Achilles tenotomy performed percutaneously under local anesthesia in operation theater room in clubfoot.

Abstract

Objectives: Achilles tenotomy is required in 80 % of cases after the Ponseti method in clubfoot. There are many complications reported if it is perfomed percutaneously under local anesthesia in the clinic. Complications are bleeding from either posterior tibial artery or peroneal artery and sometimes from small saphenous vein. Nerve injuries like tibial nerve and sural nerve are also documented. Incomplete Achilles tenotomy is another complication responsible for recurrence of deformity and redo tenotomy. On the other hand, mini-open Achilles tenotomies performed under general anesthesia in Operation Theater have no such complications as mentioned above. The rationale of this present study is to document the safety and any complications when Achilles tenotomy is performed percutaneously under local anesthesia instead of mini-open technique under general anesthesia in the operation theater room. Study Design: Retrospective review study. Setting: Pediatric Orthopedic Department of the Children Hospital and the Institute of Child Health, Lahore.  Period: 2014 to 2018. Material and Methods: In infants with congenital talipes equinovarus who underwent percutaneous Achilles tenotomy in operation theater room under local anesthesia. Results: Fifty patients with seventy five feet included in this retrospective study who underwent Achilles tenotomy percutaneously under local anesthesia in operation theater room. Before starting Ponseti casts, average Pirani score was 5.6.Before Achilles tenotomy, the average number of casts applied was 4.9.11.9 weeks was the average age at the time of Achilles tenotomy. No vascular, neural and tendon related complications occured in any infants and they discharged from hospital on same day. Conclusions: Achilles tenotomy performed percutaneously under local anesthesia in the operation theater room is more safe and comfortable for both family and pediatric orthopedic surgeon in clubfoot. No vascular, neural and tendon related complications occurred. Operation theater environment and local anesthesia are very beneficial for eliminating any chance of vascular, neural and tendon related complications.