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Background: The impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair., Methods: A systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair., Results: 12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001)., Conclusion: Nonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Among the many surgical techniques used for hallux valgus correction, different osteotomies may be performed in the proximal phalanx as well as lateral release as associated procedures. The aim of this study is to analyze the anatomical relationships and the risks for the soft tissue lessions when performing the dorsomedial minimally invasive surgery (MIS) portal for the Akin osteotomy, and the MIS dorsolateral portal for lateral release, in order to define a safety zone when conducting the procedure in order to avoid complications., Materials and Methods: The procedures were carried out on 16 fresh-frozen cadaveric feet. A MIS dorsomedial and dorsolateral portals were performed. The anatomical dissection of the cadaveric pieces was carried out and the different anatomic and surgical relationships were analyzed and measured., Results: No nerve injury was found. Injury of the extensor hallucis longus (EHL) paratendon were seen in 9 cases (56%). There was no injury of the flexor hallucis longus (FHL) tendon and or collateral plantar nerves. A partial injury of the FHL sheath was observed in 44% of the samples., Conclusions: Although percutaneous Akin osteotomy is clinically effective, the possibility of injury of anatomic structures is high (9-55%), however injuries upon vascular or nerve structures were not seen., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

First tarsometatarsal joint steroid injection is a commonly performed procedure in foot and ankle practice. The joint is in close proximity to tibialis anterior tendon insertion. We describe a rare complication of the procedure which had to be treated surgically. We have also listed available treatment options based on literature review., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Osteochondroma of the bone can cause a range of complications involving tendons, joints and neurovascular structures. Distal fibular osteochondroma and non-traumatic peroneal tendon subluxation are both rare. In this case report, we describe an unusual case of distal retrofibular osteochondroma in a 36-year old male causing peroneal tendon subluxation. He presented with pain and instability around his ankle, but with no history of trauma. He successfully underwent osteochondroma excision, peroneal groove deepening and a Brostrom-Gould type reconstruction for the lateral ankle ligament insufficiency. Complete resolution of the symptoms of instability and subluxation was noted upon 6-month follow up., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Extracorporeal shock wave therapy (ESWT) is becoming a popular method for the treatment of musculoskeletal disorders. We herein report a case of Achilles tendon rupture possibly related to ESWT., Case Report: A 49-year-old female was treated with a calcaneal osteotomy due to Haglund's disease on the right. However, she developed chronic calcific Achilles tendinopathy postoperatively, and during the following 2 year period after surgery she received various non-steroidal anti-inflammatory drugs and one injection of corticosteroids. She was subsequently treated with extracorporeal shock wave therapy (ESWT), but persistent pain, local swelling and redness over posterior right ankle were noted. Two months after ESWT she experienced an Achilles tendon tear and received Achilles tendon reconstruction., Conclusion: While ESWT is generally considered safe, physicians should be aware of potential major complications., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Rupture of the peroneal tendons is rare, particularly rupture of peroneus longus. We report a case of a peroneus longus rupture following repeated steroid injection for chronic pain.

The results and complications using the dorsal 2.4 mm 2.7 mm (AO/ASIF) pi-plate for the treatment of distal radius fractures were evaluated in a prospective study of 42 patients followed up clinically and radiologically and seven patients followed up with telephone call and radiological follow-up for an average time of 12.1 (range 4-32) months in a group of 50 patients with intraarticular distal radial fractures treated consecutively using this method. Twelve complications occurred in 10 patients including two extensor tendon ruptures, two transient cases of CRPS Type 1 (Reflex Sympathetic Dystrophy, Algodystrophy), two instances of screw loosening, three cases of posttraumatic carpal tunnel syndrome and three permanent sensory irritations on the dorsum of the hands. Using the AO score, there were 37 successful and 12 tolerable results, with no unsatisfactory outcomes. Using the NYOWR scale, there were 17 very good and 25 good results, with no satisfactory or poor outcomes. These results suggest that this osteosynthesis provides adequate fixation of comminuted distal intraarticular radius fractures with a reasonable incidence of complications.

