Objectives

Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons’ agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called ‘spectrum bias’, defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius.

The Revision Hip Complexity Classification (RHCC) was developed by modified Delphi system in 2022 to provide a comprehensive, reproducible framework for the multidisciplinary discussion of complex revision hip surgery. The aim of this study was to assess the validity, intra-relater and inter-relater reliability of the RHCC. Radiographs and clinical vignettes of 20 consecutive patients who had undergone revision of Total Hip Arthroplasty (THA) at our unit during the previous 12-month period were provided to observers. Five observers, comprising 3 revision hip consultants, 1 hip fellow and 1 ST3-8 registrar were familiarised with the RHCC. Each revision THA case was classified on two separate occasions by each observer, with a mean time between assessments of 42.6 days (24–57). Inter-observer reliability was assessed using the Fleiss™ Kappa statistic and percentage agreement. Intra-observer reliability was assessed using the Cohen Kappa statistic. Validity was assessed using percentage agreement and Cohen Kappa comparing observers to the RHCC web-based application result. All observers were blinded to patient notes, operation notes and post-operative radiographs throughout the process. Inter-observer reliability showed fair agreement in both rounds 1 and 2 of the survey (0.296 and 0.353 respectively), with a percentage agreement of 69% and 75%. Inter-observer reliability was highest in H3-type revisions with kappa values of 0.577 and 0.441. Mean intra-observer reliability showed moderate agreement with a kappa value of 0.446 (0.369 to 0.773). Validity percentage agreement was 44% and 39% respectively, with mean kappa values of 0.125 and 0.046 representing only slight agreement. This study demonstrates that classification using the RHCC without utilisation of the web-based application is unsatisfactory, showing low validity and reliability. Reliability was higher for more complex H3-type cases. The use of the RHCC web app is recommended to ensure the accurate and reliable classification of revision THA cases

Introduction and Objective. Digital infra-red thermography may have the capability of identifying local inflammations. Nevertheless, the role of thermography in diagnosing pin site infection has not been explored yet and the reliability and validity of this method for pin site surveillance is in question. The purpose of this study was to explore the capability and intra-rater reliability of thermography in detecting pin site infection. Materials and Methods. This explorative proof of concept study follows GRRAS -guidelines for reporting reliability and agreement studies. After clinical assessment of pin sites by one examiner using Modified Gordon Pin Infection Classification (Grade 0 – 6), thermographic images of the pin sites were captured with a FLIR C3 camera and analyzed by the FLIR tools software package. The maximum skin temperature around the pin site and the maximum temperature for the whole thermographic picture was measured. Intra-rater agreement was established and test-retests were performed with different camera angles. Results. Thirteen (4 females) patients (age 9–72 years) were included. Indications for frames: 4 fracture, 2 deformity correction, 1 lengthening, 6 bone transport. Days from surgery to thermography ranged from 27 to 385 days. Overall, 231 pin sites were included. Eleven pin sites were diagnosed with early signs of infection: five grade 1, five grade 2, one grade 3. Mean pin site temperature was 33.9 °C (29.0–35.4). With 34 °C as cut-off value for infection, sensitivity was 73%, specificity 67%, positive predictive value 10% and negative predictive value 98%. Intra-rater reliability for thermography was ICC 0.85 (0.77–0.92). The temperature measured was influenced by the camera postioning in relation to pin site with a variance of 0.2. Conclusions. Measurements of pin sites using the handheld FLIR C3 infrared camera was a reliable method and the temperature was related to infection grading. This study demonstrates that digital thermography with a handheld camera might be used for monitoring the pin sites after operations to detect early infection, however, future larger prospective studies are necessary

Aims

The aim of this study was to investigate the agreement in interpretation of the quality of the paediatric hip ultrasound examination, the reliability of geometric and morphological assessment, and the relationship between these measurements.

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The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective.

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The aims of this study were to compare clinically relevant measurements of hip dysplasia on radiographs taken in the supine and standing position, and to compare Hip2Norm software and Picture Archiving and Communication System (PACS)-derived digital radiological measurements.

