Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

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Abstract

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown.

CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic.

DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon.

CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

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About the authors

Saad Andaloussi

Marche Verte Hospital, Regional Delegation of Public Health Boulemane

Author for correspondence.
Email: andaloussi.saad@yahoo.com
ORCID iD: 0000-0002-5382-1481

MD, pediatric surgeon

Morocco, Avenue Annakhil, Missour 33250

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Supplementary files

Supplementary Files
Action
1. Fig. 1. Clinical examination: a, the patient has increased dorsiflexion of the ankle joint (arrow) compared to the contralateral side; b, healed skin wound of about 4 cm in the mid-portion of the tendon; c, presence of visible and palpable tendon depression indicating the location of the defect

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2. Fig. 2. Stages of surgical intervention: a, posteromedial skin incision centered on the rupture; b, gap between the two tendon stumps was approximately 3 cm after the tendon edges are mobilized; c, plantaris tendon was harvested leaving the distal end inserted; d, final view of the reconstructed Achilles tendon using plantaris tendon as an augmentation

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3. Fig. 3. Two years after the surgery: a, plantarflexion strength is the same as the uninjured side; b, the patient is able to do a heel raise; c, no skin complications have been noted

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Copyright (c) 2021 Andaloussi S.

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