Anatomic total shoulder arthroplasty is an established treatment for degenerative conditions involving the shoulder. One well-described complication of total shoulder arthroplasty is glenoid loosening, especially in younger and more active patients. As a result, several surgeons recommend against activities that may put patients at risk of implant failure after shoulder arthroplasty. Newer inlay and inset glenoid implants may have a role in treating arthritis in younger patients and may allow them to return to sports and high-impact activities, including weightlifting. These glenoid implants may also play a role in treating patients with notable glenoid deformity. However, more information is needed regarding their long-term outcomes.

The work in this article summarizes findings from our group on key biochemical cues that govern the formation and repair of tendons and ligaments. Specifically, we summarize the journey that started with a serendipitous discovery that is now being translated into novel therapies to improve tendon-to-bone repair outcomes. This journey began with the discovery that the Hedgehog (Hh) signaling pathway was expressed within the enthesis during development and that its primary role was to promote fibrocartilage production and maturation. Next, we developed an anterior cruciate ligament reconstruction model in novel transgenic mice that allowed us to discover that the Hh pathway promotes fibrocartilaginous tendon-to-bone attachments during the integration process. In addition, we established that the coordinated stages of zonal tendon-to-bone integration after anterior cruciate ligament reconstruction were comparable with the stages required for enthesis formation during development. Now that we have demonstrated that the Hh pathway is a potent therapeutic target, we are currently advancing these findings to develop drug delivery systems to improve tendon-to-bone repair. Ultimately, our group aims to establish key mechanisms that govern tendon and ligament formation that can be leveraged for novel regenerative therapies to improve clinical care.

Fingertip injuries are among the most common injuries seen in the emergency department. Specific considerations in management include ensuring robust soft-tissue coverage over exposed bone or tendon, maximizing functional length, preserving nail function and appearance, and minimizing chronic pain. Bony injuries are generally managed non-operatively, although select operative indications exist-particularly for jersey finger injuries, unstable fractures, or those with significant translation. Nail bed injuries can be managed with trephination for subungual hematomas or formal nail plate removal with nail bed repair depending on the degree of nail plate or soft-tissue injury. Soft-tissue coverage can be approached in a stepwise manner with secondary intention, grafts, or flaps from the affected digit, adjacent digits, or hand all playing a role. With proper management, most patients can achieve good outcomes.

Symptomatic interlocking screws are common after intramedullary nail fixation of tibia fractures. Low-profile headless interlocking screws recently became available and could potentially reduce the rate of symptomatic screws. The purpose of this study was to compare the rate of symptomatic screws and screw removals between these screw types.

Hereditary sensory and autonomic neuropathies (HSANs) encompass a diverse group of inherited neuropathies characterized by notable sensory and autonomic involvement that affects musculoskeletal structures and systemic function. There are 8 recognized types of HSAN. The orthopaedic manifestations of HSAN are complex and diverse, including spinal deformity, Charcot arthropathy, osteomyelitis, fractures, osteonecrosis, osteoporosis, and skeletal deformities. The sensory neuropathy with involvement of small nerve fibers can lead to unnoticed burns, fractures, and joint trauma. Spinal involvement includes progressive scoliosis/kyphosis and acute neurologic compromise. Diagnosis is dependent on clinical suspicion and confirmed with genetic analysis. Treatment is focused on the eradication of infection, stabilization of fractures, and prevention of joint instability in the spine and extremities. This review focuses on the orthopaedic manifestations to aid healthcare professionals in the recognition and treatment of these conditions.

Although the hematologic benefits of tranexamic acid (TXA) have been thoroughly evaluated, an additional value demonstrated in knee arthroplasty and rotator cuff repair is improved early postoperative range of motion (ROM). This study aims to evaluate whether TXA given during total shoulder arthroplasty (TSA) confers improved early postoperative ROM or pain.

Distal radius fractures are one of the most common injuries of the upper extremity. Although nonsurgical management is common, surgical intervention, particularly using volar and dorsal plate fixation, is essential in a subset of injuries. Historically, dorsal plates were avoided due to a high rate of extensor tendon irritation and rupture. Volar locking plates were developed in the early 1990s and first published in 2000 to avoid the complications associated with dorsal plating and have since become widely considered the workhorse for most distal radius fractures. Despite advancements, both fixation methods are still associated with complications, warranting careful selection based on fracture patterns. The purpose of this review is to summarize the most recent literature on the complications associated with the use of volar and low-profile dorsal distal radius plates.

The popularization of generative artificial intelligence (AI), including Chat Generative Pre-trained Transformer (ChatGPT), has raised concerns for the integrity of academic literature. This study asked the following questions: (1) Has the popularization of publicly available generative AI, such as ChatGPT, increased the prevalence of AI-generated orthopaedic literature? (2) Can AI detectors accurately identify ChatGPT-generated text? (3) Are there associations between article characteristics and the likelihood that it was AI generated?

