RESUMEN
Conservative treatment of Achilles tendon ruptures may lead to re-rupture. Open surgical repair entails a risk of skin necrosis or infection. Several percutaneous techniques have been used, such as Tenolig or Achillon, but these techniques are costly and may be marred by wound healing problems. Ma and Griffith described a technique for percutaneous repair which left the suture and the knot under the skin, thus reducing the risk for infection. From January 2001 to September 2006, we used this percutaneous treatment for 60 acute ruptures of tendo Achillis. The repair was made under local anaesthesia, using a single or double absorbable suture. Postoperative care was 3 weeks immobilistion in a non-weight bearing cast in equinus position, followed by another 3 weeks in a cast with the ankle at 90 degrees and progressive weight bearing. Mean followup was 19 months. Complications were 2 re-ruptures at 2 and 5 months respectively, 1 infection in a patient who presented with re-rupture after a previous surgical treatment, and 1 Achilles tendonitis. There was no sural nerve lesion. Mean time to return to working activities was 85 days; mean time to return to sports activities was 5 months. Clinical results were good with no loss in range of motion. This low-cost technique appeared as an interesting alternative to surgical or conservative treatment, providing strong repair with a low complication rate.
Asunto(s)
Tendón Calcáneo/lesiones , Técnicas de Sutura , Adolescente , Adulto , Anciano , Femenino , Humanos , Inmovilización , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Cuidados Posoperatorios , Recurrencia , Rotura , Soporte de Peso , Adulto JovenRESUMEN
Traumatic bone defects in the diaphyso-metaphyseal distal part of the femur are difficult to treat. Only two publications have described traumatic extrusion of a femoral shaft fragment and its successful replacement after autoclave sterilisation. We report the case of a 17-year-old patient who had traumatic extrusion of an 11- cm segment of his distal femur. The bone segment was retrieved on the road, and was reimplanted in its anatomical position after cleansing and autoclaving. At ten years follow-up, there is complete incorporation with full functional recovery. The preserved periosteum seems to have played a major part in this successful outcome.