Treating Checkrein Deformities After Trauma
We directed our initial attention to the lateral aspect of the lower leg and located the healed fibular fracture. Freeing the muscle from the healed fracture site provided a moderate degree of improvement in the deformity but some contracture persisted. Accordingly, we performed a release of the intramuscular portion of the flexor hallucis longus posteriorly, providing the desired release of the contracture.
The flexor hallucis longus tendon arises from the inferior two-thirds of the posterior surface of the fibula and interosseous membrane. Lee and colleagues described two types of surgical repair for checkrein deformity, one with release of adhesions and Z-plasty lengthening at the musculotendinous junction above the ankle at the fracture site and the other technique involving lengthening of the flexor hallucis longus in the midfoot.6 The authors noted prolonged success with the latter procedures while the more proximally-based procedures had varying degrees of recurrence to the formation of new adhesions.
In our particular case, the release of adhesions proximally at the location of the fracture callus did not allow for complete reduction of the deformity and more distal release was necessary. Although the gross appearance of the flexor hallucis longus muscle tissue was normal, contracture required the additional intramuscular release. We observed complete resolution of the deformity following this aspect of the procedure.
Dr. Haddon is in private practice in Mesa, Ariz.
Dr. Freed is in private practice in Mesa, Ariz.
Dr. Johnson is a third-year resident at Maricopa Medical Center in Phoenix.
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