Elective surgery cancellations in pediatric surgery: rate and reasons.

INTRODUCTION: Canceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions. METHODS: We carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital. RESULTS: One thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%. CONCLUSIONS: The rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children's medical care, operation scheduling, and efficient institution resource utilization.

Anterior Traumatic Lumbosacral Dislocation: A Case Report.

Traumatic dislocation of the lumbosacral joint is a rare and severe lesion usually caused by high-energy trauma. The literature on traumatic spondylolisthesis is limited, and most published papers are sporadic case reports. By presenting the case of an anterior traumatic L5-S1 spondylolisthesis without neurological deficits caused by a 6-meter fall, we discuss the anatomopathological mechanism of this injury, clinical and radiological evaluation, and current management options. The patient was treated surgically with a combined posterior instrumented reduction and transforaminal interbody fusion. At the final follow-up after seven years, the radiological evaluation showed an unchanged spondylolisthesis reduction with reliable fusion healing. In addition, the patient had good functional results and resumed recreational activities and work. Traumatic lumbosacral spondylolisthesis requires a careful and well-documented initial clinical and radiological assessment. Most authors advocate surgical treatment as the mainstay of management. However, the long-term prognosis remains unclear and unpredictable.

A Child With Acute Hematogenous Osteomyelitis of the Distal Fibula and Infective Endocarditis.

Acute hematogenous osteomyelitis (AHO) commonly interests the pediatric population. It typically affects the metaphyses of long tubular bones. However, the fibula is rarely involved. Regarding the hematogenous inoculation, this infection may be associated with distant foci. Herein, we present the case of a 10-year-old girl who was initially diagnosed with atypical AHO of the distal fibula complicated by a subperiosteal abscess. Upon admission, the child showed a severe septic condition, including embolic infective endocarditis (IE), which was responsible for multiple cerebral, renal, and splenic loci. AHO was successfully resolved with appropriate intravenous antimicrobial treatment targeting Staphylococcus aureus, surgical drainage, and debridement. Due to the complexity of the lesions and the embolic nature, the IE was also managed operatively with a mechanical prosthesis. The distal fibula is a rare and challenging location for AHO. EI co-infection should always be sought and suspected because, in such instances, it will genuinely complicate diagnostic and therapeutic management.

Impact of the COVID-19 Pandemic on Orthopedic and Trauma Departments in Tunisia.

OBJECTIVE: Measure the effect of the strategy to fight the Covid-19 pandemic, based on containment, on the practice of orthopedic and trauma surgery in Tunisia. METHODS: This is a comparative study, concerning the impact of Covid-19 on the flow of patients, operated in orthopedic surgery and trauma departments, during the containment period from March 12, 2020 to April 30, 2020, comparing it to the same period of the year 2019, in the Central-East region of Tunisia (Kairouan, Sousse, Mahdia, Monastir). RESULTS: A significant decrease of 27% in the flow of patients admitted to orthopedic surgery departments in central-eastern Tunisia, during the 2020 containment period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in three orthopedic departments: Sousse (39%; p<10-3), Monastir (29%; p<10-3) and Mahdia (27%; p<10-3). It focused on the following three groups: infections (45%; p<10-3), wounds (30%; p<10-2), and fractures (20%; p<10-3). CONCLUSION: The collateral effects of the strategy to fight the Covid-19 pandemic, are "obvious" in orthopedic surgical practice. A health crisis management plan (including disasters and pandemics) should be better prepared in orthopedic surgery departments.