Critically sized bone defects remain a major challenge in orthopedic surgery. Conventional techniques, including the induced membrane technique, bulk allograft reconstruction, bone transport, and acute shortening, have inherent limitations. The advent of custom 3 dimensional printed implants has expanded reconstructive options, particularly in foot and ankle surgery. Patient-specific implant design enables more precise management of complex bone defects. Although long-term clinical data are limited, early outcomes are promising.

New technologies and artificial intelligence are a huge area for growth in the field of foot and ankle. New technologies in the foot and ankle specialty are growing, but most studies and practice applications are in their infancy. Patient-specific instrumentation is the most successful use of new technology in foot and ankle. Research models and clinical applications of artificial intelligence in the field of foot and ankle are becoming more common, but studies are still lacking.

Robotic-assisted surgery has gained prominence in orthopedic practice due to its precision, enhanced visualization, and minimally invasive nature. While robotic applications for orthopedic surgery are well established in arthroplasties, their use in soft-tissue surgery remains limited. This study presents the indications, technique, and clinical outcomes of robotic-assisted latissimus dorsi tendon transfers for shoulder reconstruction. The robotic approach allows accurate identification of the axillary and radial nerves, minimal soft-tissue trauma, reduced bleeding, and excellent cosmetic outcomes. The system's motion scaling and tremor filtration enhance precision. Robotic-assisted shoulder surgery is a safe and minimally invasive technique for tendon transfers around the shoulder.

Blood flow restriction therapy (BFRT) produces effects on muscle strength and size like those seen with high-resistance training for patients in whom baseline deficits or postoperative restrictions prevent high-intensity rehabilitation. Although most existing literature details lower extremity application, BFRT has shown beneficial effects on muscle hypertrophy, endurance, and strength in the upper extremity with a safe side-effect profile. Developing a universal protocol for upper extremity BFRT is challenged by the current lack of research, but it shows promise in playing a pivotal role in the rehabilitation and recovery of injured and postoperative patients across many populations.

Three-dimensional (3D) printing has made the leap from fringe technology to routine in orthopedic surgery. Anatomic models are easily produced from standard imaging. Patient-specific prints for surgical planning, cutting guides, and durable medical equipment now can be produced in-house. Custom patient-specific instrumentation and even implants are now routinely available through commercial suppliers. Advantages include decreasing operative time, reducing radiation exposure, and limiting complications in complex cases. Operating-room savings can easily offset the capital cost of printers. This review explores the current landscape of 3D printing for patient care in orthopedic surgery and guidance on a path toward hospital-based point-of-care printing.

Three dimensional (3D) printing has progressed from an expensive laboratory curiosity to an easily accessible technology and can now be used as a cost-effective clinical tool in orthopedics. Anatomic models are easily produced from standard imaging that can enhance teaching opportunities, patient education, and complex surgical planning. For a surgeon, printing their own models can seem out of reach for numerous reasons. This review helps orthopedic surgeons understand the technology underlying 3D printing and how to get started making their own 3D prints of patient imaging data for teaching, patient education, surgical planning, and research.

This article examines bone growth stimulators in orthopedic trauma, detailing their history from early electrical devices to modern ultrasound systems, mechanisms of action, and applications for fractures, nonunions, and specialized procedures. Pulsed electromagnetic field, capacitive coupling, combined magnetic field, direct current, and low-intensity pulsed ultrasound modalities have been shown to accelerate healing in acute and chronic cases, reducing complications in high-risk patients. Supported by clinical trials, these devices offer noninvasive and invasive options to improve outcomes and lower costs. Recommendations emphasize integration into trauma protocols, with future directions exploring combined therapies.

Kinematic alignment (KA) is emerging as an alternative to mechanical alignment (MA) in total knee arthroplasty and is designed to restore native prearthritic anatomy and minimize need for ligament releases. The learning curve remains poorly defined for fellowship-trained surgeons who were trained primarily in MA. Current evidence demonstrates that fellowship-trained MA surgeons can achieve proficiency comparable to experienced KA surgeons after 30 to 40 cases. Our institution documented the learning curve of a fellowship-trained MA surgeon's adoption of calipered KA using manual instrumentation along with 12 month patient-reported outcomes for comparison. Future studies can determine evidence-based guidelines.

Alternative alignment strategies in total knee arthroplasty, such as kinematic and functional alignment, are driving a new wave of implant and technology development. This article outlines areas where current designs fall short and explores innovations for improving patient-specific outcomes.

Rapidly evolving wearable devices have the potential to transform health care delivery and enhance outcomes. Applications of wearable smart devices range from activity and motion tracking to real-time monitoring of vital signs and biochemical markers. Recent evidence provides support for the use of wearable devices in chronic disease management, rehabilitation, and perioperative care of patients with total knee arthroplasty. Data derived from these devices may enhance treatment personalization and early identification of complications. Challenges remain regarding accuracy, standardization, privacy, and patient adherence. Future advances must overcome these limitations.

The case of a sternal injury in an adolescent who went on to develop painful arthritis of the manubriosternal joint is presented. This was treated with plating and arthrodesis of the arthritic joint with the assistance of the general surgery team.

Iliac crest enthesopathy is an uncommon cause of function-limiting lateral hip pain with limited literature addressing its diagnosis and management. We present a case series of 8 adult patients with iliac crest/proximal gluteal pathology (6 degenerative, 1 posttraumatic, and 1 neoplastic) that highlights diagnostic challenges in this region. Our cases demonstrate the utility of musculoskeletal ultrasonography in both diagnosis and treatment of iliac crest enthesopathy. After reviewing relevant literature, we describe a novel ultrasound-guided surgical approach used in 5 patients in whom conservative therapies failed. This technique offers a minimally invasive alternative for managing recalcitrant iliac crest enthesopathy.

The Zadek osteotomy, also known as a dorsal closing wedge calcaneal osteotomy, is a surgical procedure used to treat insertional Achilles tendinopathy and Haglund's deformity when conservative management fails. This procedure aims to reduce the bony prominence at the heel and to relieve Achilles tendon impingement to improve function and decrease pain. Recent innovations in minimally invasive/percutaneous approaches have enhanced outcomes while minimizing complications. Clinical and radiographic evaluation aids in diagnosis and surgical planning. Literature consistently demonstrates improved pain scores, functional outcomes, and high patient satisfaction following Zadek osteotomy.