chpt 101: achilles tendon trauma Flashcards
hatchet strike defect
visible dell in the posterior ankle compared to contralateral sign. palpable deficit
thompson test
pt prone with flexing the leg, no plantarflexion noted is a positive. can have false negative due to deep posterior complex and plantaris
resting plantarflexion exam
nonaffected foot will be slightly plantarflexed due to intact achilles tenton
when is it appropriate to have nonopeative/conservative tx for achilles rupture
non surgical candidates of local or systemic contraindication
severe immmunocompromised elderly low-demand pt vascular compromised at risk for compliance
how long should pt be immobilized for nonsurgical care
min 8-12 weeks
NWB: 3-4 weeks
progressive wb in achilles boot for 2-3 weeks and slow progression to normal shoes
heel wedge in shoe
wha the is the ideal repair time for achilles tendon rupture?
within 7-14 days; after 14 days no longer in inflammatory phase so the vascularity to injury decreases.
what is the downfall for operating first 7-10 days vs after 14 days?
first 7-10 days its more difficult to repair due to amount of fraying and mop ending, after 14 days the tendon ends remodel in the sacrifice of optimal vascularity
for a krackow technique how many loops do you want proximally and distally
minimum of 5 locking loops at the proximal portion of the tendon and min of 3 locking loops to distal portion
post op protocol for achilles tendon end to end repair
places in achilles boot (with amt of wedge depending on how much plantarflexion needed) to be 20 or 30 deg plantarflexed depending on final position of repair for 2-3 weeks until incision is heeled. then allowed to bear weight in achilles boot “cam boot with wedge” for two week basis sequentially removing wedge until pt in neutral position (takes about 6-8 weeks)
PT at week 4 for early ROM without resistance for 2 weeks.
then progressive WB strengthening , proprioception
activities start at 10-12 weeks after repair.
high active athletes out for 6 months
when doing V-Y advancement, what is the ratio of length of the arms need to be compared to deficit?
Length of arm needs to be twice the length of deficit
what are some surgical options for neglected achilles ruptures
V-Y advancement, FHL transfer
FHL with muscle-tendon advancement flap, and local transfer provide augmentation to maintain strength
most common complication for post op achilles repair
soft tissue envelope compromise
