Presentation
Posterior ankle laceration caused by glass fragment.
Patient Data
Completely torn Achilles tendon. The defect is located 24 mm proximal to the calcaneal insertion. The defect is about 30 mm. Cut ends show sharp margins. No tendinosis in the distal tendon. A partial thickness defect in the flexor hallucis longus tendon sparing its deeper fibers. The medial ankle neurovascular bundle and the other two tendons (tibialis posterior, flexor digitorum longus) are uninjured. The intact sural nerve. Plantaris tendon could not be localized. An intact plantar tendon should stand out in the Achilles tendon defect which was not the case here. Peroneal tendons were intact (images not available).
Wide defect in the torn Achilles tendon. The flexor hallucis longus is elevated by forceps. The tip of another forceps points to the defect.
Case Discussion
Glass injury to the posterior ankle resulted in local bleeding. Primary suturing was done without exploring the tendon injury. Due to difficulty in walking the patient consulted a specialty surgeon who asked for an ultrasound.
The case shows laceration injuries of the Achilles tendon and the flexor hallucis longus tendon which were caused by a glass fragment.
Intraoperative photos courtesy: operating surgeon Dr. Piyush Patel.
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