Faculty Bibliography

» Isolated greater tuberosity (GT) fractures account for approximately 20% of all proximal humerus fractures. » Displaced GT fractures can compromise the rotator cuff biomechanics and behave as rotator cuff deficient shoulders, leading to weakness (external rotation and scaption strength), loss of range of motion (elevation, abduction, external rotation), and subacromial impingement. » Most nondisplaced to minimally displaced fractures (<5 mm) can be treated nonsurgically with good outcomes. Secondary displacement of GT fractures is low, but the presence of associated shoulder instability predisposes patients to a higher risk, and thus, these patients should be monitored closely. » Displaced fractures benefit from surgical treatment. A tension band construct or buttressing mechanism is required to neutralize the deforming force of the posterior and superior rotator cuff on fracture fixation. » There is no consensus on the surgical approach (arthroscopic vs. open) and type of fixation (plate, screws alone, suture anchor repair, or hybrid fixation) for the surgical treatment of these fractures. Each fixation option has its own unique profile of advantages and risks, emphasizing the importance of individualized management. » Small (<1 cm) avulsion or depressed type fractures are amenable to arthroscopic treatment with suture anchor repair, with or without screw fixation, resulting in good outcomes. » Open repair is more common in split type fracture patterns or fractures with a large fracture fragment. There is no consensus on the surgical approach (deltopectoral vs. anterolateral or lateral deltoid approach) for open repair.

BACKGROUND:To provide a systematic review on the current literature specific to the adoption of Patient-Reported Outcomes Measurement Information System (PROMIS) and trends in patient reported outcome measure (PROM) use in shoulder orthopedic literature. METHODS:A review of all English language articles in PubMed, Web of Science, and Embase was conducted in January of 2026. All articles between 2015 and 2025 reporting on patient outcomes in shoulder specific orthopedic literature had their study characteristics extracted, including publication year, country of origin, level of evidence, journal of publication, shoulder topic, and which PROMs were reported on. Review papers or studies that were non-English, failed to include PROMs, or were not specific to shoulder literature were excluded. RESULTS:= 0.08). Constant score (CS), Simple Shoulder Test (SST) and ASES score were the three most commonly reported outcome scores for shoulder condition. CS and SST utilization demonstrated a significant decline (p<0.01), while the increase in ASES utilization was not significant during the study period. CONCLUSIONS:Although PROMIS enables a standardized, patient-centered assessment of orthopedic conditions, the current study demonstrates its limited adoption over the past decade as a primary outcome measure for shoulder conditions compared to traditional legacy scores. LEVEL OF EVIDENCE/METHODS:Research Methodology, Systematic Review.

CASES/METHODS:Three patients (61-81 years) experienced abrupt shoulder pain and functional decline more than 5 months after reverse total shoulder arthroplasty (RTSA) using a monoblock central-screw baseplate in graft-reconstructed glenoids. Imaging revealed central screw breakage with variable baseplate displacement. Two underwent successful revision with restoration of stable fixation; in the third, revision was deferred for medical comorbidities. CONCLUSION/CONCLUSIONS:Central screw breakage is an important marker of glenoid fixation failure after RTSA. These cases suggest an association with graft-dependent baseplate fixation, limited native bone support, and consequently late fatigue failure. Prompt diagnosis and timely management are essential.

