Certain features of the sagging rope sign recently analysed by Apley and Weintroub (1981) are examined in detail. Evidence is presented to show that the line is a radiological shadow cast by the lateral edge of a severely deformed femoral head rather than a condensation of the spongiosa within the neck. An explanation is offered to explain the common association of the presence of this radiological sign with premature epiphysial fusion.

Thoracoplasty has been described as primarily a cosmetic resection of the rib hump. The purpose of our study was to investigate whether removal of a normal spine stabilizer affected the correction of the spine, particularly in the sagittal plane. Thirty-eight adolescent idiopathic scoliosis patients who underwent thoracoplasty were compared with eighteen controls in terms of maintenance of correction and patient satisfaction using the SRS questionnaire. Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of the thoracic hypokyphosis without any significant detractors in terms of patient outcome

To investigate whether thoracoplasty affected spinal correction. We also compared patient outcomes thoracoplasty patients and controls, as well as long-term curve maintenance.

Thoracoplasty did increase the correction of thoracic hypokyphosis, without any significant detractors in terms of patient outcome.

Current understanding of the scoliotic curve as a three dimensional helix has led to increased recognition of the importance of sagittal contour and balancing the spine’s reciprocal curves to avoid problems such as flat back syndrome. Correction of the scoliotic curve intraoperatively may require the removal of spine stabilizers such as the disc and annulus, posterior facet and capsule, and thoracic cage stabilizers such as the ribs.

Thirty-eight patients who had either concave para-median or convex Steel mid-rib thoracoplasty were reviewed and compared to eighteen controls. Prospective patient outcomes using the Scoliosis Research Society instrument with an average of > one year follow-up were available for thirty patients. Degree of curve settle and maintenance of correction was measured on follow-up radiographs.

Thoracoplasty had no effect on curve correction in the coronal plane. It did show a significant effect on sagittal plane correction of thoracic hypokyphosis. The paramedian group showed a mean increase of tweleve degrees, the Steel group 8.7 degrees, and, the control group 3.1 degrees. No significant difference between pain, satisfaction, function, and self-image was found. Long-term radiographic follow-up (average three years) showed a mean coronal curve settle of 4.6 degrees (thoracoplasty) versus 3.1 degrees (non-thoracoplasty), and an accompanying improvement in sagittal plane correction of 4.2 and 3.0 degrees, respectively.

The results of the DRAFFT (distal radius acute fracture fixation trial) study, which compared volar plating with Kirschner (K-) wire fixation for dorsally displaced fractures of the distal radius, were published in August 2014. The use of K-wires to treat these fractures is now increasing, with a concomitant decline in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question whether surgeons have been unduly influenced by its headline conclusions. Cite this article: Bone Joint J 2016;98-B:298–300

Aims. To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery. Methods. We undertook a systematic review of qualitative studies. Five databases were searched from inception to 1 February 2022. All titles and abstracts were screened, and a subset were independently assessed. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. The GRADE-CERQual checklist was used to assign confidence ratings. Thematic synthesis was used to analyze data with the identification of codes which were drawn together to form subthemes and then themes. Results. From 2,682 records, 15 studies were reviewed in full and four included in the review. A total of 72 patients were included across the four studies (47 female; mean age 50 years (17 to 80)). Methodological quality was high for all studies, and the GRADE-CERQual checklist provided confidence that the findings were an adequate representation of patient experience of distal tibia or ankle fracture. A central concept of ‘being the same but different’ conveyed the substantial disruption to patients’ self-identity caused by their injury. Patient experience of ‘being the same but different’ was expressed through three interrelated themes, with seven subthemes: i) being proactive where persistence, doing things differently and keeping busy prevailed; ii) living with change including symptoms, and living differently due to challenges at work and leisure; and iii) striving for normality, adapting while lacking in confidence, and feeling fearful and concerned about the future. Conclusion. Ankle injuries were disruptive, draining, and impacted on patients’ wellbeing. Substantial short- and longer-term challenges were experienced during recovery. Rehabilitation and psychosocial treatment strategies may help to ameliorate these challenges. Patients may benefit from clinicians being cognisant of patient experience when assessing, treating, and discussing expectations and outcomes with patients. Cite this article: Bone Jt Open 2023;4(3):188–197

