Percutaneous versus open repair of acute Achilles tendon ruptures.

BACKGROUND: Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS: We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10-24 months) for the open repair group and 20 months (range 9-24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients' return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded. RESULTS: No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7-9 weeks. The mean time of patients' return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study. CONCLUSIONS: The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.

External fixation for displaced 2-part proximal humeral fractures.

Studies have reported conflicting results regarding external fixation for displaced proximal humeral fractures. Compared with open reduction and internal fixation, external fixation for displaced proximal humeral fractures avoids dissection and soft tissue stripping and leads to higher union rates, a lower incidence of avascular necrosis, less scaring of the scapulohumeral interface, and faster rehabilitation. Some authors have reported good or excellent results and minimum complications compared with open reduction and internal fixation; however, others have reported that external fixation does not ensure acceptable reduction and fracture stability, especially in patients with osteoporosis.This article describes 18 patients with displaced 2-part fractures of the surgical neck of the humerus treated with closed reduction and external fixation using the Tension Guide Fixator (Gexfix SA, Carouge, Switzerland) external fixation system between 2010 and 2011. The patients included 14 women and 4 men with a mean age of 39 years. Mean follow-up was 18 months (range, 15-24 months). Fracture union; function using the Constant score, University of California Los Angeles score, Oxford score, and Quick Disabilities of the Arm, Shoulder and Hand shoulder score; and complications were evaluated. All patients experienced fracture union at a mean of 11 weeks (range, 9-13 weeks). The Tension Guide Fixator was removed without anesthesia at the outpatient clinic at a mean of 6 weeks (range, 4-8 weeks) with no loss of reduction or secondary displacement after removal. At 1-year follow-up, mean Constant and University of California Los Angeles scores were excellent, mean Oxford score showed satisfactory joint function, and mean Quick Disabilities of the Arm, Shoulder and Hand score showed minimal pain with no disability.

Distraction over nail using circular external fixation for septic pseudarthrosis of the tibia.

We present a report of nine patients (eight women and one man; mean age 37 years) from 2010 to 2012 with septic pseudarthrosis of the tibia treated with bone transport over an intramedullary nail using a circular external fixator. The mean follow-up was 15 months (range: 10-21 months). A two stage approach was used. At the first stage, removal of the primary osteosynthesis and extensive bone debridement to healthy, bleeding bone margins was performed. The bone defect was packed with antibiotic loaded cement beads, and stabilization of the tibia was done with a unilateral external fixator or with a long leg posterior splint. The mean size of bone defect was 4 cm (range: 3.5-5.5 cm). At the second stage, two consecutive negative wound cultures and normal values of blood cell count, C-reactive protein (CRP), and estimated sedimentation rate (ESR) were obtained. Then we reamed and locked the intramedullary nailing of the tibia, applied a circular external fixator, and performed percutaneous corticotomy of the tibia opposite the site of the bone defect. Bone distraction over the nail was initiated at the eighth postoperative day at a rate of 1 mm/day. At the last follow-up, union was achieved in all cases without recurrence of bone infection. All patients experienced excellent (n=3) or good (n=6) knee and ankle function, as well as complete return to their daily activities. Two patients experienced pin-tract infection, and one patient experienced anterior knee pain at the entry point of the nail.