BACKGROUND:Prosthetic joint infection (PJI) after total shoulder arthroplasty (TSA) is a devastating complication. Cephalosporins are considered the standard of care for antibiotic prophylaxis during TSA procedures; however reported β-lactam allergies may result in the use of less effective alternatives which are associated with higher infection and complication rates. The aim of this study is to evaluate the relationship between reported β-lactam allergies, antibiotic choice, and revision rates in TSA. METHODS:A retrospective chart review was conducted on all TSA procedures performed at a single institution between January 2015 and January 2025. Information was collected regarding reported allergies to antibiotics including allergy severity and specific reactions. Additionally, all antibiotics administered during the procedures, intraoperative reactions to administered antibiotics, surgical complications, and subsequent revision procedures were collected. Revision procedures were categorized as septic or aseptic based on preoperative diagnosis. Perioperative antibiotics and patient allergies were categorized into penicillins, cephalosporins, clindamycin, vancomycin and other. RESULTS:Data from 4,232 TSAs were collected. 23% of patients had a reported antibiotic allergy and 15% had a β-lactam allergy. Cephalosporins were administered in 94% of all TSAs, but use declined with increasing β-lactam allergy severity, dropping from 90% in mild cases to 44% in severe cases, with corresponding increases in clindamycin and vancomycin use. Higher allergy severity was strongly associated with reduced cephalosporin use and increased alternative antibiotic use (OR = 0.40, p<.001). Notably, cephalosporins were given to patients labeled as having anaphylactic reactions to penicillins or cephalosporins with no adverse events reported. Overall, intraoperative cephalosporin prophylaxis was significantly associated with decreased all-cause revision odds (OR = 0.47, p<.001) and the presence of a β-lactam allergy was associated with increased likelihood requiring a revision procedure for a presumed septic etiology. CONCLUSIONS:The severity of reported β-lactam allergies strongly influences perioperative antibiotic selection despite evidence that most reported allergies are unreliable, unnecessarily increasing patient risk for PJI. Lack of cephalosporin prophylaxis was associated with increased revision rates, underscoring the clinical and economic value of appropriate antibiotic use. Given the high prevalence of mislabeled β-lactam allergies, established delabeling strategies using allergy testing or test-dosing in the operating room may offer a safe and effective means to increase first-line antibiotic use and improve stewardship. LEVEL OF EVIDENCE/METHODS:Level III, Retrospective Cohort Comparison, Prognosis Study.

Artificial intelligence (AI) has emerged as one of the most transformative technological forces in modern medicine, with rapidly expanding applications throughout medicine including orthopaedic surgery. Recent advances in machine learning, deep learning, and natural language processing have accelerated the development of AI-enabled tools with direct relevance to orthopaedic practice. This review provides a basic overview of how AI works and current uses of AI in medicine and orthopaedics across multiple domains including documentation efficiency, patient communication, operating room optimization, imaging analysis, rehabilitation, education, and research, and briefly describes AI's limitations, ethical and legal concerns, and cost. These applications are all already being used in orthopaedics or have clear direct translation. AI holds considerable potential to augment orthopaedic care by streamlining workflows, enhancing decision-making, and improving patient outcomes. However, responsible integration requires rigorous validation, transparency, clinician oversight, and ongoing education. As AI adoption accelerates, orthopaedic surgeons must critically evaluate emerging technologies to ensure that.

Specialized clinical artificial intelligence (AI) tools are entering medical practice despite scarce independent evaluation. We quantitatively evaluate two clinical AI tools, OpenEvidence and UpToDate Expert AI, built on large language models (LLMs) against three frontier LLMs: GPT-5.2, Gemini 3.1 Pro and Claude Opus 4.6. Our evaluation has three stages: (1) 500 MedQA questions testing medical knowledge, (2) 500 HealthBench items measuring alignment with clinicians and (3) the real clinical queries (RCQ) benchmark, built from 100 de-identified queries from physicians to a general-purpose language model in a live clinical environment. For the RCQ benchmark, 12 US clinicians performed randomized, blinded review of model outputs, producing 1,800 model-question annotations. Frontier LLMs outperformed clinical AI tools in all three evaluations. Clinical AI tools performed comparably to auto-enabled Google Search AI Overview on the RCQ. These findings highlight the need for independent, real-world evaluation of AI tools before they enter clinical settings.

