Journal of Korean Foot and Ankle Society

Indexed in /covered by CAS, KoreaScience & DOI/Crossref:eISSN 2288-8551   pISSN 1738-3757

Fig. 1.

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Fig. 1. Operative technique. (A) After the longitudinal incision posterolateral to the distal fibular, the peroneal tendon sheath and superior peroneal retinaculum (SPR) were incised leaving a 3-mm cuff at the posterior border of the fibula and then, the dislocated peroneal tendon was observed. Black arrow heads indicate dislocated peroneus longus. (B) After dislocating the peroneal brevis and longus tendon laterally (asterisk [*] indicates fibrocartilaginous ridge), (C) the osteotomy with sagittal saw was done 3 cm proximally to the distal tip of the fibula from posterolateral margin of the peroneal groove with 5 mm in depth to the half width of the distal fibular. In this process, the fibrocartilaginous surface of peroneal groove was preserved as much as possible by including the fibrocartilaginous ridge and cutting at just posterolateral margin of the peroneal groove. (D) The bone block was temporary fixed with two K-wires after rotating 15~20 degrees counterclockwise and making 5 mm roof to preventing tendon dislocation at posterolateral aspect of distal tip of fibula. The C-arm fluoroscopy image showed the direction of K-wires. The proximal K-wire was inserted vertically, and the distal one was inserted with oblique direction from posterolateral bone block to anteromedial distal fibula. (E) The bone block was fixed with two 4.0 mm cancellous screws along the direction of the K-wires. (F) The peroneal brevis and longus tendon were relocated and the stability of tendon was confirmed with a stress test. The firm screw fixation and no penetration of screws to the joint were confirmed with the C-arm fluoroscopy. (G) The SPR was repaired to the posterolateral margin of the fibula without damage to a fibrocartilaginous ridge and the fascia was closed. And the stability of tendon was confirmed again with a stress test and the skin repaired layer by layer (asterisk [*] indicates fibrocartilaginous ridge).
J Korean Foot Ankle Soc 2020;24:168-72 https://doi.org/10.14193/jkfas.2020.24.4.168
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