Introduction.The Achilles tendon is one of the most frequently ruptured tendons in the human body. Surgical management commonly includes end to end repairs in acute tears, and chronic ruptures require autologous tendon transfer with Flexor hallucis longus or Flexor digitorum longus. Methods. A longitudinal observational study was done on 22 confirmed cases of chronic Achilles tendon rupture. Two incision technique of FHL tendon transfer with no exposure/debridement of the Tendoachilles was incorporated and functional outcome with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, modified RUPP and Achilles Tendon Total Rupture (ATRS) scores both pre-and post-operatively were evaluated. Wound healing time and complications, heel-floor distance, calf circumference, hallux function and morbidity, graft characteristics and anatomic variation of master Knot of Henry were evaluated. Patients were followed up and assessed at 6 weeks, 3 months, and 6 months post-operatively. Results. The mean length of the FHL graft obtained from 2 incision technique was 8.09 cm. There was significant improvement in the Heel Rise Height Index from 7 to 63% (p < 0.0001), mean AOFAS ankle-hindfoot score from 43.9 to 89.6 (p < 0.001), mean ATRS Score from 19.6 to 79 (p < 0.0001) and mean Hallux MTP-IP scores to 96.3 (p < 0.0001) at 6 th month follow up was found. 13 (59%) had "Excellent" modified RUPP scores. 20 (90.9%) had Type I variation while 2 (9.1%) had Type II variation in MKH. Mean length of the graft obtained was 8.09cm. Mean wound healing time was about 13 days and only one had wound complication. Conclusions. FHL tendon transfer has advantages of requiring minimal dissection, being stronger than FDL and PB and it is an in-phase transfer with the same axis of contraction. KEY WORDS Chronic Tendoachilles rupture; FHL tendon transfer; 2 incision technique; functional outcome; anatomical variation of Master Knot of Henry.
Introduction Fractures of the proximal tibia, particularly those that extend into the knee joint, are serious injuries that frequently result in functional impairment. Complications include infection, compartment syndrome, stiffness, skin loss, and possible amputation. These can be minimized using the Ilizarov external fixator which allows early weight bearing, minimal soft tissue injury, and a multiaxial stable fixation. Materials and Methods A total of 30 patients with open/closed Schatzker type 5 and 6 tibial plateau fractures were studied for outcome following surgery and implant removal using the modified Hohl and Luck criteria which include functional (extensor lag, valgus or varus instability, knee range of movement, walking distance and pain) and radiological parameters (valgus/varus deformity, depression of articular surface, and osteoarthritis). Results In our study, out of 30 patients 53.3% patients had an excellent outcome functionally, whereas 23.3% had a good outcome, 13.3% fair, and 10% had a poor outcome. Radiologically, 46.6% had an excellent outcome, 40% had a good outcome, and 13.3% had a fair outcome. All the patients achieved union with a mean time of 23.9 weeks. Common complication was pin tract infection in 13.3% patients. In total, 60% of the patients could be mobilized immediately with the remaining mobilized within 1 to 4 weeks. Conclusion Most patients had an excellent to good functional or radiological outcome once the implant was removed. Weight bearing could be started immediately in most cases with minimal complications encountered in few patients like pin tract infection, deep venous thrombosis, and osteomyelitis.
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