Journal List > J Korean Foot Ankle Soc > v.19(1) > 1043367

Kim, Lee, Young, Lee, Cho, and Lee: Checkrein Deformity Due to Flexor Digitorum Longus Adhesion after Comminuted Calcaneus Fracture: A Case Report

Abstract

The checkrein deformity describes tethering of the flexor hallucis longus tendon, which mainly occurs after fracture of the distal tibia. The deformity increases with dorsiflexion of the ankle and decreases or disappears with plantarflexion of the ankle. In some cases, the deformity may occasionally include the second and third toes. In the current study, the authors experienced secondary checkrein deformity of all lesser toes after open reduction and plate fixation for comminuted fracture of the calcaneus. As a treatment, plate and screws were removed, followed by an additional medial incision which showed a partially ruptured flexor digitorum longus tendon with severe adhesion. Resection of the adhesed tendon and tenodesis of its distal portion to the flexor hallucis longus was performed for correction of the checkrein deformity. Then the lessor toe checkrein deformity recovered immediately. The authors report on this rare lessor toe checkrein deformity after calcaneal fracture fixation with a review of literature.

REFERENCES

1.Carr JB. Complications of calcaneus fractures entrapment of the flexor hallucis longus: report of two cases. J Orthop Trauma. 1990. 4:166–8.
2.Sanhudo JA., Lompa PA. Checkrein deformity--flexor hallucis tethering: two case reports. Foot Ankle Int. 2002. 23:799–800.
crossref
3.Rosenberg GA., Sferra JJ. Checkrein deformity--an unusual complication associated with a closed Salter-Harris type II ankle fracture: a case report. Foot Ankle Int. 1999. 20:591–4.
crossref
4.Clawson DK. Claw toes following tibial fracture. Clin Orthop Relat Res. 1974. 103:47–8.
crossref
5.Leitschuh PH., Zimmerman JP., Uhorchak JM., Arciero RA., Bowser L. Hallux flexion deformity secondary to entrapment of the flexor hallucis longus tendon after fibular fracture. Foot Ankle Int. 1995. 16:232–5.
crossref
6.Bae SY., Chung HJ., Kim MY. Checkrein deformity by incarcer-ated posterior tibial tendon and displaced flexor hallucis longus tendon following ankle dislocation: a case report. J Korean Fract Soc. 2011. 24:271–6.
7.Feeney MS., Williams RL., Stephens MM. Selective lengthening of the proximal flexor tendon in the management of acquired claw toes. J Bone Joint Surg Br. 2001. 83:335–8.
crossref
8.Kim SH., Lee KT., Smith RW., Park YU. Checkrein deformity secondary to entrapment of FHL after talus fracture: a case report. Foot Ankle Int. 2010. 31:336–8.
crossref
9.Lee HS., Kim JS., Park SS., Lee DH., Park JM., Wapner KL. Treatment of checkrein deformity of the hallux. J Bone Joint Surg Br. 2008. 90:1055–8.
crossref
10.LaRue BG., Anctil EP. Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int. 2006. 27:528–32.
crossref

Figure 1.
A 32-year-old male sustained Sander’s type IIA calacaneal fracture with medial fragmentation by a car accident. (A) Initial lateral radiograph show calcaneal fracture. (B) Initial calcaneal axial view show medial fragmentation. (C) Computed tomography coronal view shows Sander’s type IIA calacaneal fracture.
jkfas-19-35f1.tif
Figure 2.
(A) Checkrein deformity of lesser toes were diagnosed when the lessor toe clawing aggrevated with ankle dorsiflexion. The medial calcaneal bony bump was explored and excised, then the partially ruptured flexor digitorum longus was resected with its distal portion repaired to flexor hallucis longus using side to side suture. (B) At 12 months following operation, the checkrein deformity disappeared.
jkfas-19-35f2.tif
Figure 3.
(A) Open reduction and plate fixation was performed for the calcaneal fracture. However, the patient complained of progressive lesser toe clawing at five months, postoperatively. (B) At the 12 months follow-up, axial view of the computed tomography showed protruded medial fragment along the screw shaped like a beak. (C) Excision of the bony bump was performed that caused lessor toe checkrein deformity.
jkfas-19-35f3.tif
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