As the number of upper extremity arthroplasty procedures increases, the incidence of periprosthetic upper extremity fractures is expected to rise. It is important to evaluate the approach to the workup and management of periprosthetic shoulder and elbow fractures, along with technical considerations Recent evidence regarding the management of these injuries should be reviewed.
The recent legalization of cannabinoids across the United States, both recreationally and medically, has presented an opportunity for cannabinoids to be used for a wide array of medical applications, most notably as an alternative to opiate pain medication. Despite this changing landscape and the growing cultural attention, much is still unknown about cannabinoids and their effect on the human body, specifically in the orthopaedic patient. There is basic science evidence that cannabinoids can positively affect bone metabolism; however, clinical studies are lacking to validate this. Moreover, clinical studies that have examined the effect of cannabinoids on orthopaedic outcomes are primarily retrospective database studies and have yielded conflicting results. Thus, despite growing usage of cannabinoids by patients and even some clinicians, substantiating evidence is lacking. The onus is on medical professionals and researchers alike to produce high-level evidence before any strong conclusions or clinical recommendations can be made.
Middiaphyseal clavicle fractures are prevalent in children and adolescents, and they are typically treated nonsurgically because of their strong bone-healing capabilities. However, increasing trends toward surgical intervention in adult patients have sparked debate over whether younger populations could experience similar benefits from the surgical approach. Recent studies have suggested that surgical fixation may offer quicker pain relief and faster recovery, particularly in adolescents and specific fracture cases involving severe displacement or complications. However, despite these potential short-term benefits, there are no long-term differences in patient-reported function and satisfaction between surgical and nonsurgical treatment. The decision to perform surgery should be individualized, balancing potential complications against possible improvements in early recovery. Ultimately, nonsurgical management remains the standard, with surgical intervention reserved for select cases and determined collaboratively between families and health care clinicians.
Tibial shaft fractures are common injuries in children and may occur as a result of trauma, sports-related activity, or falls. Casting has historically been considered the gold standard form of treatment; however, the inherent risks associated with casting, such as malunion and prolonged immobilization, have led to a rise in surgical techniques to treat these injuries. Minimally invasive, elastic stable intramedullary nailing is commonly used, whereas rigid intramedullary nailing is better suited for older children. Patients with complex fractures and severe soft-tissue injury or bone loss are treated with external fixation, whereas plate fixation is reserved for specific fracture patterns not amenable to intramedullary fixation. There is ongoing debate regarding the ideal pediatric and adolescent tibial shaft fracture management algorithm. It is important to assess changing treatment paradigms, comparing the surgical stabilization options and making evidence-based recommendations tempered by the authors' experience.
As the field of pediatric sports medicine continues to evolve, there are several advances in the management of anterior cruciate ligament tears, tibial spine fractures, juvenile osteochondritis dissecans, and patellar instability. The role of limb alignment and guided growth is increasingly recognized as an important determinant of clinical outcomes. It is important to review the latest information on each of these injuries and conditions, based on recently published studies and current practices.
