Contracture of extensor hallucis longus after fracture of di
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Post-traumatic isolated big toe extensor contracture after tibiofibular fracture is uncommon and only a few cases have been reported. Major causes of it include anterior compartment syndrome, direct injury, entrapment or adhesion of the muscle or tendon.

Case report

A 40-year-old man presented with a 20-year-long medical history of hyperextension contracture of the right big toe. He had undergone an operation (open reduction and internal fixation with plate) at another hospital because of a right distal tibial and fibular shaft fracture caused by a traffic accident 20 years ago. The implant was then removed 1 year after the operation due to bone union. The patient's big toe extensor tendon tightness gradually developed and did not subside. This persisting tightness discomfort had not affected his daily activity until he slipped at a toilet 3 months ago. After that, he claimed that the hyperextension contracture of the right big toe got worse and he could not sustain it.

On physical examination, there was an operative scar at the patient's anterior side of the right lower leg. Extension deformity of his right hallux was noted. This hyperextension of right big toe became improved with dorsiflexion of the ankle and aggravated with plantarflexion of the ankle. X-rays of right leg showed union of right tibia-fibular fracture.

Operative technique

During the operation, the patient was placed in a supine position under general anesthesia. The incision site was at dorsal side of right foot. Z-lengthening of the EHL tendon and abductor hallux tendon was then performed, followed by wound closure with 4–0 nylon sutures .

Postoperative period

Short leg splint was applied for 3 weeks. After the operation, rehabilitation such as passive range of motion was arranged. After the splint was removed, the patient was educated to do active range of motion of the big toe. 1 month later, the operative wound healed well and there was no discomfort complained from the patient.

In summary,this is a rare case of 20-year-long extensor hallucis longus (EHL) tendon contracture following a distal tibiofibular shaft fracture without any symptoms or signs of compartment syndrome of the affected leg or foot. The clinical outcome is great after Z-lengthening of the EHL tendon and abductor hallux tendon in 1-year follow-up. This case can provide more thorough understanding of extensor contracture of lower extremities in a long-term framework.

Dr. S●t P●l
Dr. S●t P●l Orthopaedics
Very nice management
Mar 13, 2020Like