Introduction. Subcutaneous rupture of achilles tendon is a frequent trauma and most patients with such pathology are men of working age. Even though it is not difficult to diagnose such ruptures, especially those that need surgical treatment, there are numerous cases when patients come to a surgeon with a big delay. In such cases, the rupture becomes «chronic» or «neglected» and can be no longer treated as an acute rupture. There are many techniques of operative treatment of chronic achilles tendon ruptures, but still there is no consensus on which technique is to be considered the most simple, effective and safe.The aim of this study is to evaluate the effectiveness of using peroneus brevis tendon as a graft for treatment of achilles tendon defects type 3 in Kuwada classification. Will this technique bring good and excellent results that are comparable with end-to-end suture after acute achilles tendon ruptures?Materials and methods. The present study includes 13 patients in which peroneus brevis was used for treatment of neglected achilles tendon rupture (group I) and 18 patients after end-to-end suture after acute achilles tendon rupture (group II). Group I consisted of patients with neglected rupture of achilles tendon that was not previously treated due to various reasons and with a significant defect.Results. Mean surgery duration in group I was 91.9±6.6 (Me — 100) min, in group II — 43.2±2.2 (Me — 45) (p = 0.0001). damaged limb was evaluated using achilles Tendon Total Rupture Score, mean post-op follow up was around 1 year. The results were: group I — 86.6±2.28 (Me — 87), group II — 93.4±1.01 (Me — 94) (p = 0.04). This means, that despite quite high scores in group I, they are still statistically worse than scores after suture of acute rupture in group II. There was no difference in post-operative complication rate between the groups (p0.05). The most common complication for both groups was range of motion restriction in ankle joint. None of the patients had ankle joint instability after surgery.Conclusion. Management of neglected ruptures of achilles tendon type 3 (in Kuwada classification) with peroneus brevis autologous graft is an effective and safe technique, that achieves good and excellent results in treatment of this group of patients, in absolute numbers is comparable to functional outcomes after end-to-end suture of acute achilles tendon ruptures, but statistically demonstrates significantly worse results.

Основную часть пациентов с последствиями переломов пяточной кости составляют люди трудоспособного возраста, но у таких больных часто имеется постоянно существующий многокомпонентный болевой синдром, не позволяющий им вернуться к трудовой деятельности. Цель данного исследования -в ходе анализа зарубежной и отечественной литературы, а также по данным клинического и рентгенологического обследования пациентов выявить спектр всех возможных источников болевого синдрома. Для анализа литературы по данной тематике было отобрано 79 иностранных публикаций, выпущенных в период с 1993 по 2017 г., а также 22 отечественные публикации за период с 2008 по 2017 г. Клиническая часть исследования представлена 22 пациентами, прооперированными в период с 2016 по 2017 г. в клинике РНИИТО им. Р.Р. Вредена. Среднее значение по ВАШ болевого синдрома у обследованной группы пациентов до оперативного лечения составил 6,5±0,3 (4-9) балла. В результате анализа литературы и клинических наблюдений сформирован перечень возможных источников болевого синдрома, а также выделены рекомендации по их дифференциальной диагностике, что позволит практикующим травматологам-ортопедам выбирать более эффективную тактику лечения пациентов рассматриваемого профиля. Ключевые слова: последствия переломов пяточной кости, задний отдел стопы, болевой синдром, импинджмент-синдром, сухожилия малоберцовых мышц, икроножный нерв. Переломы пяточной кости составляют 60-70% от переломов костей заднего и среднего отделов стопы и около 2% от всех переломов костей скелета [1]. Лечение таких переломов требует значительного опыта хирурга, индивидуально подобранной тактики лечения и полноценного оснащения, но даже при соблюдении всех требований риск возникновения осложнений остается достаточно высоким. При анализе 108 случаев

Background: Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning—even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. Methods: We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. Results: The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). Conclusion: The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level of Evidence Level III, retrospective cohort study, case series.

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Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of mechanical damage of bundles and inflammation. In prolonged impingement the intensity of inflammation decreases, but the connective tissue degeneration of the tendon continues with lipoid infiltration.