Anterior Compartment Of Leg Research Articles

Fibularis tertius muscle in women & men: A surface anatomy cross-sectional study across countries.

The fibularis tertius muscle (FTM) is a rare anatomic variation. The prevalence of this exclusively human structure, which is found in the anterior compartment of the leg, is often underestimated, and it is believed that foot and ankle conditions are more difficult to manage in patients with an FTM. The aim of this study was to assess the presence of the FTM palpation and determine whether its presence is associated with an individual’s sex, because the exact prevalence in males and females is unclear. An observational cross-sectional study was carried out. The study included 481 people (23.49% men and 76.51% women) with a mean age of 23.51±5.369 years, who were recruited from a Podiatric Medicine and Surgery Clinic (Spain). Data on routine demographic and clinical factors were recorded, and the presence or absence of the FTM was determined based on surface visual or palpated localization of the tendon (using a consistent protocol). The FTM was present in 38.25% (184/481) of the participants. Furthermore, FTM were present in 38.6% (142/481) of females and 37.2% (42/481) of males. The study revealed that the presence of the FTM varies between individuals and does not depend on an individual’s sex. Significant differences in the prevalence of the FTM between countries should be carefully evaluated rather than generalizing the results of this Spanish study to other non-Spanish populations. Larger numbers of participants should be enrolled in future studies in order to meet the statistical criteria.

Variations of the Fibularis Tertius

Fibularis tertius, also called peroneus tertius, is a muscle located in the anterior compartment of the leg. It shares a synovial sheath with extensor digitorum longus and attaches at the base of the fifth metatarsal. It is noted in both Moore's Clinically Oriented Anatomy and Gray's Anatomy that the muscle is ‘not always present’. This study examined the dorsum of the feet of 16 cadavers for the presence of fibularis tertius tendons and variations of the tendon. Two cadavers were lacking the fibularis tendon on the right foot. Their left feet and the other 14 cadavers bilaterally had fibularis tertius tendons. Variations seen included insertion of the tendon on the shaft of the fifth metatarsal, tendons branching from the extensor digitorum longus tendon of the fifth digit, and multiple fibularis tertius tendons.Support or Funding InformationWork was supported by D'Youville College Department of Biology and Math.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Feasibility of ultrasound measurement in a human model of acute compartment syndrome

BackgroundEarly diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS.MethodsA model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA).ResultsTFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8–4.0, p < 0.001).ConclusionsWe found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now.

Microsurgical Reconstruction of the Lower Extremity.

Reconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

Tendon Transfer for Foot Drop: A Simple Procedure with Effective Outcome Local Experience

Introduction: Patients presented with old neglected common peroneal nerve injuries, failed 2ry repair, compression neuropathies not improved after decompression and closed injuries with no improvement on conservative measures which are still unsolved problems. Poor recovery of this nerve after repair or decompression gives great importance to tendon transfer in these situations. Material and Methods: This study was conducted in Neurosurgery Department of Mansoura University from 2015 to 2018 on twenty-six patients (16 males and 10 females). Their age ranged from 6 - 58 years. All of them presented with persistent foot drop at least for one year after injury with no signs of improvement clinically or in electrophysiological studies. All patients underwent tibialis posterior tendon transfer through the interosseous membrane to the tendons of the leg anterior compartment. All of them were put in a plaster cast for four weeks postoperative. A physiotherapeutic program was applied for all patients as preoperative preparation and postoperative rehabilitation. Results: Twenty-two patients showed satisfactory results, three patients fair improvement and one patient no improvement. Two patients had wound infection and there was no mortality in this study. Conclusion: Tendon transfer is an effective valid solution to be considered in the management of foot drop in these patients.

