J Korean Fract Soc.  2011 Jul;24(3):271-276.

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

• Bae SY
• Chung HJ
• Kim MY

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.

Keyword

Ankle; Dislocation; Checkrein deformity; Posterior tibial tendon incarceration

MeSH Terms

Animals
Ankle
Ankle Joint
Dislocations
External Fixators
Foot
Foot Deformities, Acquired
Joint Dislocations
Ligaments
Tendon Transfer
Tendons

Figure

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  Fig. 1 Equinus of right ankle and flexion deformity of interphalangeal joint of great toe.

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  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.

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  Fig. 3 Immediate post-traumatic radiographs of other clinic show that talus was displaced into distal tibiofibular space.

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  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.

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  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).

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  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).

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  Fig. 7 Intra-operative ankle X-ray (AP and lateral views).

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  Fig. 8 Follow-up standing ankle radiograph.

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