Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

Background: metatarsal fractures are a commonly encountered musculoskeletal injury. Scant literature exists to support current treatment guidelines and few studies describe the functional or occupational outcomes of patients with lesser metatarsal fractures. The purpose of this study is to describe occupational outcomes for traumatic lesser metatarsal fractures in relation to current treatment guidelines. Methods: a retrospective review of metatarsal fractures in adult military patients 18 years and older was performed. Data included: patient demographics, fracture angulation and displacement, treatment modality, associated injuries, rate of return to active duty, requirement for additional surgeries, ability to run a 2-mile physical fitness test, and presence of permanent activity limitations. Treatment guideline criteria were applied and compared with the occupational outcomes measured. Results: 38 fractures were included. The mean age was 27.2 ± 7.8 (19–48). Here, 28 fractures were initially treated non-operatively. Fractures selected for non-operative treatment had a mean displacement of 1.7 +/− 1.1 mm and a mean angulation of 3.3 +/− 3.5° at initial presentation. Fractures selected for operative treatment had a mean displacement of 4.5 +/− 2.4 mm and a mean angulation of 15.7 +/− 13.8° at initial presentation. The return to run rate was 89% in non-operatively treated patients and 50% in operatively treated patients (p = 0.02). Non-operative patients returned to running at a mean of 119 +/− 103 days and operative patients returned to running at a mean of 306 +/− 191 days (p = 0.0039). 50% of operatively treated patients and 11% of non-operatively treated patents were unable to remain in the military due to their metatarsal fractures. Conclusions: patients treated non-operatively were more likely to return to running and returned to running sooner than operatively treated patients. Current treatment guidelines could not be supported or refuted based upon the study results. The occupational and functional outcomes demonstrated in this study may assist surgeons in counseling patients on their planned treatment and anticipated recovery following a lesser metatarsal fracture.

Introduction: Septic arthritis of a native hip is a relatively uncommon condition in adults. Prompt diagnosis and treatment of septic hip arthritis are imperative to preserve joint integrity, as failure to quickly intervene can allow rapid degenerative changes. Case Report: This is a case report of a 50-year-old male that presented with right septic hip arthritis in the acute setting. He complained of pain with attempted range of motion and log-roll. Laboratory workup demonstrated no leukocytosis, but elevated inflammatory markers. A hip aspiration under fluoroscopy was performed, revealing a cell count of 100,600/cm3 with 91% neutrophils. His right hip underwent irrigation and debridement with a muscle-sparing anterolateral approach (Rottinger). Conclusion: This case report describes the successful use of the anterior based muscle-sparing approach for incision and drainage of septic arthritis of the native hip joint in an adult patient. Advantages to this strategy include lower rate of nerve injury compared to classical anterior and lateral approaches, less muscle damage than the posterior approach, and no requirement for special skills or equipment as in the case of hip arthroscopy. Keywords: Septic arthritis, anterior based muscle sparing and anterolateral