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.

Metacarpophalangeal (MCP) joint arthritis leads to significant limitation in hand function in many adults. Current options for surgical management include silicone, pyrocarbon and resurfacing arthroplasties, or interposition techniques. While overall many patients have improved pain and some function with current modalities, there are many complications. We describe a novel technique for MCP arthroplasty utilizing a custom acellular dermal allograft implant, which we believe to have properties that can improve implant failure rates. We describe a case for proof of concept of our technique and discuss its potential for improved hand function and pain relief, particularly in higher demand patients.

Upper-extremity conditions, including carpal tunnel syndrome, de Quarvians disease, trigger finger, and joint laxity, are common during pregnancy and are related to hormonal fluctuations and fluid shifts. These conditions generally respond well to conservative management with medications, bracing, and corticosteroid injection. However, surgery should be offered during pregnancy if nonoperative treatment fails. Regional and local anesthesia decreases fetal anesthetic exposure, minimizes airway issues, and assists postoperative pain control. Pregnant patients with trauma should be evaluated for extremity injury, and appropriate imaging should be obtained while minimizing pelvic radiation exposure. Surgical management should include fixation techniques with minimal radiation exposure.

Three dimensional (3D) surgical planning and patient-specific instrumentation (PSI) are transforming pediatric orthopedic surgery by directly enabling visualization and precise correction of complex limb deformities, among other indications. This article reviews the current applications, outcomes, workflow, and regulatory context for 3D technology in pediatric orthopedics. We also present a case demonstrating successful ankle reconstruction using 3D-printed PSI in a child with severe tibial deformity. With growing evidence and implementation, 3D planning is already becoming integral to pediatric limb reconstruction.

Posttraumatic osteoarthritis is one of the most common complications following open reduction and internal fixation of acetabular fractures. Total hip arthroplasty is a well-accepted option for posttraumatic arthritis in the setting of previously treated acetabular fractures. However, the incidence of acetabular fractures continues to increase in the aging population. This poses challenges including osteoporosis and the emphasis on early mobilization. Questions remain regarding the major differences in outcomes of delayed total hip arthroplasty versus acute "fix-and-replace." This review aims to compare outcomes between these treatment algorithms for displaced acetabular fractures.

With an expanding volume of primary and revision knee arthroplasty cases, techniques to successfully navigate the challenges of a complex operation are necessary. Adequate exposure is needed to execute the planned arthroplasty. An algorithmic approach should be utilized to assist in the exposure of knees with a limited range of motion. This approach offers a stepwise sequence, with successive maneuvers indicated by the need for further exposure: medial parapatellar arthrotomy with wide synovectomy, quadriceps snip, then tibial tubercle osteotomy. The V-Y turndown, femoral peel, and "banana peel" are historical techniques not routinely utilized as part of the exposure sequence.

Gluteal tendon tears are an increasingly recognized source of laterally based hip pain. These tendon tears are typically degenerative in nature and require careful history, physical examination, and imaging interpretation for accurate diagnosis. After a trial of nonoperative management, open or endoscopic repair can predictably improve pain, though expected functional improvement is correlated to the degree of preoperative muscle atrophy. The authors advocate for an open double-row suture technique to reliably visualize the full extent of the tear, restore the anatomic footprint of the avulsed tendons, and achieve stable fixation.

The management of mangled extremities has long produced contention among the orthopedic surgery community due to the complexity of injuries and difficulty predicting postoperative outcomes for limb reconstruction and amputation. This review discusses reliable prognostic indicators as well as socioeconomic factors that can drastically alter the feasibility and burden of various treatments for mangled lower extremity patients and treating surgeons. This review emphasizes an integrated, multidisciplinary approach to mangled extremity management, allowing for efficient utilization of resources and prompt stabilization and fixation for patients. The guidelines detailed in this review may expedite clinical decision-making and improve outcomes for future patients.

The management of mangled extremities has long produced contention among the orthopaedic surgery community due to injury complexity and difficulty predicting postoperative outcomes for limb reconstruction and amputation. This review discusses a series of reliable prognostic indicators and socioeconomic factors that can drastically alter the feasibility and burden of various treatments for mangled lower extremity patients and treating surgeons. This review emphasizes an integrated, multidisciplinary approach to mangled extremity management, allowing for efficient utilization of resources and prompt stabilization and fixation for patients. The guidelines detailed in thie review may expedite clinical decision-making and improve outcomes for future patients.

Return to sport (RTS) after shoulder stabilization surgery is a critical milestone for athletes. However, emerging evidence supports a shift toward objective, individualized assessments. This article reviews evidence-based RTS criteria, emphasizing the role of range of motion, strength, stability, and power metrics in optimizing recovery and minimizing reinjury risk. Functional testing using dynamometry, force plates, and velocity tracking provides measurable benchmarks to assess readiness. Despite advancements, no universal RTS guidelines exist, and variability persists across institutions. By integrating sport-specific functional testing with biologic healing considerations, clinicians can enhance decision-making, ensuring athletes return to play safely and effectively.

Proximal humerus fractures occur frequently, especially in the aging population, and require a tailored approach considering patient-specific factors like age, activity level, and comorbidities. While nonoperative treatment is common, surgical options such as open reduction internal fixation, reverse total shoulder arthroplasty (rTSA), and hemiarthroplasty are available based on fracture complexity and patient needs. Recent studies highlight the potential benefits of acute rTSA over delayed procedures, emphasizing improved outcomes in range of motion and reduced complications. Treatment choice should align with the patient's functional goals and lifestyle, ensuring optimal recovery and satisfaction.