Orthopedics Commons^™

Full Issue: Volume 4, Issue 1 - 2026

Bone Bulletin

i - Editors’ Note by Elijah Hoffman and Liam Gibbons

ii - Foreword by Dr. Alan Hilibrand

7 - Clinical Uncertainty in Digital Monitoring After Shoulder Arthroplasty by Abhi Pandey

10 - The Changing Value of Joint Arthroplasty Under the RVU System by Kiley Hamou

13 - SCALPEL TO ROBOT TO ALGORITHM: Robotics, Artificial Intelligence, and the Evolution of Spine Surgery by Mateja Stefanovic

18 - Suture-Free Nerve Repair in Upper-Extremity Surgery by Adam Gaughan

20 - The Impact of Wide-Awake Local Anesthesia No Tourniquet Surgery on Distal Radius Fracture Plating by Michael Carey

23 - Unicompartmental Versus Total Knee …

Biologic Adjuncts In Hand Surgery: Current Evidence, Limitations, And Clinical Implications, Joseph Kelly

Bone Bulletin

Introduction Biologic therapies such as platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) based treatments, have gained substantial attention across orthopaedics as agents that may enhance tissue healing and modulate inflammation.^1,4 Their use has expanded in the management of degenerative joint disease, tendinopathies, and fracture nonunion across multiple subspecialties within the field.^1,3,6 Despite the developing research base, prior hand-focused reviews have noted that orthobiologics in hand surgery remains an underdeveloped area, leaving limited guidance available to inform clinical decision making.^1-2

Optimizing Total Knee Arthroplasty In Young Patients: Strategies For Enhancing Durability And Function, Bridger Bell

Bone Bulletin

Introduction

The subspecialty of orthopaedics focuses on the prevention, diagnosis, and treatment of diseases and injuries impacting the musculoskeletal system.1 Within orthopaedics, surgery for arthritis and related conditions make up half of those performed.² Of the surgical interventions for arthritis, total knee arthroplasty (TKA) is one of the most frequent, with over 700,000 performed per year in the United States and an expectation that nearly one million will be performed by 2030.3 Interestingly, since the 1980s, the prevalence of surgery in younger patients has continually increased.⁴ This has been accompanied by a declining average age of primary TKA …

Hazards For The Female Athlete: Disparities In Acl Injury Risk And The Evolving Research Base, Abby Skiena

Bone Bulletin

Introduction

Sex plays a significant role in sports medicine risk factors, but historically, there has been a lack of research involving female participants and investigating physiologic factors unique to female athletes.^1–4 Male athletes face a 2.26 times higher risk of hip and groin injuries, a 2.4 times higher risk of hamstring injuries, and a 1.8-2.8 times higher risk of acute fractures, especially in competitive situations.² Alternatively, female athletes experience a 2-8 times higher rate of anterior cruciate ligament (ACL) injuries, a 3.4 times higher risk of bone stress injuries, a 1.25 times higher rate of foot and ankle …

Outcomes In Robotic Knee Surgery, Tyler West

Bone Bulletin

Introduction

Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries worldwide and is the mainstay for treating severe knee arthritis. In the United States, surgeons perform over 700,000 TKAs each year, and that number is expected to climb as osteoarthritis becomes more common in an aging population.^1,2 Roughly, two TKAs are completed for every one total hip arthroplasty (THA) and yet patient satisfaction after TKA has always lagged behind the THA.³ Hip replacements routinely see satisfaction rates above 90 percent.^2,3 For knees, however, satisfaction rates historically have fallen between 80 and 89 percent.^{4 …}

Conceptual Frameworks, Evolving Technology, And Common Misconceptions: How Orthopedic Hand Surgeons Choose Fracture Fixation Technique, Sudesh Jaisi

Bone Bulletin

Fracture fixation is often taught as a binary decision between operative and nonoperative management, which fails to reflect the complexity of real-world clinical decision-making. This article analyzes fracture fixation through a conceptual, fracture personality-based framework incorporating biomechanics, fracture characteristics, patient-specific factors, and evolving implant technology. Clinical decision-making is best understood as a spectrum of interventions, where multiple fixation strategies may be technically appropriate but differ in invasiveness, stability, complication risk, and functional recovery. Across representative fracture types, including distal radius and olecranon injuries, management is driven by fracture stability, anticipated behavior under physiologic load, and patient functional demands rather than …

