Introduction:Early reports of outpatient shoulder arthroplasty are promising, although a paucity of outcome data exists, particularly for the outpatient shoulder arthroplasty performed at a freestanding ambulatory surgery center (ASC).Methods:A retrospective analysis of 61 shoulder arthroplasty procedures (21 consecutive outpatients and 40 inpatients) was performed. Outpatient shoulder arthroplasties were conducted at a freestanding ASC using a multimodal pain regimen without the use of regional anesthesia. The primary outcome was 90-day postoperative complication rate. Secondary outcomes included 90-day hospital admissions or readmissions, emergency department and urgent care visits, revision surgeries, mortality, postoperative pain, and functional scores.Results:No major complications, readmissions, revision surgeries, or deaths occurred in the outpatient cohort. The rate of 90-day complications was 9.5% and 17.5% for the outpatient and inpatient cohorts, respectively. All patients who had their shoulder arthroplasty as an outpatient were discharged home the day of surgery. No complications related to the outpatient protocol were observed. However, 4.8% of those who had outpatient surgery visited an emergency department or urgent care within 90 days compared with 5.0% of those who had surgery as an inpatient.Discussion:Outpatient shoulder arthroplasty can be performed safely and predictably in select patients at an ASC using a multimodal pain regimen without regional nerve block.

Background: Few studies have reported the outcomes following minimally invasive medial displacement calcaneal osteotomy (MDCO) for correction of pes planovalgus deformities. Methods: Charts were retrospectively reviewed for consecutive patients who underwent minimally invasive MDCO procedures by a single surgeon from 2013 to 2019 with more than 3 months of follow-up. A total of 160 consecutive patients who underwent 189 minimally invasive MDCO procedures were included in the study. Median follow-up was 12 months (interquartile range, 7-25 months). Results: Osteotomy healing complications were present in 7% of cases during the 6-year study period. A 12-month case cluster of osteotomy healing complications was observed. Healing complication rates were 28% during the cluster and 0.7% outside of the cluster. No definitive cause was found for the case cluster, although heat osteonecrosis from the burr was suspected to be involved. Osteotomy healing complications were significantly associated with higher American Society of Anesthesiologists (ASA) classification, female sex, current tobacco use, and higher body mass index (BMI). Healing complications were not associated with osteotomy technique or fixation type. Other complications included wound dehiscence (3%), surgical site infection (2%), transient nerve symptoms (6%), and persistent nerve symptoms (2%). Nerve symptoms were significantly associated with an increased number of concomitant procedures. Conclusion: Patients with higher ASA classification, current tobacco use, and higher BMI were at higher risk for osteotomy healing complications after minimally invasive MDCO procedures. Patients were also more likely to develop nerve complications with more extensive surgical procedures. Level of Evidence: Level IV, retrospective case series.

High-pressure water injection injuries of the hand are uncommon, and there is limited literature to guide their treatment. The ideal management of these injuries, whether nonoperative with close observation or early surgical debridement, remains unknown. The authors retrospectively identified a cohort of patients with high-pressure water injection injuries to the hand during a 16-year period. Data collected included demographics, location of injection, hand dominance, type of treatment, need for additional surgery, and complications. The authors attempted to reach all patients by phone and email to assess long-term motion loss, sensation loss, and chronic pain. Nineteen patients met the inclusion criteria. The nondominant hand was involved in 84% and the index finger in nearly half. Two of 10 patients in the early surgery group required additional procedures, including a trigger finger release and serial debridements for Pseudomonas infection. Three of 9 patients without early debridement eventually required surgery, including debridement of a septic flexor tenosynovitis, fingertip amputation, and metacarpophalangeal disarticulation. Sixteen percent of patients developed infection, and 1 patient developed compartment syndrome. This is the largest reported cohort of both operatively and nonoperatively treated high-pressure water injection injuries to the hand. This is the first report of amputation as a complication. Infection and delayed presentation portend a poor outcome. Complications may arise even after early surgical debridement, and long-term sequelae are common. These injuries are not inherently benign and warrant immediate medical attention, early antibiotics, and a low threshold for close observation or surgical debridement. [Orthopedics. 2018; 41(2):e245-e251.].

Background: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. Methods: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. Results: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. Conclusion: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. Clinical Relevance: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.