The purpose of this study is to compare intramedullary headless screw (IMN) versus plate and screw fixation (open reduction internal fixation [ORIF]) in metacarpal (MC) fractures, specifically looking at implant cost, operating room time, outcomes, and complications. We hypothesize that IMN will provide at least equivalent outcomes and complication rates compared with ORIF while simultaneously decreasing operating room time and lowering overall costs.

With increasing orthopaedic surgical demand, the importance of operating room (OR) efficiency and safety is paramount. However, there is a lack of research regarding the effect of OR and staff workflow factors on postoperative outcomes. The purpose of this study was to evaluate the effect of OR workflow on outcomes after elective cervical fusion, with a focus on inpatient complications and discharge disposition.

Despite the resurgence of noncemented total knee arthroplasty (TKA) following implant advancements in recent years, instances of greater postoperative pain remain a common finding compared with TKAs with cemented fixation. Newer noncemented designs have become appealing to younger, heavier, and active patients, with appropriate bone stock.

This study aimed to evaluate the clinical outcomes and complication rates after reverse total shoulder arthroplasty (RTSA) with lateralized implant for patients with high-grade fatty infiltration (FI) of posterior rotator cuff including infraspinatus (ISP) and teres minor (TM).

Injuries to the rectus femoris (RF) are an infrequently reported injury and can range from mild muscle strains to full tears, including injuries to the proximal and distal tendons of the RF. Patients often present with anterior thigh pain sustained after kicking or sprinting and describe a sudden "pop" in their thigh. Magnetic resonance imaging is the preferred modality for diagnosing the location, type, and severity of pathology. To date, there is no current treatment algorithm developed for managing these injuries. Nonsurgical management consists of rest, stretching, anti-inflammatory medications, gradual strengthening, and progressive functional rehabilitation before returning to activity. Injection therapy is sometimes used as well. Surgical treatment has typically been reserved for full-thickness muscle tears and tendon avulsions in high-level athletes. The literature has demonstrated that elite athletes have a high return to sport rate and do not have long-term effects. This review seeks to discuss the epidemiology, pathology, and outcomes of injuries to the RF muscle. Injuries to the quadriceps muscle in general are outside of the scope of this review.

Endoscopic spine surgery (ESS) represents a development in minimally invasive procedures, offering the potential benefits of reduced tissue disruption, shorter recovery times, and enhanced precision. This review traces the historical development of ESS, explores its core techniques-including transforaminal, interlaminar, and biportal approaches-and evaluates its role in treating conditions like herniated disks and spinal stenosis. By comparing clinical outcomes of ESS with standard open surgery, this article highlights the importance of patient selection, surgeon expertise, and evidence-based practice. Challenges, such as the steep learning curve, limitations in visualization, and risk of complications, are discussed, along with strategies for integrating ESS into modern spine care. The review concludes by identifying research gaps and opportunities for technological advancements, aiming to guide surgeons in adopting ESS and improving patient outcomes.

Femoral neck fractures are common geriatric fractures, with an incidence of approximately 500 per 100,000 people. Utilization rates of cemented femoral components in the treatment of geriatric femoral neck fractures are markedly lower in the United States relative to other Western countries. Surgeons may feel uncomfortable cementing femoral components secondary to a lack of experience or training, increased surgical time, concern for cardiopulmonary injury secondary to bone cement implantation syndrome, and/or concerns for increased rates of perioperative morbidity or mortality. This review covers contemporary data on the use of cemented femoral components for geriatric femoral neck fractures, preoperative considerations when using a cemented femoral implant, intraoperative techniques and communication, and how to avoid/mitigate acute medical complications during cementing.

A recent survey found that 68% of women reported experiencing sexual harassment (SH) during their orthopaedic training. This study aims to (1) characterize Title IX understanding; (2) describe SH occurrences, subtypes, and reporting rates; (3) evaluate the impact of Title IX understanding on SH reporting; and (4) compare these findings by level of training.

Anterior knee pain, with varus deformity and excessive external tibial torsion, can markedly impair function and quality of life. Although various surgical techniques address these deformities, dome-shaped osteotomy offers a promising approach for correcting malalignment while preserving joint integrity. This study evaluated clinical and radiological outcomes of dome-shaped osteotomy in patients with these combined deformities.

Many orthopaedic foot and ankle (FA) procedures require substantial technical expertise, yet the adequacy of their compensation remains largely unexplored. This study evaluates whether orthopaedic FA surgeries are fairly compensated compared with other orthopaedic procedures.

Distal femur fractures are commonly treated with retrograde intramedullary nails or lateral locked plates. Although enthusiasm is growing for dual-implant constructs, most fractures are still treated with a single implant, though it remains unclear whether one implant type offers superior outcomes. This study compared revision surgery rates as well as clinical and radiographic outcomes between matched cohorts of distal femur fractures treated with intramedullary nails or lateral plates.

