J Korean Foot Ankle Soc.  2021 Sep;25(3):145-148. 10.14193/jkfas.2021.25.3.145.

The Checkrein Deformity of Extensor Hallucis Longus Tendon and Extensor Retinaculum Syndrome with Deep Peroneal Nerve Entrapment after Triplane Fracture: A Case Report

• Gwak H
• Ahn J
• Lee JH

• KMID: 2520106
• DOI: http://doi.org/10.14193/jkfas.2021.25.3.145

Abstract

A checkrein deformity can occur after a distal tibiofibular fracture. Usually, a checkrein deformity due to a dysfunction of the extensor hallucis longus muscle is rarer than that of the flexor hallucis longus. Only a few related studies have been reported. The authors encountered an extensor hallucis longus checkrein deformity due to extensor retinaculum syndrome while managing a triplane fracture. In magnetic resonance imaging, an increase in the heterogeneous signal was observed on the T2-weighted images suggesting muscle necrosis or ischemic changes in a part of the extensor hallucis muscle. Postoperative great toe motor weakness, unintentional movement, sensory changes, and weakness improved spontaneously during the follow-up.

Keyword

Checkrein deformity; Extensor hallucis longus; Extensor retinaculum syndrome; Triplane fracture

Figure

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  Figure. 1 Preoperative anteroposterior (A) and lateral (B) view of plain radiographs. A 14-year-old male with triplane fracture, which showed Salter–Harris type IV (epiphysis, minimally involved) fracture configuration.

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  Figure. 2 Postoperative state; anteroposterior (A) and lateral (B) view. Anatomical reduction of fracture was obtained.

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  Figure. 3 Involuntary extension of great toe during ankle plantar flexion was observed.

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  Figure. 4 Preoperative computed tomography (CT) sagittal image shows slight tenting of extensor hallucis longus tendon, but there is no incarcerations on CT image.

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  Figure. 5 The sonography of ankle and lower leg was evaluated. (A) The abnormality of integrity and continuity of extensor hallucis longus (EHL) were not identified. (B) Abnormal findings of a 5~6 cm long hypoechoic edema pattern were observed in the anterior muscle compartment.

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  Figure. 6 Postoperative magnetic resonance imaging of anterior compartment muscles. (A) Diffuse and heterogeneously increased signal intensity at anterior compartment muscles on T2-weighted image involving extensor digitorum longus, extensor hallucis longus, and tibialis anterior. (B) Geographic and thick, peripheral enhancements, and internal non-enhancing or decreased enhancing portions in the muscles on contrast enhanced T1-weighted image.

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