Aims. Machine-learning (ML) prediction models in orthopaedic trauma hold great promise in assisting clinicians in various tasks, such as personalized risk stratification. However, an overview of current applications and critical appraisal to peer-reviewed guidelines is lacking. The objectives of this study are to 1) provide an overview of current ML prediction models in orthopaedic trauma; 2) evaluate the completeness of reporting following the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement; and 3) assess the risk of bias following the Prediction model Risk Of Bias Assessment Tool (PROBAST) tool. Methods. A systematic search screening 3,252 studies identified 45 ML-based prediction models in orthopaedic trauma up to January 2023. The TRIPOD statement assessed transparent reporting and the PROBAST tool the risk of bias. Results. A total of 40 studies reported on training and internal validation; four studies performed both development and external validation, and one study performed only external validation. The most commonly reported outcomes were mortality (33%, 15/45) and length of hospital stay (9%, 4/45), and the majority of prediction models were developed in the hip fracture population (60%, 27/45). The overall median completeness for the TRIPOD statement was 62% (interquartile range 30 to 81%). The overall risk of bias in the PROBAST tool was low in 24% (11/45), high in 69% (31/45), and unclear in 7% (3/45) of the studies. High risk of bias was mainly due to analysis domain concerns including small datasets with low number of outcomes, complete-case analysis in case of missing data, and no reporting of performance measures. Conclusion. The results of this study showed that despite a myriad of potential clinically useful applications, a substantial part of ML studies in orthopaedic trauma lack transparent reporting, and are at high risk of bias. These problems must be resolved by following established guidelines to instil confidence in ML models among patients and clinicians. Otherwise, there will remain a sizeable gap between the development of ML prediction models and their clinical application in our day-to-day orthopaedic trauma practice. Cite this article: Bone Jt Open 2024;5(1):9–19

Background. Both-bone diaphyseal forearm fractures constitute up to 5.4% of all fractures in children under 16 years of age in the United Kingdom. Most can be managed with closed reduction and cast immobilisation. Surgical fixation options include flexible intramedullary nailing and plating. However, the optimal method is controversial. Objectives. The main purpose of this study was to systematically search for and critically appraise articles comparing functional outcomes, radiographic outcomes and complications of nailing and plating for both-bone diaphyseal forearm fractures in children. Methods. A literature search of MEDLINE (PubMed), EMBASE and Cochrane library databases using specific search terms and limits was undertaken. The critical appraisal checklist (adapted from Critical Appraisal Skills Programme-CASP, Oxford; Guyatt et al) for an article on treatment was used to aid assessment. Results. All 7 studies identified were retrospective, comparative and non-randomized. They all included patients with similar baseline characteristics. There were no statistically significant differences in group outcomes for range of forearm movement, time to fracture union and complication rates. Less operative time and better cosmesis was noted in the IM nailing groups. Some studies showed post-operative radial bow was significantly abnormal in the IM nailing groups, but did not affect forearm movement. Conclusion. Based on similar functional and radiographic outcomes, nailing seems to be a safe and effective option when compared to plating for forearm fractures in children. However, critical appraisal of the studies in this review identified some methodological deficiencies and further prospective, randomized trials are recommended

Background. Despite arthroscopy being the gold standard for long head of biceps pathology, the literature is seemingly lacking in any critical appraisal or validation to support its use. The aim of this study was to evaluate its appropriateness as a benchmark for diagnosis. The objectives were to evaluate whether the length of the tendon examined at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses when compared to an open approach. Methods. A systematic review of cadaveric and clinical studies was performed. The search strategy was applied to Medline, PubMed and Google Scholar databases. All relevant articles were included. Critical appraisal of clinical studies was performed using a validated quality assessment scale. Results. Six articles were identified for inclusion in the review. This included both clinical and cadaveric studies. The overall population comprised 25 cadaveric specimens and 575 patients. Cadaveric studies showed that the use of a hook probe allowed arthroscopic visualisation of between 28% and 48% of the overall length of the LHB. In the clinical series the rate of missed diagnoses at arthroscopy when compared to open exploration ranged between 33% and 49%. Conclusions. The standard technique of pulling the LHB tendon into the joint at glenohumeral arthroscopy provides only limited excursion and does not allow visualisation of areas of predilection of pathology. This is confirmed by an extremely high rate of missed diagnoses when comparing arthroscopy to open exploration. It is important that clinicians recognise that a “normal” arthroscopic examination of the LHB tendon does not exclude pathology and that published literature reporting sensitivities and specificities for physical examination and imaging tests based on arthroscopy as a gold standard are invalid. Level of evidence. IIa – systematic review of cohort studies. Conflict of Interests. The authors confirm that they have no relevant financial disclosures or conflicts of interest. Ethical approval was not sought as this was a systematic review