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The impact of tobacco use on readmission and medical and surgical complications has been documented in hip and knee arthroplasty. However, there remains little information about the effect of smoking on the outcome after total shoulder arthroplasty (TSA). We hypothesized that active smokers are at an increased risk of poor medical and surgial outcomes after TSA.

Forearm fractures are a common paediatric injury. This study was aimed to describe the epidemiological of paediatric forearm fractures in the urban population of Glasgow. We reviewed of all the forearm fracture treated by the orthopaedic service in Yorkhill Children's Hospital in 2008. Datum gathered from case notes and radiographs using the prospective orthopaedic database to identify patients with forearm fractures. The age, sex, side and type of fracture, the timing and mechanism of the injury and treatment were documented for the 436 fractures. Census data were used to derive absolute age-specific incidences. Distinction was made between torus and other types of fractures. Torus fractures require no specific orthopaedic treatment and were segregated out. For the remaining 314 fractures, the age and sex distribution, seasonal variation of fractures and treatments for each type of fracture were examined. The incidence of forearm fractures in our population is 411 fractures per 100,000 population per year. An increased number of fractures occurred during the months of May and August. A fall from less than one metre was the commonest mechanism of injury, sporting injuries were the second commonest with football the most common sport associated. This study identifies some features which are in good agreement with studies from elsewhere in Britain, such as incidence and seasonality. However, there are also interesting differences – such as the Glasgow peak incidence for forearm fractures being at age 8, with a marked decline by 12 years. Furthermore, our findings have been extended to consideration of type of intervention, and likelihood of successful treatment

Introduction. Several in vitro and in vivo studies have found correspondence between transepicondylar axis (TEA) and functional flexion axis (FFA) in healthy subjects. In addition some studies suggest that the use of FFA for rotational alignment of femoral implant may be more accurate than TEA. Ostheoarthritis (OA) may modify limb alignment and therefore flexion axis, introducing a bias at different flexion ranges during kinematic acquisition. In this study we want to understand whether OA affects somehow the FFA evaluation compared to TEA and whether the FFA could be considered a usable reference for implant positioning for osteoarthritic knees. Methods. We included a group of 111 patients undergoing TKA. With a navigation system, we recorded intraoperative kinematic data in three different ranges of motion (0°-120°; 35°-80°; 35°-120°). We compared the difference in orientation of FFA (computed with the mean helical axis method) in the three ranges as also the difference with the TEA on frontal and axial planes. The correlation of preoperative limb deformity with FFA and TEA was also performed. Results. In OA patients an average difference of −2.8° ± 5.0° between TEA and FFA was found on frontal plane, while on axial plane results showed a difference of 0.6° ± 4.7°. No statistical difference was found among the three ranges in axial view whereas some difference was found in frontal view (p<0.0001). Angle between TEA and FFA was not correlated with limb alignment on axial plane, while it was, even if poor, in frontal plane. Conclusions. In pathological knees there is the same correspondence between TEA and FFA both in frontal and axial plane and preoperative limb alignment does not correlate with orientation of FFA and TEA. Results are in agreement to studies on healthy subjects. FFA can be used as reference for femoral implant positioning in axial plane also in pathologic knees, while for the frontal plane further investigations are required

The aim of the study was to assess the effectiveness of surgical treatment for degenerative lumbar spinal stenosis (LSS) as compared with non-operative measures. Four university hospitals contributed, after agreement on study protocol, surgical rationale and non-operative procedures (For details, see . Spine. 2007. ;. 32. :. 1. –8. ). Ninety-four patients were randomized into a surgical or nonoperative treatment group, 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments, in 10 patients augmented with transpedicular instrumented fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (ODI, scale 0–100). Intensity of leg and back pain (scales 0–10), as well as self-reported walking ability, were recorded at randomization and at follow-ups at 6, 12, 24 months and on average 6 years after the randomization. At the 2-year follow-up, back and leg pain scales and ODI had improved more in the surgical than the nonoperative group (p-values for global difference < 0,01). At the 6-year follow-up the mean difference in ODI in favor of surgery was 9.5 (95% confidence interval 0.9–18.1). However, the intensity of pains did not any-more differ between the two treatment groups at the 6-year follow-up. Walking ability did not differ between the treatment groups at any time point. Of the 44 patients in the nonoperative group, 4 had been subjected to surgery within two years after randomization because of persistent symptoms. We conclude that surgical treatment improves functional ability in lumbar spinal stenosis. We emphasize that improvement also occurs after nonoperative measures. We recommend starting treatment with non-operative measures during a 2-year surveillance period, as during this period only 10 per cent of the patients will need surgical intervention

