The author's present a case with supporting evidence- based evaluation and management of a 31-year-old right-hand-dominant healthy man presenting with a chief complaint of pain, numbness, and loss of strength in the distal left upper extremity over a 24-hour period. The patient reported an occupation-related injury, after lying on his left side for several minutes at a time, while performing maintenance of an aircraft fuselage. Initial evaluaton and management was differentiated as an acute radial nerve compressive inury causing a characteristic “wrist drop,” of the affected extremity. The incidence of radial nerve injury is relatively high in contrast to its adjacent peripheral nerves of the upper extremity. An anatomical vulnerability exists at the level of the cervical spine and along the humeral diaphysis promoting compression pathology. The author's contend that with a high index of suspicion based on history, detailed and focused examination, radial nerve injuries resulting in acute neuropraxia can be managed conservatively with reasonable return to baseline function.
Postoperative pain management in orthopedic surgery is vital for patient recovery yet challenging, given the high pain experienced by patients and variable prescribing patterns for opioids. Enhanced Recovery After Surgery (ERAS) protocols emphasize a multimodal, opioid-sparing approach; however, options are currently limited to primarily acetaminophen and nonsteroidal anti‑inflammatory drugs (NSAIDs). Suzetrigine (VX-548), recently approved by the FDA and marketed under the brand name Journavax, represents an innovative approach to pain management. Suzetrigine is a novel, peripherally selective sodium channel inhibitor targeting NaV1.8. Clinical trials have shown analgesia through Suzetrigine that is comparable with opioid therapy while maintaining a favorable safety profile and no evidence of abuse potential. This narrative review evaluates the existing framework for orthopedic pain management, examines the mechanism of action and clinical data for Suzetrigine, and assesses its potential integration into ERAS pathways with a focus on clinical efficacy and implementation feasibility.
In severe distal tibia, ankle, and foot trauma, decisions between limb salvage and amputation are governed primarily by systemic physiology, injury burden, and patient capacity to tolerate reconstruction, rather than limb anatomy alone. Advances in orthoplastic and microsurgical techniques have expanded salvage options, but critical illness, microcirculatory dysfunction, sepsis, and vasopressor dependence impose firm limits on reconstructive success. Traditional mangled extremity scoring systems lack sufficient sensitivity in contemporary practice and should function as adjuncts to clinical judgment rather than definitive decision tools. Large prospective cohorts demonstrate comparable long-term functional, quality of life, and psychological outcomes between salvage and transtibial amputation, with mortality driven by associated injuries rather than limb management strategy. Optimal outcomes depend on multidisciplinary coordination, judicious use of time-limited salvage trials, and shared decision-making that transparently weighs operative burden, rehabilitation trajectory, costs, access to care, and patient priorities.
This integrative review evaluates the effectiveness of platelet-rich plasma (PRP) injections in treating patients with chronic pain secondary to osteoarthritis (OA). A comprehensive review was performed, incorporating 13 peer-reviewed clinical trials, systematic reviews, and meta-analyses evaluating PRP for OA treatment. These studies focused primarily on comparing the efficacy and safety of PRP to other forms of analgesia and the effects of these medications on disease progression. Evidence suggests that PRP injections provide clinical benefit in patients with mild to moderate OA. Some studies demonstrate superior or comparable efficacy compared with other common forms of OA analgesia, including corticosteroid injections, hyaluronic acid injections, and nonsteroidal anti-inflammatories. PRP may additionally have disease-modifying effects to reduce the loss of cartilage in patients with OA, although this has not been definitively established. In addition, a reduction in analgesic burden after injection of PRP has not been demonstrated. Limitations remain in the study of PRP efficacy to include selection bias, short-term studies, inconsistent formulations of PRP, and differing injection techniques. Future research should focus on eliminating these limitations to allow for more certain recommendations regarding PRP injections. After over a decade of use, PRP injections remain a reasonable alternative for treating patients with OA but not a definitively better one.