A cadaveric model of anterior compartment leg syndrome: Subcutaneous minimally invasive fasciotomy versus open fasciotomy

ObjectiveBecause of disabling sequelae of open fasciotomy in anterior compartment syndrome (ACS) of the leg, we wanted to describe and validate a cadaveric model of ACS. We hypothesized that, first, anterior compartment syndrome (ACS) could be reproduced in cadaveric leg and, second, fasciotomy without complete skin incision could lower the intramuscular pressure (IMP) in an equivalent range to complete dermatofasciotomy. Materials and methodsLower limb ACS was reproduced by progressive injection of physiologic serum in the anterior compartment of 23 fresh frozen cadaveric legs with monitoring of IMP, in order to reach a maximal stabilised IMP higher than 30mmHg. Subcutaneous minimally invasive fasciotomy was performed on 14 legs through 5 transversal mini-incisions of the skin (2cm) along the axis from the tibial tuberosity to the posterior aspect of the lateral malleolus. Standard open fasciotomy of the anterior compartment was performed on the remaining 9 legs as control. IMP was measured after the skin incisions and after every fasciotomy through skin incisions in the first group and after skin and fascia incisions in the control group. ResultsA maximal IMP of 43±2mmHg was obtained by injection of 177±9ml physiologic serum into the anterior compartment of the leg. In the control open fasciotomy group, the skin incision alone did not lower IMP significantly, whereas fasciotomy lowered IMP to 10±1mmHg, which is statistically different from maximal IMP (p<0.001). In the subcutaneous fasciotomy group, complete fasciotomy lowered significantly the IMP to 11±4mmHg (p<0.001), without statistical difference with the control group. DiscussionThis cadaveric model is effective to reproduce the hyperpressure encountered in ACS. In this model, IMP release after fasciotomy is as efficient through minimally invasive subcutaneous incision as with control open fasciotomy. This in vitro technique appears as an attractive alternative treatment in anterior compartment syndrome of the leg. It should be tested in the other compartments of the leg and its in vivo feasibility in acute conditions has to be clarified. Level of evidenceIII, control laboratory study.

Anterolateral retrograde access to the distal popliteal artery and to the tibioperoneal trunk for recanalization of femoropopliteal chronic total occlusions

ObjectivesTo describe and assess the safety of a technique for the percutaneous retrograde access to either the P3 segment of the popliteal artery or the tibioperoneal trunk (TPT) through the anterior muscle compartment of the leg to treat distal femoropopliteal chronic total occlusion (CTO). MethodsAfter a failed antegrade attempt of endovascular recanalization of a femoropopliteal CTO, 41 symptomatic patients (29 men; mean age of 75.8 ± 8.4 years) underwent a percutaneous retrograde access by means of the puncture of the TPT in 15 cases (36.6%) and of the P3 tract of popliteal artery in 26 cases (63.4%). The puncture was performed on the anterolateral aspect of the proximal leg through the anterior muscle compartment with the patient in a standard supine position. Access to the vessel was obtained with a sheathless approach. After retrograde recanalization and guidewire rendezvous, the distal wire was retrieved proximally and a standard antegrade endovascular intervention was carried out. ResultsRetrograde access was achieved successfully in all patients. Recanalization was carried out in 16 cases (39.0%) with an endoluminal technique and in 25 cases (61.0%) in a subintimal fashion. Hemostasis was successfully attained in 31 patients (75.6%) by inflating a blood pressure cuff at the calf. In 11 cases (26.8%), the hemostasis was accomplished instead by means of a low-pressure ballooning as a bailout strategy for small residual bleedings. The transcutaneous oximetry at the 1-month follow-up from the procedure was significantly increased compared with the preprocedural values (10.4 ± 6.8 vs 42.4 ± 18.7 mm Hg; P < .01). No early or late postoperative access-related complications were observed at a mean follow-up of 12.6 ± 9.5 months. ConclusionsAfter a failed antegrade approach, the anterolateral retrograde puncture of the P3 or of the TPT is a valuable and safe technique to treat femoropopliteal CTOs in selected patients, regardless the distal spread of the lesion to the popliteal artery.

