Achilles tenotomy performed percutaneously under local anesthesia in operation theater room in clubfoot.

摘要

Objectives: Achilles tenotomy is required in 80 % of cases after the Ponsetimethod in clubfoot. There are many complications reported if it is perfomed percutaneouslyunder local anesthesia in the clinic. Complications are bleeding from either posterior tibial arteryor peroneal artery and sometimes from small saphenous vein. Nerve injuries like tibial nerveand sural nerve are also documented. Incomplete Achilles tenotomy is another complicationresponsible for recurrence of deformity and redo tenotomy. On the other hand, mini-openAchilles tenotomies performed under general anesthesia in Operation Theater have no suchcomplications as mentioned above. The rationale of this present study is to document thesafety and any complications when Achilles tenotomy is performed percutaneously under localanesthesia instead of mini-open technique under general anesthesia in the operation theaterroom. Study Design: Retrospective review study. Setting: Pediatric Orthopedic Department ofthe Children Hospital and the Institute of Child Health, Lahore. Period: 2014 to 2018. Materialand Methods: In infants with congenital talipes equinovarus who underwent percutaneousAchilles tenotomy in operation theater room under local anesthesia. Results: Fifty patientswith seventy five feet included in this retrospective study who underwent Achilles tenotomypercutaneously under local anesthesia in operation theater room. Before starting Ponseticasts, average Pirani score was 5.6.Before Achilles tenotomy, the average number of castsapplied was 4.9.11.9 weeks was the average age at the time of Achilles tenotomy. No vascular,neural and tendon related complications occured in any infants and they discharged fromhospital on same day. Conclusions: Achilles tenotomy performed percutaneously under localanesthesia in the operation theater room is more safe and comfortable for both family andpediatric orthopedic surgeon in clubfoot. No vascular, neural and tendon related complicationsoccurred. Operation theater environment and local anesthesia are very beneficial for eliminatingany chance of vascular, neural and tendon related complications.