» Both medial patellofemoral ligament reconstruction (MPFLR) and medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) reliably restore patellar stability, with low redislocation rates and comparable improvements in patient-reported outcomes when performed with anatomic technique and appropriate graft tensioning. » MQTFLR avoids patellar drilling and may more closely reflect native medial patellofemoral complex anatomy, making it an attractive option in skeletally immature patients, individuals with compromised patellar bone stock, and select revision settings. » Biomechanical studies demonstrate that MQTFLR more closely reproduces native patellofemoral kinematics, while MPFLR may introduce mild medial overconstraint when femoral fixation is nonanatomic or graft tensioning is excessive, although these differences have not translated into consistent clinical outcome disparities. » Combined MPFL-MQTFL reconstruction distributes medial restraint across proximal and distal components of the medial patellofemoral complex but has not consistently demonstrated superior clinical outcomes compared with isolated reconstruction and introduces additional operative complexity. » Optimal surgical outcomes depend more on patient selection, accurate femoral fixation, and appropriate graft tensioning than on the specific choice of patellar-based versus quadriceps-based fixation, emphasizing individualized decision making based on anatomy, skeletal maturity, and clinical context.
The purpose of this review was to examine the risk factors associated with ulnar collateral ligament (UCL) injuries in high-level baseball pitchers and to provide a comprehensive analysis of both nonsurgical and surgical treatment options. Particular emphasis is placed on recent advancements in surgical management of UCL injuries. As medical knowledge and surgical technology continue to evolve, novel techniques have emerged with the potential to optimize return-to-play timelines for competitive athletes while reducing intraoperative and postoperative morbidity. This review compares established reconstructive procedures—including the Jobe, modified Jobe, and docking techniques—with the more recently developed UCL repair with internal brace augmentation. The goal is to evaluate the advantages and limitations of each approach and to provide an in-depth review of both nonsurgical and surgical treatment options in the context of individual player characteristics, specific UCL injury patterns, and surgeon expertise.
Case: A 3-year-old previously healthy girl presented with persistent leg pain following conservative treatment of a nondisplaced distal femur fracture and was found to have symptomatic scurvy and multinutrient deficiency secondary to food selectivity. Following nutritional repletion and iron supplementation, the patient experienced full resolution of symptoms with return to normal activities without residual musculoskeletal complaints. Conclusion: This case demonstrates the importance of considering systemic and nutritional conditions, particularly vitamin C deficiency (scurvy), when evaluating patients with persistent musculoskeletal complaints. Early recognition may enable timely medical treatment of these often-reversible conditions.
Relative Energy Deficiency in Sport (REDs) is a syndrome that negatively affects athletes and can have long-term consequences. REDs is characterized by physical and psychological dysfunction that is caused by problematic low energy availability. One of the most detrimental effects of REDs is low bone mineral density (BMD), which can lead to stress fractures, decreased performance, and osteoporosis. Resistance training is known to provide osteogenic stimulus and is commonly prescribed in the management and prevention of osteoporosis. There is no standard screening or management of REDs, including a lack of protocols for prescribing resistance training, making identification and treatment difficult. This review examines the effect of resistance training on BMD in male athletes who are at risk of developing REDs. Evidence suggests that resistance training may improve or preserve BMD in this population, but further studies are needed to determine optimal training protocols and to establish the safety and efficacy of resistance training as part of REDs management.
Calcific tendinopathy is a condition marked by the deposition of hydroxyapatite crystals within tendons. Although it most frequently affects the rotator cuff tendons, cases involving the lower extremities are exceedingly rare, with no documented cases involving the semimembranosus in the literature. A 41-year-old man presented with 2 years of nontraumatic, medial knee pain, catching, and tightness. Clinical examination revealed localized tenderness over the posterior medial knee with no laxity or reproduced pain with provocative maneuvers. Radiographs and magnetic resonance imaging confirmed a calcific deposit at the semimembranosus tendon. The patient had attempted over-the-counter anti-inflammatories and stretches. Corticosteroid injection was performed under ultrasound guidance with resolution of symptoms at 2 and 6 weeks follow-ups. Based on review of literature, this is the first reported case of semimembranosus calcific tendinopathy and thus should be considered in the differential diagnosis of posteromedial knee pain. Ultrasound-guided corticosteroid injections can be effective in confirming the diagnosis and treatment of semimembranosus calcific tendinopathy.
