Surgical repair of subcutaneous rupture of the Achilles tendon.

The present study analyses 70 consecutive patients who were operatively treated for a rupture of the Achilles tendon, the mean follow-up time being 6 years (range 3-8). The injury was sustained in 70% of the cases during sport exercise. Direct suturation was applied in 18 cases and various types of tenoplasty in 52 cases. Postoperative plaster immobilization after surgery lasted 6-8 weeks. The median sick leave was 57 days, 70% of the sick leaves ranging from 1 to 3 months. At the follow-up, 48 patients showed excellent results (as good as before the accident), 20 good (no distress other than when running), and two fair (distress while walking). Statistically, the operative techniques did not differ from one another with regard to the final clinical result. The injured Achilles tendon was found to have increased thickness and the girth of the calf to have decreased in thickness, both at a statistically highly significant level (P less than 0.001). The plantar flexion of the ankle was limited at a statistically significant level (P less than 0.01). The location of the scar did not influence the final clinical result. Recurrence of the rupture was experienced in two cases, this being doe to another accident. The authors recommend that ruptured Achilles tendons should be operatively treated at the acute stage.

Pyogenic vertebral osteomyelitis as a complication of an abdominal stab wound.

Haematogenous seeding from the genitourinary tract and the rectosigmoid region may cause pyogenic vertebral osteomyelitis. Diagnosis is often difficult due to misleading symptoms. Infection in this case arose as a complication of an abdominal stab wound which has been reported only once previously. Our patient suffered from increasing back pain for two months after the abdominal stab wound and laparotomy, before the true nature of the disease was diagnosed. The diagnosis was confirmed radiologically and by blood culture (Staphylococcus aureus). ASTA (antistaphylolysin titre) appeared to have diagnostic value in continuing hidden staphylococcal infection. Antibiotics and bed rest were effective in treatment. The patient subsequently made a full recovery and returned to his work. The physical signs and the principles of diagnosis and management of pyogenic vertebral osteomyelitis are discussed.