A Segmental Rupture of Achilles Tendon, its Management, and Outcome - A Rare Case Report.

Introduction: Achilles tendon is the thickest and strongest tendon of the body, spanning from the middle of the calf up to its insertion into the calcaneal tuberosity, and it is estimated to be the third most frequent tendon to rupture. Segmental Achilles tendon rupture, however, is a very rare occurrence and it comes with challenges of salvaging the tendon segment, preventing necrosis of the overlying skin, preventing infection, and preserving the repaired construct to regain good functional outcome. We present a rare case of an acute traumatic segmental rupture of Achilles tendon in a young male, its management and outcome. Case Report: A 25-year-old male suffered a direct blow to the posterior aspect of his left ankle above the heel and presented to us on the same day. On examination, a lacerated wound with visible ruptured ends of the tendon was found. A palpable gap was also felt over a proximal sutured wound and a real-time ultrasonography revealed a complete tear of Achilles tendon in the proximal site as well. Both the wounds were explored and a segmental Achilles tendon rupture was found. A dual level Krackow's suturing was done with augmentation of the distal repair with anchorage in the calcaneus. Following a stringent post-operative rehabilitation, the patient was allowed weight-bearing from 12 weeks onward. At 6-month follow-up, the tendon continuity was intact both clinically and radiologically, and the patient was able to ambulate bearing full weight having bilaterally comparable ankle range of motion. Conclusion: Rupture of Achilles tendon is relatively common; however, a segmental rupture of the tendon is very rare and poses a challenge for optimum management. Awareness about the possible complications and addressing them with a timely intervention followed by a well-balanced rehabilitation can salvage the tendon and yield good results.

Conservative management of Beta-thalassemia major cases in the sub-division level hospital of rural West Bengal, India.

BACKGROUND: The ideal management of thalassemia involves a multidisciplinary therapeutic team approach and should be preferably done at a comprehensive thalassemia care center with all sorts of specialists and the backup of a well-equipped blood bank. However, in developing country like ours, these facilities are not available in rural set up. So, a situation where conservative therapy with regular blood transfusion is the only choice left to innumerable thalassemic children. OBJECTIVE: To evaluate the existing conservative management protocol of Beta-thalassemia major patients in the setup of a subdivision level Government Hospital of rural West Bengal, India. MATERIALS AND METHODS: The study was performed between December 2009 and December 2011. Beta-thalassemia major patients, registered in blood bank for moderate transfusion regimen, were taken in study. All the patients were screened for Transfusion Transmittable Infections at the time of registration and thereafter periodically every six months. Iron chelation therapy was given simultaneously with transfusion at a dose of 20 to 40 mg/kg/day for six days. The patients were advised to follow up with chelation therapy at home by daily infusion with a goal of maintaining serum ferritin level below 1000 ng/ml. Over this long period of study, the patients were periodically evaluated for complications. RESULTS: The average blood requirement (ml/kg/year) in 1-5 years, 6-10 years, and 11-15 years were 110, 150, and 180, respectively. Incidence of Hepatitis C Virus infection in 1-5 years and 6-10 years were 1.75% and 2.08%, respectively. It is well seen that serum ferritin level increase with ascending age as does the blood consumption. CONCLUSION: Conservative management may be the best alternative and at times the only hope for patients in developing country like ours. However, in order to decrease the disease load, steps need to be taken to introduce preventive measures.

Management of non-united neck femur fracture by valgus osteotomy--a viable alternative.

Management of non-united neck femur fracture in young patients is still a challenge for orthopaedic surgeons. In this study 35 patients with non-united fracture neck femur were treated by valgus osteotomy and fixation with dynamic hip screw over a period of 4 years. Union was achieved in 30 patients (86%) after an average period of 20 weeks. Among them avascular necrosis of femoral head was seen in 4 patients. Average limb length shortening in the affected limb after union was 1 cm. Valgus intertrochanteric osteotomy and fixation by dynamic hip screw is an effective, cheap and relatively easy method for treatment of non-united fracture neck femur in young patients.

Distal femoral fit non-cemented arthroplasty in proximal deficient femur--early results.

Revision surgeries in failed proximal femoral pathologies following osteosynthesis or some kind of replacements pose a challenging task. These can be well managed by distally well fitted extensively coated hydroxyapatide long non-cemented interlocked Reef-Dupuy stem. Here a short series of 10 cases with average follow-up of 3 years is being presented.