Volume 35-1, Spring 2026

Internal fixation of femoral neck fractures typically involves three parallel cannulated screws (3CS) and sliding hip screws (SHS). The Femoral Neck System (FNS) was developed to replicate the minimally invasive nature and short operative time of 3CS while maintaining the biomechanical strength of SHS. A literature search was conducted using Ovid MEDLINE, PubMED, Cochrane, and ClinicalTrials.gov to find relevant literature which ultimately resulted in 17 included studies. FNS may provide be!er biomechanical properties compared to 3CS and similar biomechanics compared to SHS for femoral neck fractures. Patient reported outcomes between the three constructs as well as overall complications may be similar. FNS is a safe and effective treatment modality for internal fixation of femoral neck fractures in younger, middle-aged, and older adults; however, it is considerably more expensive than 3CS and SHS. More clinical and biomechanical trials comparing FNS to SHS are warranted. (Journal of Surgical Orthopaedic Advances 35(1):001 – 009, 2026)

Key words: femoral neck system, femoral neck fracture, garden fracture, pauwels fracture, internal fixation, literature review

Children treated for leukemia or lymphoma are predisposed to a higher incidence of osteonecrosis at a young age. Core decompression (CD) is performed for treatment of osteonecrosis of the femoral head (ONFH) to delay or prevent subchondral collapse and subsequent total hip arthroplasty (THA). The goal of the present systematic review was to determine outcomes of CD in pediatric patients with a history of hematologic malignancy who developed ONFH. Of 4,424 studies screened by title, abstract, and full text, 4 retrospective studies were included. Of 253 hips with ONFH, CD was performed in 78 (30.8%). Conversion to THA occurred in 46.2% of patients an average of 20.3 months after CD. None of the studies reported a signidicant difference in risk of joint collapse following CD. There is limited evidence for or against the use of CD in the treatment of ONFH for pediatric patients with a history of hematologic malignancy. Level of Evidence: Level III, Diagnostic study. (Journal of Surgical Orthopaedic Advances 35(1):010 – 013, 2026)

Key words: pediatric leukemia and lymphoma, osteonecrosis, core decompression

This study aims to identify risk factors for an unsuccessful aspiration of total hip arthroplasty (THA). Cases of painful THA requiring image-guided arthrocentesis between May 1, 2008 and May 1, 2018 were identidied. Patient demographics, comorbidities, laboratory values and surgical histories were assessed. Aspirations performed by musculoskeletal radiologists (MR) and arthroplasty surgeons (AS) were compared. Pre-aspiration risk factors were placed in a univariate analysis to look for risk factors for a failed aspiration - defined as a procedure yielding less than one milliliter (ml) of synovial fluid without lavage. Three hundred and forty-seven patients required a total of 429 arthrocenteses, and 55 index cases were performed by an AS and 292 by a MR. MR performing the index aspiration was the only significant variable associated with a failed aspiration (odds ratio: 2.23; 95% confidence interval: 1.1 - 6.5; p = 0.021). Sixteen failed MR aspirations required subsequent AS aspiration (75% successful). The median volume of synovial fluid obtained in the AS cohort was 5 ml (interquartile range [IQR] 2.5, 15) versus 3 ml in MR cases (IQR 0.5, 7) (p = 0.002). Anterior placement of the needle and aspiration from the head-neck junction had a higher failure rate when compared to all other described needle positions (42% vs. 29%, p = 0.020; 51% vs. 29%, p = 0.002; respectively). Successful arthrocentesis of a THA was associated with provider type and needle location. All proceduralists performing image-based aspirations should be encouraged to avoid placing the needle tip anterior to the implant or at the head-neck junction. (Journal of Surgical Orthopaedic Advances 35(1):014 – 018, 2026)

Key words: total hip arthroplasty, aspiration, arthrocentesis, synovial fluid, periprosthetic joint infection, musculoskeletal radiology

This study aims to identify outcomes after corticosteroid injection (CSI) in the posterior tibial tendon (PTT) sheath. The authors retrospectively analyzed data from February 28, 2018 to January 14, 2020 and performed a follow-up patient phone call to assess subjective data. Of the 27 patients, 19 (70%) reported some relief from the procedure; 17 of 27 (63%) reported this pain improvement as > 5 on the pain scale. Common side effects were temporary flares of pain (11/27, 41%) and whitening of skin (3/27, 11%). No severe side effects, including tendon rupture, were observed. The phone survey occurred at an average of 10.08 months after injection (range 4.16 – 26.23 months). No patient experienced major complications, and 70% of patients experienced signidicant relief from a CSI in the PTT sheath. However, the median duration of pain relief was only 1.5 months, and the minor side effect rate was 41% (11/27), which may indicate treatment failure and should be considered along with a discussion with the patient about these risks. (Journal of Surgical Orthopaedic Advances 35(1):019 – 021, 2026)