We report six patients with closed flexor tendon rupture affecting the little finger, occurring secondarily to non-union of the hook of the hamate bone. The ununited fragments were separated from the basal part of the hook by more than 1mm. The fragments were also rounded and showed marginal sclerosis. Non-union was located in the middle part of the hook in three patients, the tip in two, and the base in one. At operation, the fragments were removed in all patients. Five patients were treated by free tendon grafts using three palmaris and two plantaris grafts and one underwent tendon transfer. Postoperative total range of active motion of the little finger averaged 218 degrees (range 185-265 degrees ). All patients returned to their original employment. This series would suggest that flexor tendon rupture can occur after fracture of the hook of the hamate bone, even when the ununited fragment is small and/or rounded.

Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.

Performance rock climbing places high demands on the hand and may lead to specific injuries. In a "one-finger-pocket" hold, the interphalangeal joints remain in 20-40 degrees flexion. To increase the maximum force of the holding finger by the quadriga effect, the interphalangeal joints of the adjacent fingers become almost maximally flexed. Holding a "one-finger-pocket" with the ring or small finger leads to a shift of the deep flexor tendons which increases the distance between the two adjacent origins of either the third or the fourth lumbrical. This may cause disruption and tear of that muscle. An organized haematoma in the third lumbrical was visible by ultrasonography in one of the three cases described.

We assessed the outcome of tendon grafting of multiple finger extensor tendon ruptures in 14 patients with rheumatoid arthritis. Extensor lags improved from a preoperative mean of 33 degrees (range, 20 degrees-65 degrees) to a postoperative mean of 18 degrees (range, 0-60 degrees). However, loss of finger flexion was observed, with a mean postoperative fingertip to palm distance of 1.6 (range: 0-7.5) cm. Patient satisfaction correlated with the fingertip to palm distance, though not with the postoperative extensor lag. Because of the loss of finger flexion which was probably due to muscle contracture, we conclude that the results of tendon grafts in this situation are unsatisfactory.

We retrospectively reviewed the surgical treatment for 16 cases of traumatic soft tissue injury to the metacarpophalangeal joint (Boxer's knuckle). A history of trauma was present in all cases and there was an associated extensor tendon dislocation in seven cases. Eight cases were initially treated conservatively, but their symptoms persisted. Intraoperative findings included rupture of the extensor hood or joint capsule in all cases. Surgical closure of the rupture of the joint capsule resulted in a successful outcome in all cases. We consider that conservative treatment of this injury may not be effective when the joint capsule of the metacarpophalangeal joint is ruptured. We recommend arthrography of the metacarpophalangeal joint to assist in the decision as to whether to proceed with surgical or conservative treatment., (Copyright 2002 The British Society for Surgery of the Hand.)

During a four month period 851 patients presented to the Edinburgh Orthopaedic Trauma Unit with an acute sporting injury. Eighteen (2%) patients had either a soft tissue or bony mallet deformity. Six different sports were identified with rugby accounting for eight of the 18 mallet deformities. All patients were treated with splintage. Fourteen patients returned questionnaires regarding subjective digit function following treatment and nine patients claimed excellent function. The average splinting time for this group was 6 weeks and sports were avoided for an average of 5 weeks. Mallet deformity accounts for a minority of sporting injuries, but excellent functional outcome can be achieved with splintage and avoidance of the causative sport while splinted., (Copyright 2001 The British Society for Surgery of the Hand.)

A 10 mm wide ring graft from the second extensor compartment with periosteum from the floor of the sheath was used to correct bowstringing in six patients who sustained an isolated rupture of the A2 pulley. It was attached to the lateral rims of the sheath. Periosteum was used for additional graft fixation. Bowstringing was assessed by magnetic resonance imaging and ultrasound preoperatively and 19.5 months after surgery. It was corrected in five patients and improved in one. Pain was reduced from 35 to 7 points on a visual analogue scale. Digital circumference decreased from 76 to 71 mm. Flexion at the PIP joint increased from 88 degrees to 116 degrees. Pinch grip improved from 28 to 56 N.

A case of sequential spontaneous loss of flexion in the thumb and index finger over a 10 year period is reported. Previously unrecognized carpal collapse as a consequence of a longstanding scaphoid nonunion was identified as the cause. Fusion of the interphalangeal joint of the thumb and suture of the index profundus tendon to the middle profundus tendon resulted in a good outcome.