Unicompartmental Versus Total Knee Arthroplasty In Osteoarthritis: Indications, Outcomes, And Value-Based Care, Spencer Uggla

Bone Bulletin

Introduction

Knee osteoarthritis (OA) is a highly prevalent and disabling condition, affecting an estimated 654 million people worldwide in 2023. It is the most common diagnosis among patients over 45 years of age who present with activity-related knee pain.1 When nonoperative management fails, surgical intervention is frequently required to relieve pain and restore function. Traditionally, total knee arthroplasty (TKA) has been considered the gold standard surgical treatment for advanced OA, with approximately 700,000 procedures performed annually and projections exceeding 1 million by 2030.²

The Impact Of Wide-Awake Local Anesthesia No Tourniquet Surgery On Distal Radius Fracture Plating, Michael Carey

Bone Bulletin

Introduction

The surgical technique known as wideawake local anesthesia no tourniquet (WALANT) has been widely used in soft tissue hand procedures since 2005.1 A local surgical field block using lidocaine with epinephrine provides local anesthesia and hemostasis via alpha-1 adrenergic agonism without the need for general anesthesia with a tourniquet. In addition to reducing costs related to general anesthesia (GA), WALANT procedures are suitable for American Society of Anesthesiologists Physical Status Classification 4 (ASA 4) high-risk patients, specifically by eliminating anesthesia risks such as nausea, aspiration, pneumonia, and thromboembolism, all while maintaining or improving clinical outcomes compared with the current …

Suture-Free Nerve Repair In Upper-Extremity Surgery, Adam Gaughan

Bone Bulletin

Introduction

Peripheral nerves have a limited capacity to regenerate.¹ Treating peripheral nerve injuries and the ensuing recovery of sensory and/or motor function are challenging for surgeons due to a number of variables that impact nerve recovery; including, the mechanism of nerve transection, the level or distance of injury relative to the target organ, patient age and comorbidities, and the repair technique employed. Most factors are not modifiable, but repair techniques are modifiable and can have a meaningful impact on outcomes. Nerve repair opt ions inc lude di r e ct end- to- end r epai r (neurorrhaphy), conduit-assisted repair, …

Scalpel To Robot To Algorithm: Robotics, Artificial Intelligence, And The Evolution Of Spine Surgery, Mateja Stefanovic

Bone Bulletin

Introduction

The past five decades in spine surgery have seen innovations in pedicle screw fixation, image-guided navigation, and first-generation robotics; each change was confronted with skepticism for uprooting existing paradigms until pushback inevitably yielded progress. Artificial intelligence (AI) and machine learning (ML) feel different in kind. Beyond better instrumentation, they represent entirely new frameworks for processing clinical information at unprecedented scale and speed. A neural network trained on thousands of preoperative records can learn to detect interactions among imaging findings, laboratory indices, functional variables, and comorbidity burden that conventional statistical models are structurally unable to identify.¹˒² Simultaneously, robotic platforms outfitted …

The Changing Value Of Joint Arthroplasty Under The Rvu System, Kiley Hamou

Bone Bulletin

Background and Introduction of Total Knee Arthroplasty

Few procedures in modern medicine illustrate the value of surgical advancement more clearly than total hip and total knee arthroplasty. Over the past several decades, advances in surgical technique, pre-operative management, and postoperative rehabilitation have transformed joint replacement into one of the most successful procedures in medicine. Patient satisfaction rates routinely exceed 90% and millions of individuals regain mobility, independence and quality of life each year through these operations.¹ However, despite this clinical success and societal value, physician reimbursement for joint replacement surgery and many other successful orthopedic procedures has steadily declined. …

Clinical Uncertainty In Digital Monitoring After Shoulder Arthroplasty, Abhimaneu Pandey

