Treatment of flexion deformity of the hallux after fibular fracture / 中华骨科杂志

ABSTRACT

Objective To discuss the etiology,clinical findings,anatomical characters,diagnosis and treatment of the painful flexion deformity of the hallux after open reduction and internal fixation of the fibular fractures.Methods From October 1996 to March 2004,we treated 33 cases with flexion deformity of the hallux after fibular fracture,including 19 males,14 females,with a mean age of 33.2 years old(ranged from 22 to 49 years).24 cases were ankle fractures,according to Lauge-Hansen clssification,pronation-external rotation for 18 cases;supination-exteral rotation for 4 cases;pronation-eversion for 2 cases.9 cases were distal third tibial and fibular fractures.19 cases were simple hallux flexion deformity,8 cases were combined with the second and third toes deformity,6 cases were combined with not only the second and third toes but also the fourth and fifth toes deformity.The deformities were corrected by flexor hallucis longus tendolysis or lengthening alone or flexor digitorum longus lengthening in combination.Results 19 cases were simple hallux flexion deformity,the deformities were corrected simply by flexor hallucis longus tendolysis(7 cases)and lengthening(12 cases).14 cases were combined with the lesser toes deformity,the flexor hallucis longus tendon were lengthened alone in 6 cases,and both the flexor hallucis longus and the flexor digitorum longus were lengthened in 8 cases.During an average duration of follow-up of 6 months(2 to 10 months),there were no postoperative complications.All patients had full correction of all deformed toes and reported relief from pain,ease of shoe-fitting and subjective improvement of gait.There was no recurrence of the deformity.Conclusion Adhesions of the flexor hallucis longus tendon to the fibular fracture site should be considered when a flexion deformity of the hallux occurs after open reduction and internal fixation of the fibular fractures.Variations in the interconnections between flexor hallucis longus and flexor digitorum longus in the region of the knot of Henry also have special clinical significance.