Avulsion fractures are common in athletes and result from high-impact or sudden, forceful movements involving the separation of a bone fragment at the ligament or tendon attachment site. The key focus areas include the anterior and posterior cruciate ligaments, medial collateral ligament, anterolateral complex, arcuate complex, medial patellofemoral ligament, patellar tendon, and quadriceps tendon. Diagnostic approaches combine radiography with advanced imaging techniques, such as computed tomography and magnetic resonance imaging, to elucidate the extent of injury and guide treatment decisions. Treatment ranges from conservative management for non-displaced fractures to surgical intervention for displaced fractures, with strategies customized based on the specific ligament involved and the nature of the fracture.
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.
An irreducible ankle dislocation is a rare injury. The cause is a dislocation of the distal fibula anteriorly or posteriorly or the insertion of soft tissue, such as the deltoid ligament or posteromedial tendon. The tibialis posterior tendon can be dislocated through distal tibiofibular diastasis and prevent reduction of the ankle joint. The authors experienced anterolateral ankle fracture dislocation with a diastasis of the distal tibiofibular joint, and reduction was impossible because of impingement of the tibialis posterior tendon dislocated anteriorly through the distal tibiofibular diastasis. This paper reports the treatment of this injury.
The delayed rupture of the flexor tendons is a rare complication of malunited distal radius fractures after nonoperative management. The known cause of a flexor tendon rupture is attrition between the palmarly displaced ulnar head and the involved tendons. Sharp bony spurs on the volar side of the malunited distal radius can also cause flexor tendon rupture. About 30 cases have been reported in literature. There were only four case reports about the delayed rupture of the 2nd, 3rd, 4th, and 5th flexor tendons. In this case, we experienced flexor digitorum superficialis and flexor digitorum profundus tendon ruptures of the index, middle, ring, and little fingers, after 8 months following the malunion of a distal radius fracture. At two years follow-up after tendon graft and corrective osteotomy, the range of motion and motor weakness of the 2nd, 3rd, 4th, and 5th fingers improved.
The tendon connects the muscles to the bones and transmits the loads generated by the muscles to the bones to move the joints, support the joints, and provide stability to the joints. Approximately 30% of patients complaining of musculoskeletal pain are associated with tendon disease, and approximately 50% of musculoskeletal injuries are caused by a tendon injury. Despite this frequent treatment of tendon damage, studies on the basic biology that provide scientific evidence for treatment, such as development, tendon injury, and healing, are still very limited. This review first summarizes the classification and composition of the tendon identified so far, the surrounding tissue, and the blood supply to the tendon. The limitations of the tendon recovery process after a tendon injury are also discussed.
Finally, this review examines ways to improve tendon recovery and the biological approaches and tissue engineering that have been currently studied. In conclusion, innovative progress in promoting tendon healing has not been achieved despite the many advances in the basic structure of the tendon, and the cell and regulatory molecular factors involved in tendon recovery. Biological approaches and tissue engineering, which have become a recent issue, have shown many possibilities for the recovery of damaged cases, but further research will be needed until clinical application.
Dorsal dislocation of the proximal interphalangeal joint is a common injury in the orthopedic department. In most cases, the joint is reduced simply by closed manipulation. However, in rare cases, the joint is not reducible by closed manipulation, therefore, surgery is required. We report on a case of irreducible open dorsal dislocation of the proximal interphalangeal joint which was surgically treated. Because the flexor tendon interposed between the head of the proximal phalanx and the base of the middle phalanx, we could reduce the joint only after repositioning of the flexor tendon.
Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.
As volar plate fixation of distal radius fracture becomes more common, reports of ruptured extensor pollicis longus tendon by a protruding distal screw tip are also increasing steadily. Authors have experienced a rare case of ruptured extensor pollicis longus tendon at the prominent proximal screw of fixed volar plate for distal radius fracture, and we report it herein with a review of the literature.
Heterotopic ossification around the patellar tendon is known to be extremely rare. A 42-year-old man had a transverse fracture of the left patella. Open reduction and tension band wiring were performed. At four weeks, plain radiographs showed an extensive ossification around the patellar tendon and the patient presented limitation of flexion and pain in kneeling position. We just encouraged active and passive ranges of motion exercises and performed one manipulation under anesthesia. At the final follow-up (10 months post-operatively), he was able to flex his knee by 140 degrees. We present a case of heterotopic ossification around the patellar tendon with limitation of knee flexion that was successfully treated with nonoperative treatment.
Entrapment of the extensor pollicis longus tendon is reported rarely on Smith's fractures in children. In our case, a 15 year old boy with Smith's fracture received treatment of closed reduction at another hospital. When he visited our hospital, a wide gap at the fracture site was detected on radiograph and the thumb movement was limited. We have doubt the entrapment of the soft tissue, especially the tendon. We decided on open reduction. In the operation field, entrapment of the extensor pollicis longus tendon at the gap of the fracture site was found through dorsal approach. In addition, fracture treatment with K-wire fixation after reduction of extensonr pollicis longus tendon reduction was done. Therefore, we report this case with a review of the literatures.
