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Review Question - QID 837

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QID 837 (Type "837" in App Search)
The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw during fixation of what structure?

Lisfranc fracture-dislocation

4%

109/2537

Navicular body fracture

4%

101/2537

Intra-articular calcaneus fracture

78%

1973/2537

Nutcracker cuboid fracture

2%

47/2537

Talar neck fracture

12%

298/2537

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A drill bit or screw that penetrates the subchondral area of the posterior facet of the calcaneus can lead to direct injury of the flexor hallucis longus as it runs just inferior to the sustentaculum tali on its way to its insertion on the first phalanx of the great toe. A medial calcaneal groove is seen where this structure runs from superior to inferior. Injury to the flexor hallucis longus tendon can be acute or attritional.

Bajammal et al investigated intra-articular calcaneus fractures and reported that patients who were NOT receiving Workers' Compensation, were younger (less than twenty-nine years old), had a moderately lower Böhler angle (0 degrees to 14 degrees ), a comminuted fracture, a light workload, or an anatomic reduction or a step-off of < or =2 mm after surgical reduction (p = 0.04) scored significantly higher on the scoring scales after surgery compared with those who were treated nonoperatively.

Illustration V demonstrates the relative position of the FHL to the posterior facet of the calcaneus.

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