Subscribe to RSS
Floor-level Indian Toilet Seats and Shooting Stones: Unusual Causes of Open Achilles Tendon Ruptures among the Pediatric Age Group in Rural IndiaArticle in several languages: español | English
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.
Written informed consent was obtained from all patients and/or their families.
Received: 10 August 2021
Accepted: 10 April 2022
Article published online:
24 June 2022
© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 1999; 9 (03) 157-160
- 2 Möller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 1996; 67 (05) 479-481
- 3 Gulati V, Jaggard M, Al-Nammari SS. et al. Management of achilles tendon injury: A current concepts systematic review. World J Orthop 2015; 6 (04) 380-386
- 4 Yang X, Meng H, Quan Q, Peng J, Lu S, Wang A. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018; 7 (10) 561-569
- 5 Ochen Y, Beks RB, van Heijl M. et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ 2019; 364: k5120
- 6 Langer V. Toilet seat injury of the Achilles tendon: Another culprit. Foot Ankle Surg 2013; 19 (01) 65-69
- 7 Tudisco C, Bisicchia S. Reconstruction of neglected traumatic Achilles tendon rupture in a young girl. J Orthop Traumatol 2012; 13 (03) 163-166
- 8 Mine R, Fukui M, Nishimura G. Bicycle spoke injuries in the lower extremity. Plast Reconstr Surg 2000; 106 (07) 1501-1506
- 9 Eidelman M, Nachtigal A, Katzman A, Bialik V. Acute rupture of achilles tendon in a 7-year-old girl. J Pediatr Orthop B 2004; 13 (01) 32-33
- 10 Awe AA, Esezobor EE, Aigbonoga QO. Experience with managing open achilles tendon injuries in a tertiary hospital in southern Nigeria. J West Afr Coll Surg 2015; 5 (04) 30-40
- 11 Dar TA, Sultan A, Dhar SA, Ali MF, Wani MI, Wani SA. Toilet seat injury of the Achilles tendon a series of twelve cases. Foot Ankle Surg 2011; 17 (04) 284-286
- 12 Chatterjee SS, Sarkar A, Misra A. Management of acute open tendo- achilles injuries in India lavatory pans. Indian J Plast Surg 2006; 39: 29-30
- 13 Mak CY, Chang JH, Lui TH, Ngai WK. Bicycle and motorcycle wheel spoke injury in children. J Orthop Surg (Hong Kong) 2015; 23 (01) 56-58
- 14 Said MN, Al Ateeq Al Dosari M, Al Subaii N. et al. Open Achilles tendon lacerations. Eur J Orthop Surg Traumatol 2015; 25 (03) 591-593
- 15 Zhu Y, Xu Y, Li J, Yag J, Ouyang Y, He X, Chen H, Fan X. Treatment of spoke heel injuries in children. ZhonggyoXio Fu Chong Jian Wai Ke Za Zhi 2009; 23 (10) 1180-1182