Journal of Musculoskeletal Trauma

Review Article

Checkrein Deformity after Fracture: Jungtae Ahn, Gu-Hee Jung; J Korean Fract Soc 2024;37(1):60-68. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.60

Abstract PDF: Checkrein deformity has dynamic characteristics in which the degree of extension contracture of the metatarsophalangeal joint and flexion contracture of the interphalangeal joint change according to the movement of the ankle joint. Although the primary lesion is the flexor hallucis longus, several clinical features exist because of the accessory connection with the flexor tendon of other toes. After a physical diagnosis, a radiological examination should be performed to determine the cause and location of adhesion. Moreover, it is vital to determine if it is direct adhesion to the tendon tissue or muscle contracture due to ischemic muscle damage. Although there are no clear guidelines for surgical treatment, it can be divided broadly into two methods: soft tissue release and Z-plasty performed through direct access to the lesion site or indirect access through the tarsal tunnel or medial midfoot approach. Direct tendon tissue release surgery should be attempted if the tendon tissue is locally attached to the fracture callus or specific soft tissue. On the other hand, operation on the lesion site should be performed first if the checkrein deformity occurred due to an implant or bone fragments, followed by release surgery. If muscle contracture and movement are limited due to ischemic damage, surgery should be performed to remove adhesions and additional tendon connections around the flexor hallucis longus and digitorum longus by approaching through the tarsal canal and the medial side of the midfoot. The fixed contractures of the metatarsophalangeal and interphalangeal joints should be addressed if the limitations of tendon excursion are identified despite the release techniques.

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Case Report

Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation: A Case Report: Su Young Bae, Hyung Jin Chung, Man Young Kim; J Korean Fract Soc 2011;24(3):271-276. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.271

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.

Citations

Citations to this article as recorded by

Management of Checkrein Deformity
Min Gyu Kyung, Yun Jae Cho, Dong Yeon Lee
Clinics in Orthopedic Surgery.2024; 16(1): 1. CrossRef
A Neglected Extensor Hallucis Longus Tendon Rupture Caused by Arthritic Adhesion
Sung Hun Won, Sung Hwan Kim, Young Koo Lee, Dong-Il Chun, Byung-Ryul Lee, Woo-Jong Kim
Medicina.2023; 59(6): 1069. CrossRef
The Checkrein Deformity of Extensor Hallucis Longus Tendon and Extensor Retinaculum Syndrome with Deep Peroneal Nerve Entrapment after Triplane Fracture: A Case Report
Hyungon Gwak, Jungtae Ahn, Jae Hoon Lee
Journal of Korean Foot and Ankle Society.2021; 25(3): 145. CrossRef
Checkrein Deformity Due to Flexor Digitorum Longus Adhesion after Comminuted Calcaneus Fracture: A Case Report
Jin Su Kim, Han Sang Lee, Ki Won Young, Keun Woo Lee, Hun Ki Cho, Sang Young Lee
Journal of Korean Foot and Ankle Society.2015; 19(1): 35. CrossRef

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