Evaluation of the effectiveness of inveterate Achilles tendon rupture V-Y plasty with immediate subsequent weight-bearing and rehabilitation. Case study

In our paper, we would like to present two cases of treatment of the Achilles tendon ruptures by means of surgical V-Y technique, and implementation of immediate rehabilitation and weight-bearing. V-Y plasty on ruptured tendons was performed. The continuity of the tendon was restored. The sheath of the tendon was stitched together. Dressing was put on; the foot was immobilized in a Walker-type shoe in pes equinus with heel pads and compression underwear. From the first hour after the procedure, the wound area was cooled with a Game Ready device. From the first day after the procedure, both patients were allowed to apply full weight to the limb in the shoe. The crutches were put away as soon as possible. Rehabilitation began right away on the next day; during its course, attempts were made to reduce the use of the shoe to a minimum and to achieve the full range of foot motion as soon as possible. In both patients, the full range of motion was reached approximately 2 weeks after the surgery. The video support for the article is available at: https://youtu.be/bi3xuwOT9vs

Application of the First Expert Arthrodesis Nail to a Patient with Previous Performed Arthrodesis According to Ulrich Holz – Case Report

AIM: The aim of this paper was to present application of the first expert arthrodesis nail in our clinic to a patient with previous performed arthrodesis according to Ulrich Holz.CASE REPORT: Patients A.M. on the age of 22 (1992) have a motor vehicle injury, (fall from a motor bike) with diagnosis polytrauma, shock, supra and transcondyar open fracture of the right femur III degree, open fracture of the right tibia and fibula. We perform reposition and fixation of supra and transcondyar femoral fracture with “cobra” plate. Also we perform reposition and fixation of right cruris with external fixation. After the operation we found fistula in the place of operation of the right crural regia. During the time the infection goes worse and the patient develop osteomyelittis on the right crural regia. After 5 months with therapy the situation become calm. We remove the external fixation. The patient develops severe “pes equinus” on the right leg and he cannot walk. We try to reduce this equines situation with elongation of the Achilles tendonin the first step, and because we didn’t solve the problem we continue with complete section of the Achilles tendon and after that we perform osteotomy of the right talocrural joint simultaneous to tibia plafond and talus and resection of fibula 2sm.above the syndesmosae tibiofibularis and we fixed the talocrural joint with two screws according the technique of Ulrich Holz.CONCLUSION: So we received fixed position on of the food on 110 degrees which was steel unacceptable for normal walking. At last we remove the screws, make once again osteotomy with positioning of the food in maximal dorsiflexion and perform the Experf Hindfood arthrodesis nail so with this method we achieve correction of dorsiflexion on 95 degrees, and the patient become satisfied because he can walk without support.

Comparing normal walking and compensated walking: Their stability and perturbation resistance. A simulation study

People usually develop different kinds of compensated gait in response to local function deficits, such as muscle weakness, spasticity in specific muscle groups, or joint stiffness, in order to overcome the falling risk factors. Compensated walking has been analysed empirically in the impaired gait analysis area. However, the compensation could be identified spatially and temporally. The stability and perturbation resistance of compensated walking have not been analysed quantitatively. In this research, a biomimetic human walking simulator was employed to model one individual paraplegic subject with plantarflexor spasticity. The pes equinus was expressed by biasing the outputs of plantarflexor neurons corresponding to the spastic muscles. Then, the compensatory mechanism was explored by adjusting the outputs of the other muscles. It was shown that this approach can be used for quantitative analysis of the spastic gait and compensated walking. Thus, this research can improve the understanding of the behaviour of compensated walking, bringing insights not only for building useful walking assist systems with high safety but also for designing effective rehabilitation interventions.

Reconstruction of the Achilles Tendon and Overlying Soft Tissue Using an Anteromedial Thigh Flap for a Post-Burn Pes Equinus Deformity: A Case Report

We present a 36-year-old man with a severe pes equinus deformity of the ankle and an intractable ulcer over the Achilles tendon after a 4th-degree burn. He underwent a one-stage reconstructive surgical procedure using an anteromedial thigh flap with its vascularised fascia. After lengthening of the Achilles tendon and posterior release of the ankle, the anteromedial thigh fasciocutaneous flap was transferred. The ischaemic Achilles tendon was wrapped with the vascularised femoral fascia for vascularisation and reinforcement. The skin defect was covered with the skin paddle of the combined flap. There were no postoperative complications. At the 3-year follow up, the range of movement of the ankle was almost normal. The patient was able to walk and climb stairs without support, and the ulcer was cured.