Complete rupture of the Achilles tendon is a well described injury. Assessment of outcome and rehabilitation post surgery is difficult to qualify objectively. We undertook a prospective evaluation of patients who had surgical repair of their ruptured Achilles tendon at our institution over a five year period. All patients underwent clinical and functional assessment. Objective function was evaluated using isokinetic testing on a Biodex dynamometer. Measurements included peak torque/body weight, average power, deficits, total work and range of movement. Studies were repeated at 60, 120 and 240 degrees/second. This was correlated with average time off work and time of return and level of sporting activities. Although 53 patients were entered into the study, only 24 returned for full isokinetic testing. Males (16) were more commonly affected than females (9). Peak incidence was in the fourth and fifth decades of life. Mean hospital stay was 1.8 days. There were no problems with wound healing, and there were no infections. 22 of 25 patients returned to their pre-injury level of activity after an average of 6 months. Time off work averaged 14 weeks. 16 of 25 patients were the same or better when comparing peak torque/body weight, average power, maximum average peak torque and total work/body weight when compared with the unaffected limb. Rehabilitation following Achilles tendon repair can be monitored clinically, however isokinetic testing can provide a more objective assessment of progress.
Waste disposal is an issue that affects us all. Medical waste disposal has posed even more difficulties with the appearance of needles, syringes, and other similar items on our beaches. The amount and toxicity of medical waste has increased in line with increasing medical facilities and diagnostic and therapeutic procedures. Demand for landfill sites and increasing household and hospital waste loads, have made the current situation untenable. New thinking and new strategies must be employed. There is significant waste production in the operating department during a primary total hip arthroplasty. A prospective observational study of the waste from packaging and non-clinical materials in consecutive total hip replacements was undertaken. The total weight and volume of waste, the cost of disposal and percentage of recycled items were recorded for each case. Inappropriate segregation of waste was recorded and the hazards involved are discussed. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling. We must revisit the packaging of implants, the use of recycled paper. We did not inherit our environment from our parents; we are only minding it for our children.
