Clinical series of three hundred and twenty two cases of Achilles tendon section with laceration

We aim to report the epidemiology of open Achilles tendon lacerations to determine the incidence of associated complications and identify the factors contributing to the development of the infection after repair and to propose a treatment protocol for this rare injury.

Retrospective review of the medical charts of patients with open Achilles tendon injury operated and followed up at the orthopedic department at Hamad Medical Corporation, Doha, Qatar, from 2010 to 2015.

There were (322) cases of open Achilles tendon lacerations, average age (32.1 years), (97.5 %) male. The most common cause was found to be slipping in the bathroom (81.7 %), followed by injury from sharp objects (15.5 %), and injury while using a grinder (2.8 %). Partial cuts were more common than complete cuts (63.5 %) and (35.9 %). The infection rate was 8.7 %. The patient-related factors that affected the infection rate was age (p = 0.02), diabetes, smoking status, the cause of injury and type of cut did not affect the infection rate. Management-related factors that affected the infection rate were time to surgery (p <0.001) and the length of hospital stay (p <0.001). With regard to surgery-related factors, there was no difference in infection rate by suture type (p = 0.373), immobilization type (p = 0.493), and surgeon experience (p = 0.481). The reoperation rate was a higher in the infected group as compared to the non-infected group (p = <0.001).

Open Achilles tendon lacerations is common in Qatar, despite the dirty environment of the common cause (bathroom injury) the incidence of infection is low if proper protocol is followed including early irrigation in emergency, early antibiotics such as cefazolin for 72 hours, and primary repair under sterile environment in operating theater, followed by immobilization with or without slab.

The incidence of a major complication in primary open Achilles tendon lacerations repairs is relatively low. Primary Achilles tendon laceration repair is safe.