BACKGROUND/UNASSIGNED:Advantages of preoperative planning computed tomography (CT) scans for shoulder arthroplasty (SA) are known; however, risks of ionizing radiation exposure remain unknown. We retrospectively reviewed institutional trends in utilization and estimated radiation risk of preoperative planning CT scans obtained for SA. METHODS/UNASSIGNED:From 2016 to 2024, the annual percent incidence of SA patients that received a preoperative planning CT was determined. The National Academy of Sciences Biological Effects of Ionizing Radiation VII report on lifetime attributable risk (LAR) cancer incidences and received radiation dose were utilized to estimate patient-level LAR projections for 100 patients stratified by sex, age, and cancer type. RESULTS/UNASSIGNED: = 0.78) from 53% to 66% of all SA patients. For all solid cancers, LAR (per 100,000 people) decreased as patient age increased, ranging from 73.1 to 9.6 for females and 40.7 to 31.4 for males (from the 50-59-year-old group to the 80-89 group). In the 60-69-year-old and 70-79-year-old groups, estimated thyroid and lung LARs were significantly higher in women. DISCUSSION/UNASSIGNED:Utilization of preoperative shoulder CT scans is increasing. Preoperative shoulder CT may be associated with a small but quantifiable projected cancer risk most pronounced in younger women.

BACKGROUND:The use of large language models (LLMs) is increasingly common. However, LLMs may exhibit sycophancy, echoing users' beliefs while avoiding contradiction. In the present study, we describe sycophancy in general-purpose LLMs when applied to orthopaedic contexts. METHODS:We investigated sycophancy in 2 general-purpose LLMs. We evaluated performance on 3 tasks: (1) accuracy on benchmark answering: LLMs were tested on validated benchmark orthopaedic questions, with correct and incorrect cues, and the change in accuracy and sycophancy error rate were determined; (2) user belief agreement: LLMs were provided with ambiguous statements and a user belief, and LLM agreement, contradiction, and uncertainty were described; and (3) false information detection: false information was placed within a task prompt to measure noncontradiction and propagation rates. RESULTS:Baseline factual accuracy on benchmark questioning was 78%, decreasing with correct hints (71%) (p = 0.49). With incorrect hints, LLM accuracy declined significantly (48%) (p < 0.001), with a sycophancy error rate of 52%. Presented with user beliefs about an indefinite, controversial statement, models echoed user beliefs in 56%, expressed uncertainty in 12%, and contradicted users in 32% of statements. In noncontradiction tasks, models perpetuated incorrect attributions 99% of the time yet reliably corrected statistical distortions 97% of the time. CONCLUSIONS:Although popular general-purpose LLMs have useful orthopaedic applications, they exhibit sycophancy, with a tendency toward agreement and without recognition of ambiguity. This is a key weakness to be addressed. Findings should be interpreted cautiously given the variability in model design, prompting, and models evaluated. CLINICAL RELEVANCE/CONCLUSIONS:The tendency of general-purpose LLMs to agree without recognizing clinical ambiguity may limit their reliability in orthopaedic applications.

Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic "gold standard." This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.

BACKGROUND/UNASSIGNED:Few studies have directly compared limitations in activities of daily living (ADLs) between reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (aTSA). This study evaluates ADL function at mid-term follow-up in patients with revision-free RSA and aTSA. METHODS/UNASSIGNED:This retrospective cohort study included 250 patients who underwent primary aTSA (n = 177) or RSA (n = 73) with a minimum follow-up of 7 years (mean 10 ± 2 years). Patients who had revision surgery were excluded. Multivariable ordinal logistic regression analysis was used to assess the odds of RSA patients reporting better ADL function compared to aTSA patients. RESULTS/UNASSIGNED:Postoperatively, a greater proportion of aTSA patients reported normal ADLs compared to RSA patients. On multivariable analysis, controlling for baseline differences, RSA patients reported lower ADL function for personal hygiene/toilet needs (Odds ratio [OR] 0.21 [95% CI: 0.07-0.65]; p = 0.006), washing/combing hair (OR 0.36 [0.13-1.02]; p = 0.049), putting on a button-up shirt (OR 0.08 [0.02-0.25]; p < 0.001), and putting on pants (OR 0.12 [0.03-0.39]; p < 0.001). DISCUSSION/UNASSIGNED:After adjusting for differences in baseline factors, RSA patients reported greater difficulty with specific ADL tasks-including toileting, personal hygiene, grooming, and dressing-compared to aTSA patients. LEVEL OF EVIDENCE/UNASSIGNED:Level III; Retrospective cohort study.