Open Achilles tendon laceration in Bhutanese population- Retrospective study at tertiary health care center of Bhutan

Abstract

Introduction: There is a wealth of literature on closed Achilles tendon injuries but open-lacerations are rarely reported. We aimed to assess the frequency of open Achilles tendon laceration in Bhutanese patients with a particular emphasis on age and sex distribution, mechanism of injury, and management provided to these patients.

Methods: Retrospective study was conducted at department of orthopedic surgery, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu. All patients treated at JDWNRH for open-laceration of Achilles tendon between January 2018 to December 2020 were included. Data were analyzed for means and frequencies using SPSS software.

Results: Of the 48 cases involved, 36 (75%) cases were male and 12 (25%) cases were female. The most affected age groups were between 21-60 years (70.8%). Majority of the cases inflicted injury following slip in squat-toilet (85.4%).Thirty-eight (79.2%) cases had a complete-laceration of the tendon and the remaining cases (20.8 %)
had a partial-laceration. All patients underwent operative-irrigation, debridement and primary-repair. Complications occurred in 9 patients (18.8%), including seven early wound infection and two late infections.

Conclusions: Open Achilles tendon laceration is not an uncommon entity in developing country like Bhutan where the squat toilet is still being used regularly. Changing the toilet designs to commode-type and installing proper lighting in toilet would significantly reduce the incidence of open injury. Although management can be challenging due to irregular nature of the wound and inherent contamination present, a good outcome can be achieved with early-irrigation, debridement, surgical repair and the administration of intravenous antibiotics.