case_images: PMC5759099_01
case_images: Lateral x-ray of the original fracture.
case_images: TOORTHJ-11-1568_F2.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F2.jpg
case_images: F2
case_images: X-rays confirmed an avulsion fracture of the heel at the insertion of the Achilles tendon Fig. (2).
case_images: Lateral x-ray after open reduction and internal fixation of avulsed fragment.
case_images: TOORTHJ-11-1568_F3.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F3.jpg
case_images: F3
case_images: Postoperative x-rays demonstrated adequate reduction of the fracture (Fig. 3).
case_images: Skin necrosis and infection after re-fracture.
case_images: TOORTHJ-11-1568_F4.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F4.jpg
case_images: F4
case_images: The skin around this necrotic area had the clinical appearance of infection, though we were unable to determine whether it was a local or a deep infection (Fig. 4).
case_images: Removed bone fragment.
case_images: TOORTHJ-11-1568_F5.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F5.jpg
case_images: F5
case_images: The bone fragment was removed together with the screw used for the initial osteosynthesis Fig. (5), but the attached part of the Achilles tendon was preserved and re-attached to the calcaneous tuberosity using two anchor sutures Fig. (6).
case_images: Plaster cast applied after debridement and tendon reattachment.
case_images: TOORTHJ-11-1568_F7.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F7.jpg
case_images: F7
case_images: The wound was inevitably left uncovered; a full plaster cast was applied, with the leg in plantar flexion and a posterior window to allow observation of the wound on a daily basis (Fig. 7).
case_images: Wound before final coverage, eight weeks post op.
case_images: TOORTHJ-11-1568_F8.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F8.jpg
case_images: F8
case_images: The size of the skin lesion was reduced to 2x2 cm and the depth of the deficit was less than 1 cm (Fig. 8).
case_images: Complete, stable coverage, ten weeks post op.
case_images: TOORTHJ-11-1568_F9.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F9.jpg
case_images: F9
case_images: Two weeks later, the flap and 90% of the grafts had survived, the Achilles tendon was at that time completely covered (Fig. 9) and the patient was put on a removable dynamic brace that allowed ankle mobilization and gradual weight bearing.
case_images: Final functional outcome, three months post-op.
case_images: TOORTHJ-11-1568_F10.jpg
case_images: PMC5759099_01_TOORTHJ-11-1568_F10.jpg
case_images: F10
case_images: Finally, 12 weeks after skin excision and tendon re-attachment the skin was completely healed, the patient had restored her right ankle motion (plantarflexion of 35 degrees and dorsiflexion of 15 measured with a goniometer) and was able to perform a single heel rise (Fig. 10).