Immediate and early complications of the open Latarjet procedure: a retrospective review of a large consecutive case series.

BACKGROUND: Immediate and early postoperative complications of the Latarjet procedure are not well documented in the literature. The purpose of this study was to report the procedure-related complications of our large consecutive case series of 3 surgeons at a single high-volume center. METHODS: We conducted a retrospective chart review of 416 Latarjet procedures performed on 400 patients (16 patients had bilateral procedures) who underwent surgery by the 3 senior authors from October 2002 to July 2015. Immediate and early complications included hardware problems, infection, and neurologic injury. In addition, the patient's age and history of prior instability surgery were noted and evaluated as risk factors for complication. RESULTS: The overall complication rate was 5.0% (21 complications in 19 procedures). Thirteen neurologic injuries (3.1%) occurred to the axillary (7), musculocutaneous (4), and suprascapular (2) nerves, including 2 patients with multiple nerves affected. All but 2 patients had complete resolution of symptoms at time of last follow-up. Six infections (1.4%) developed, including 3 superficial infections treated with oral antibiotics and 3 deep infections requiring irrigation and débridement with intravenous antibiotics. Two early hardware-related complications (0.05%) were also noted. Increased age was associated with a higher complication rate. History of prior surgery was not associated with increased complications in our series. CONCLUSIONS: This study highlights the procedural complications of the Latarjet procedure. Neurologic injury was the most common complication in our series, with complete or near-complete recovery in 11 of 13 patients.

Reverse Shoulder Arthroplasty for Management of Postinfectious Arthropathy With Rotator Cuff Deficiency.

Treatment of patients with rotator cuff deficiency and arthritis in the setting of a prior glenohumeral infection (postinfectious arthropathy) is complex, with little evidence to guide treatment. The current authors present their approach to management of these patients and clinical outcomes after reverse shoulder arthroplasty (RSA). All primary RSAs performed for postinfectious arthropathy and rotator cuff deficiency with native glenohumeral joints were identified in a prospective shoulder arthroplasty registry. Eight patients with a minimum of 2-year follow-up were included in the analysis. Clinical outcomes, including the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Osteoarthritis Shoulder (WOOS) index, the Single Assessment Numeric Evaluation (SANE) score, and range of motion measurements, were assessed preoperatively and at final follow-up. At an average follow-up of 4.4 years, no patient had a clinically detectable recurrence of infection. Significant improvements were noted in all outcome scores from preoperative evaluation to final follow-up after RSA, including Constant score (P=.003), ASES score (P<.001), WOOS index (P=.002), SANE score (P=.025), forward flexion (P<.001), abduction (P<.001), and external rotation (P=.020). Seven of 8 patients reported they were satisfied or very satisfied at final follow-up. Reverse shoulder arthroplasty can be performed in patients without significant medical comorbidities in the setting of postinfectious arthropathy and rotator cuff deficiency with a low risk of recurrence of infection. Significant clinical improvements were noted at short-term follow-up.

Gastrointestinal hemorrhage: The prehospital recognition, assessment & management of patients with a GI bleed.

Gastrointestinal hemorrhage may result from an upper or a lower source. It may present in many different ways; however, prehospital management is similar regardless of cause. It's imperative to recognize that a seemingly stable GI bleed can become hemodynamically unstable at any time. The prehospital provider, therefore, should understand the pathophysiology, signs, symptoms and therapeutic interventions for patients with GI bleeds to be better prepared to manage any such emergency when it arises.