Variations in distal attachment of muscles of the leg, foot and the hand and their clinical implications in population of central Ethiopia

Anatomical variations in the distal attachment of lower and upper limb muscles are of paramount importance in surgical and clinical practice. Reports show variations in the insertion of the fibularis longus and brevis tendon from the lateral compartment of the leg, extensor hallucis longus and fibularis tertius from the anterior compartment of the leg, flexor digitorium brevis from the sole of the foot and the existence of accessory muscles in the dorsum of the hand. However, reports are scanty from Ethiopia. The present study was aimed at assessing the existence of variation in the distal attachments of muscles of the lower and upper limbs in the central Ethiopia population. Twenty-two formalin fixed cadavers were used. Careful dissection, critical observation and imaging were done accordingly. We have found the presence of two tendons of extensor halluces longus in one cases, absence of the lateral tendon to the 5thdigit of the flexor digitorum brevis of the sole of the foot in another case and the presence of the accessory extensor indicis muscle on the dorsum of the hand in a third case. These variations are important owing to the use of the tendons in tendon transfer surgeries to correct deformities of the hand, foot and ankle joint, and also for radiologists, clinicians, and surgeons in order to prevent adverse surgical events.

Accuracy and Reliability of Assessing Lateral Compartmental Leg Composition Using Dual-Energy X-ray Absorptiometry.

This study aimed to investigate the accuracy and reliability of a novel dual-energy x-ray absorptiometry (DXA) scanning method in the frontal plane for total, fat, and lean mass quantification of the anterior and posterior upper leg compartments. Twenty-one (11 females; X¯age = 20.3 ± 1.3 yr) college athletes were assessed for total and regional body composition using DXA. The segmentation of anterior/posterior thigh compartments was measured with participants lying on their right and left sides and the scanned leg elevated with two foam pads. Custom regions of interest (ROIs) were created manually with enCore software for each scan using bony landmarks to quantify lean, fat, and total masses. Paired t-tests assessed this novel positioning method's accuracy against standard positioning. Intraclass correlation coefficients and coefficients of variation examined inter- and intrarater reliability for lateral scan measures of total, fat, and lean masses from manually created ROIs. All mean ± SD differences between frontal and lateral DXA scans of right (R) and left (L) leg total mass (R: 8.42 ± 195.57 g; L: 19.47 ± 131.80 g), fat mass (R: 61.26 ± 215.66 g; L: -5.89 ± 239.97 g), and lean mass (R: -103.00 ± 302.54 g; L: -27.58 ± 288.14 g) were nonsignificant (P value range = 0.15-0.91). Intraclass correlation coefficients were high for all composition measures between and within raters, ranging from 0.983 to 0.999 and from 0.954 to 0.999, respectively, with low variation across measures (all coefficients of variation ≤ 5%). The results of this study suggest that DXA measures using lateral subject positioning and custom ROIs to assess upper leg total, fat, and lean masses are accurate and reliable compared with total-body frontal subject positioning. Future studies are needed to determine the clinical usefulness of lateral view measures regarding prevention or rehabilitation of sports- or age-related injury.

Calcific myonecrosis following snakebite

Calcific myonecrosis is a rare condition and is believed to be a late sequela of untreated compartment syndrome. Patients usually present with a progressively enlarging mass, years after the initial injury, that can be misdiagnosed as a soft tissue sarcoma. Calcific myonecrosis following snakebite is extremely rare. The anterior compartment of the leg is most frequently involved and appears to be especially vulnerable to developing this complication. Conservative management should be considered in asymptomatic patients but spontaneous soft tissue breakdown with sinus formation may develop and prolonged surveillance is advised. We report two similar cases of calcific myonecrosis of the anterior compartment of the lower leg that developed decades following snakebite.

Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

Introduction:Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results.Methods:One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days.Results:After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future.Conclusion:Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

Excision of an intramuscular hemangioma within the anterior muscle compartment of the leg in a thirteen-year-old female: A case report

Excision of an intramuscular hemangioma within the anterior muscle compartment of the leg in a thirteen-year-old female: A case report

Unilateral Sensitive Spinal Anesthesia. Case Report

A 46-year-old male was admitted for tenolisys of anterior compartment of lower leg under spinal anesthesia. Spinal puncture was performed with the patient in the lateral left side, in the L3-L4 using 27 G needle, and 4 mg of 0.1% hypobaric bupivacaine were administered. The patient remained in that position for 10 min. In the limb to be operated, the level of sensory block was observed in L1 without motor block. With this new technique that was obtained surgical analgesia, but without motor blockade. We call this new technique of unilateral sensitive spinal anesthesia.

Electrophysiological/sonographic mapping of the superficial peroneal nerve to facilitate biopsy under local anaesthesia

The anatomical surface markings for the superficial peroneal nerve have been described and it may be preferred for biopsy in cases of suspected vasculitis as biopsy of the peroneus brevis muscle increases diagnostic yield. The procedure is however unfamiliar to many surgeons and the anatomical variability of the subcutaneous part underestimated. Where the nerve has some preserved sensory nerve action potential it may be mapped pre-operatively, greatly facilitating minimally traumatic biopsy with potential logistical and wound healing advantages. We review the literature relating to the anatomical course of the nerve and present a case illustrating the advantages of pre-operative mapping, given its location in the anterior compartment of the leg 26% of the time.

Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

BackgroundChronic exertional compartment syndrome (CECS) is a common cause of exertional leg pain. It is commonly treated with a surgical fasciotomy, which has a surgical complication rate of up to 16% and takes approximately 6-12 weeks to return to preprocedure activity levels. Therefore, the development of a less invasive, effective outpatient intervention to treat CECS is desirable. ObjectiveTo describe and validate an ultrasound-guided (USG) fasciotomy technique for the anterior and lateral compartments of the lower limb in an unembalmed cadaveric model. DesignProspective, cadaveric laboratory investigation. SettingAcademic institution procedural skills laboratory. SubjectsTen unembalmed cadaveric knee-ankle-foot specimens from 1 female (2 specimens) and 7 male donors aged 62-91 years (mean 78.6 years) with body mass indices of 18.9-35.3 kg/m2 (mean 27.1 kg/m2). MethodsTwo experienced operators each performed USG anterior and lateral compartment fasciotomies on 5 unembalmed cadaveric legs. A third physician subsequently dissected the legs to assess the continuity of the fasciotomies and to identify any neurovascular damage related to the procedures. Main Outcome MeasuresFasciotomy length (in centimeters) and classification by completeness (achieved target length or did not achieve target length) and continuity (continuous or discontinuous) based on predetermined criteria. Muscles, retinaculae, and neurovascular structures were assessed for damage. ResultsNo neurovascular injuries occurred in any of the 20 USG fasciotomies. The average fasciotomy length was 22.5 cm. All 20 of the fasciotomies achieved the target length. A continuous cephalocaudal fasciotomy was accomplished in 13 of 20 fasciotomies. When a fasciotomy was not continuous, the average length and number of intact fascial bands was 1.52 cm and 2.3, respectively. ConclusionsUSG fasciotomy of the anterior and lateral leg compartments can be safely performed in a cadaveric model and can achieve a fasciotomy length comparable to surgical fasciotomy. Most procedures successfully achieved a continuous cephalocaudal fasciotomy, although small areas of intact fascial bands were identified in approximately one-third of procedures. The clinical significance of this finding is indeterminate. Given the safety demonstrated with this minimally invasive USG fasciotomy in a cadaveric model, further research is warranted to develop and refine the technique for clinical application. Level of EvidenceNot applicable.

