Intra-articular injections are widely used for diagnostic and therapeutic purposes of joint pathologies throughout the body. These injections can be performed blind by utilizing anatomical landmarks or with the use of imaging modalities to directly visualize the joint space during injections. This review of the literature aims to comprehensively identify differences in the accuracy of intra-articular injections via palpation vs. image guidance in the most commonly injected joints in the upper and lower extremities. To our knowledge, there are no such comprehensive reviews available. A narrative literature review was performed using PubMed and Google Scholar databases to identify studies focusing on the accuracy of blind or image-guided intra-articular injections for each joint. A total of 75 articles was included in this review, with blind and image-guided strategies being discussed for the most commonly injected joints of the upper and lower extremities. Varying ranges of accuracy with blind and image-guided modalities were found throughout the literature, though an improvement in accuracy was seen in nearly all joints when using image guidance. Differences are pronounced, particularly in deep joints such as the hip or in the small joints such as those in the hand or foot. Image guidance is a useful adjunct for most intra-articular injections, if available. Though there is an increase in accuracy in nearly all joints, minor differences in accuracy seen in large, easily accessed joints, such as the knee, may not warrant image guidance.

Olecranon fractures comprise ∼10% of upper extremity fractures, often managed with open reduction and internal fixation (ORIF). Despite generally favorable outcomes, short-term complications remain challenging and uncharacterized. This retrospective study aims to address this gap by evaluating short-term complications of olecranon ORIF using a large, nationwide database to determine complication rates and identify associated risk factors. The American College of Surgeons National Surgical Quality Improvement Program database (2010-2023) was queried for patients undergoing olecranon ORIF (Current Procedural Terminology Code 24685). Demographic, comorbidities, operative variables, and postoperative complications within 30 days were analyzed. Descriptive statistics and multivariate logistic regression were used to identify significant predictors (P < .05). A total of 8,524 patients (average age 59.4 ± 19.3; 62.3% female) were included. Surgical site infection was amongst the most common singular complications at a rate of 1.8%, with any adverse event reported at a rate of 7.2%. Risk factors included increased age (odds ratio [OR] = 1.03; P < .001), operative time (OR = 1.02; P < .001), blood transfusion (OR = 3.16; P = .001), ascites, and smoking history. Surgical site infection was associated with smoking (OR = 1.66; P = .01) and ascites (OR = 11.38; P = .03). ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. These findings highlight opportunities for improving care through providing smoking cessation efforts and tailored perioperative management for high-risk patients.

Background: Reverse shoulder arthroplasty (RSA) is an alternative to anatomic total shoulder arthroplasty (TSA) for treating glenohumeral osteoarthritis (OA), particularly in elderly patients. This study evaluates 90-day postoperative complication rates and identifies risk factors for adverse outcomes in RSA and TSA patients. Methods: A retrospective cohort study was conducted using the TriNetX Research NLP Network to identify patients aged 65–90 years who underwent RSA or TSA for OA from 2006 to 2024. 1:1 propensity score matching controlled for demographics and comorbidities. Orthopedic and infectious complications were compared using multivariate logistic regression. Results: The final matched cohort included 4,117 RSA and TSA patients. RSA was associated with significantly higher odds of orthopedic complications compared to TSA. Significant risk factors for orthopedic complications in RSA included nicotine dependence (OR, 1.592; P=0.001) and hypertension (OR, 1.545; P=0.001). In TSA, risk factors included male sex (OR, 0.702; P=0.005), chronic obstructive pulmonary disease (OR, 1.650; P=0.016), and obesity (OR, 1.776; P<0.001). For infections, RSA risk factors were male sex (odds ratio [OR], 1.698; P=0.005), heart failure (OR, 2.396; P<0.001), and diabetes (OR, 1.525; P=0.039). Diabetes was the only significant risk factor in TSA (OR, 2.453; P=0.003). Conclusions: RSA carries a higher risk of orthopedic complications and infection than TSA within 90 days. Distinct risk factors for each procedure highlight the need for patient-specific risk stratification to optimize preoperative assessment and surgical decision-making. Level of evidence: III.

Background: Orthopaedic personnel are routinely exposed to noise from saws, drills, and hammers that exceeds safety thresholds, placing them at significant risk of noise-induced hearing loss (NIHL). Despite this hazard, preventive measures remain infrequently used. This systematic review evaluates NIHL prevalence, intraoperative noise, and effectiveness of protective measures in operating rooms. Methods: Studies on the prevalence, risk, and prevention of NIHL in orthopaedic personnel published before July 21, 2025 were screened from PubMed/Medline, Ovid Embase, and CENTRAL (Cochrane). Thirty-four studies met the inclusion criteria. Results: NIHL was identified in 17% of participants, and 56 of 75 surgical instruments exceeded the National Institute for Occupational Safety and Health (NIOSH) A-weighted limits. Noise levels were consistently unsafe during total hip and knee arthroplasty, particularly when robotic-assisted. Custom hearing protection with interchangeable noise reduction filters reduced exposure while maintaining intraoperative communication, whereas surgical hood systems showed minimal benefit, and active noise-cancelling headphones had mixed results. Conclusions: Orthopaedic personnel are frequently exposed to noise levels exceeding safety thresholds, especially during robotic-assisted total knee arthroplasty, placing them at risk for NIHL. Evidence supports using custom hearing protection with communication-preserving filters, developing quieter surgical equipment, and implementing routine hearing assessments to improve long-term hearing outcomes. Level of Evidence: II.