CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2023; 64(01): e1-e4
DOI: 10.1055/s-0042-1743544
Artículo Original | Original Article

Floor-level Indian Toilet Seats and Shooting Stones: Unusual Causes of Open Achilles Tendon Ruptures among the Pediatric Age Group in Rural India

Article in several languages: español | English
1   Departamento de Ortopedia, Pt. JLNGMC Chamba, Himachal Pradesh, India
1   Departamento de Ortopedia, Pt. JLNGMC Chamba, Himachal Pradesh, India
2   Departamento de Anestesia, SGRD Medical College Amritsar, Punjab, India
1   Departamento de Ortopedia, Pt. JLNGMC Chamba, Himachal Pradesh, India
3   Departamento de Ortopedia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
› Author Affiliations


Context Isolated Achilles tendon (AT) injuries are rarely reported in the pediatric age group. There are only few case reports of traumatic AT injuries in children. Floor-level Indian toilet seats and shooting stones from mountains make such injuries reasonably common in northern India.

Aims To identify similar patterns of AT rupture in the pediatric age group from floor-level Indian toilet seats and shooting stones.

Materials and Methods We report a series of 13 patients in the age group between 8 and 18 years who presented to our hospital between January 2019 and January 2021 with open AT injuries. All the patients were operated on after wound washing and debridement. Standard injectable antibiotic coverage was given to all. In the statistical analysis, the values were expressed as means and medians.

Results In 10 out of the 13 patients, the toilet seat induced the AT injury; for the remaining 3 patients, the injury was induced by shooting stones. A total of two patients had postoperative wound complications, and one patient needed flap coverage. All the patients did well by the final follow up.

Conclusion The main aim of the present study was to show the unusual causes of an injury rarely reported in pediatric age group. We observed that open AT ruptures in children are reasonably common in our region as compared with the rest of the world. Indian toilets can be replaced with Western toilets or modified so they have a less slippery surface, in order to prevent such injuries in children.

Informed Consent

Written informed consent was obtained from all patients and/or their families.

Publication History

Received: 10 August 2021

Accepted: 10 April 2022

Article published online:
24 June 2022

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