A case of delayed extensor tendon rupture is reported. This followed repeated attempts at intravenous cannulation 16 months previously. The differential diagnosis and treatment are discussed.

Over a 6-month period 147 consecutive deep hand lacerations referred to a plastic surgery department were explored in 136 adult patients. At operation 121 complete tendon divisions, and 72 nerve injuries were found. Accident and emergency (A&E) officers diagnosed only 64% of tendon divisions compared with 84% for the admitting hand surgeons. Nerve injuries were more accurately diagnosed, 87% by A&E officers compared with 94% by hand surgeons. These findings support the view that significant palmar hand lacerations should be referred for a hand surgery opinion.

A 30-year-old man presented with bilateral, simultaneous, transient triggering of the middle digits which developed acutely after prolonged and sustained use of a garden rotavator. He was asymptomatic in the period before presentation and has remained so 7 years since.

A 62-year-old woman sustained multiple attritional ruptures of the flexor tendons at the wrist caused by displacement of the head of the ulna. She had had injuries of the wrist and elbow when she was young, which were thought to have caused chronic longitudinal radioulnar dissociation with palmar dislocation of the head of the ulna. Attrition of the flexor tendons by the dislocated ulnar head during pronation and supination was the major mechanism for the ruptures in this case. She was successfully treated with tendon transfer and resection of the ulnar head.

An avulsion of the profundus tendon associated with a chondroma of the distal phalanx is presented. The injury occurred during housework and the tendon avulsion can be explained by a weakness of the profundus tendon insertion.

Isolated ulnar subluxation of the extensor pollicis longus (EPL) tendon occurs when there is damage to the radial side of the extensor hood on the dorsum of the metacarpophalangeal joint of the thumb. The thumb collapses into a pseudoboutonnière deformity because the EPL tendon subluxes and comes to lie palmar to the centre of rotation of the metacarpophalangeal joint to act as a flexor instead of an extensor. The extensor pollicis brevis tendon which lies in a deeper plane to the EPL is unaffected. We describe four cases and propose conservative treatment as being effective in recent injuries.

Extensor tendon rupture as a complication of Kienbock's disease is rare. We report a case of attritional rupture of the extensor tendon to the index finger by a comminuted dorsal fragment of the lunate after Kienböck's disease in an elderly woman. Excision of the fragment and extensor reconstruction with tendon graft led to a favourable result.

Avulsion fractures of the index metacarpal at the insertion of extensor carpi radialis longus are rare. We report such a fracture and the resulting complication of division of the extensor pollicus longus tendon, by the avulsed bony fragment. Careful clinical assessment and appropriate radiological examination is needed to diagnose this rare fracture and internal fixation is recommended.

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

A series of 233 patients with complete divisions of flexor tendons in zones 1 and 2 underwent operation following emergency admission over a period of 3.5 years. These included 203 patients with 317 divided tendons in 224 fingers injuries in zones 1 and 2 and 30 patients with 30 complete divisions of the flexor pollicis longus tendon in zones 1 and 2. All of these patients were mobilized post-operatively in a controlled active motion regimen. 13 (5.8%) fingers and five (16.6%) thumbs suffered tendon rupture during the post-operative period. Patients treated during the last year of the study were followed prospectively for a minimum period of 3 months; ten of the 16 (62.5%) fingers with zone 1 repairs, 50 of the 63 (79.4%) fingers with zone 2 repairs, all three (100%) FPL divisions in zone 1 and three of four (75%) FPL divisions in zone 2 had good and excellent results on assessment by the original Strickland criteria (Strickland and Glogovac, 1980). These results confirm the safety of this regimen as an alternative to other regimens of post-operative flexor tendon repair mobilization in zone 1 and 2 finger injuries. However, in the unmodified form used in this series, this regimen has too high a rupture rate for FPL mobilization.

We report a case of a closed rupture within the carpal tunnel of the flexor digitorum profundus tendon of the little finger. There was no underlying pathology.

Post-traumatic rupture of flexor tendons is a very rare event. We report such an event following an epiphyseal fracture of the distal radius. This has not previously been reported in the English literature.

Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. We describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The patient was treated by a two stage reconstruction of the flexor digitorum profundus. He regained full flexion and extension of the finger.

