In approximately 20% of the population, at the os peroneum, an ossified sesamoid bone is present at the calcaneocuboid joint [2].
The fibular muscles are antagonists to the tibialis posterior, flexor hallucis longus, flexor digitorium longus and tibialis anterior muscles. Zone C is a high-stress area, particularly at the cuboid notch, and is the location of the majority of fibular longus tears [6]. The second type is peroneal tendinopathy associated with instability of the fibular tendons at the level of the superior peroneal retinaculum. Indirect injury mechanisms are multifactorial and depend heavily on anatomic location, vascularity, and skeletal maturity, as well as on the magnitude of the applied forces.
A partite os peroneum may be misdiagnosed, as fracture and the diagnosis of fracture of the os peroneum may be difficult.
Biltz and Nemes [12] reported that the peroneus longus transfer to the peroneus brevis tendon above the ankle joint after excision of the fracture ossicle of os peroneum was successful. In the present case, the proximal os peroneum was excised and the peroneus longus tendon stumps sutured side-to-side, strengthened with a fibularis tertius transfer.

The weakest point of peroneus longus tendon is the point where it changes direction and rounds the plantar surface of the cuboid.
AP and lateral radiographs of the left foot and ankle were made and the diagnosis of fractured os peroneum was made (Figure 1 and 2). The patient was operated under spinal anesthesia in a dorsal decubitus position. The os peroneum predisposes to the development of stenosing fibular longus tenosynovitis in the region of the cuboid tunnel [3]. Tendon ruptures, complete or incomplete may occur at the musculotendinous junction beneath the superior peroneal retinaculum or at its distal edge. The third type is stenosing tenosynovitis of the fibular longus tendon, which may be associated with a painful os peroneum, and an enlarged peroneal tubercle [7].
However, an absence of marked eversion weakness does not preclude a fibular tendon tear or rupture. Biltz demonstrated the usefulness of magnetic resonance imaging (MRI) to diagnose the retracted fractured os peroneum retained within the peroneus longus tendon [11]. Conservative treatment with immobilization or excision of the fractured os peroneum is one of the options for treatment of os peroneum fracture [15-18].
We believe that excising the proximal remnant of the fractured os peroneus in a subperiosteal way will provide us with more room to work and with a longer proximal peroneus longus stump allowing thus an easier solid side-to-side repair. Because the distal part of the os peroneum was too small to be fixed, we decided to excise in a subperosteal way the proximal fractured os peroneum.
The peroneus tertius is the smallest of the three peroneus muscles in the lower leg.
Tears may occur within the cuboid tunnel, where a rupture may be associated with an intratendinous sesamoid bone. Loss or limitation of plantar flexion of the first ray is consistent with dysfunction of the peroneus longus tendon [1]. By contrast, 3D-CT is applied and useful for evaluation of tendons of foot and hand and is useful for surgical planning and patient education [12,13].
The trick of using the mini scorpion suture passer in the distal stump is very helpful and efficiacous. They occur most frequently at the site of the os peroneum- a small accessory bone found within the peroneus longus tendon at the lateral wall of the cuboid. A curved incision was made from the tip of the lateral malleolus to the base of the fifth metatarsal going through the inferior edge of the sinus tarsi. Situated on the lateral side of the leg between the calf and shin, it is found near the fibula bone just below the extensor digitorum longus muscle and to the inside of the peroneus brevis.
Fujioka et al used a 3D-CT in their case and agreed that it has an advantage of visualizing the disorders of tendon and bone simultaneously in threedimension compared with MRI [14].
For that purpose, we used a mini scorpion suture passer that allowed us to have a thin fibre wire anchored 1 cm away from the distal stump.
On the more proximal longer stump, we used again a thin fibre wire that we passed according to the Kessler technique providing us enough stability for the traction and the approximation of both stumps. We then sutured the proximal and distal fiber wires getting thus a good overlap between the 2 stumps. For more strength we did a fibularis tertius transfer by cutting it at the more distal part and suturing it to both stumps of the peroneus longus tendon.

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