Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation - A Case Report -

Su-Young Bae; Hyung-Jin Chung; Man-Young Kim

doi:10.12671/jkfs.2011.24.3.271

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Bae, Chung, and Kim: Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation - A Case Report -

Case Report

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(3): 271-276.

Published online: 15 July 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.271

Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation - A Case Report -

Su-Young Bae, M.D., Ph.D., Hyung-Jin Chung, M.D., Ph.D., Man-Young Kim, M.D.

Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University, Seoul, Korea.

Address reprint requests to: Su-Young Bae, M.D., Ph.D. Foot & Ankle Center, Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University, 761-1, Sanggye 6,7-dong, Nowon-gu, Seoul 139-707, Korea. Tel: 82-2-950-1399, 1032, Fax: 82-2-950-1398, sybae99@gmail.com

Received 2 March 2011 Revised 8 April 2011 Accepted 28 April 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of 20 year-old man who had unusual equinus and checkrein deformity following dislocation of his right ankle joint. He had been treated with distal tibiofibular screw fixation and external fixation. After removal of external fixator, he had suffered from progressive deformity of foot and ankle. Widening of distal tibiofibular joint and medial clear space was found on radiograph and it was revealed that posterior tibial tendon had been dislocated and incarcerated into the distal tibiofibular joint on MRI. We corrected the deformity with excision of incarcerated posterior tibial tendon, adhesiolysis and lengthening of flexor hallucis longus tendon, reconstruction of deltoid ligament and flexor digitorum longus tendon transfer.

Keywords: Ankle, Dislocation, Checkrein deformity, Posterior tibial tendon incarceration

Figures and Tables

Fig. 1

Equinus of right ankle and flexion deformity of interphalangeal joint of great toe.

Fig. 2

(A) Anteroposterior view of right ankle shows widening of tibiofibular space and medial clear space.

(B) Lateral view shows equinus and flexion deformity of great toe.

Fig. 3

Immediate post-traumatic radiographs of other clinic show that talus was displaced into distal tibiofibular space.

Fig. 4

(A) For initial treatment, open reduction and external fixation of ankle joint was done and a syndesmotic screw was inserted at other clinic.

(B) Follow-up X-ray with the external fixator removed 2 months later.

Fig. 5

Ankle MRI shows incarceration of posterior tibial tendon into the fibular groove of distal tibia (white arrows) and displaced flexor hallucis longus tendon (black arrows).

Fig. 6

(A) Posterior tibial tendon was displaced into the posterolateral aspect of the ankle joint.

(B) Continuity of flexor hallucis longus tendon was intact (freer under the tendon).

Fig. 7

Intra-operative ankle X-ray (AP and lateral views).

Fig. 8

Follow-up standing ankle radiograph.

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