Ankle fractures are among the most common orthopaedic injuries, frequently necessitating surgical intervention to restore joint alignment and function. Although open reduction and internal fixation (ORIF) with plates and screws has traditionally been the gold standard, it is associated with notable postoperative complications—particularly in patients with multiple comorbidities or compromised soft tissue. Intramedullary (IM) fibular nails have emerged as a minimally invasive alternative, offering comparable biomechanical stability with reduced complication rates, expedited recovery, and increasing cost-effectiveness. This report reviews the clinical rationale and evolving role of fibular IM nails, with particular attention to the Arthrex FibuLock system. We also present a case involving a 50-year-old woman with a trimalleolar Weber B ankle fracture treated successfully using a combination of IM nailing and ORIF, highlighting the technique’s utility in achieving anatomic reduction and stable fixation. This educational resource is intended to inform orthopaedic physician assistants about the expanding role of fibular IM nails in contemporary ankle fracture management.
Turf toe is a sprain of the first metatarsophalangeal (MTP) joint caused by hyperextension of the great toe, commonly seen in athletes. This injury results from repetitive or forceful dorsiflexion when the forefoot is planted and the heel elevated, leading to damage of the plantar capsuloligamentous structures. The clinical presentation includes pain, swelling, and decreased push-off strength, which can impair athletic performance. Risk factors include playing surface, footwear, position-specific movements, and previous injury. Diagnosis relies on clinical examination and imaging modalities such as x-ray and magnetic resonance imaging. Management is primarily nonoperative for Grades I and II injuries, involving rest, immobilization, and rehabilitation. Grade III injuries may require surgical intervention to restore joint stability. Outcomes are generally favorable with appropriate treatment, but severe cases may lead to chronic joint dysfunction or even career-ending complications. Continued advancements in turf technology, footwear design, and surgical techniques offer hope for better prevention and management of this debilitating injury.
Osteochondral defects (OCDs) represent a major concern for high-level running and jumping athletes, often leading to significant knee injuries. If left untreated, large OCDs can progress to osteoarthritis, making it imperative for effective repair to restore the knee to its pre-injury state. This article offers a comprehensive review of osteochondral defects, including their etiology, specifically how different injury mechanisms contribute to their development. It also delves into the classification of the defect and categorization by the extent, depth, size, and location of the defect. While surgical intervention is often the best approach for managing most OCD lesions and optimizing patient outcomes, the surgeon must consider the patient’s individual goals. One must evaluate the cost-effectiveness of surgery, anticipated rehabilitation and recovery time, and the patient's desired postoperative activity level. Evidence suggests that small, favorably located, and early-diagnosed defects respond best to early treatment. Despite various treatment approaches, there is currently no “gold standard” surgical technique, which remains an active area of ongoing research and debate. Further research should focus on identifying the optimal surgical procedure for patients who aim to return to high-level athletic activity after their injury.
