Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers.

Background: For several years, many orthopedic surgeons have been performing total joint replacements in hospital outpatient departments (HOPDs) and more recently in ambulatory surgery centers (ASCs). In a recent shift, the Centers for Medicare and Medicaid Services began reimbursing for total knee replacement surgery in HOPDs. Some observers have expressed concerns over patient safety for the Medicare population particularly if Centers for Medicare and Medicaid Services extends the policy to include total hip replacement surgery and coverage in ASCs.

Preoperative diagnosis of infection in patients with nonunions.

Background: The surgical treatment of a fracture nonunion is complicated in the presence of infection. The purpose of the present study is to report on the utility of a standardized protocol to rule out infection in high-risk patients and to evaluate the efficacy of each component of the protocol.

Methods: A single protocol of preoperative laboratory tests (white blood-cell count, C-reactive protein level, and erythrocyte sedimentation rate) and a combined white blood cell/sulfur colloid scan were performed for patients with a high risk of fracture nonunion.

Treatment of the stress positive ligamentous SE4 ankle fracture: incidence of syndesmotic injury and clinical decision making.

Objectives: The objective of the study was to review our experience with the treatment of stress positive (+) supination and external pattern injuries using shared decision making with the patients.

Design: Retrospective case review.

Setting: Level 1 trauma center.

Reuse of external fixation components: a randomized trial.

Objectives: External fixation devices are sold in the United States as single-use devices and can be costly. Approved processes for refurbishment of nonimplantable components are available. We evaluated one such program for safety, efficacy, and fiscal ramifications.

Syndesmotic instability in Weber B ankle fractures: a clinical evaluation.

Objective: Syndesmotic instability may coexist with unstable Weber B supination-external rotation (SE) lateral malleolar fractures. Current recommendations suggest that Weber B injuries should not have associated syndesmotic instability after open reduction and internal fixation of the lateral malleolus. The purpose of this study was to evaluate syndesmotic stability with respect to the current recommendations for syndesmotic fixation in Weber B SE pattern lateral malleolar fractures.

Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol.

Background: An ipsilateral fracture of the femoral neck is seen in association with 1% to 9% of femoral shaft fractures, and 20% to 50% of these injuries are missed initially. Recognition of an associated femoral neck fracture prior to stabilization of the femoral shaft fracture is imperative to avoid or minimize complications of displacement and osteonecrosis.

Methods: A protocol to look for a femoral neck fracture in all patients with a femoral shaft fracture was instituted at a single level-I trauma center.