There are three kinds of injuries to tendons which it is practical to consider as emergencies: dislocated tendons, subcutaneous rupture, and divided tendons. Dislocation of Tendonis—Dislocation is not a frequent injury, yet it occurs and must be considered in diagnosing joint accidents after sprains. The most frequently dislocated are the peroneal muscles' tendons, especially the brevis, following an ankle wrench. It can be replaced but retained with difficulty; immobilize the ankle at a right angle for about four weeks to heal the ruptured tendon sheath or lateral ligament. Subcutaneous Rupture—Subcutaneous rupture is likely in quadriceps extensor or triceps cubiti tendons, caused by sudden violent effort. The gap between the ends of the ruptured tendon and loss of function point to this injury; immediate exposure and suturing are necessary. Divided Tendons—These are found frequently at the wrist and must be immediately sutured for easier approximation. Begin with careful disinfection and securing complete hemostasis, identify divided tendons near the lower lip of the wound, and look for nerves if involved.
<Callout type="important" title="Immediate Suturing">It is crucial to suture divided tendons as soon as possible to ensure easier approximation and better healing outcomes.</Callout>
Suture techniques vary depending on whether the tendon is round or flattened. For a round tendon, pass a suture through the whole thickness one-quarter inch from the end, entering the superficial surface and emerging on the deep surface of the segment; tie the ends together. If the tendon is shattered or lacerated, tie firm ligatures around either end before suturing to prevent pulling out.
<Callout type="risk" title="Infection Risk">The synovial sac is particularly susceptible to infection, and sterilization over the patella can be challenging.</Callout>
If the divided tendon ends cannot be approximated, bridge the space with sutures or split a neighboring tendon for attachment. Immobilize the part in flexion or extension to relax tendons post-surgery.
Key Takeaways
- Dislocated tendons can be replaced but require immobilization for healing.
- Subcutaneous ruptures need immediate exposure and suturing to ensure proper healing.
- Divided tendons must be sutured immediately to prevent retraction or adhesions.
Practical Tips
- Ensure complete hemostasis before attempting tendon repair surgery.
- Use appropriate sutures for different types of tendon injuries (round, flattened, shattered).
- Immobilize the affected limb in a position that relaxes tendons post-surgery.
Warnings & Risks
- Failure to immediately suture divided tendons can lead to retraction or adhesions.
- Infection risk is high due to the synovial sac's susceptibility and difficulty sterilizing over the patella.
Modern Application
While modern medicine has advanced surgical techniques for tendon repair, understanding historical methods provides valuable insights into immediate emergency care. Techniques like suturing divided tendons quickly remain crucial in remote or austere environments where rapid intervention is necessary.
Frequently Asked Questions
Q: What are the three types of tendon injuries discussed?
The chapter discusses dislocated tendons, subcutaneous rupture, and divided tendons as the three main types of tendon injuries.
Q: Why is immediate suture important for divided tendons?
Immediate suturing prevents retraction or adhesions that can make later approximation difficult. It ensures better healing outcomes by keeping the ends close together.
Q: What should be done if a tendon cannot be approximated after division?
If divided tendon ends cannot be brought into contact, bridge the space with sutures or split and attach to a neighboring tendon for support.