Key words: corticosteroid injection, tendonitis, tendinopathy, corticosteroid injection side effects, posterior tibial tendon

The purpose of this study was to observe how the COVID-19 pandemic impacted surgical volume for metastatic bone disease to the femur and humerus and whether the proportion of surgeries performed prophylactically signidicantly changed during the pandemic (March 2020 to April 2021). Patients who underwent surgical management for metastatic disease of the humerus and femur from January 2018 to April 2021 were identidied in the PearlDiver Database. These patients were further stratified to surgeries performed prophylactically or not. The monthly changes in surgical volume and percentage of surgeries performed prophylactically were recorded. A linear forecast analysis using historical data from January 2018 to February 2020 was utilized to determine the expected volume and percentage of surgeries performed prophylactically during the pandemic period. From March to May 2020, there was a significant decrease in the volume of surgical procedures for metastatic bone disease to the humerus and femur. The surgical volume returned to pre-pandemic projections by June 2020. From March 2020, the backlog of surgical cases increased by 245%. The proportion of surgeries performed prophylactically did not significantly change during the COVID-19 pandemic. This study demonstrates a reduction in surgical management for metastatic lesions in the humerus and femur with an associated increase in backlog of cases during the COVID-19 pandemic in the United States. (Journal of Surgical Orthopaedic Advances 35(1):022 – 026, 2026)

Key words: epidemiology, oncology, COVID, metastatic disease to the femur and humerus

This study sought to characterize patient interest in utilizing telemedicine for orthopaedic surgery clinic visits in a primarily Medicaid population. The authors hypothesized that interest in telemedicine would be associated with higher education level, lower age, private insurance, and internet access. Patients who called the clinic between October 2020 and February 2021 were asked to participate in a 5-question phone survey. The association between willingness to use telemedicine and other variables was determined using statistical analysis. Two hundred and fifty-six patients participated; they were predominantly female (50.8%), Black (57.6%), 50 – 60 years old (33.6%), with public insurance (83.2%). In total, 76.6% were interested in telemedicine. No significant association was observed between interest in telemedicine and education level or insurance. Patients who were younger and had internet access were significantly more interested in utilizing telemedicine services. Contrary to our hypothesis, no association was noted between interest in telemedicine and education level or insurance. (Journal of Surgical Orthopaedic Advances 35(1):027 – 030, 2026)

Key words: telemedicine, health disparities, access to care, COVID19, technology

The COVID-19 pandemic and policies transformed how people live and receive healthcare. The pandemic’s effect on elective orthopaedic surgeries has been well documented. However, its effect on orthopaedic problems in the emergency department (ED) has not. A cross-sectional retrospective study of all ED patients who received an orthopaedic surgery consult between March 11, 2019, and March 11, 2021, was conducted. Characteristics of orthopaedic problems before and during the pandemic were compared to elucidate what effect the pandemic had on orthopaedic presentations to the ED. The ED documented 2,487 orthopaedic problems. During the pandemic, 15% fewer orthopaedic problems were reported; however, more shoulder and fall injuries and fewer arm injuries occurred. No signifiant differences in demographics, mechanism of injury, operative status, or ED and overall disposition were found. Orthopaedic surgery departments should anticipate fewer ED consults overall after pandemic-like emergencies. (Journal of Surgical Orthopaedic Advances 35(1):0031 – 034, 2026)

Key words: COVID-19, emergency, musculoskeletal, falls, orthopaedic, consults

Since the year 2000, there have been numerous advances in the indications for surgery and technical/procedural fixation methods regarding the treatment of distal radius fractures (DRFs). The purpose of this study is to analyze the epidemiological trends surrounding their management. The authors hypothesize that the reported treatment for DRF will correlate with the advancing technologies in plating. Through cross-sectional analysis of a state healthcare hospital database from 2002 to 2018, 79,481 treated DRFs were identified. Operative management of DRFs significantly increased from 2002 to 2010. However, from 2011 to 2018, the incidence in operative treatment declined. From 2002 to 2018, a significant decline in both closed reduction percutaneous pinning (CRPP) and external fixation (Ex-Fix) was also observed. Of the operative cases, a significant trend toward plate fixation was demonstrated between 2002 and 2018. (Journal of Surgical Orthopaedic Advances 35(1):035 – 037, 2026)

