The aim was to assess the effect of caudal block on patients who have had proximal femoral &/or pelvic osteotomy compared to patients who have had epidural anaesthesia with regards to pain relief and hospital stay. We looked at two patient cohorts; epidural & caudal pain relief in aforementioned procedures. Interrogation of our clinical database (WinDip, BlueSpeir&clinical notes) identified 57 patients: 33 proximal femoral osteotomy, 13 pelvic osteotomy and 11 combined(25 Males 32 Females), aged 1–18 years-old between 2012–2014, in two institutions. A database of demographics, operative indications, associated procedures, analgesia and type of anaesthesia was constructed in relation to daily pain score and length of hospital stay. 39 patients had epidural anaesthesia, and 18 had caudal block. Cerebral palsy with unstable hips was the commonest indication(21), followed by dysplastic hip(10), Perthes disease(8) and other causes(18). The Face, Legs, Activity, Cry, Consolability(FLACC) scale was used to assess pain. Length of hospital stay in caudal block patients was 3.1 days(1–9), in epidural anaesthesia patients stay was 4.46 days(2–13). Paediatrics high dependency unit after an epidural was needed in 20(Average stay 3.4 days) compared to 1 who received caudal block. Caudal block FLACC pain score in the first 36 hours was 1.23(0–4) compared to 0.18(0–2) in patients who had an epidural. Caudal block is associated with less hospital stay and fewer admissions to the high dependency unit, it also provides adequate pain relief post osteotomies when compared to epidural, therefore could be performed at units lacking epidural facilities. A change in related practice however should be cautious and supported by further studies.
We wish to report a technique for the reconstruction of the late presenting Achilles tendon rupture. A proximal intra muscular Z lengthening through a separate incision facilitates distal translation of the proximal tendon stump, allowing direct repair distally with minimum tension. Post operatively, a below knee cast is applied for six weeks, with progressive dorsiflexion at two weekly intervals. A dorsiflexion restriction splint accompanies early physiotherapy for a further six weeks, with unprotected weight bearing commencing at three months. There were eleven patients in the study group with an average follow up of 24 months. All tendons united. There were no re-ruptures. Two distal wound breakdowns occurred and one of these healed by secondary intention. Good single stance power returned in patients with smaller separations but greater calf wasting and weakness was observed in those patients with large separations. We conclude that this technique can be employed for the reconstruction of late presenting Achilles tendon ruptures, but great care is required with soft tissue dissection distally. Consideration could be given to deep flexor transfers in the widely separated case.
We wish to report a technique for the reconstruction of the late presenting Tendo Achilles rupture. A proximal intra muscular Z lengthening through a separate incision facilitates distal translation of the proximal tendon stump, allowing direct repair distally with minimum tension. Post operatively, a below knee cast is applied for six weeks, with progressive dorsiflexion at two weekly intervals. A dorsiflexion restriction splint accompanies early physiotherapy for a further six weeks, with unprotected weight bearing commencing at three months. There were eleven patients in the study group with an average follow up of 24 months. All tendons united. There were no re-ruptures. Two distal wound breakdowns occurred and one of these healed by secondary intention. Good single stance power returned in patients with smaller separations but greater calf wasting and weakness was observed in those patients with large separations. We conclude that this technique can be employed for the reconstruction of late presenting Achilles tendon ruptures, but great care is required with soft tissue dissection distally.
The operative and non-operative treatment options for acute tendo achilles rupture are well documented in the literature. The management of late presenting tendon rupture is usually operative, and can be complicated by acute shortening of the muscle-tendon unit and leave repairs under tension, which may lead to re-rupture. We report the use of the sliding graft technique for reconstruction of late presenting rupture. A proximal intra muscular Z lengthening through a separate incision facilitates distal translation of the proximal tendon stump, allowing direct repair distally with minimum tension. Post operatively a below knee cast is applied for six weeks with progressive dorsiflexion at two weekly intervals. A dorsiflexion restriction splint accompanies early physiotherapy for a further six weeks with unprotected weight bearing commencing at three months. There were eleven patients in the study group with an average follow up of 13 months. All tendons united. There were no re-ruptures. Two distal wound breakdowns occurred and one of these healed by secondary intention. Good single stance power returned in patients with smaller separations but greater calf wasting and weakness was observed in those patients with large separations. We conclude that this technique can be employed for the reconstruction of late presenting tendo achilles ruptures but great care is required with soft tissue dissection distally. Consideration could be given to deep flexor transfers in the widely separated case.
