Lourdes Health System

Background:Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality.Purpose:To assess the risks associated with in-office needle arthroscopy.Study Design:Case series; Level of evidence, 4.Methods:A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients’ ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure.Results:Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported.Conclusion:Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.

Hip fracture is one of the major causes of morbidity and mortality, 95 % are related to falls and 5 % are spontaneous. Spontaneous hip fractures are more common on the frail bedridden elderly individuals who reside in long term care facilities. We present a case of a 91 year-old female patient that who resides with her daughter. She had cerebral vascular accident that occurred three years ago which resulted on left sided hemiparesis with subsequent body contraction, deconditioning, and bed confinement. Patient developed an acute episode of pain on her left lower extremity for which she was transferred to the emergency department. An X-ray of the left femur revealed a closed left subtrochanteric femoral shaft fracture. The decision to repair the fracture was taken to ease the pain. Patient underwent procedure for open reduction, cephalomedullary nailing, left subtrochanteric femoral shaft fracture repair. Further studies reported evidence of osteopenia. Patient went home with no rehabilitation therapy. Spontaneous hip fractures in immobile patients are very rare, and when reported, more than 85% are intracapsular or trochanteric. Subtrochanteric femoral fracture in immobile elders accounts for less than 10% of the cases. In patients with a combination of lower limb contractures and osteoporotic bones, a simple twisting force or mild contusion is sufficient to cause fracture. Although we believe that our patient did not experienced physical abuse, unexplained fracture should also prompt physicians to investigate possible abuse. Identifying high-risk patients and providing meticulous nursing care, like methods for lifting and transferring patients, are paramount.