Acute Reconstruction of Traumatic Zone IV Re-tear of Extensor Hallucis Longus Tendon using Extensor Hallucis Brevis loop Technique - A Mid-term Follow-up Case Report

Introduction

The present case report describes an acute reconstruction of extensor hallucis longus (EHL) tendon with defect treated using looped extensor hallucis brevis (EHB) tendon graft.

Case Report

A 40 year male manual labor had an acute traumatic EHL tear which was repaired at a primary health care center. After 2 days, the patient felt a sudden click and a re-tear at zone IV of EHL. Since there was a defect of 3.5 cm which was not amenable for primary repair, EHB graft was used for the reconstruction in a loop fashion. The foot and ankle disability index score was 95.2 at 2 years follow-up with grade 4 + power.

Conclusion

EHB graft is a good alternative to other autografts for extensor hallucis longus reconstructions with good clinical and functional outcomes.

Mallet hallux injury: A case report and literature review

Mallet injury is associated with variable degrees of extensor hallucis longus tendon tearing, ultimately leading to the well-known mallet toe deformity; this entity, commonly described at the lesser toes and fingers, has rarely been reported at the hallux. We present a surgically proven case of mallet hallux injury with radiographic and magnetic resonance imaging assessment and review the literature, including clinical and radiological findings, along with basic treatment concepts.

A cadaveric study of the morphology of the extensor hallucis longus - a proposal for a new classification

Background

Morphological variations of the EHL concern mainly the accessory tendons and the site of their insertion. The aim of our study is to present a new classification of the EHL.

Methods

Classical anatomical dissection was performed on 104 lower limbs (51 right, 53 left, fixed in 10% formalin solution).

Results

In the cadavers, three types of morphology (insertion and addidtional band) were observed. Type I, the most common type, was characterized by a single tendon that ends as an extensor hood on the dorsal aspect of the base of the distal phalanx of the big toe (57.7%). Type II was characterized by two distal tendons and was subdivided into three subtypes according to (A-29.9%, B-4.8% and C-5.7%). Type III was characterised by three distal tendons (two cases - 1.9%).

Conclusion

The EHL presents high morphological variability. Knowledge of particular types of insertion is essential for both clinicians and anatomists.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2688-8) contains supplementary material, which is available to authorized users.

Can water lacerate a tendon? A car-wash accident: A lacerated extensor hallucis longus tendon

Our purpose in this report, involving an unusual mechanism described for the first time in the literature, is to show that high-pressure water sprays used for washing cars can cause injury to the extensor hallucis longus (EHL).

A 21-year-old man presented to our emergency department (ED) due to looseness in the hallux. His history revealed that while operating a pressurized water spray machine for car-washing one week before, he had inadvertently sprayed his foot, and despite wearing protective plastic boots this had resulted in a laceration at the level of the hallux, which had been sutured in a state hospital.

Cleaning equipment using pressurized water can be dangerous if sufficient safety measures are not taken. We think that such occupational accidents with serious outcomes can be prevented through simple protective measures.