Achilles tendon lengthening: open
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An acquired equinus contracture of the ankle has a number of more common causes. Despite early bracing and functional rehabilitation it can occur after traumatic or ischemic brain injury, spinal cord injury, ischaemic muscle contracture or as part of a more generalised neurological condition.
Recovery specifically following traumatic or ischaemic brain and spinal cord injury is variable. In those whose function is sufficient enough to allow standing or walking, the equinus contracture can become a limiting factor in their rehabilitation. Whilst equinus deformities can be caused by a variety of muscle contractures and joint contractures, normally the achilles-gastrocnemius-soleus complex is the first to develop the fixed deformity. Thus in those cases that present within 2-3 years of a contracture developing an isolated achilles release is usually sufficient to correct the deformity.
The restriction caused by a contracted Achilles tendon will usually become apparent within 2 years of the neurological insult, and as such, this patient population more often have not yet developed significant contracture of their long flexors and joint capsules, when compared to the more chronic neurological or pediatric equinus contractures, or the ischemic muscle contracture group.
Patients with ischemic or traumatic brain injury should be managed in a multi-disciplinary environment, and will require input from Neurologists and Neuro-rehabilitation therapists, Occupational therapists and of course the most important part of any team, the Orthopaedic surgeons.
Author:Mr Nick Cullen, FRCS (Tr & Orth).
Institution: The Royal National Orthopaedic hospital, Stanmore, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
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- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
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- When you restart you will resume at the same point in the module.
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The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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