Bone Bulletin

Introduction

Wearable sensor technology and smartphone based care platforms have been identified as promising technologies for postoperative care after joint arthroplasties.^1,2 In fact, in lower extremity arthroplasty, these technologies have already demonstrated their effectiveness in a multitude of randomized trials.^1,2 One recent multicenter RCT with 401 patients undergoing primary total knee arthroplasty (TKA) showed that self-directed rehabilitation using a smartwatch and mobile application (mymobility with Apple Watch, Zimmer Biomet) achieved comparable range of motion and patient-reported outcomes measures (PROMs) to standard post-operative rehab without increasing adverse events.¹ Related evidence also indicates that “episode of care” smartphone applications …

Foreword, Alan S. Hilibrand, Md, Mba

Bone Bulletin

As the Director of Undergraduate medical education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am happy to oversee the fourth annual issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have an excellent venue to learn about orthopaedic surgery and to receive support for their application to the specialty. The Bone Bulletin has provided a great opportunity for our orthopaedic surgery faculty members at Rothman Orthopaedics to mentor younger students interested in the field of orthopedic surgery. This is one of the many initiatives the …

Editors' Note, Elijah Hoffman, Liam Gibbons

Bone Bulletin

It is our pleasure to present the fourth edition of the Bone Bulletin, DePalma Orthopaedic Society’s student-run journal for Sidney Kimmel Medical College (SKMC) students. The journal provides a unique opportunity for medical students to be involved with scholarly work in orthopaedics, often representing their first experience with orthopedic scholarship and academic writing. Through the journal, students gain valuable experience in orthopedic research and scientific writing with close mentorship from the renowned physicians of Rothman Orthopaedics.

Each year, the journal has grown in scope and impact, addressing new topics in orthopaedics. We are thrilled to introduce our new contributors …

Full Issue: Volume 3, Issue 1 - June 2025

Bone Bulletin

i - Editors’ Note

ii - Foreword by Dr. Alan Hilibrand

7 - Challenges and Concerns of Artificial Intelligence in Shoulder and Elbow by Claude J. Regis

10 - Exploring Robotic-Assisted Total Knee Arthroplasty by Sahil Shah

13 - The Future of Robot-Assisted Surgery in Foot and Ankle Procedures by Sam Duggan

16 - Revolutionizing Spine Surgery: The Potential Role of AI in Enhancing Surgical Workflow and Patient Outcomes by Samuel Ezeonu

21 - Management of Periprosthetic Humeral Fractures Following Shoulder Arthroplasty by Akshay Khanna

24 - Patient Specific Implants in Total Shoulder Arthroplasty by Alexander Zavitsanos

26 - Posterior …

Comparison Of Autograft, Allograft, And Conduits For Peripheral Upper Extremity Nerve Repair A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Samantha Meacock

Bone Bulletin

Introduction

Several mechanisms of injury can cause peripheral nerve injury (PNI) and subsequent impaired quality of life with loss of motor and/or sensory function. Trauma is a common cause of injury with the most commonly injured nerves being the radial (53%), ulnar (32%), and median nerves (15%).¹ The preferred treatment for PNI is reconnecting severed nerve ends anatomically with tension-free end-to-end direct nerve repair of healthy fascicles. However, if the nerve ends cannot be brought together without tension, gapping can occur, and a direct tension-less repair is not possible.⁵ In the case of a lengthy nerve gap, a …

A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Joseph Kelly

Bone Bulletin

Introduction

Millions of people around the world currently suffer from orthopaedic injuries and illness due to trauma, degenerative diseases, cancer, and infections that require bone grafting techniques to heal. Bone grafting allows a surgeon to replace missing, broken, or infected bone with a substitute that returns the structural integrity of the bone. Bone grafting can rebuild bones but can also help bones with existing defects to heal properly. There are multiple types of bone grafts, and each may be indicated in different scenarios to optimize healing, restore function, and prevent complications depending on the bone in question. The three broad …

Distal Radius Fractures: A Common Injury With Disproportionate Results, Brady Stillman