Health literacy (HL) is a multidimensional construct influencing patients' ability to access, understand, and use health information. In certain clinical contexts, higher HL has been linked to improved treatment decision making and outcomes. Its role in patients with spinal complaints remains underexplored. We aim to systematically review existing literature examining the association between HL and treatment selection and outcomes in adult patients presenting with spinal complaints. Comprehensive literature search of PubMed, Embase, CINAHL, Web of Science, and Google Scholar (January 2005-June 2025) was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Inclusion required use of validated HL assessment and reporting of treatment selection or outcome data. Risk of bias assessed with the Joanna Briggs Institute checklist. Certainty of evidence evaluated using GRADE. Three cross-sectional studies met inclusion criteria. Higher HL was associated with reduced surgical acceptance and increased second opinion seeking. Adequate HL was linked to greater medication adherence and follow-up in one study. No significant association was found between HL and postoperative drug-related problems. Educational attainment correlated with HL but did not fully account for differences. Racial and ethnic data were not reported. Higher HL may influence treatment selection in spinal care by reducing surgical acceptance and promoting active decision making. Evidence for HL's impact on treatment adherence and outcomes is limited and mixed. The small number of studies, cross-sectional designs, and lack of diverse samples limit generalizability. Future longitudinal and interventional studies should clarify HL's role in spinal treatment pathways and inform the development of HL-sensitive interventions.
Throughout the years, unicompartmental knee arthroplasty has proven to be a reliable and successful treatment option for patients who suffer from unicompartmental osteoarthritis of the knee joint. Shorter length of hospitalization, decreased intraoperative blood loss, reduced postoperative pain, and an expedited recovery time are some of the advantages that this surgery poses over more commonly used treatment options such as a total knee replacement. This article explores the relevant anatomy, biomechanics, clinical assessment, indications, contraindications, postoperative management, and clinical outcomes as well as complications of this procedure that have been documented within the current medical literature.
Medial humeral epicondyle fractures are relatively common adolescent injuries and account for 10% to 20% of elbow injuries in that age group. The 2 most common surgical techniques are use of cannulated screws and K-wires. While those techniques have high-fracture union rates, K-wires must be removed and cannulated screws can potentially cause painful hardware, which may require subsequent removal. A retrospective cohort study was performed over a recent 2-year span, analyzing 4 teenagers who had displaced or incarcerated medial humeral epicondyle fractures. Every fracture was stabilized with small low-profile all-suture anchors. Postoperatively, all 4 patients had full bony union with excellent range of motion, strength, and Broberg and Morrey scores. Use of small all-suture anchors is a great alternative surgical option for medial epicondyle humeral fractures. Results show no hardware pain necessitating removal and no metallic implant to interfere with future magnetic resonance imaging.
Case: A previously healthy 3-year-old nonverbal boy presented with a 4-day history of hesitancy in gait progressing to refusal to bear weight. Initial emergency department workup was inconclusive. Empiric vitamin C was administered, and a subsequent vitamin C level was undetectable, confirming the diagnosis of scurvy. Conclusion: Scurvy should be considered in the differential diagnosis of a pediatric patient presenting with an abnormal gait. Empiric vitamin C administration is inexpensive and carries minimal risk. Timely diagnosis is critical for minimizing healthcare utilization and mitigating the risks associated with imaging and invasive procedures, as was demonstrated in this case.
Distal radius fracture (DRF) is the most common fracture among pediatric patients, usually occurring after a fall onto an outstretched hand. The growing incidence of DRFs highlights the need to explore improved treatment methods to ensure proper healing and realignment. Current immobilization methods are inconsistent and have negative impacts on patient satisfaction. Drawbacks of fiberglass casts include thermal injuries, discomfort, and increased risk of skin infection. Although prefabricated splints have less downsides than fiberglass casts, skin irritation and odor are still a concern. 3D-printed orthoses present a viable alternative to traditional immobilization methods for DRFs, especially in the pediatric population. By scanning the fractured radius, the orthosis is tailored specifically to the patient's anatomy. 3D-printed orthoses are water resistant, breathable, and tend to weigh less. As a result, they offer improved hygiene, comfort, and patient satisfaction while reducing complications seen with more traditional methods of immobilization. Preliminary research suggests that 3D-printed orthoses are as effective as traditional immobilization methods in pediatric patients with DRFs. However, additional studies are needed to further assess the patient satisfaction, compliance, and durability of 3D-printed orthoses compared with traditional immobilization methods in the pediatric population.
