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Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 250 - 250
1 Mar 2003
Smith AM Modarai B Davies M Birch R
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An inability to extend the hallux following trauma is most often observed after direct laceration to the Extensor Hallucis Longus [EHL]. Primary repair, subsequent splinting and appropriate rehabilitation best deal with this type of injury. Damage to either the EHL muscle belly or the motor nerve to EHL are uncommon causes of the dropped hallux and present difficult reconstructive problems. Damage to the motor nerve branch to EHL in isolation is an uncommon problem and as far as we are aware surgery to address this pathology has not previously been described in the literature. This problem can occur after a penetrating injury, high tibial osteotomy or intramedullary nailing of a fractured tibia. We describe the operative procedure, technique and outcome in two cases of extensor hallucis longus to extensor digitorum communis (EDC) transfer to overcome this problem. A longitudinal skin incision is made just lateral to the tibia in the distal anterior part of the leg. The extensor retinaculum is divided and the EHL tendon identified and divided just distal to the EHL musculotendinous junction. The extensor digitorum communis (EDC) is then identified and the proximal stump of EHL woven into the EDC. A Pulvertaft weave technique is used and secured with 3/0 Ethibond suture. The appropriate amount of tension is placed on the repair by simulating weight bearing on the foot, ensuring the great toe remains in the neutral position. The extensor retinaculum is then repaired with 2/0 Vicryl and the skin closed with interrupted nylon sutures. The wound is infiltrated with 0.5% Marcaine to aid postoperative pain relief. A protected active motion rehabilitation program follows the surgery. We have used this technique in two cases, both have regained active extension of the hallux.


The Journal of Bone & Joint Surgery British Volume
Vol. 36-B, Issue 4 | Pages 618 - 621
1 Nov 1954
Smith AM

Sprain of the pisiform triquetral joint is a definite clinical entity. It presents as a "tenosynovitis" of the flexor carpi ulnaris muscle from which it can be distinguished by the tests described. The disability in most cases is such that operation is justifiable. Fusion of the pisiform-triquetral joint is preferred to excision of the pisiform because it restores stability to the wrist with the least disturbance to related structures.