Prevalence of Fibularis Tertius Muscle in Southeastern Indian Population: a Surface Anatomical Study

Background:Fibularis tertius (FT) is a variant muscle of the anterior compartment of leg which involves in dorsiflexion and evertion of the foot. Literature shows that the reported prevalence of FT ranges from 49-100%. This study investigates the prevalence of FT in South-eastern population of India using surface anatomy techniques in living subjects and comparing it with the studies available in the literature.Material and Methods:Study included the evaluation of 195 subjects from Year 1 & 2 medical students (102 females and 93 males) which correspond to 390 feet in total. The average age of the sample was 17.9 years, with lower and upper limits of 17 and 20 years, respectively. The presence of FT was identified with a standard palpation technique that determines the presence of muscle on the basis of the progression tests called F1, F2, and F3.Results:The total FT prevalence was found to be 52% of the sample. On the right foot, FT was found to be 26.6% in males and 24.6% in females and on the left foot, it was 27.2% in males and 25.6% in females. FT palpation criterion showed 0 (zero) cases for F1, 31 cases for F2 and 172 cases for F3.Conclusions:This surface anatomical study reports for the first time the FT prevalence in South-eastren population of India. Further studies on prevalence of FT are needed to understand its role in biomechanics and reconstructive surgeries of the ankle and foot.

Neuromotor response of the leg muscles following a supine, stand retraining with/without neuromuscular electrical stimulation training intervention for individuals with SCI: A case series.

The goal of this paper is to study the effects of supine and stand retraining (SRT) interventions with and without multi muscle neuromuscular electrical stimulation (NMES) on the neuromuscular EMG responses of the leg muscles for individuals with motor complete SCI during walking on a body-weight support (BWS) treadmill. The main outcome variables were EMG amplitude, integrated EMG and co-contraction indices (co-excitation and co-activation) collected during a 10-minute walking treadmill trial. Data was analyzed for the first, fifth and tenth minute of walking. Results showed that both Supine+NMES and SRT+NMES interventions increased spatial-temporal aspects of muscle activity (mean EMG amplitude and integrated EMG) of lower limb muscles. SRT+NMES (loading) showed greater gains in the proximal anterior leg compartments. On the contrary, SRT without NMES (SRT only) exhibited deterioration of activity within the same muscle groups. Co-contraction indices increased for both post-NMES interventions suggesting that task-specificity of training is important to achieve the fundamental reciprocal firing known to able-bodied gait. These results show that combination of NMES+loading during passive rhythmic gait will induce neuroplasticity in the lower limbs that ultimately provides a potential effective means to recover gait in individuals with SCI.

Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg.

BackgroundChronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity.MethodsThe study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded.ResultsThe median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded.ConclusionsMinimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term.

Unilateral Variation in Extensor digitorum longus muscle.

During a routine dissection of an adult embalmed male cadaver for educational purpose in the department of anatomy at AIIMS, New Delhi, India, a rare unilateral variation of extensor digitorum longus (EDL) was found which is a muscle of anterior compartment of the leg. There was a split tendon of EDL muscle in the anterior compartment of left leg which became a common tendon in front of the ankle joint. This common tendon of EDL muscle again divided into four slips and were inserted in to the lateral four toes. In the upper part of the leg, the anterior tibial vessel and deep fibular nerve lie between the EDL and tibialis anterior. Knowledge of this type of anomaly is useful in diagnosis and treatment of compartmental syndrome. One of the tendon from the split tendon of EDL muscle can be used as a graft in tendon replacement surgeries. The split tendon may also be capable for some precise movements of the toes.

An unusual calcific myonecrosis: a case report

Calcific myonecrosis is a rare painful, expansile, calcified mass that develops as a result of compartment syndrome in a muscle of lower extremity. Patient usually present several years after trauma as a mass typically in anterior compartment of leg which can be mistaken for soft tissue tumor. Imaging studies can aid in the diagnosis of this less known entity. However, diagnosis is confirmed by histopathologinal findings of linear calcification and central necrosis inside a cavity in a muscle. We report a rare case of calcific myonecrosis involving posterior compartment of leg in a forty three year old female who had presented with pain in right mid-calf region for two weeks. Color Doppler showed small cystic lesion with calcification suggestive of probable neurofibroma for which complete excicion of the lesion was done and diagnosis of calcific myonecrosis was made on histopathological examination. Keywords: Calcification, Myonecrosis, Trauma