The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes After Anterior Fusion Plating for Severe Ankle Arthritis.

Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior (TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 2 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, 38 patients who underwent arthrodesis without TA tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion, fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points at final follow-up, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in functional outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed a significantly lower wound complication rate (4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate. Although there were no specific functional deficits related to absence of TA tendon, further studies are needed to determine long-term effects of TA tenotomy in patients with a fused ankle.

Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children: a systematic review and meta-analysis.

BACKGROUND: The quality of reduction is an important factor affecting clinical outcomes for displaced femoral neck fractures (FNFs). However, concerns remain about the invasiveness of open reduction and internal fixation (ORIF) as compared to that of closed reduction and internal fixation (CRIF), and the choice between ORIF and CRIF as an optimal treatment strategy for displaced pediatric FNF remains controversial. MATERIALS AND METHODS: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to December 22, 2022, that compared ORIF and CRIF techniques for treating FNF in children. Pooled analysis identified differences in surgical outcomes between ORIF and CRIF, especially regarding postoperative complications, such as osteonecrosis of the femoral head (ONFH), nonunion, coxa vara deformity, leg-length discrepancy LLD, and premature physeal closure (PPC). RESULTS: We included 15 studies with 635 pediatric FNF cases in our review. Of these, 324 and 311 were treated with ORIF and CRIF, respectively. The pooled analysis revealed that no significant differences existed between each reduction technique for ONFH (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.51-1.56; P = 0.69), nonunion (OR = 0.51; 95% CI 0.18-1.47; P = 0.21), coxa vara deformity (OR = 0.58; 95% CI 0.20-1.72; P = 0.33), LLD (OR = 0.57; 95% CI 0.18-1.82; P = 0.35), and PPC (OR = 0.72; 95% CI 0.11-4.92; P = 0.74). CONCLUSIONS: Despite concerns about the invasiveness of ORIF, no differences in complications exist between ORIF and CRIF after FNF in children. Therefore, we believe that ORIF should be performed in FNF when the fracture is irreducible by closed manner.

Impact of the COVID-19 Pandemic on Mortality Following Hip and Knee Joint Arthroplasty Surgeries: A Systematic Review and Meta-Analysis.

We performed a meta-analysis comparing the mortality rates after hip and knee joint arthroplasty between the coronavirus 2019 (COVID-19) pandemic and pre-pandemic periods. The purpose of present study was to investigate the impact of the COVID-19 pandemic on mortality rates after hip and knee joint arthroplasty. We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies published up to 28 March 2022. We included studies which directly compared mortality rates after hip and knee joint arthroplasty between the COVID-19 pandemic and pre-pandemic periods. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). We compared the overall mortality rate as the primary outcome. For the subgroup analysis, the mortality rates included were: within 30 days and unrelated to COVID-19; we excluded studies with only elective arthroplasties. Readmission rates following arthroplasties were also compared. We included five studies with 3044 patients, of which 838 patients underwent surgeries during the pandemic period and 2206 patients underwent surgeries in the pre-pandemic period. The mean MINORS score was 15.4/24 (range: 15-16). The overall mortality rate showed no significant differences between the pandemic and pre-pandemic periods (OR, 2.71; 95% CI, 0.78-9.35; p = 0.12; I2 = 19%). No differences were observed in mortality following arthroplasties within 30 days and unrelated to COVID-19 nor in the readmission rates. Mortality, after excluding studies with only elective arthroplasty, presented significant differences between the COVID-19 pandemic and pre-pandemic periods (OR, 3.80; 95% CI, 1.18-12.28; p = 0.03, I2 = 0%). The limitation of the present study was that elective arthroplasty and urgent arthroplasty were not completely differentiated. The overall mortality rate in the COVID-19 pandemic period following hip and knee arthroplasty did not show a significant increase. This finding could help to maintain the practice of elective arthroplasty during a pandemic situation in the future (PROSPERO-CRD42022335471).