Arthury J. Perry

Case: A 26-year-old man with recurrent posterior shoulder instability in the setting of glenoid dysplasia (41° of glenoid retroversion and 18% posterior glenoid bone loss) underwent combined opening-wedge osteotomy and posterior bone-block augmentation surgery. Postoperative imaging demonstrated retroversion correction to 9° of residual glenoid retroversion and increase in the glenoid arc by 22%. At 18 months, he reports no pain or instability and has regained full motion and strength. Conclusion: Combined glenoid osteotomy and posterior bone block technique is a novel treatment option for posterior shoulder instability in the setting of glenoid dysplasia characterized by severe glenoid retroversion and posterior glenoid bone loss.

Cases: 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: 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: 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: The tendency of general-purpose LLMs to agree without recognizing clinical ambiguity may limit their reliability in orthopaedic applications.

» 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.