A case of post-traumatic rupture of the common extensor tendon without associated fracture is reported. The extensor digitorum communis tendon to the middle finger was frayed by the distal edge of the extensor retinaculum at the fourth dorsal compartment.

Spontaneous rupture of the extensor pollicis longus tendon in excessive exertion is well-recognised, but similar rupture is rare in the common extensor tendons of the fingers. Two cases caused by occupational overuse are reported. Mechanical attrition at the distal edge of the extensor retinaculum produced by excessive use was thought to be responsible for the rupture.

Three cases of closed rupture of the flexor carpi radialis tendon associated with scapho-trapezio-trapezoidal arthritis are reported. Carpal tunnel surgery preceded all three ruptures. Local steroid injection preceded two ruptures. Long-term disability was minimal.

A case of flexor pollicis longus tendon rupture as a complication of a Colles' fracture in a 17-year-old male is described. Tendon repair by means of a one-stage tendon graft produced a good functional result.

During the period 1973-1986, 116 patients with rupture of the extensor pollicis longus tendon were operated upon. The lesions were categorised into three anatomical levels: proximal, intermediate and distal. Direct suture was performed for acute lesions; later reconstructive procedures were by means of tendon transfers or free tendon grafts.

The authors have treated 14 cases of spontaneous rupture of extensor pollicis longus tendon after fractures of the distal end of the radius, most of which were undisplaced or only slightly displaced. A microvascular study on five cadavers revealed that this tendon is subject to mechanical bending and attrition, has no mesotenon and has a poorly vascularised portion about 5 mm in length, which may be a cause of spontaneous rupture of the tendon.

We describe three instances of ruptured flexor pollicis longus tendons due to bony spurs within the carpal tunnel. In each case, the bony spur was excised and the remaining exposed bone was covered with a flap of flexor retinaculum.

A case is presented of acute loss of function of flexor pollicis longus and profundus tendon to the index finger. Although the aetiology was obscure, the acute onset suggested a mechanical cause rather than a nerve compression disorder such as anterior interosseous nerve palsy. X-rays showed an ununited scaphoid fracture related to an injury many years previously. Surgical exploration revealed attritional rupture of flexor pollicis longus and partial division of profundus tendon to index finger by a spicule of ununited scaphoid which had eroded through the volar capsule. Removal of the spicule and tenodesis of flexor pollicis longus gave a good long term result.

The authors report the case of a 23-year-old man who sustained ipsilateral volar Barton's and scaphoid fractures which were complicated by a late rupture of the extensor pollicis longus tendon. The anatomy of the injury precluded attrition as the cause of the tendon rupture and the alternative theory of ischaemic rupture is examined. Clinicians should be aware that injuries other than the Colles' fracture may be complicated by rupture of extensor pollicis longus.

Flexor tendon ruptures are a very rare complication of Colles' fracture. Only ten cases have been previously reported in the literature. We describe a case of multiple sequential flexor tendon rupture as a delayed consequence of a malunited Colles' fracture.

A case of closed rupture of the tendon of flexor pollicis longus following treatment of a Bennett's fracture is described. This unusual complication was treated by transfer of the tendon of flexor digitorum superficialis of the ring finger.

Two cases of closed rupture of the extensor communis tendons are presented following excision of the distal ulna after fracture of radius and ulna. This complication has not been previously reported. A mechanism of injury is described.

Primary or delayed suture was performed on 174 patients involving 234 digits with flexor tendon injury on the day of injury to a maximum of 486 days after injury during the past eight years from 1974. In the treatment a 4-0 or 5-0 looped nylon suture was used. Follow-up study was made on 121 patients involving 164 digits in whom at least six months had elapsed since the operation. The evaluation showed the results in 53.0% excellent, 15.3% good, 18.9% fair and 12.8% poor. Discussion is made of a number of factors which have effects upon the results of treatment of flexor tendon injury of the hand.

Attrition ruptures of flexor tendons to the fingers following Colles' fractures are very rare. In the case reported here, a protruding bony fragment caused a delayed rupture of the flexor digitorum profundus tendon to the index finger one year after a fracture of the distal end of the radius. Suture of the distal end of the tendon to the adjacent profundus tendon two years after the fracture produced a successful result.