INTRODUCTION Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. AIM To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. METHODS We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records were reviewed for laterality, age, sex,mode of injury, associated injuries and operative interventions. 50 ankles met the inclusion criteria. 49 were males, mean age was 32.5 year and the predominant mode of injury was a fall from height. RESULTS Peroneal tendon dislocation was found in ten patients out of 50 (20%). Risk of dislocation increased with severity of the fracture and neck fractures. Most of the dislocations were missed by surgeons and radiologist, and no additional procedures were done to address such an injury. The Fleck sign had a statistically significant correlation with peroneal tendons dislocations (p=.005) CONCLUSION: Peroneal tendons dislocation is associated with as high as 20% of talus fractures. The authors recommend carefully reviewing CT scans by surgeons and radiologists alike to avoid missing such injury and allow for appropriate surgical approach utilization. The Fleck sign is a highly specific radiographic sign that has a statistically significant correlation with PT dislocation and hence we recommend intra-operative assessment of peroneal tendons in patients with the fleck sign.

中文翻译：

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腓骨距骨骨折的肌腱脱位及斑点征的诊断价值。

引言距骨骨折并不少见，并且是足部和踝部严重的骨折之一。腓骨腱脱位是常见的软组织损伤之一，可能对包括持续性疼痛和肿胀在内的预后产生重大影响。据报道它们与跟骨以及距骨骨折有关。目的报道距骨骨折腓骨腱脱位的发生率及斑点征在诊断腓骨腱脱位中的意义。方法我们回顾性回顾了2011年1月1日至2018年11月11日之间的93例距骨骨折。纳入标准为：该患者行切开复位内固定术，术前进行了CT扫描以供检查，并进行了三张踝关节平片检查。两名独立作者回顾了X线片的腓骨腱脱位，斑点迹象和骨折分类（如果有）。任何争议均由资深作者解决。对患者的病历，侧面，年龄，性别，伤害方式，相关伤害和手术干预进行了审查。50个脚踝符合纳入标准。男性49名，平均年龄32.5岁，主要伤害方式是从高处坠落。结果在50名患者中，有10名患者发现了腓骨腱脱位（20％）。脱位的风险随着骨折和颈部骨折的严重程度而增加。外科医生和放射科医生错过了大多数错位，并且没有采取其他措施来解决这种伤害。Fleck征与腓骨肌腱脱位有统计学意义（p = .005）。结论：腓骨腱脱位与高达20％的距骨骨折有关。作者建议由外科医生和放射科医生仔细检查CT扫描，以避免遗漏此类伤害，并允许适当地利用手术方法。Fleck体征是高度特异性的放射学体征，与PT脱位在统计学上具有显着相关性，因此我们建议在术中评估患有斑点体征的患者的腓骨肌腱。