Achilles tendon is the strongest tendon in the body . Achilles tendon rupture is a debilitating ankle injury especially among the athletes. We would like to highlight an unusual case of acute dual-level injuries of the Achilles tendon. Case report: A 30-year-old footballer presented with left ankle injury during a football tournament. Examination revealed tenderness at posterior left heel, palpable gap at Achilles tendon region and positive Thompson test. Radiological assessment showed dual-level injuries of the Achilles tendon-proximally was a rupture at musculotendinous junction and distally was an avulsion calcaneal fracture. We performed a mini-open approach Achilles tendon reconstruction for this patient. First, we reconstructed the distal avulsion calcaneal fracture using double row anchor sutures technique. Next, we repaired the proximal ruptured Achilles tendon using percutaneous Achilles reconstruction system (PARS) from Arthrex. Postoperatively, patient was put on functional rehabilitation protocol. At present, patient recovers well and regains back the Achilles tendon function. In conclusion, segmental Achilles tendon injury is rare and its surgical treatment can be challenging and must be well-planned.
Snapping scapula syndrome is a condition with audible and palpable grating localized to the superomedial angle of the scapula associated with pain. The etiology is likely secondary to anomalous tissue between scapula and chest wall (e.g. bursitis, hooked superomedial angle scapula, Luschka tubercle, malunited rib/scapula fracture and osteochondroma). Case report: We present a case of a 17year-old gentleman, with chronic pain over bilateral upper scapula associated with grating sound upon shoulders movement. Examination revealed significant audible crepitus on bilateral scapula without restriction of shoulders motion. MRI showed no abnormal finding. An attempt for conservative approach including physical therapy and steroid/local anaesthesia injection has been unsuccessful. We subsequently performed an arthroscopic bursectomy and superomedial angle scapula decompression on the right scapula. There were inflammed bursa with fibrotic tissue and prominent superomedial angle of scapula observed during the surgery. Postoperatively, the symptom over right scapula completely resolved with good patient satisfaction. At present, patient is scheduled for the similar surgery on the remaining symptomatic left scapula. In conclusion, arthroscopic scapulothoracic bursectomy with superomedial angle scapula decompression is a reliable treatment for snapping scapula syndrome with predictably high rates of pain relief, patient satisfaction as well as improvement in functional outcomes.
Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among teenager. For those indicated, early surgical intervention allows better surgical correction due to flexibility of the spine during teenage years, hence good functional outcome and better cosmetic can be expected. In this case report, there is the management of four patients surgically using the posterior spinal instrumentation and fusion. Pre-operatively patients were examined at IIUM Medical Centre spine clinic, all necessary investigations were carried out. A thorough explanation was done to patient and parents regarding procedure, risk and benefit. All patients were treated using the same surgical technique. Neuromonitoring was used throughout the whole surgery until skin closure. All patients were hospitalized around one week. Post-operatively patients were followed up at two weeks, six weeks, three months, and every six months thereafter. It is important for clinicians to identify patients with AIS as early detection and timely treatment will change the natural history of curve progression. Surgical intervention when necessary will be easier and with less risk of complications when surgery was carried out during teenage years as the spine is more flexible and the deformity is less severe.