Postoperative Outcomes Between Positive and Negative Electrodiagnosis in Patients With Tarsal Tunnel Syndrome: A Retrospective Comparative Study.

BACKGROUND: The sensitivity of diagnosing tarsal tunnel syndrome with an electrodiagnostic study is just over 50%. Given this low reliability, many surgeons prefer to make a diagnosis solely from a physical examination, despite reported electrodiagnostic findings. Thus, to understand the clinical ramifications between these 2 methods of diagnosis, this investigation compared the postoperative outcomes following a tarsal tunnel release between patients with positive and negative preoperative electrodiagnosis (EDx). METHODS: This study retrospectively reviewed 53 consecutive patients who underwent tarsal tunnel release by a single surgeon between 2015 and 2022. The primary outcome was pain level using visual analog scale (VAS) whereas the secondary outcomes were 36-Item Short Form Health Survey questionnaire, Foot and Ankle Ability Measure, recovery times (time to return to activities of daily living, work, and sports), and complications. Pre- and postoperative functional outcomes were compared within each EDx group using a paired sample t test. Postoperative outcomes between groups were compared using a generalized linear model adjusted for potential confounders. RESULTS: Both EDx groups (positive studies = 31 patients and negative studies = 22 patients) demonstrated significant improvement of all functional outcomes (P < .001). We found no significant difference in recovery time or postoperative outcomes between the 2 groups (P > .05). Multivariable analysis showed diabetes (risk ratio [RR] = 1.79, 95% CI 1.11-2.90) and longer duration of symptoms before surgery (RR = 1.02, 95% CI 1.00-1.04) as prognostic factors for residual pain following tarsal tunnel release. CONCLUSION: In our series, we found that preoperative electrodiagnostic results did not prognosticate postoperative functional outcomes or recovery times after tarsal tunnel release. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Bilateral Os Trigonum Fracture Treated With Simultaneous Posterior Ankle Arthroscopy.

This is a case report of a 21-year-old female undergraduate student who sustained bilateral ankle injuries while jumping from a moving van wearing 3-inch high heel shoes. Upon initial presentation, her injury was treated conservatively as an acute bilateral ankle sprain for 6 weeks. However, the patient reported no improvement of pain and remained unable to self-ambulate. Bilateral MRI and CT scans of both ankles demonstrated bilateral os trigonum fractures. She underwent bilateral posterior ankle arthroscopic débridement of both os trigonum. At the postoperative 36-month follow-up, the patient reported notable improvement of all functional outcomes (36-item Short Form survey and Foot and Ankle Ability Measure), reported return to the same level of sports activities, and experienced no pain (visual analog scale) on either ankle. This is the first report in the literature of bilateral os trigonum fracture treated with simultaneous posterior ankle arthroscopic débridement.

Factors for Blood Transfusions Following Hemi Hip Arthroplasty for Patients With Femoral Neck Fracture.

BACKGROUND: Hemi hip arthroplasty is one treatment option for femoral neck fractures; however, there has been limited evidence on factors associated with blood transfusions following hemi hip arthroplasty. Hence, the aim of this study was to identify the predictors of blood transfusion after hemi hip arthroplasty, which could lead to the establishment of proper guidelines for management protocols. MATERIALS AND METHODS: This study was a retrospective cohort study, conducted in a single center of 323 femoral neck fracture patients having undergone hemi hip arthroplasty. Peri-operative factors and demographic data were extracted from the electronic medical records, from 2007 to 2019. A predictive model was developed by logistic regression (LR), and adjusted by multivariate logistic regression. RESULT: One hundred and twenty-six (39%) patients received blood transfusions. On multivariate analysis, those of a female gender (odds ratio (OR) 2.00, p = 0.037), having a body mass index lower than 18.5 kg/m2 (OR 2.40, p = 0.028), lower preoperative hemoglobin levels (OR 0.52, p < 0.001) and given general anesthesia (OR 2.07, p = 0.028) were shown to be significantly associated with a higher risk of requiring a blood transfusion. CONCLUSION: The authors recommend that preparation of blood components coupled with the utilization of blood conserving methods for high risk patients, as studies have stated, in addition to the consideration of spinal anesthesia; if patients have no contraindication, should be implemented.

Septic arthritis following femoral neck fracture: A case report.

INTRODUCTION: Femoral neck fracture is common in the elderly, especially in the era of aging populations. Septic arthritis of the hip after femoral neck fracture is a rare complication. There are limited reports on this complication especially in patients without a severe medical condition and there is no consensus on the method of treatment of this complication. CASE PRESENTATION: A 75-year-old male had right hip pain for two weeks after falling on his right hip. The patient was diagnosed as pathological fracture with hematologic malignancy. He was scheduled for bipolar hemiarthroplasty. However, an intraoperative finding found that the hip joint was filled with pus. The treatment was successful with a two-stage procedure. The first stage was implantation of an antibiotic cement spacer and the second stage was total hip replacement. CONCLUSION: Septic arthritis following femoral neck fracture is a complication which requires special attention for the diagnosis and treatment. Increasing hip pain or the developing signs of infection in patients awaiting surgery may indicate infection in the hip. The two-stage procedure is the treatment of choice in this condition.