Carlson Bradley, Carlson DuWayne, Chirongoma Tadiwanashe, Scheid D Kevin
Loma Linda University, Loma Linda, CA, USA.
Community Hospital, Grand Junction, CO, USA.
Foot Ankle Orthop. 2024 Jul 30;9(3):24730114241265342. doi: 10.1177/24730114241265342. eCollection 2024 Jul.
Extensor retinaculum syndrome (ERS) is a relatively rarely diagnosed compartment syndrome-like entity caused by elevated pressures in the tissues deep to the superior extensor retinaculum (SER). ERS is identified as out-of-proportion anterior ankle pain, pain with passive toe plantarflexion, elevated SER pressures (>40 mm Hg), and ultimately toe extension weakness and first web space numbness. Although previously described in a pediatric population, this case series is the first to our knowledge in an adult population.
Seven nonconsecutive cases over 18 years from 2 surgeons are reported who underwent complete SER release for ERS either through the direct lateral approach to the fibula or the anterolateral approach to the distal tibia. All were associated with traumatic injuries including 3 bimalleolar ankle fractures, 3 tibial pilon fractures, and 1 distal tibial/fibular shaft fracture. All patients developed writhing anterior ankle pain worsened with passive toe plantarflexion. SER compartment pressures ranged from 50 to >135 mm Hg. Five cases displayed decreased first web space sensation.
The diminished or absent first web space sensation uniformly improved post-release. Complications included 1 patient with complex regional pain syndrome type 1, 1 patient required hardware removal, and 2 had persistent but improved first web space sensation changes.
Clinical suspicion for possible ERS should arise after distal tibial/fibular fractures when the excruciating pain localizes to the ankle instead of the classic anterior leg muscle bellies. If pain is worsened with passive toe plantarflexion, this diagnosis should be considered. Recommended treatment involves complete release of the SER anywhere on the anterior surface between the tibia and fibula depending on the approach needed for fixation of the associated fracture.
Level IV, case series.
伸肌支持带综合征（ERS）是一种相对罕见的、类似骨筋膜室综合征的疾病，由伸肌上支持带（SER）深层组织压力升高引起。ERS的表现为不成比例的前踝疼痛、被动足趾跖屈时疼痛、SER压力升高（>40mmHg），最终出现足趾背伸无力和第一跖骨间隙麻木。尽管此前曾在儿科人群中描述过，但据我们所知，本病例系列是首例关于成人患者的报道。
报告了来自2位外科医生的7例非连续性病例，这些患者年龄均超过18岁，因ERS接受了SER完全松解术，手术途径为经腓骨直接外侧入路或经胫骨远端前外侧入路。所有病例均与创伤性损伤相关，包括3例双踝骨折、3例胫骨Pilon骨折和1例胫腓骨远端骨干骨折。所有患者均出现前踝剧痛，被动足趾跖屈时疼痛加剧。SER骨筋膜室压力范围为50至>135mmHg。5例患者出现第一跖骨间隙感觉减退。
第一跖骨间隙感觉减退或消失在松解术后均有改善。并发症包括1例1型复杂性区域疼痛综合征患者，1例患者需要取出内固定物，2例患者第一跖骨间隙感觉改变持续存在但有所改善。
当胫腓骨远端骨折后出现剧痛且疼痛局限于踝部而非典型的小腿前侧肌腹时，应怀疑可能存在ERS。如果被动足趾跖屈时疼痛加重，则应考虑该诊断。推荐的治疗方法是根据相关骨折固定所需的入路，在胫骨和腓骨之间的前表面任何位置对SER进行完全松解。
IV级，病例系列。