Key words: distal radius fracture, surgery, ORIF, external fixation, percutaneous pinning

Due to frequent failure of osteosynthesis after fracture fixation among the elderly, total knee arthroplasty (TKA) is emerging as a viable alternative. The purpose of this study was to determine incidence rates and risk factors for early adverse events following TKA for periarticular knee fractures among geriatrics. Query of the 2010 – 2019 American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) databases yielded 154 geriatric patients (> 65 years) managed with TKA for periarticular knee fractures. Patient demographics, comorbidities, and 30-day complications were collected. Most patients were female (n = 141, 92%), with BMI 30.5 ± 9.5 kg/m² and age 78 ± 7.6 years. Most common adverse events were readmissions (n = 13, 8.4%) and pulmonary embolisms (n = 5, 3.2%). Multivariate analysis revealed that only increased BMI (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 – 1.11) was independently associated with adverse events. Given that rates of geriatric patients with obesity presenting with periarticular knee fractures are rising, this association may be increasingly useful in informing surgical planning and decision-making. (Journal of Surgical Orthopaedic Advances 35(1):038 – 040, 2026)

Key words: total knee arthroplasty, periarticular knee fracture, geriatric, NSQIP, TKA

Surgeon self-confidence is a valued trait that may be built over time and can improve surgeon-patient relationships. The authors seek to study how the use of Virtual Reality (VR) impacts the confidence of a naive trainee. Twenty-five first- and second-year medical students were recruited to compare methods of preparation for intramedullary tibial nail insertion. Participants were randomized into groups that used a technique guide, VR simulation, or both. Each completed an assessment of confidence and retention before and after preparation. Procedural confidence was significantly higher in the VR and combined groups in three of the four parameters evaluated: confidence with steps, confidence with a compact bone model, and confidence performing the surgery with an a!ending present. Retention of procedural steps was significantly higher in VR and combined groups. A trainee’s confidence and short-term retention of a procedure can be improved through virtual reality simulations. Improved confidence may foster improved autonomy and improve trainee education. (Journal of Surgical Orthopaedic Advances 35(1):041 – 044, 2026)

Key words: virtual reality, tibial nail insertion, residency education, confidence, retention

Widespread legalization of marijuana in the United States has brought the implications of marijuana use on medicine into question. Of interest is cannabis’ utility as an alternative to opioids in the management of surgical pain. However, limited research on the effects of perioperative cannabis use has been conducted. A retrospective cohort study was conducted, examining morphine milliequivalents (Meq) administered post-operatively for patients undergoing distal radius fracture fixation. One to one propensity matching was performed between marijuana users and non-users to isolate the effect of marijuana usage. Four hundred and two patients were identified for inclusion, 35 of which reported use of marijuana. Following matching, marijuana users were found to require 94 fewer Meq to manage post-operative pain (p = 0.041) and achieved comparable pain scores despite receiving fewer opioids. The findings illustrate a potential connection between marijuana use and decreased opioid requirements for pain control, thus encouraging a lessened reliance on opioids to manage surgical pain. (Journal of Surgical Orthopaedic Advances 35(1):045 – 048, 2026)

Key words: cannabis, opioids, postoperative pain, distal radius fractures

This study analyzed the efficacy and patterns of social media use among the Board of Specialty orthopaedic societies. Twitter (now called X), Facebook, and Instagram profiles were identified. Twitter was most commonly utilized, and therefore the focus. Twitonomy, a social media analytics tool, was used to analyze data. Most societies (11 of 15) increased number of tweets from 2018 to 2020. AAOS had the oldest and most followed account. Although J. Robert Gladden Orthopaedic Society (JRGOS) and Ruth Jackson Orthopaedic Society (RJOS) had the least tweets, they had the greatest increase from 2018 to 2020. RJOS had the greatest percentage of tweets that were liked and retweeted. Tweets about patient advocacy and society initiatives had the most engagement, while societies focused on diversity in orthopaedics had the fastest growth. These findings may help societies develop content that yields higher engagement from stakeholders. (Journal of Surgical Orthopaedic Advances 35(1):049 – 054, 2026)

Key words: social media, professional society, orthopaedics, twitter, diversity