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Aim:The aim of this study is to describe a case of isolated extensor hallucis longus (EHL) dysfunction leading to dropped hallux, which to our belief is due to entrapment of EHL tendon in the fracture callus following open reduction and internal fixation (ORIF) and autologous bone grafting of nonunion of distal 1/3 tibia fracture. Background: Dropped hallux due to EHL dysfunction is a problematic condition because during the swing phase of the gait cycle, the hallux drags across the ground surface leading to altered gait pattern. Isolated dysfunctions of EHL due to various causes are rarely described in the literature. Case description: Dropped hallux in a 61-year-old lady with nonunion distal 1/3 tibia fracture, treated by ORIF with interlocking nail and autologous bone grafting, after the fracture was united, which got corrected after surgical release of the tendon from fracture callus and EHL anastomosis to extensor digitorium longus (EDL) tendon. Conclusion: Awareness of the possibility of entrapment of long tendons in fracture callus leading to their dysfunction, where a simple release and anastomosis of tendon could correct their function, provided the tendon is viable. Clinical significance: Tendon adherence to fracture callus leading to dropped hallux as a differential diagnosis in cases of isolated EHL dysfunction in distal 1/3 tibia fracture.

Introduction: Modified tension band wiring (MTBW) using two cannulated cancellous screws which also achieve a horizontal figure of eight patterns of tension band is established as a superior fixation to using Kirschner wires for type 34-C1 fracture of the patella. We are describing a case where this method was used for failed MTBW using two Kirschner wires where an impending failure in the early post-operative period proceeded to complete bony union without any implant failure or functional deficit following a period of conservative management. Case Presentation: We are describing a 67-year-old man with type 34-C1 fracture of patella treated by MTBW using Kirschner wires and a stainless steel (SS) wire, with fixation failure after around 6 weeks, which was revised by MTBW using two vertically placed cannulated partially threaded cancellous screws and SS wire as a tension band. In the early post-operative period, a routine X-ray of the operated part showed fracture fragment separation with a slight sack in the tension band wire without any signs of implant failure. To our surprise, the fracture proceeded to complete bony union while continuing gradually increased active knee range of motion exercises. Conclusion: This case report presents how an impending failure proceeded to complete fracture healing because of dynamic compression of the fracture provided by the tension band construct.