Postoperative urinary retention (POUR), the inability to urinate spontaneously after surgery, affects up to 43% of orthopaedic patients and can lead to pain, bladder injury, urinary tract infections, increased healthcare costs, and delayed rehabilitation. POUR arises from decreased neurologic signaling, reduced bladder sensation and contractility, or mechanical obstruction. Risk factors include advanced age, prior urinary retention, comorbidities (eg, benign prostatic hyperplasia, diabetes, renal dysfunction), anesthesia type, perioperative opioid use, and catheterization. Despite its prevalence, standardized management approaches for POUR are lacking within orthopaedic literature. We propose a structured, evidence-based protocol to be used by orthopaedic surgeons that is centered on specific time and bladder volume thresholds to guide interventions including noninvasive techniques to promote spontaneous voiding, bladder scans, straight catheterization, placement/removal of indwelling catheters, and urology consultation for persistent POUR. The protocol aims to reduce complications, such as infections and bladder injury, by addressing patient- and procedure-specific risk factors, particularly in high-risk groups such as pediatric patients with neuromuscular conditions and geriatric patients undergoing hip fracture fixation.

Patients with complex anatomy and osseous deformity undergoing primary and revision total shoulder arthroplasty can pose challenges to surgeons and render off-the-shelf implants insufficient. The advent of three-dimensional printing has enabled the emergence of patient-specific instrumentation and custom implants which offer tailored solutions to address each patient's unique anatomy. This article examines the principles, indications, and clinical outcomes of patient-specific instrumentation and custom implants in total shoulder arthroplasty.

Reverse total shoulder arthroplasty (rTSA) is a feasible reconstruction technique for proximal humerus tumors and can be combined with allograft-prosthetic composite (rTSA-APC) for extensive lesions. We assessed postoperative complications and functional outcomes after rTSA with and without allograft prosthetic composites for oncologic indications, comparing them with a matched nononcologic cohort.

Volar plate fixation is a common surgical fixation method for distal radius fractures. The aim of the study was to perform a large-scale quantitative analysis of intact distal radius anatomy to (1) investigate the demographic and anatomical factors associated with lengths of locking screws for volar plate fixation and (2) determine the optimal screw distribution in a single-use distal radius set for the overall patient cohort, ensuring inclusion of all necessary screws while minimizing waste.

Limited data exist regarding whether Broström with InternalBrace augmentation bolsters ankle stability compared with nonaugmented Broström. Our study aims to determine whether augmented Broström produces greater stability measured by Cumberland Ankle Instability Tool (CAIT).

Shoulder injuries can pose as a diagnostic challenge for clinicians. Owing to the wide variety of pathologies and the fact that they frequently coexist, diagnosis can be difficult. Accurate diagnosis and management not only require a thorough understanding of each condition but the ability to narrow down the broad differential through detailed physical examination. This review article provides an in-depth examination of common shoulder conditions and outlines key physical examination techniques for upper extremity surgeons and other clinicians who manage these conditions. It begins by providing an up-to-date overview of the various pathologies that affect the shoulder girdle, including rotator cuff tears, quadrangular space syndrome, labral instability and glenohumeral bone loss, adhesive capsulitis, superior labral and biceps pathology, thoracic outlet syndrome, acromioclavicular joint degeneration, and glenohumeral osteoarthritis. This review then discusses key physical examination aspects, such as the history of present illness, cervical spine evaluation, range of motion assessment, strength testing, and shoulder girdle-specific maneuvers. This comprehensive review highlights the importance of a thorough understanding of shoulder physical examination and special diagnostic tests, emphasizing history-taking and examination to ensure diagnostic accuracy and optimize patient outcomes for surgeons.

Psychiatric disorders are known risk factors for complex regional pain syndrome (CRPS), but little is known about psychiatric outcomes after CRPS type I. This study investigates the development of psychiatric conditions after CRPS type I diagnosis in patients with surgically treated long-bone fractures.

Elbow fractures and fracture-instability injuries are increasingly prevalent. Gaining adequate exposure to the joint surface poses considerable challenges due to the unique articular anatomy and intricacies of the neurovascular structures traversing the elbow. Laterally, the radial head and capitellum are accessed through a classic Kocher or variations of the Kaplan technique. Posteriorly, the distal humerus is exposed by retracting the extensor mechanism through triceps split, reflection, or olecranon osteotomy. The medial approach may expose the coronoid through or around the flexor carpi ulnaris while protecting the ulnar nerve. The anterior elbow is approached by splitting brachioradialis and biceps, but extensile measures are limited. With increasing fracture complexity, posterior approaches are popular due to the access of medial and lateral columns of the distal humerus. Management of the triceps varies by surgeon preference and the need for articular exposure. More extensile techniques with lateral ulnar collateral ligament release provide near-total visualization of the articular surface. In addition, arthroscopic-assisted fracture fixation is an available adjuvant to provide minimally invasive access to the joint. Because of the complexity of elbow anatomy with limited global access, surgeons' familiarity with classic, extensile, and combined exposures is necessary to facilitate surgical reconstruction.

Minimizing postoperative complications is imperative to improving patient outcomes. The purpose of this investigation is to develop machine learning (ML) models that can predict complications following open reduction and internal fixation of ankle fractures and compare them with legacy indices.