PurposeA tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).MethodsThe current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.ResultsForty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5–48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6–13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.ConclusionsIn conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.

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Objectives: To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus.Design: A retrospective trauma system database study.Setting: Accredited trauma centers in Pennsylvania.Patients: A statewide trauma database was searched for children 2-13 years of age admitted with a SC fracture between January 2001 and December 2015. Four thousand three hundred eight children met inclusion criteria. Intervention: Treatment of a SC fracture. Main Outcome Measurement: Diagnosis of CS/performance of a fasciotomy.Results: During the study period, 21 (0.49%) children admitted with a SC fracture of the humerus were treated with fasciotomy. CS/ fasciotomy was more likely in males (P = 0.031), those with a nerve injury (P = 0.049), and/or ipsilateral forearm fracture (P , 0.001). Vascular procedure, performed in 18 (0.42%) children, was strongly associated with CS/fasciotomy (P , 0.001). Closed reduction and fixation of a forearm fracture was associated with CS (P = 0.007). Timing of SC fracture treatment did not influence outcome. Fasciotomy was performed subsequent to reduction in 13 subjects; mean interval between procedures was 23.4 hours (r = 4.5-51.3).Conclusions: Risk factors for CS exist; however, they are not required for the condition to develop. CS may develop subsequent to admission and/or SC fracture treatment. In timing of operative management and hospitalization, the results support contemporary practice.

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