Distraction osteogenesis (DO) is a process which uses the bone’s natural healing tendencies to repair and lengthen pathologic, missing, or malformed bone. The mechanism of DO mimics the pathway that the body uses in any other fracture repair however the location of the fracture is carefully controlled by a surgical osteotomy. Postoperatively, the bone is allowed to begin its natural healing process, with the lengthener applying constant tension and thus re-initiating the process of healing along the length of the distraction gap. Current clinical indications for DO include limb length discrepancy, congenital bone length deformity, large bone defects, and extremity reconstruction due to hypoplasia or limb salvage procedures. The risks of DO include soft tissue complications, relapse or improper correction, cost or resource-related challenges, and psychosocial stigmas surrounding long treatment durations and the necessity of wearing the distraction lengthening hardware. Future directions for DO include supplements to the bone regeneration process (such as growth factors and/or mechanical stimulation) or improvements to the distractor device itself (changes in material and/or the structure of the device itself). This review aims to offer a comprehensive summary of the indications, underlying biological mechanisms, and practical considerations when implementing the use of distraction osteogenesis in clinical practice.

Case: A 16-year-old, right-hand–dominant, Asian male, elite tennis player presented to the clinic with a 1-month history of left shoulder pain. Originally, the pathology was believed to be shoulder-based, but lack of improvement after several weeks of therapy warranted further imaging, which ultimately revealed a nondisplaced fracture of the posterior left first rib. Conclusion: Stress injuries are not uncommon in the sport of tennis, but atraumatic rib fractures are rare. Given the increase in youth sports specialization and overtraining and other risk factors such as adolescent age and race, it is important to keep rib stress fracture on the differential.

Introduction: Despite growing enthusiasm for artificial intelligence (AI) implementation in orthopaedic care, patient attitudes toward AI adoption remain unexplored. This study assesses patient perceptions of AI integration in diagnosis, treatment, and patient communication in orthopaedic surgery. Methods: A 28-question survey was administered to patients in hand surgery, orthopaedic oncology, and joint replacement surgery clinics. The survey queried patients' baseline comfort with AI and its perceived strengths, weaknesses, risks, and benefits. Results: Among 300 patients, the median age was 59 years. Most (55.2%) were comfortable with AI-assisted radiologic diagnosis, 58.3% with robot-assisted surgery, and 34.7% with AI-driven communication tools. Higher education and income correlated with greater AI acceptance ( P < 0.001). Patients with lower education levels perceived fewer benefits in daily AI use and a less positive impact of surgical outcomes ( P = 0.03, P = 0.05). Common concerns included loss of patient-surgeon relationships (70.0%), surgeon overreliance on AI (56.9%), and lack of individualized care (51.5%). Men were more accepting of AI use in diagnosis and surgery ( P < 0.03), whereas women were more concerned about AI perpetuating biases ( P = 0.05). Older patients were less comfortable with using AI for diagnostics ( P < 0.001). Conclusion: As AI implementation in orthopaedic care expands, women, older patients, and patients with lower education and household income levels may feel less comfortable with AI integration, threatening their quality of clinical care. Universal concerns about AI implementation include AI potentially weakening the patient-surgeon relationship. Targeted patient education efforts to address common concerns about AI adoption will enable orthopaedic surgeons to responsibly integrate these tools into practice.

Study Design: Delphi study. Objective: Optimal spine trauma care requires extensive resource availability and training. In LMICs, where resources and training are scarcer, spine trauma represents a major source of disability and public health burden. This study aimed to evaluate the highest priority resource needs for spine surgeons in sub-Saharan Africa in order to provide safe, high-quality spine trauma care. Methods: This study utilized a Delphi methodology with three electronic surveys. Participants were identified through the Continental Association of African Neurosurgical Societies (CAANS) and College of Surgeons of East, Central, and Southern Africa (COSECSA) networks. Response collection lasted from August 2024 to May 2025. The initial survey was an open-ended collection of all spine trauma resource priorities. In each subsequent round, participants rated topics on a Likert scale from 1 (most important) to 9 (least important). Consensus was defined as topics ranked 1, 2 or 3 (highly important) by >70% of participants. Results: Invitations were sent to 75 potential participants, with 36 participating in round one. Thirty-four participants (94.4%) and thirty-five (97.2%) completed the second and third consensus rounds respectively. Fifty-one items reached consensus. The most highly rated items included braces/c-collars, spine training/education of emergency room physicians and surgeons, and access to implants. Items not reaching consensus included microscopes, endoscopes, navigation and specialized auxiliary personnel. Conclusion: Given the high burden of traumatic spine injury and resource needs in these regions, efforts should be focused on providing essential resources related to timely stabilization of the spine over advanced tools and technologies.