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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Original Articles

A Biomechanical Advantage of the Lengthening with an External Fixator Over an Intramedullary Nail: An Experimental Study in Saw Bones and Cadeveric Bones: Chang Wug Oh, Poong Taek Kim, Hae Ryong Song, Jong Keon Oh, Hyung Soo Ahn, Byung Chul Park, Byung Guk Min, Sung Ki Park, Young Heon Sohn; J Korean Fract Soc 2005;18(3):335-340. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.335

Abstract PDF: PURPOSE
To know biomechanical differences in methods of limb lengthening between using monolateral external fixator and using external fixator over an intramedullary nail.
MATERIALS AND METHODS
In acryl rods, saw-bone, and cadeveric bone, we created two lengthening models of using monolateral external fixator and using external fixator over an intramedullary nail. The axial compression test was done on the site of osteotomy for lengthening. To fix the models, half pins of 5 mm in diameter and nails of 9 mm in diameter were used. Using MTS (Material Test System) machine, we evaluated the differences of axial stiffness according to the presence of an intramedullary nail or the numbers of half-pins which were fixed at each side of osteotomy.
RESULTS
Lengthening over an intramedullary nail, comparing to monolateral external fixator only, increased the axial stiffness by 1.1~1.2 times in acryl rods, 1.2~1.6 times in saw bones, and 15.6~15.9 times in cadeveric bones when the same numbers of half-pins were used. In saw bone and cadaveric bone, the group of two half pins in lengthening over an intramedullary nail was stiffer than the group of three pins in lengthening with monolateral external fixator.
CONCLUSION
In the distraction of the limb, the addition of an intramedullary nail may increase the axial stiffness of the frame of monolateral external fixator. In lengthening over an intramedullary nail, it is enough to distract the bone with fixing two half pins at each sides of osteotomy.

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Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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