Avulsion for once

Revelations and Going Home

September 15, 2009 · No Comments

Nearly Awake

I’d heard the day nurse tell the night nurse that the doctors would be making rounds about 6:30 and when I awoke yet again at 5:30 I stayed awake hoping to catch them and hear what my complication was.

I had a decent breakfast of scrambled eggs, juice, toast, fruit and milk and waited longer.

The night nurse changed to the day nurse and I waited longer

Eventually my wife came in and we talked about what the complication might have been, deciding that we’d stick around until we were able to see someone about what had gone on, so I waited longer.

The day nurse came in to get some numbers from the pump and see how things were going so we had a talk with him about finding out what was going on, he went off to make some calls and I waited longer.

Lunch came, macaroni and cheese and I think it was the Velveeta kind, still it was hot and not too bad. But I still had to wait.

About Noon Dr Whelan himself came in and sat down asked if we had any questions and then explains.

The Surgery (from the point of view of someone awake at the time)

They opened me up with the typical off center incision they use about 6cm up from the calcaneous. As soon as Dr Whelan had opened the sheath he knew he wasn’t seeing a rupture because he was looking at the end of my Achilles, I’d suffered was is called an Avulsion.

An avulsion is a parting of the ways, literally. Unlike a rupture the tendon itself remains intact but it pulls off the bone that its attached to. In many cases the avulsion is the result of a fracturing of the bone its attached to and the tendon actually pulls part of the bone with it. Because of the porous nature of the calcaneous it is prone to this injury. When this happens the injury is called an Avulsion Fracture and requires a debridement of the mount point or even that the tendon be attached to another like the Achilles to the Flexor Hallicus or somesuch.

What this meant is that Dr Whelan continued the surgery but reworked it to be very much like the surgery that is involved in dealing with a Haglund’s Deformity.

They whip stitched the tendon to provide some extra stability, drilled two holes through my calcaneous and out my heel, dropped thick sutures through the whip stitching and out through my heel, mounted two suture pins in the calcaneous on either side of the tendon, pulled the tendon tight with the heel sutures, sutured through the tendon and suture pins and then tied off the heel suture against the outside of my foot.

I ended up with a penetrating suture tied off to a button on the bottom of my foot and two extra pins. The goal was to get the tendon to heal back onto the calcaneous and because the calcaneous is weak under specific tension like that the tendon had to be put into traction. They  rested my foot in extreme plantar flexion and put me in a surgical splint.

Dr Whelan predicted that my recovery time shouldn’t be much longer than with a regular Achilles rupture and then said I could go home, with all the caveats that entailed. Keep it elevated, don’t get it wet, take your antibiotics and don’t forget your percocet.

And no, Ontario has not approved Vicodin.

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