A higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.
Background: Angulated wrist and forearm fractures are among the most common pediatric fractures, and they often require closed reduction with anesthesia. There are several issues associated with pediatric anesthesia including the low but non-zero risk of significant complications, increased physician and staff time and effort, and increased cost. Despite these issues, there have not been any studies to prove that using anesthesia results in better outcomes or higher caregiver satisfaction in comparison to performing closed reductions without anesthesia. The purpose of this study was to evaluate the quality of closed reductions of angulated pediatric wrist and forearm fractures and to determine caregiver satisfaction with an anesthesia-free reduction technique. Methods: This study included 54 pediatric patients with closed, angulated fractures of the radius or combined radial and ulnar shafts. All closed reductions were performed by a single pediatric fellowship-trained orthopaedic surgeon in the office setting without any anesthesia. Radiographs were obtained to assess the quality of the reduction. At the first follow-up visit, caregivers were asked about their interim use of pain medications. Caregivers were later surveyed about patient use of analgesics and their satisfaction with an anesthesia-free reduction technique. Results: The average age of the 54 patients in this study was 9 years (1.8 to 16.8 y). Thirty-three fractures were combined radial and ulnar forearm shaft fractures, 18 were distal radius fractures, and 3 were radial shaft fractures. ≤ 10 degrees of residual angulation was achieved in 98% of patients. Nine percent (5/54) of the patients used ibuprofen or acetaminophen for pain control. Seventy eight percent (42/54) of the caregivers responded to the telephone and email surveys. All responding caregivers stated that the patients returned to full function and had satisfactory outcomes. Ninety eight percent (41/42) of the caregivers stated they would choose the same anesthesia-free reduction technique again. Conclusions: Closed reduction of angulated pediatric wrist and forearm fractures in the office without anesthesia can achieve satisfactory reductions and high caregiver satisfaction while eliminating the risks and complications associated with pediatric anesthesia. Level of Evidence: Level IV Case series.
Background A single stage bilateral total hip arthroplasty utilizing the direct anterior approach has been reported to have a similar incidence of perioperative complications as unilateral total hip arthroplasty. However, previous studies have included various surgeons with differences in contraindications, protocol, technique and/or experience. Questions/Purposes The purpose of this retrospective review was to compare perioperative outcomes in single-stage bilateral and unilateral total hip arthroplasties via the direct anterior approach performed by a single, fellowship trained, high volume arthroplasty surgeon. Methods A retrospective review was completed on consecutive single-stage bilateral total hip arthroplasties performed between 2009 and 2017 and compared to consecutive unilateral total hip arthroplasties performed between 2014 and 2016. Perioperative data and complications occurring within 90 days were collected for all included patients. Student t-tests were performed to detect differences between bilateral and unilateral surgical variables. Results A total of 349 patients (531 hips) were included, consisting of 182 BTHA patients (364 hips) and 167 unilateral THA patients. Patients undergoing unilateral THA had significantly lower operating time, shorter length of stay, lower estimated blood loss, lower rate of transfusions and higher rate of home discharge compared to BTHA (p<0.001). Complications were present in four unilateral THA patients, three requiring revision, and nine BTHA patients, three requiring revision. Conclusions There was no difference in complications, as well as no perioperative mortalities or systemic complications, within 90 days following surgery between unilateral and bilateral patients. Based on these results, single-stage DAA BTHA is a safe procedure to perform, and did not appear to result in higher rates of complications when compared to patients receiving a DAA unilateral THA.
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