Peroneal Tendon Lengthening as an Adjunct Procedure to Aid in the Reduction of the Lateral Malleolus in Diabetic Ankle Fractures: 2 Case Reports.

Abstract

It is well-documented that individuals with longstanding diabetes mellitus are at risk for specific metabolic abnormalities; this includes but is not limited to increased glycation of collagenous soft-tissue structures. It is also apparent that such changes can manifest as thickening and increased stiffness of tendinous structures. What remains unknown are the biomechanical ramifications of these changes and how they should affect the surgical management of lower extremity injuries. Previous research suggests that the Achilles tendon demonstrates increased stiffness in the presence of diabetes. It is therefore reasonable to presume that increased collagen glycation and the resultant tendon stiffness can also lead to decreased extensibility and shortening of the peroneus longus and brevis tendons. The significance of this leads us to the conclusion that glycation of the peroneal tendons can create a deforming force in displaced lateral malleolar fractures because of the adjacent position of the peroneal tendons relative to the lateral malleolus. Complications stemming from this can lead to increased difficulty in reducing fibular fractures and subsequent shortening of the fibula. For the purpose of this article, we present 2 cases, 1 using open reduction with internal fixation and the other with external fixation. We will demonstrate that, in both reduction methods, lengthening of the peroneal tendons can be a useful adjunct procedure to aid in restoration of fibular length in diabetic ankle fractures.