Bone Bulletin

Introduction

A distal radius fracture (DRF) is a common upper-extremity injury that occurs when the radius is fractured near the wrist, usually after falling on an outstretched or flexed hand. DRFs account for one-sixth of fracture-related emergency department visits.² In a 2009 study, a sample of 87 million Americans with upper-extremity fractures revealed the most common fracture sites were the distal radius and ulna.³ The distal radius was the most common fracture site in patients younger than 18 and older than 49, and the incidence is increasing in older adulthood.^{3, 4} A DRF can be classified as …

Innovative Pain Management Protocols In Orthopedics And Their Role In Reducing Postoperative Opioid Use, Jake Lamonaca

Bone Bulletin

Background

The opioid epidemic has emerged as one of the most pressing public health challenges of our time, marked by significant increases in opioid-related dependence, abuse, and death in recent years. Excess prescription of opioids represents a major contributing factor to this crisis.¹ The origins and impact of the opioid epidemic in the United States are documented in Sam Quinones research narrative, Dreamland. He highlights how pharmaceutical companies leveraged misinterpreted research—particularly a 1980 letter published in The New England Journal of Medicine suggesting a low risk of addiction associated with opioids—to normalize their widespread prescription. This flawed evidence served …

Analyzing The Common Criteria And Decision-Making Process For Opting Between Same-Day And Overnight Surgeries For Improved Patient Management, Gaston Davis

Bone Bulletin

Introduction

Within the scope of sports medicine, the decision to opt for same-day or overnight surgeries is multifactorial and relies on many interplaying considerations. Common factors include patient health, surgical complexity, and post-operative care requirements. This article explores the criteria and decision-making process involved in choosing between these two surgical options for common sports-related injuries, such as shoulder, elbow, hand, hip, knee, and ankle injuries.

Posterior Shoulder Dislocations In The Setting Of Seizures, Alex Charlton

Bone Bulletin

The shoulder joint provides an exceptional range of motion that allows for flexion, extension, adduction, abduction, internal rotation, external rotation, and 360-degree circumduction; however, this mobility comes at the expense of decreased stability.¹ Shoulder dislocations account for 50% of all joint dislocations, with anterior dislocation being the most common and usually associated with trauma.² In comparison, about 2-5% of shoulder dislocations are posterior and are often associated with more unique etiologies.¹ One of the most interesting resulting from a tonic seizure in an individual with epilepsy.

Patient Specific Implants In Total Shoulder Arthroplasty, Alexander Zavitsanos

Bone Bulletin

Primary total joint arthroplasty (TJA) is one of the most commonly performed procedures in the United States, and is expected to be utilized more in the coming decades, with estimates of around 2 million TJAs performed annually by 2030.^1,2 While the first attempts at TJA occurred in the late 1800s, utilizing a variety of implant materials such as ivory and rubber, over the past 100+ years, the methods employed in TJA and the quality of implants used have progressed immensely with advances in material science and procedural methods^8-12. However, the implants currently used in all types of …

Management Of Periprosthetic Humeral Fractures Following Shoulder Arthroplasty, Akshay Khanna

Bone Bulletin

Introduction Since the introduction of reverse total shoulder arthroplasty (RTSA) in 2004, the total incidence of primary total shoulder arthroplasties in the United States has doubled to over 30 cases per 100,000 persons.^1,2 Despite overall complication rates decreasing with the advancement of novel techniques and implant designs, there are rising concerns regarding the frequency of certain complications including glenohumeral instability, rotator cuff tearing, and periprosthetic fracture.^3,4 Glenoid fractures are relatively rare, occurring at a rate of 1.4% in one national registry study.^19,20 The risk of periprosthetic humeral fracture, however, is of particular concern because of how devastating …

Revolutionizing Spine Surgery: The Potential Role Of Ai In Enhancing Surgical Workflow And Patient Outcomes, Samuel Ezeonu

Bone Bulletin

Introduction

With the growing incidence of degenerative spine pathology¹, surgeons have been tasked to treat more patients than ever. According to Mani et al., the number of single and multilevel fusion procedures are both projected to double over the next 25 years.² In light of this trend, several strategies have been proposed to reduce the resultant burden placed on hospitals and surgeons, while maintaining optimal standards of care. Namely, the use of artificial intelligence (AI) is a growing field that has greatly increased in the last decade. AI has the potential to relieve the cognitive workload placed …

