Adhesion of flexor hallucis longus at the site of a tibial-shaft fracture – A cause of a checkrein deformity

Yuen, Chi Pan; Lui, Tun Hing

doi:10.1016/j.fas.2014.09.011

Cited by 11 publications

(12 citation statements)

References 12 publications

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“…FHL arises from the inferior two-thirds of the posterior surface of the fibula and interosseous membrane, and it inserts into the plantar surface of the great toe distal phalanx. 20 As FHL went close to the medial malleolus, restrictive adhesion of the FHL tendon by bone callus could be seen in some cases and the adhesion was almost located at the distal end of the tibia.…”

Section: Resultsmentioning

confidence: 99%

Application of ultrasound in preoperative localization diagnosis of checkrein deformity: A retrospective case series

Yuan

Gao

Jia

2023

J Orthop Surg (Hong Kong)

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Background Checkrein deformity, is a rare claw toe dynamic deformity of the hallux or great toe. This study investigated the use of diagnostic ultrasound in positioning the accurate injury location causing checkrein deformity and its clinical significance for etiological diagnosis and selection of surgical methods. Methods This retrospective study included patients with confirmed checkrein deformities (according to typical symptoms) at the Department of Traumatic Orthopedics of Tianjin Hospital (Tianjin, China) from March 2017 to July 2021. Results A total of 11 patients (8 males and 3 females) with a mean age of 36.7 ± 16.8 (range 19–61) were included in this study. The injuries included six cases of tibia and fibula fracture, one case of single tibia fracture, and one case of single fibula fracture. Four patients were treated with steel plate internal fixation, three patients with intramedullary nailing, and one patient with external fixation. Three patients reported no history of any high-energy trauma or surgery. The ultrasound results showed that seven patients suffered from flexor hallucis longus (FHL) lesions, two patients suffered from flexor digitorum longus (FDL) lesions, and two patients suffered from FHL and FDL lesions. The patients underwent different surgeries tailored to their specific lesions. Toe flexion deformity was completely corrected after operation in all patients. The function of the toes was recovered to varying extent. Conclusion The results of this study demonstrates that the checkrein deformities can be confirmed by ultrasound. It could be used to determine the adhesions before the operation, acting as guidance while establishing the surgical planning.

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Section: Resultsmentioning

confidence: 99%

Application of ultrasound in preoperative localization diagnosis of checkrein deformity: A retrospective case series

Yuan

Gao

Jia

2023

J Orthop Surg (Hong Kong)

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“…Different surgical methods are available for correcting checkrein deformity, including FHL to extensor hallucis longus (EHL) transfer ( 16 ), lengthening the FHL with or without Z-plasty at the fracture site or midfoot ( 11 , 17 , 18 ), tenotomy at the forefoot level ( 5 ), or releasing tendon adhesion ( 19 ). Currently, the optimal surgical strategy is still not defined.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the optimal surgical strategy is still not defined. Lengthening of the FHL tendon might be an option for the correction of checkrein deformity caused by diffuse ischemic contracture or poliomyelitis producing a fixed length phenomenon ( 19 ). Tenolysis is a feasible option for FHL tendon entrapment or tethering.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic checkrein deformity following isolated Lauge–Hansen pronation external rotation stage IV malleolar fracture—a case report and literature review

2023

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The checkrein deformity is characterized by flexion contracture of the interphalangeal joint and extension contracture of the metatarsophalangeal joint. It is a rare condition occurring after lower extremity trauma, especially a malleolar fracture. Little is known about the possible cause and therapeutic strategy. This unique case presents a 20-year-old male patient with a diagnosis of the checkrein deformity secondary to open reduction and internal fixation of a Lauge–Hansen pronation external rotation stage IV malleolar fracture. After performing a detailed physical examination, radiographic evaluation, and ultrasonography, open exploration was performed to remove the hardware and correct the deformity with sole tenolysis of the flexor hallucis longus (FHL). In the 4-month follow-up, no recurrence of the checkrein deformity was observed. This deformity was caused by FHL adhesion. Interosseous membrane injury and fibular fracture together with local hematomas increases the risk of FHL adhesion. Open exploration and tenolysis of the FHL are feasible options to correct the checkrein deformity.

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“…Therefore, less chance of recurrence of adhesions. Besi des, releases at the fracture site requires longer incisions with extensive soft tissue dissection around neurovascular structures (7) . Lee at al.…”

Section: Discussionmentioning

confidence: 99%

Checkrein deformity treated through a forefoot approach

et al. 2019

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Checkrein deformity is characterized by flexible plantar flexion contracture of the interphalangeal joint and flexible extension contracture of the metatarsophalangeal joint of the hallux. It occurs due to entrapment of the flexor hallucis longus in the callus formation at the fracture site or within scar tissue on lower limb. Currently, there is still no consensus about the best surgical treatment for this deformity. The aim of this study is to report a case of a patient that was treated with a novel approach for the treatment of checkrein deformity of the hallux located in the forefoot, with satisfactory functional outcomes. Level of Evidence V; Therapeutics Studies; Expert Opinion.A deformidade em flexão do hálux é caracterizada pela contractura em flexão da articulação interfalângica e em extensão da articulação metatarsofalângica do hálux. Ocorre devido ao encarceramento do flexor longo do hálux na formação do calo no local da fratura ou no tecido cicatricial do membro inferior. Ainda não há consenso sobre o melhor tratamento cirúrgico para essa deformidade. O objetivo deste estudo é relatar um caso de um paciente que foi tratado com uma nova abordagem para o tratamento da deformidade em flexão do hálux localizado no antepé, com resultados funcionais satisfatórios. Nível de Evidência V; Estudos Terapêuticos; Opinião do Especialista.Palavras-chave: Deformidades articulares adquiridas/cirurgia; Deformidades nos pés; Articulação metatarsofalângica; Traumatismos dos tendões.How to cite this article: Miranda BR, Barroco RS, Nishikawa DRC, Oliveira LZP, Ghani MBA. Checkrein deformity treated through a forefoot approach: a case report. Sci J Foot Ankle. 2019;13(4):259-63.

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Adhesion of flexor hallucis longus at the site of a tibial-shaft fracture – A cause of a checkrein deformity

Cited by 11 publications

References 12 publications

Application of ultrasound in preoperative localization diagnosis of checkrein deformity: A retrospective case series

Application of ultrasound in preoperative localization diagnosis of checkrein deformity: A retrospective case series

Posttraumatic checkrein deformity following isolated Lauge–Hansen pronation external rotation stage IV malleolar fracture—a case report and literature review

Checkrein deformity treated through a forefoot approach

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