Acute Achilles tendon rupture: percutaneous tenorrhaphy

Introduction. Acute injury of Achilles tendon represents 20% from large tendon ruptures and the incidence is 11-37 per 100 thousand people (by Park et al. 2020). Case presentation. A 43-year-old man, after a sprint, heard a crack and a sharp pain in his right ankle, on the posterior part a day ago. He went directly to the Clinical Hospital of Traumatology and Orthopedics. He was clinically examined where it was determined swelling of the ankle region and 1/3 of the lower back of the right leg, erasing the Achilian contour, the foot is moved sideways. Palpation of the Achilles tendon diastase. Thomson sign - positive on the right. The sonographic examination determined the Achilles tendon tears with a diastase of 4 cm. The patient was recommended surgery to repair the rupture of the Achilles tendon by percutaneous tenorrhaphy. An informed agreement was obtained after explication of the risks and benefits of the surgical treatment. Surgery was made with spinal anesthesia and fixing sterile zone, the distal and proximal ends of the Achilles tendon were drawn with a sterile marker from the visually determined and palpable injury on the skin. Percutaneous sutures were applied after Cuneo in two rows at the proximal end and one row at the distal end, through two mini-incisions, the opposite ends were adapted on the lateral and medial edge, the foot in the equine (hyperflexion), thus the final ligation of the threads was achieved. Applying the dressing. The final step is followed by the application of the leg immobilization with the foot in the equine on the right. Simple evolution of the postoperative period. After 6 weeks of immobilization, the patient starts rehabilitation. Discussion. Fresh Achilles tendon injury needs to be diagnosed primarily as early as possible, with the use of sonographic examination to confirm the clinical diagnosis allowing us to perform minimally invasive treatment such as percutaneous tenorrhaphy. Conclusion. Achilles tendon is the largest and strongest tendon of the human body and its usual injury is caused by recreational activity. Early establishing the diagnosis of Achilles tendon injury permitted primary repairing this anatomical structure by minimally invasive technique

Surgery of triangular fibrocartilaginous complex post-traumatic injury Palmer 2B

Introduction. The triangular fibrocartilage complex (TFCC) is an important anatomical morphology of distal radioulnar joints, knowing its structure, clinical signs which evidence the pathology of this „black box” human body region will contribute threat this clinical problem(by Kleinman W. B 2007). Case presentation. A 55-year-old woman fell down on both her hands 2 months ago. First medical aid was given at the regional trauma point, being examined clinically with wrist x-ray. The diagnostic was a contusion of a radiocarpal joint with applying a cast for 3 weeks, after starting rehabilitation of hand function. 24 days ago she fell down on her right hand - diagnostic was contusion of radiocarpal joint with applying a cast for 2 weeks. After 7 days of kinetic therapy, the pain was in pronation and supination with pain on the dorsal side of the hand (shuck, piano key tests were positive). X-rays showed displacement of the ulnar head from radial fovea posteriorly. Sonography exam visualized total injury of fibrocartilaginous disc and anterior and posterior radioulnar ligaments of DRUJ. The patient was informed about the risks and benefits and accepted the surgical treatment tactic„Reconstruction of right distal radius ulnar ligaments with tendon autograft after Johnston Jones and Sanders”. Was made an sinusoidal incision through 5-6 extensor compartments, TFCC have degenerative aspect and irreparable, by volar access by ulnar flexor of the carpus, pronator square was delimited with L-shaped capsulo-tomy of the DRUJ, the long palmar flexor tendon graft was collected, by passage the tendon graft through the tunnel at the level of the distal metaphysis of the antero-posterior radial bone, performing 2 tunnels through the fovea and ulnar neck (volar and palmar), the ends of the tendon graft are passed through the radial bone tunnel, then from the sigmoid fossa through the fovea and tunnels to the ulnar neck making a suture loop with the forearm in supine, fixing the distal radio-ulnar joint with 2 k-wires.The patient had a forearm-hand immobilization for 4 weeks, by removing k-wires with initiation of rehabilitation of hand function. Discussion. I hope that this clinical case as a whole will help colleagues in the treatment of DRUJ pathology and the efficient management of these patients with painless results. Conclusion. TFCC injury type 2B posttraumatic(chronic) by Palmer with sonographic examination was possible and on surgery it was confirmed. Quality of diagnosis of TFCC injury in early time remains as a surgical possibility

Bennett fracture-dislocation. Diagnosis and treatment

Introduction. The metacarpal bone fractures-dislocations bones an around 4% of hand injuries (by Liverneaux et al. 2015) Case presentation. A 37-year-old man supported an accident at work by falling down on the hand 4 weeks ago. At the local polyclinic was examined by an trauma doctor (clinical exam and x-ray investigation in 2 orthoplans). Was determined to be a contusion of carpal joint with applying a cast for 3 weeks. After this period, the patient has started rehabilitation and after 1 day, the patient presents thumb pain. He had pain with limitation of range of movement in abduction/adduction, flexion/extension. Computer tomography was made and showed displacement of the baze of the first metacarpal bone with a fragment at trapezometacarpal joint. The surgery option was proposed to the patient. The risks and benefits of the surgical treatment were presented to the patient, and accepted by him through signing the informed agreement. Before start the surgery was made with locoregional anesthesia, with delimitation of steril zone, by marked zone in the projection extensor pollicis brevis tendon and protect the cutaneous branch of the radial nerve, was made a dorsal skin incision of 2 cm - over the base of the thumb capsule-tomia, was determine articular surface of metacarpal base and trapez with a fragment. By longitudinal traction, pronation and pressure at the thumb metacarpal base was obtained, after this internal fixation with k-wires in „X”. X-rays confirm the successful osteosintesis of metacarpal fragments. Operative wound was closed step by step of anatomical topography. Postoperative period has a simple evolution. The patient had a well-padded gypsum splint forearm-thumb in abduction immobilisation for 6 weeks. Discussion. Bennett injury is a fracture of the internal angle of the base of the first metacarpal at which the palmar ligament of the trapezius-metacarpal joint is inserted, this fragment remains unmoved, the rest of the metacarpal being pulled up and back by the long abductor that is inserted on the external fragment of the base, thus achieving a dorso-radial dislocation fracture in the teapezo-metacarpal joint, as well as the thenar muscles. So at the start this fracture is unstable and is indication for surgery(by Antonescu 2006; El- Hadidy et al. 2019) Conclusion. Bennett injury can even overlook an experienced traumatologist. This case, which is relatively rare in hand injuries, argues for the need to consult a hand surgeon, because not being treated in time the given injuries lead to deformed osteoarthritis of the thumb joint by disabling consequences for the patient