Introduction: Several in vitro and in vivo studies have found correspondence between transepicondylar axis (TEA) and mean helical axis (MHA) in healthy subjects. In addition some studies suggest that the use of MHA for rotational alignment of femoral implant may be more accurate than TEA. Ostheoarthritis (OA) may modify limb alignment and flexion axis, introducing a bias during kinematic acquisition. An in-vivo study comparing normal and osteoarthritic knees using MHA is still lacking. The purposes of this study were: to understand whether arthritis affects somehow the functional axis evaluation and then to assess whether the MHA could be considered as reference flexion axis also for osteoarthritic knees; starting from hypothesis that there is a correspondence between TEA and MHA, to evaluate whether in pathologic subjects there still is the same correspondence. Material and Methods: We included a group of 15 OA patients undergoing TKA and, as control group, 60 patients that underwent ACL reconstruction, since in vivo studies reported small differences in kinematics between ACL reconstructed and uninjured limbs. With a surgical navigation system we recorded intraoperative kinematic data of different passive ranges of motion (PROM) and calculated the MHA applying a least square approach to the set of finite helical axes (FHA) obtained in three different ranges of motion (0°–120°; 35°–80°; 35°–120°). We compared the difference in orientation of MHA in the three ranges with respect to the TEA on frontal (XZ) and axial (XY) planes. The correlation of preoperative limb deformity with MHA-TEA angle was also performed. Results: The results of difference of MHA-TEA angle between the OA and ACL groups for all the three ranges of flexion and in XZ and XY views showed no statistical difference (p=0.5188; p=0.7147 respectively). No statistical difference was found also about MHA-TEA angle between the three ranges in frontal and axial views (ANOVA p=0.6373; p=0.4183 respectively). There was no difference between the flexion and extension movements in the three ranges. We also found that correlation between limb alignment and MHA-TEA angle showed good correlation (r> 0.54, p< 0.001) in frontal view and fair correlation (r< 0.37, p< 0.05) in axial view for all ranges. Conclusions: Our work has demonstrated that pathologic knees shows no differences in MHA orientation compared to nearly healthy subjects, moreover there is the same correspondence between TEA and MHA both in XZ and XY plane. We also found that preoperative limb alignment does not correlate with MHA-TEA angle. results are in agreement to studies on healthy subjects. Therefore the MHA may be considered a reliable reference for determining femoral flexion axis and a useful tool in the determination of femoral implant positioning on axial plane, even in surgical setup on osteoarthritic patients

Aims

Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

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It has been suggested that mobile-bearing total knee arthroplasty (TKA) might lead to better outcomes by accommodating some femorotibial rotational mismatch, thereby reducing contact stresses and polyethylene wear. The aim of this study was to determine whether there is a difference between fixed- and mobile-bearing versions of a contemporary TKA with respect to durability, range of movement (ROM) and function, ten years postoperatively.

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Although we often encounter patients with an aortic aneurysm who also have diffuse idiopathic skeletal hyperostosis (DISH), there are no reports to date of an association between these two conditions and the pathogenesis of DISH remains unknown. This study therefore evaluated the prevalence of DISH in patients with a thoracic aortic aneurysm (AA).

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We aimed to characterise the effect of expeditious hip fracture surgery in elderly patients within 24 hours of admission on short-term post-operative outcomes.

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Our purpose was to determine the quality of current randomised controlled trials (RCTs) in hand surgery using standardised metrics.

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The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).

Objective

Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia.

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To evaluate whether an ultra-low-dose CT protocol can diagnose selected limb fractures as well as conventional CT (C-CT).

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Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature.