Date: Sat, 08 Dec 2001 16:02:20 -0500
Subject: 0/5 EHL s/p tibia fx
From: Charles Blitzer
I have a skier 4 mos s/p tib/fib fx. Rodded in Chile. Has 0/5 EHL. EMG shows denervation of EHL & EDB, minimal deficit TA and EDL. I am considering EHL to EDL 2nd toe tenodesis as the drooping of the big toe bothers the patient.
Any thoughts or suggestions?
Date: Sat, 8 Dec 2001 20:21:07 EST
What we often call "peroneal palsy" in US is often referred to as "dropped hallux" in Britain (and ? elsewhere) suggesting some specificity of loss of big toe extention. There was a recent JBJS article on "dropped hallux" management but I don't recall what they said about extensor transfer. I wonder if the second would be strong enough?
Date: Sat, 8 Dec 2001 23:23 EST
From: Bill Burman
See: Robinson CM, O'Donnell J, Will E, Keating JF.; Dropped hallux after the intramedullary nailing of tibial fractures.; J Bone Joint Surg Br. 1999 May;81(3):481-4.
"We made a prospective study of 208 patients with tibial fractures treated by reamed intramedullary nailing. Of these, 11 (5.3%) developed dysfunction of the peroneal nerve with no evidence of a compartment syndrome. The patients with this complication were significantly younger (mean age 25.6 years) and most had closed fractures of the forced-varus type with relatively minor soft-tissue damage. The fibula was intact in three, fractured in the distal or middle third in seven, with only one fracture in the proximal third. Eight of the 11 patients showed a 'dropped hallux' syndrome, with weakness of extensor hallucis longus and numbness in the first web space, but no clinical involvement of extensor digitorum longus or tibialis anterior. This was confirmed by nerve-conduction studies in three of the eight patients. There was good recovery of muscle function within three to four months in all cases, but after one year three patients still had some residual tightness of extensor hallucis longus, and two some numbness in the first web space. No patient required further treatment."