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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A 38-year-old patient has an acute Achilles tendon rupture. He is active in sports and is deciding between operative and nonoperative treatments. Which of the following statements applies to patients undergoing conservative treatment with a cast for 6 weeks followed by a course of physical therapy?
They have lower patient satisfaction scores
They are less likely to return to sport
Their ultimate strength is decreased
They have a higher risk for rerupture
They have a higher risk of skin problems
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Which of the following outcomes has been reported with surgical repair of acute Achilles tendon ruptures as compared to non-operative treatment with functional rehabilitation?
Improved ankle dorsiflexion strength at 6 month follow-up
Improved ankle dorsiflexion range-of-motion at 6 month follow-up
Improved mean SMFA scores at 12 months
A statistically significant decrease in re-rupture rates
Increased complication rates
Which factor increases the chance of wound complications after Achilles tendon repair?
Increased body mass index
Age over 40 years old
A 36-year-old man presents with fever, pain, and wound drainage 4 months after repair of an acute Achilles tendon rupture. A clinical image is shown in Figure A. Laboratory studies show an ESR of 29 (reference range 0-22 mm/hr). It is decided that he will undergo debridement and irrigation followed by culture specific antibiotic therapy. In the operating room, the Achilles tendon is found to have re-ruptured with a 5 cm defect. What is the most appropriate surgical treatment at this time?
Primary repair of the re-ruptured Achilles tendon
Debridement of necrotic and infected tendon tissue, with no attempt at reconstruction
V-Y plasty of the re-ruptured Achilles tendon
Repair of the re-ruptured Achilles tendon with a turndown procedure
Repair of defect with flexor hallucis longus tendon transfer
A 58-year-old golfer fell stepping into a sand trap and ruptured his Achilles tendon one year ago. He initially chose non-operative treatment, but became unsatisfied with a tender fullness behind his ankle and ankle weakness noticeable during his tee shots. At the time of surgery, a large disorganized fibrous mass is found at the site of rupture. Following extensive debridement there is a 5 cm gap between viable tissue ends. Which of the following surgical techniques provides the greatest likelihood of a successful clinical outcome?
Gastocnemius turndown repair augmented with transfer of the posterior tibial tendon
Gastocnemius turndown repair augmented with transfer of the extensor digitorum longus
Gastocnemius turndown repair augmented with transfer of the flexor hallucis longus
Reconstruction with hamstring autograft
Primary repair with the foot in maximal plantarflexion followed by a gradual stretching program
What is the greatest advantage of surgical repair of an acute Achilles tendon rupture with early range of motion compared to non-operative treatment with immobilization in a short-leg cast for 6 weeks?
Lower rate of infection
Higher rate of normal skin sensation
Better skin cosmesis
Lower rate of dehiscence
Lower rate of re-rupture
A 41-year-old female feels a pop in her ankle while playing tennis. She is diagnosed with an acute Achilles tendon rupture and elects to undergo nonoperative management. Which of the following is a difference seen with nonoperative management with early functional rehabilitation compared with operative treatment?
decreased incidence of deep venous thrombosis
no significant differences
increased rate of re-rupture
earlier return to sport
increased complication rate
HPI - Felt a pop when landing after a layup in basketball. Had some immediate pain and inability to push off his left ankle. Was seen in urgent care and given an ankle brace for a "sprain." Little pain at rest, but difficulty walking. After a week of not getting better, PCP orders and MRI and referred patient.
What treatment options would you recommend for this patient?
HPI - s/p glass vs. leg, with multiple tendon lacerations and 15cm laceration
How would you rehab this?