Complications of achilles and posterior tibial tendon surgeries.

Surgery of the Achilles and posterior tibial tendons requires finesse to achieve optimal function. Although superficial in anatomic location, various critical neurovascular structures exist in close proximity. The superficial blood supply is fragile, requiring a delicate touch to prevent problems with wound healing. Damaged tendon tissue often is friable, making it difficult to sew or anchor. Adjusting the tendon length to the appropriate tension requires good judgment and affects long-term outcome through power and range of motion. Finally, surgery on these two tendons significantly affects function of the ankle and longitudinal arch, where small changes are magnified into large changes in maintaining normal gait. The current authors review the complications encountered in various common surgeries of the Achilles and posterior tibial tendons.

Bone infarction versus infection in sickle cell disease in children.

We reviewed emergency admissions for the complaint of musculoskeletal symptoms for 113 children with sickle cell disease. Over a 2-year period, we accumulated a total of 247 admissions to a major children's hospital. Four osteoarticular infections were identified, resulting in an incidence of 1.6% per admission for musculoskeletal complaints. Admission history, physical findings, laboratory values, and radiographic studies were reviewed. We compared findings in the group with the positive diagnosis of osteoarticular infections with those who were thought to have only vaso-occlusive crisis. Although three of the four patients with infection had plain roentgenogram changes at the time of diagnosis, no statistically significant differences in the two groups could be determined.