The Future Of Robot-Assisted Surgery In Foot And Ankle Procedures, Sam Duggan

Bone Bulletin

Robot-assisted surgeries are becoming common in most fields of orthopaedics by providing increased accuracy and precision, reducing revision procedures.^1,2 Surgeons specializing in hip and knee, and more recently, spine, have seen tremendous increases in the use of robotics. Still, foot and ankle surgery has had little to no adoption of robotics due to the complex foot and ankle anatomy, in addition to small operating windows; however, usage in spine surgery may be a strong indicator of future use in foot and ankle surgery, as spine surgery similarly requires extreme precision in small operating spaces, with the added benefit of …

Exploring Robotic-Assisted Total Knee Arthroplasty, Sahil Shah

Bone Bulletin

Background and Introduction of Total Knee Arthroplasty

Within the field of orthopedics, joint replacements rank amongst the most common procedures. Among those, total knee arthroplasty (TKA) is the most commonly conducted joint replacement procedure at approximately 51.02% of arthroplasties between 2012 and 2022.¹ Annually, the American Academy of Orthopedic Surgeons estimates more than 700,000 TKAs are performed within the United States.² The procedure was introduced in 1968 to relieve severe joint pain and stiffness, as well as restore mobility in patients suffering from “end-stage degenerative knee osteoarthritis” or rheumatoid arthritis.³ TKAs revolutionized the treatment plan for patients …

Challenges And Concerns Of Artificial Intelligence In Shoulder And Elbow, Claude J. Regis

Bone Bulletin

Background

Artificial intelligence (AI) is rapidly transforming shoulder and elbow surgery, driving significant advancements across various domains. Currently, AI is enhancing diagnostic accuracy through imaging-based analysis, predictive modeling of clinical outcomes, implant identification, and automated image segmentation.^1,2 AI-driven personalized treatment plans are also anticipated to optimize patient care by tailoring interventions based on individual data analysis.³ Additionally, deep learning algorithms have been developed to automatically classify large sets of preoperative and postoperative radiographs in the setting of shoulder arthroplasty.⁴ These technologies, combined with AI, could revolutionize surgical training and intraoperative guidance, offering real-time data and enhanced visualization. …

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Director of Undergraduate medical education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am happy to once again oversee the third annual issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have an excellent venue to learn about orthopaedic surgery, and through articles in this publication our surgeons at Rothman Orthopaedics have enthusiastically mentored younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard on many initiatives in recent years: providing forums for orthopaedic faculty to speak about their …

Editors' Note, Liam Gibbons, Amit Syal

Bone Bulletin

We are thrilled to introduce the third edition of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal aims to offer an additional avenue for medical students to engage with orthopaedics in medical school. Through the 1-on-1 mentorship with physicians from the Rothman Orthopaedic Institute, students gain hands-on experience writing about and directly engaging with current orthopaedic research and developments.

After each edition, it’s been exciting to see the journal continue to grow, with increasing numbers of students eager to get involved. This year, we are proud to announce …

Full Issue: Volume 2, Issue 1 - April 2024

Bone Bulletin

i - Editors’ Note by Ari Clements & Amit Syal

ii - Foreword by Dr. Alan Hilibrand

7 - Exploring Approaches to Treatment of Musculoskeletal Injuries by Catherine Alvaro

9 - A Spotlight on the Various Subspecialties of Orthopedic Surgery by Ryan Garemani

14 - Exploring the Importance of Implant Selection in Total Hip Arthroplasty by John Czarnecki

16 - Revolutionizing Orthopaedics: Exploring the Therapeutic Potential of Stem Cells by Harrison Fellheimer

18 - Shoulder Arthroplasty in Patients with Inflammatory Arthritis: Preoperative and Perioperative Management of Disease Modifying Anti-Rheumatic Drug Therapy by Daniel Kwak

22 - The Role of Psychological …