Evaluation of early complications, outcome, and mortality in Coronavirus Disease 2019 (COVID-19) infection in patients who underwent orthopedic surgery.

BACKGROUND: A higher mortality and morbidity rate has been reported in COVID-19 patients undergoing surgery. To reduce the morbidity and mortality rate in COVID-19 patients undergoing orthopedic procedures, we aimed to increase the threshold for surgical planning. METHODS: In a prospective cohort study, COVID-19 patients who underwent elective or emergent orthopedic surgery in three orthopedic surgery centers from February 2020 to September 2020 were included. In this period, 6751 patients were scheduled for orthopedic surgery. To increase surgical threshold planning, all patients with grade 5 of the American Society of Anesthesiologists (ASA) classification and patients with COVID-19 related moderate to severe pulmonary involvement were identified as high-risk patients and were excluded. RESULTS: 35 deaths occurred during the study. The frequency of deaths was significantly higher in patients with COVID-19, 6 (9.4%) than patients without COVID-19, 29 (0. 43%). The average hospitalization stay was 12.8 ± 12.1 days. The odds ratio (OR) for death was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 8.13, Confidence interval 95% (CI95%) (5.02-11.25), P: 0.001]. Four (6.3%) COVID-19-associated complications were recorded in this series that all were respiratory failure requiring unexpected postoperative ventilation. Twenty surgical complications (31.3%) were recorded. The odds ratio for ICU admission was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 5.46, CI 95% (2.68-8.68), P: 0.001]. CONCLUSIONS: An increased threshold for orthopedic surgery is suggested for COVID-19 patients with a mortality rate of 9.3%, which is less than the mortality rate in other studies. Level of evidence III.

Calcaneostop Provides Favorable Short-term Outcomes in Patients With Flexible Flatfoot.

Background: Flatfoot is a relatively frequent deformity seen in almost 5% of children. It is classified into flexible and rigid flatfoot. Symptomatic flexible flatfoot (FFF) can be managed using several procedures, and calcaneostop is one of the procedures that has gained popularity recently. This study aimed to evaluate the outcome of the calcaneostop procedure using screws. Methods: We retrospectively evaluated 57 feet in 44 consecutive patients with FFF undergoing calcaneostop surgery. The same pediatric orthopedic surgeon performed all surgeries. Following a 10-mm incision on the sinus tarsi, a partial thread 6.5 cancellous screw size 40 was inserted. Achilles tendon lengthening was performed on all patients, and a short leg cast was applied. Pain relief, complications, and the change in the talocalcaneal (Kite), talometatarsal (Meary's), and calcaneal inclination (Pitch) angles were evaluated on plain radiographs using a paired t test. Results: Pain relief was achieved in 55 (96.5%) cases, and 2 (3.5%) patients experienced pain after surgery. Other complications, including nerve damage, infection, screw loosening, fracture, or position loss, were not observed. The mean preoperative and postoperative Meary's, Kite, and Pitch angles were 15.74 ± 2.02 (12.30-21.60), 8.72 ± 1.03 (7.20-10.60), 31.23 ± 1.97 (27.80-37.30), 21.30 ± 1.98 (18.50-24.60), 12.40 ± 1.64 (8.50-16.60), and 18.52 ± 1.97 (15.90-22.60), respectively. A significant improvement was observed in each angle following surgery (p<0.001). Conclusion: Calcaneostop is an inexpensive and simple procedure that avoids the involvement of several joints and uses a simple incision leaving a small scar. This procedure is remarkably successful and can be quite convenient.