PURPOSE To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach. MATERIALS AND METHODS Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated. RESULTS Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p<0.001). The effect of AO type and the duration of nail retension on the decrease of Insall Salvati ratio was not significant (p>0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058). CONCLUSION After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.
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
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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
There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.
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Acute Rupture of Flexor Tendons as a Complication of Distal Radius Fracture Youn Moo Heo, Sang Bum Kim, Kwang Kyoun Kim, Doo Hyun Kim, Won Keun Park Journal of the Korean Orthopaedic Association.2015; 50(1): 60. CrossRef
The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.
Ruptures of extensor pollicis longus tendon after distal radial fractures are well-known. However, delayed flexor tendon rupture of finger as a complication of the fracture are less common. We report the case of delayed rupture of flexor digitorum profundus tendon to middle and ring fingers and flexor digitorum superficialis to ring finger in 72 year old female patient. She was treated by free tendon graft with palmaris longus tendon. After 1 year follow-up, range of motion and flexion power were recovered to nearly normal.
Os peroneum is one of the normal sesamoids in the foot and it can be insertion of peroneus longus tendon. We report a case of as peroneum fracture with complete tear of peroneus longus tendon. This case was finally diagnosed in operation and treated by suture with peroneus brevis tendon and short leg cast.
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Painful Os Peroneum Syndrome Presenting as Lateral Plantar Foot Pain Seon Jeong Oh, Young Hoon Kim, Sun Ki Kim, Min-Wook Kim Annals of Rehabilitation Medicine.2012; 36(1): 163. CrossRef
The superior peroneal retinacular injury in ankle is often diagnosed as an ankle sprain and treated conservatively because of normal bony contour in type 1,2 injury according to Eckery's classification and small bony fragment with early union, evenly displaced in type 3. But its complications such as peroneal tendinitis and recurrent subluxation or dislocation of peroneal tendons sometimes develop late. Compared to peroneal tendinitis, the surgical treatment method for recurrent subluxation or dislocation of peroneal tendons is known superor to conservative method in results. And many reconstructive methods have been reported. In spite of their good results, harmfulness to normal structures, recurrences and technical difficulties may be a problem. So we perfomed 10 cases of acute surgical repair in superior peroneal retinacular injuries in ankle from March 1993 to February 1997 and prospectively analysed their clinical and radiological results with complications. Preoperative radiological diagnosis was done by plain films, peroneal tenography with computed tomography and also postperatively evaluated with plain films and peroneal tenography. 1. The most common cause of injury was sports(6 cases) including ski injury(4 cases) and average age of the patient was 29(17-56) years. 2. 4 cases of bony avulsion(type 3) were fixed with mini-screws and mean duration of bony union was 3.6 months. 3. The incidental subluxation or dislocation of peroneal tendons was not found intraoperatively and postoperatively. 4. All patients are able to participate in active exercise postoperatively except one patient who complains of lateral ankle discomfort due to peroneal tendinitis. In conclusion, acute surgical repair of superior peroneal retinacular injury in ankle is a recommended method to prevent it's complications such as peroneal retinacular injury in ankle is a recommended method to prevent it's complications such as peroneal tendinitis and subluxation or dislocation of peroneal tendons especially, in young and active patients.
There are a few of reports of delayed rupture of flexor tendon around the wrist and hand by attrition. Only 4 cases of delayed flexor tendon rupture of finger except rupture of flexor pollicis longus after Cellos fracture were reported until now. Several causes of the delayed rupture of the tendon around the wrist and hand were reported by many authors. Cellos fracture is one of the cause of the attritional rupture. But the frequency of the attritonal rupture of the flexor tendon was only one-third of the extensor tendons. Furthermore, flexor tendons of the finger were less commonly affected than that of the thumb by their anatomical features. We would like to report a very rare case of delayed rupture of flexor digitorum profundus on 73 year old male patient by attrition on the bony spur which was formed by malunion of distal radial fracture about 10 years ago. They were treated by direct repair for ring finger and free tendon graft with flexor digitorum sublimis of middle finger for little finger. After 1 year follow up, range of motion and flexion power were recovered to nearly normal.
As a complication of Smiths fracture, traumatic entrapment and closed rupture of the extensor pollicis longus tendon may occur rarely at the fracture site and cause loss of thumb extenion. Traumatic entrapment of the extensor pollicis longus tendon in Smiths fracture which was anatomic barrier of successful closed reduction was first described by Hunt in 1969. Since then, several authors reported another few cases.
The mechanism of tendon rupture in Smiths fracture is thought that the sharp dorsal edge of the proximal fragment may tear the stretched muscular tendon unit during extreme wrist flexion.
We experienced a case of traumatic rupture of the extensor pollicis longus tendon associated with a closed Smiths fracture and report this case with our treatment method.