J Korean Orthop Assoc.  2010 Oct;45(5):399-403.

Contracture of Extensor Hallucis Longus Tendon Occurring after Intramedullary Nailing for a Tibial Fracture

• Heo YM
• Roh JY
• Kim SB
• Kim JY
• Lee JB
• Kim KK

Abstract

Toe deformities occurring after tibial shaft fracture can result from compartment syndrome or adhesion of muscle to tendon. Claw toes or checkrein deformity caused by injury of posterior compartment muscles has been reported relatively often. But, a deformity due to injury of the anterior compartment muscles is very rare. We observed the two cases of an extension deformity at the metatarsophalangeal joint of the hallux following intramedullary nailing of a tibial shaft fracture. There was no evidence of compartment syndrome. Extension deformity of the hallux was decreased with dorsiflexion of the ankle and increased with plantar flexion. Contracture of the extensor hallucis longus tendon was diagnosed, and Z-lengthening of that tendon was performed. Satisfactory results were obtained without a recurrence of deformity. We report these rare cases of toe deformities occurring after a tibial shaft fracture, with a brief review of the literature.

Keyword

tibia; extensor hallucis longus tendon; shaft fracture; contracture; lengthening

MeSH Terms

Animals
Ankle
Compartment Syndromes
Congenital Abnormalities
Contracture
Fracture Fixation, Intramedullary
Hallux
Hammer Toe Syndrome
Metatarsophalangeal Joint
Muscles
Recurrence
Tendons
Tibia
Tibial Fractures
Toes

Figure

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  Figure 1 (A) Pre-operative anteroposterior radiograph shows fracture at the shaft of right tibia and fibula. (B) Radiograph taken at 6 months after surgery shows intramedullary fixation of tibia and union of fracture.

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  Figure 2 (A) Passive dorsiflexion of ankle minimized extension deformity at the metatarsophalangeal joint of big toe because of the relaxation of extensor hallucis longus (EHL) tendon. (B) Passive plantar flexion exaggerated extension deformity because of the tightness of EHL tendon.

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  Figure 3 This photograph shows the lengthening of extensor hallucis longus with looped tendon suture technique.

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  Figure 4 Photographs taken at 12 months follow-up. (A) With dorsiflexion of ankle, active extension of big toe was possible. (B) And, with plantar flexion of ankle, full flexion of big toe was possible.

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  Figure 5 The contracture of EHL tendon leaded to extension at the metatarsophalangeal joint of big toe in standing posture.

Reference

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