Background: Electronic medical record (EMR) Inbasket management is a routine part of modern healthcare including direct access to providers from patients. We aimed to determine the quantity and time spent with direct Inbasket management tasks by subspecialty advanced practice providers (APPs) at an academic medical center. Methods: In a cohort review of four orthopedic surgery APPs at an academic medical center, each were asked document the time spent on the most common tasks encountered in our EMR system over a 6-week span in 2023 during the 5-day workweek. Providers would log the quantity of tasks and the time spent on each task in real time and would be averaged weekly. Minimum of three weeks of tasks were requested to be part of the investigation. Results: Four providers met inclusion criteria. Providers averaged 102.8 tasks per week. Messages sent to administrative assistant regarding patient care coordination accounted for the highest number of tasks per week (24.6). Patient advice requests (via InBasket) (24.3) and test results reviewed with patients on the phone (23.6) accounted for the second and third highest tasks performed. Reviewing test results accounted for the most amount of time spent at 83.6 minutes per week. “Other” tasks accounted for the second most at 79.7 minutes, and patient advice requests at 48.2 minutes at third. In total, providers spent an average of 356.8 minutes per week on tasks (5.9 hours). Conclusions: Advanced practice providers in a surgical subspecialty spend nearly 6-hours per week on administrative patient care tasks. This should be considered when evaluating a providers objective output as well as consideration of various employment positions. Clinical Relevance: There is no significant data in publication to reference the quantity of “non-RVU” generating tasks that various healthcare providers. This evaluation provides some level of reference for healthcare professionals including provider and administrator. Level of Evidence: IV.
Case: A 51-year-old White woman with rheumatoid arthritis presented to the ED with right knee pain. She was initially discharged with steroids and anti-inflammatory medicines. On her third ED visit, knee arthrocentesis showed synovial white blood count (WBC) of 18,800 E9/L, 90% neutrophils, calcium pyrophosphate deposition (CPPD) crystals, and Serratia marcescens in cultures. Arthroscopic irrigation and debridement were performed. She was given IV antibiotics and discharged on postoperative day 5. This case expands the diagnostic challenge posed by dual diagnosis—CPPD masking or complicating the recognition of septic arthritis.
Hemiarthroplasty (HA) has been the traditional gold standard for managing displaced femoral neck fractures (DFNFs) in elderly patients, offering satisfactory functional outcomes with lower technical demands. However, total hip arthroplasty (THA) has emerged as an alternative because of its superior long-term function, despite concerns regarding higher early dislocation rates. This review evaluates the comparative outcomes of HA and THA in patients aged 70 years or older to guide optimal treatment selection. A systematic review of PubMed, Embase, and MEDLINE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing HA and THA in patients aged 70 years or older with DFNFs were included. Data extraction focused on functional outcomes, dislocation rates, revision rates, operative time, blood loss, length of stay, infection, and mortality. Risk of bias was assessed using the Cochrane RoB-2 tool and Methodological Index for Non-Randomized Studies criteria. Five studies (2 RCTs and 3 retrospective cohorts) comprising 661 patients (346 HA and 315 THA) met the inclusion criteria. Functional outcomes, primarily assessed by the Harris Hip Score, favored THA at long-term follow-up, although one study found no difference at 12 years. Dislocation occurred exclusively in THA patients (0-9.1%), with higher rates associated with the posterior approach. Revision rates varied, with one randomized controlled trials reporting a higher reoperation rate for HA, whereas another found no significant difference. THA was associated with longer operative times (14-28 minutes) and greater blood loss (170 mL higher on average). Length of stay findings were inconsistent. Infection rates were low (0-3.6%), and mortality rates showed no significant difference, although long-term follow-up revealed high overall mortality (23.3%-76.6%). Although THA provides superior function in elderly patients with DFNFs, it carries increased early complications, particularly dislocation risk. Patient selection should be individualized, considering frailty, mobility, and surgical risk. Additional high-quality RCTs are needed to clarify the optimal treatment strategy for functionally active elderly patients.
