Simultaneous flexion and extension checkrein deformity following tibial and fibular fractures: a rare case treated with concomitant surgical intervention.

Checkrein deformity of the hallux is commonly characterized by rigid flexion of the interphalangeal joint in ankle dorsiflexion but with flexibility in ankle plantarflexion which can be named as flexion checkrein deformity and as rare condition, extension checkrein deformity, characterized by rigid extension of the first metatarsophalangeal joint in ankle plantarflexion and flexibility in ankle dorsiflexion, has been reported. However, there has not reported coexistence of flexion and extension checkrein deformity. The patient, a 27-year-old male, was referred to our department 3 years after tibial and fibular fractures which was treated by open reduction and internal fixation at a previous hospital. His chief complaint was pain and impaired plantarflexion of the affected great toe. The diagnosis was double checkrein deformity characterized by simultaneous rigidity in both flexion and extension of the hallux due to the adhesion of the flexor hallucis longus (FHL) muscle and the extensor hallucis longus (EHL) tendon after a fracture. Surgical intervention was performed, which involved the transection of the FHL tendon using hindfoot endoscopy and transfer of the EHL to the extensor digitorum longus, resulting in a successful outcome with no postoperative complications. The patient demonstrated a favorable prognosis 2 years after the procedure. This report represents the first documented case of double checkrein deformity and underscores the importance of considering this condition and the potential advantages of surgical intervention.

Induced membrane technique using beta-tricalcium phosphate for reconstruction of clavicle bone defect after fracture related infection - A case report.

The induced membrane technique (IMT) is among the most innovative reconstructive methods for clavicle defects after fracture-related infection (FRI). Herein, we report a case in which a clavicle bone defect after FRI was reconstructed with an autogenous cancellous bone graft mixed with ß-tricalcium phosphate (ß-TCP) in the second stage of the IMT. A 62-year-old male patient with left clavicle fracture underwent open reduction and internal fixation. Refracture occurred immediately after the implant was removed. The patient was diagnosed with FRI after reopen reduction and internal fixation and was then referred to our hospital. The surgery was performed using the IMT. In the second stage of the IMT, the bone defect was filled with an autogenous cancellous bone mixed with wool-type ß-TCP. At 8 months after surgery, the nonunion area had fused, and the patient had no restrictions in activities of daily living. The IMT with ß-TCP can be a reconstructive method for bone defects after clavicular nonunion.