Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom.

Background: This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital. Methods: Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually. Results: There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to -13.7; d = -0.95, 95% CI -1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients. Conclusion: Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.

Headless Compression Screw Fixation of Delayed Union Jones Fractures: A Case Series.

BACKGROUND: Different methods have been adopted to treat delayed union and non-union of fractures of the base of the fifth metatarsal using screws, plates and tension band wires. There has been increasing use of intramedullary screw fixation to treat these fractures with variable rates of success. The optimum screw diameter and properties have been a subject of debate. To assess the results of using a larger diameter 5.5 mm cannulated, headless variable-pitch screw to fix delayed union of Jones fracture of the base of the fifth metatarsal. METHODS AND METHODS: A case series study including 24 patients with delayed union of Jones fifth meta-tar-sal fractures. The fractures were fixed by a 5.5 mm cannulated variable-pitch compression titanium screw (Acumed® Acutrak 2® Screw System). RESULTS: Radiological union was achieved in all patients at a mean of 7.2 weeks. At 12 months' follow up, patients had a mean American Orthopedic Foot & Ankle Society midfoot score of 95.6. The mean Short Form 12 Physical and mental survey scores improved from 22.71 and 29.31 points preoperatively to 57.88 and 59.54 respectively. CONCLUSION: The headless compression screw achieved a satisfactory union rate for delayed union Lawren-ce zone II fractures of the base of the fifth metatarsal with satisfactory functional results.

Achilles Tendon Rupture: Can the Tendon Gap on Ultrasound Scan Predict the Outcome of Functional Rehabilitation Program?

Background and objectives  There is a growing use of functional rehabilitation programs for the treatment of Achilles tendon rupture. Factors such as patient age and level of activity have been used to guide the decision. One of the debated indications is the gap size between the ruptured ends of the tendon. This study aims to define any correlation between the amount of the initial gap between tendon ends and patients outcome treated with the functional rehabilitation program. Method  A prospective case series study of all patients with acute Achilles tendon rupture treated non-surgically with the functional rehabilitation program between 2016 and 2018. The tendon gap was measured with an ultrasound scan on the initial presentation. Patients were followed for a minimum of 12 months and assessed for Achilles Tendon Rupture Score (ATRS), plantarflexion strength, and re-rupture rate.  Results  A total of 56 patients completed one-year follow-up, and 2 patients had re-ruptures. The mean plantar flexion gap was 13.7 mm. The mean ATRS at 12 months was 85.12. There was no statistically significant correlation between the final ATRS and the mean rupture gap. Conclusion  The outcome following non-operative functional rehabilitation treatment of rupture Achilles tendon did not correlate with the size of the tendon gap, and authors recommend that decision on functional rehabilitation should not be based on these criteria.