Successful Boutonniere Reconstruction With Wide-Awake Local Anesthesia No Tourniquet.

Purpose: In this retrospective study, we evaluated the results of central slip reconstruction with a modified Snow's technique under wide-awake local anesthesia no tourniquet. Methods: Between 2016 and 2019, 13 patients with boutonniere deformity were operated. All of the patients had boutonniere deformity with a passively correctable proximal interphalangeal joint. In 7 patients, temporary proximal interphalangeal joint transfixation with a K-wire to secure the repair was preferred. For the rest of the patients, postoperative follow-up was done with an orthosis. All patients were referred to a hand therapist for postoperative rehabilitation. Results: The mean interval between the injury time and the surgery was 55.7 days. After the surgery, the average proximal interphalangeal joint flexion was 104.8° and the loss of proximal interphalangeal joint extension was 6.15°. The average distal interphalangeal flexion was 65.3°. Seven cases had excellent results, 4 patients had good results, and 2 patients had fair results. Conclusions: Our study demonstrated that with a modified Snow technique, encouraging results can be achieved for neglected central slip injuries in which primary repair is impossible. Surgery under wide-awake local anesthesia no tourniquet enables the surgeon to check the stability of the repair, and early active motion with relative motion flexion orthoses can be started with confidence. Type of study/level of evidence: Therapeutic IV.

Does the COVID-19 pandemic period itself increases early mortality rates of elderly patients with hip fractures in Turkey?

ABSTRACT: Hip fractures are common in elderly patients and prone to serious morbidity and mortality particularly when the treatment is delayed. The objective of this study was to evaluate the effect Coronavirus disease of 2019 (COVID-19) pandemic on the early mortality rates of geriatric patients with hip fractures.281 patients who were followed and operated on with the diagnosis of proximal femur fracture were included in this retrospective study. Patients were divided into 2 groups, that is, 180 patients presenting between March and June 2018 to 2019 (prepandemic period) and 101 patients presenting between March and June 2020 (pandemic period). Age, sex, type of fracture, time from fracture to presentation to hospital, comorbidities, time from admission to operation, length of intensive care unit stay, length of hospital stay, and mortality rates were retrieved from hospital records and evaluated.While there was no significant difference in terms of age, sex, type of fracture, in-hospital mortality, 30-day mortality, time to surgery, Charlson comorbidity index and length of intensive care unit stay through pandemic and prepandemic period (P > .05), significant differences were observed in terms of length of hospital stay, time to admission, refusal of hospitalization and attending outpatient visits regularly (P < .05). Attending outpatient visits and the length of hospital stay were the main significant differences in multivariate analysis.The early mortality rates in patients with hip fractures were similar during the pandemic period to before in Turkey. However, the length of hospital stay was prolonged and more patients refused the treatment and fewer of them attended regular outpatient controls in the pandemic.