case_images: PMC9949674_01
case_images: X-ray (A, anteroposterior view and B, lateral view) and 3D reconstruction of a CT scan (C) of a primary left ankle injury. Radiographic evaluation confirmed the diagnosis of a Lauge-Hansen PER stage IV malleolar fracture.
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case_images: PMC9949674_01_fsurg-10-887611-g001.jpg
case_images: F1
case_images: A 20-year-old male patient [98 kg, 181 cm, body mass index (BMI) = 29.9] was first admitted to our department with diagnosis of Lauge-Hansen PER stage IV malleolar fracture (Figure 1).
case_images: X-ray of the left foot and ankle 32 months after the primary operation. No dislocation of the IP and MP joints (A,B) and synostosis formation at the fracture site or interosseous membrane (D) was observed. Syndesmotic screws (C) were removed at postoperative 10 weeks after primary operation.
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case_images: PMC9949674_01_fsurg-10-887611-g002.jpg
case_images: F2
case_images: The syndesmotic screws were removed at 10 weeks postoperatively (Figure 2). The fibular fracture healed with no synostosis formation at the fracture site or interosseous membrane (Figure 2).
case_images: Macroscopic appearance of the checkrein deformity of the left hallux and second toe 32 months after the primary operation. (A) The deformity was exaggerated with ankle dorsiflexion. (B) The deformity was ameliorated with ankle plantar flexion.
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case_images: PMC9949674_01_fsurg-10-887611-g003.jpg
case_images: F3
case_images: The physical examination revealed that the deformity of the hallux and second toe was exaggerated with ankle dorsiflexion and ameliorated with ankle plantar flexion (Figure 3).
case_images: The asterisk indicated the presence of FHL tendon in the malleolar canal by the dynamic ultrasound.
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case_images: PMC9949674_01_fsurg-10-887611-g004.jpg
case_images: F4
case_images: Dynamic ultrasonography indicated the presence of an excursion of the FHL tendon in the malleolar canal (Figure 4).
case_images: Incisions of the exploration operation and FHL tenolysis. (A) The glide of the FHL tendon was observed within the malleolar canal through posteromedial incision. (B) The FHL muscle belly was attached to the fibula in the deep posterior compartment.
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case_images: F5
case_images: After dissecting and protecting the neurovascular bundle, the glide of the FHL tendon was observed within the malleolar canal with ankle and foot motion through posteromedial incision (Figure 5). After removing the fibular hardware, the FHL muscle belly was identified as being attached to the fibula with fibrous adhesion in the deep posterior compartment (Figure 5).
case_images: Macroscopic appearance of the left foot after surgical correction. Independent of the ankle position, dorsiflexion (A), plantar flexion (B), neutral (C), and the range of motion of the hallux and second toe was restored.
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case_images: PMC9949674_01_fsurg-10-887611-g006.jpg
case_images: F6
case_images: Independent of the ankle position, the range of motion of the hallux was restored, and the checkrein deformity was corrected (Figure 6).