Objectives:Although there are several reports of clinical outcomes after the Latarjet procedure for recurrent anterior glenohumeral instability, the literature is sparse for these Latarjet outcomes in the strictly contact or collision-type sport athletes who have significant glenoid deficiency and/or failed previous stabilization surgery. The purpose of this study was to evaluate the clinical and functional results of these contact or collision athletes who underwent a Latarjet for symptomatic instability with glenoid bone loss or failed stabilization surgery, using modern instability outcome measures. Study Design: Case series, Level of evidence, 4 Methods: Sixty-one consecutive contact and/or collision athletes (64 shoulders) treated with an open Latarjet procedure for recurrent anterior glenohumeral instability with significant glenoid bony deficiency and/or failed prior stabilization were retrospectively identified from two surgeons' practices. Thirty-nine patients and 42 shoulders (66%) were evaluated at a mean follow-up of 46 months (range: 24-95), whose an average age of surgery of 25.9 years (range: 16-47). Primary outcome measures were the Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Society Questionnaire (ASES), Visual Analogue Scale, and return to sporting activity. IRB approval was granted for this study. Results: Thirty-seven of forty-two shoulders (88%) were perceived as stable to these athletes. Two patients experienced subluxation events at 18 and 24 months after their Latarjet procedures. These 2 patients underwent further surgery including an arthroscopic debridement with biceps tenodesis and the other a revision stabilization Eden-Hybinette procedure, performed at 22 and 29 months after their Latarjets, respectively. One additional patient underwent surgery for hardware removal with arthroscopic debridement, with no reports of concomitant instability. Average WOSI and ASES scores for 42 shoulders were 76.5% (range: 6.4-100%, +/-24.4) and 89.9 (range: 21.7-100, +/-17.3). The average VAS score was 1.1. Fifty-four percent (21/39) of the athletes returned to their preoperative sports level, 18% (7/39) decreased their activity level in the same sport, 13% (5/39) changed sports and 15% (6/39) decreased level and changed sport, or stopped sports altogether. Conclusion: At a minimum of 2 year follow-up, 72 % of contact/collision athletes returned to their original sport, whereas 28% had to change their sport type after their Latarjet, or stop sporting activities altogether. Failure by subluxation occurred in 4.8% of shoulders (at an average of 21 months); 88% reported their shoulder as feeling stable with average WOSI and ASES scores of 76.5% and 89.9 respectively. In this challenging group of patients, the Latarjet procedure successfully restores stability in 88% of cases; 72% return to their pre-operative sport type.

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Purpose of review Delirium is a frequent complication of serious medical illness in children. The purpose of this review is to highlight recent data on the epidemiology and outcomes related to pediatric delirium, and discuss prevention strategies. Recent findings Delirium rates in the pediatric ICU are greater than 25%. Delirium in children is associated with prolonged mechanical ventilation and hospital length of stay, increased costs, and excess mortality. Pediatric delirium may affect postdischarge cognition and quality of life. Recent initiatives targeting universal screening, early mobilization, and minimization of benzodiazepine-based sedation have shown reduction in delirium prevalence. Summary Widespread screening is needed in critically ill children to detect and mitigate delirium. The identification of modifiable risk factors has provided an opportunity for delirium prevention. Large-scale longitudinal studies are needed to investigate the long-term sequelae of delirium in children.

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