Hip fractures are among the most morbid acute orthopaedic injuries often due to accompanying patient frailty. The purpose of this study was to determine the reliability of assessing surgical risk after hip fracture through machine learning (ML) algorithms.

Foot and ankle arthrodesis surgery is often associated with high rates of nonunion ranging from 8% to 40%. This complication can result in individual patient burden and system burden in the management of these complex patients. Biologic factors contribute greatly to the development of a nonunion, including patient-related modifiable risk factors, metabolic and endocrine factors, systemic disease, previous surgeries, medications, weight loss treatments, and posttraumatic and postsurgical factors. Despite the high nonunion rate, there is a lack of high-level evidence in the identification of high-risk patients, strategies to minimize nonunion, and the management of patients with nonunion. An accepted standard of practice has not been established. This review aims to provide foot and ankle surgeons with (1) a comprehensive review of risk factors for nonunion, (2) a tool to identify high-risk patients using a preoperative patient questionnaire, (3) a clinical practice guide to preoperative and intraoperative testing that aims to improve preoperative counselling and patient optimization, and (4) perioperative strategies to minimize nonunion risk. With the above framework, our goal is to minimize nonunion risk in patients undergoing foot and ankle arthrodesis surgery to improve patient care and outcomes.

The utilization of total shoulder arthroplasty (TSA) in an aging population continues to rise, but the perioperative risk profile of TSA in the very elderly is not well-described. The objective of this study was to quantify the risk profile of 30-day perioperative adverse events after TSA in octogenarians and nonagenarians using a large national database over a recent 10-year period.

Orthopaedic surgery has been recognized as one of the least diverse surgical specialties. Previous studies have demonstrated that women are heavily underrepresented within orthopaedic surgery. The purpose of this study was to determine whether orthopaedic surgery residency programs with a higher presence of women faculty had a higher proportion of women residents.

Although glycated hemoglobin A1C (HbA1c) has classically been used for glycemic control screening before surgery, fructosamine, a short-term glucose variability indicator, has been reported to be a more accurate predictor of postoperative periprosthetic joint infection among patients with diabetes mellitus (DM). Given the variability of diabetic medication management, this study aims to identify the associated effect of glycemic control medication regimen (GCMR) on the incidence rate and associated odds of abnormal preoperative fructosamine levels among diabetic primary total knee arthroplasty or total hip arthroplasty patients.

Foot injuries are one of the most commonly injured areas of the body in many collegiate and professional sports. The wide range of pathology, pathophysiology, mechanisms of injury, differences in sport demands, evolution of treatment, and variable return-to-play time lines make it difficult, at times, for physicians to treat these injuries. Modern diagnostic tools, surgical treatment devices, and rehabilitation protocols have allowed for more accurate and rapid diagnosis, an improved ability to reestablish normal anatomy, and accelerated return to play for many sports-related foot injuries. This summary will provide the most up-to-date, evidence-based treatment options for common sports-related foot injuries along with the authors' preferred method of treatment and return-to-play algorithms for the elite athletes.

The purpose was to determine whether computed tomography (CT) Hounsfield units (HU) as a proxy for bone quality can predict postoperative complications following surgical treatment of proximal humerus fractures.

Venous thromboembolism (VTE) prophylaxis is the standard of care after total joint arthroplasty. However, there have been changes in the prevalence of certain medication classes used by institutions over time driven by the literature and national clinical practice guidelines. The purpose of this study was to analyze the patterns of VTE medications over the past 10 years at our institution.

Optimal management of upper extremity nerve palsy caused by low-velocity ballistic trauma (LBT) remains controversial. The aim of this systematic review was to summarize the available evidence on the management of nerve injuries caused by LBT to the upper extremity.

Dexamethasone is used extensively during total hip and knee arthroplasty total joint arthroplasty (TJA) to control pain and decrease the risk of nausea and vomiting. However, the safety of dexamethasone utilization in diabetic patients is poorly understood. Therefore, this study aims to evaluate complications associated with perioperative dexamethasone administration during primary TJA in diabetic patients.

Scaphoid nonunions are a complex challenge that are frequently encountered by hand surgeons. Because of the tenuous blood supply of the scaphoid and secondary deformities that occur as a result of delayed or unsuccessful treatment, the treatment of scaphoid nonunions frequently requires the use of internal fixation and supplemental bone graft. There are multiple bone graft sources and techniques that can be employed based on the patient, the viability of the proximal pole fragment, and the presence of a deformity. Without osteonecrosis or disruption of the scaphoid blood supply, nonvascularized autologous grafts can be used from the distal radius, proximal ulna, or iliac crest. In cases where there is concern for an insufficient blood supply, vascularized bone graft sources can be employed, including pedicled local grafts and free flap grafts. When there is a nonviable and fragmented proximal pole, using osteochondral autografts has become increasingly used to reconstruct the scaphoid. Bone graft substitutes can additionally be used to supplement the fixation construct. This review focuses on the indications and role of bone grafts in scaphoid nonunions to help augment internal fixation, promote healing, and restore carpal alignment.