Case of the Fortnight 1June

Case of the Fortnight

APOA Foot & Ankle Council Presents..

Upcoming Case of the Fortnight on 15th June 2021

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Presented by:

Presented by:

Prof. Andri Primadhi

Prof. Chayanin [email protected]

Dr Kwai Ming [email protected]

1st June 2021

Chronic Achilles Tendon Rupture

Title:

Medial Peri-Talar Fracture Dislocation- Look for associated injuries

Title:

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Chronic Achilles tendon rupture is not uncommon in Asian countries, partially due to the relatively benign symptoms following rupture.The patients usually came to the hospital after several months, complaining hindered gait.Preferred treatments:< 2cm gap : tenorrhaphy2-5 cm gap : V-Y advancement> 5 cm gap : tendon transfer with or without advancement/flapFHL is preferred tendon for transfer, because of its length, identical function, close axis, and its muscle belly can aids in vascular supply to the distal stump.

Department of Orthopaedics and TraumatologyUniversitas Padjadjaran Medical School / Hasan Sadikin Hospital

Bandung, Indonesia

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Dr. Arvind PuriMBBS, FRCS (IRELAND),

FRACS (ORTH), ORTHOPAEDIC SURGEONReef Orthopaedic Clinic,

Cairns, Australia

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1st June2021

Chronic Achilles Tendon Rupture

Andri PrimadhiDepartment of Orthopaedics and TraumatologyUniversitas Padjadjaran Medical, School / Hasan Sadikin Hospital, Bandung, IndonesiaEmail:

A 57 year-old male patient came to our hospital complaining difficulty in walking, following a popping sensation on his heel during a badminton game 6 months before. Throughout the times, he had never seen an orthopaedic surgeon, instead he went to a traditional bone setter.

Clinical evaluation Upon physical examination, he was able to walk, but hindered and without propulsive step. The Thompson test was positive with 5 cm palpable gap and retracted proximal stump.

Treatments FHL tendon transfer and turn-down flap were performed. Post operative rehabilitation protocol included 3 weeks of casting in 30° plantarflexion, continued by another 4 weeks of partial weight bearing in a ankle foot orthosis with gradually changed heel cushion. The patient can walk full weight bearing without orthosis after 2 months.

(Fig 1.)MRI image showing an Achilles tendon rupture with large gap

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Fig.1Fig. 1











1st June2021

(Fig 2.)Patient on prone position, medial longitudinal incision was made

(Fig 3.)After getting into deep posterior compartment, FHL tendon

was identified as lying most laterally

(Fig 4.)Knot of Henry was released. FHL and FDL attachments is divided and transected

(Fig 5 & 6.) The harvested stump was

sutured to the distal stump or to the calcaneus

through bone tunnel / tenodesis screw


Fig.1

Fig. 2

Fig. 4

Fig. 3

Fig. 5 Fig. 6










1st June2021


(Fig 7.)The remaining triceps surae was bridged using Turn-down

flap technique

(Fig 8.)The plantar flexion cascade was checked intraoperative, compared with normal contralateral side

(Fig 9.)The patient was able to heel raise at 3 months follow-up

Fig. 8

Fig. 7

Fig. 9







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Case of the Fortnight 1June