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Review Question - QID 3301

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QID 3301 (Type "3301" in App Search)
A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention as shown in Figure A. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. What is the most likely etiology of this finding?
  • A

Use of a lateral extensile approach to the calcaneus

2%

102/4851

Calcaneal tuberosity varus malalignment

3%

165/4851

Use of screws in the constant fragment that are too long

87%

4202/4851

Missed foot compartment syndrome

5%

233/4851

Plantar nerve palsy

2%

120/4851

  • A

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The flexor hallucis longus runs along the medial aspect of the hindfoot, medial to the posterior facet and inferior to middle facet just under sustentaculum tali(constant fragment) This tendon can be injured with poor drilling technique or use of screws that are too long during reduction and fixation of a calcaneus fracture using a lateral plate. If present, the great toe will be in a fixed, flexed position from the tendon being tethered over a screw.

Figure A shows a calcaneus fracture with a lateral plate and screws.

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