title: Irreducible tongue-type calcaneal fracture due to interposition of flexor hallucis longus.
abstract: We present a rare case of interposition of the flexor hallucis longus (FHL) tendon blocking percutaneous closed reduction of a displaced tongue-type calcaneal fracture, and necessitating open repositioning of the tendon and internal fixation through a single extensile lateral approach. Although not recognized until during surgery, with a high index of suspicion, preoperative diagnosis of this injury combination should be possible on high resolution CT, thus enabling better planning of the procedure. The presence of a small sustentacular fragment, especially if markedly displaced or rotated, should further alert the physician as to increased likelihood of such tendon entrapment within the fracture. In the literature, fracture fixation and extrication of the FHL tendon have been performed via either or both lateral and medial approaches. A medial approach may prove necessary when there is severe displacement or rotation of the sustentacular fragment. Arthroscopically assisted surgery may aid in disengaging the tendon from within the fracture site.
authors.affiliation: Department of Trauma & Orthopaedics Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK. Electronic address: johnwong@doctors.org.uk.
authors.forename: John
authors.initials: J
authors.lastname: Wong-Chung
authors.affiliation: Department of Trauma & Orthopaedics Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: Diarmaid
authors.initials: D
authors.lastname: O'Longain
authors.affiliation: Department of Trauma & Orthopaedics Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lynch-Wong
authors.affiliation: Department of Trauma & Orthopaedics Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
authors.forename: Harriet
authors.initials: H
authors.lastname: Julian
mesh_terms: D000328:Adult; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D000070628:Closed Fracture Reduction / Q000009:adverse effects*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D053682:Tendon Entrapment / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery
keywords: Calcaneal fracture; Interposition of flexor hallucis longus tendon; Small sustentacular fragment