Abstract. Objective. There is no specific framework for the clinical management of sports related brachial plexus injuries. Necessarily, rehabilitation is based on injury presentation and clinical diagnostics but it is unclear what the underlying evidence base to inform rehabilitative management. Methods. A systematic review of the literature was undertaken in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We applied the PEO criteria to inform our search strategy to find articles that reported the rehabilitative management of brachial plexus injuries sustained while playing contact sports. An electronic search of Medline, CINAHL, SPORTDiscus and Web of Science from inception to 3rd November 2022 was conducted. MESH terms and Boolean operators were employed. We applied an English language restriction but no other filters. Manual searches of Google Scholar and citation searching of included manuscripts were also completed. All study types were considered for inclusion provided they were published as peer-reviewed primary research articles and contained relevant information. Two investigators independently carried out the searches, screened by title, abstract and full text. Two researchers independently extracted the data from included articles. Data was cross-checked by a third researcher to ensure consistency. To assess internal validity and risk of bias, the Joanna Briggs Institute (JBI) critical appraisal tools were utilised. Results. The search generated 88 articles. Following removal of duplicates, 43 papers were evaluated against the eligibility criteria. Nine were eligible for full text review, with the majority of exclusions being expert opinion articles. Eight case reports were included. One article reported three individuals, resulting in data for ten athletes. The mean age was 19.8 years (±4.09). Injuries occurred in five American football players, two wrestlers, two rugby players, and a basketball player. No two studies applied the same diagnostic terminology and the severity of injury varied widely. Burning pain and altered sensation was the most commonly reported symptom, alongside motor weakness in the upper limb. Clinical presentation and management differed by injury pattern. Traction injuries caused biceps motor weakness and atrophy of the deltoid region, whereas compression injuries led to rotator cuff weakness. In all cases treatment was separated into acute and rehabilitative management phases, however the time frames related to these differed. Acute interventions varied but essentially entailed soft tissue inflammation management. Rehabilitation approaches variously included strengthening of shoulder complex and cervical musculature. Return-to-play criteria was opaque. The methodological quality of the case reports was acceptable. Four met all nine of the JBI evaluation criteria, and a further three met at least 75% of items. Conclusion(s). There is a distinct lack of evidence supporting rehabilitation management of sports related brachial plexus injury. Through systematic review we found only eight reports, representing ten individual case studies. No trials, cohort studies, or even retrospective registry-based studies are available to inform clinical management, which, necessarily, is driven by expert opinion and application of basic rehabilitation principles. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Chronic postoperative pain (CPP) can occur in elective mid/hindfoot and ankle surgery patients. Multimodal pain management has been reported to reduce postoperative pain and opioid use, which may prevent the development of CPP. However, few studies have examined the impact of multimodal pain management strategies on CPP following complex elective mid/hindfoot and ankle surgery. The purpose of this study was to 1) evaluate current pain management strategies and 2) determine current definitions, incidence, and prevalence of CPP after elective mid/hindfoot and ankle surgery. Three databases (MEDLINE, Embase and Cochrane Library) were manually and electronically searched for English language studies published between 1990 and July 2017. For the first aim, we included comparative studies of adults undergoing elective mid/hindfoot and ankle surgery that investigated pre-, peri- or postoperative pain management. For the second aim, we included observational studies examining CPP definition, incidence, and prevalence. Two reviewers independently screened titles and abstracts, followed by full texts. Conflicts were resolved through discussion with a third reviewer. Reviewers also independently assessed the quality of studies meeting inclusion criteria using the Joanna Briggs Institute Critical Appraisal Checklist. For the first aim, 1159 studies were identified by the primary search, and seven high quality randomized controlled trials were included. Ankle arthroplasty or fusion and calcaneal osteotomy were the most common procedures performed. The heterogeneity of study interventions, though all regional anesthesia techniques, precluded meta-analysis. Most investigated continuous popliteal, sciatic and/or femoral nerve blockade. Participants were typically followed up to 48 hours postoperatively to examine postoperative pain levels and morphine consumption in hospital. Interventions effective at reducing postoperative pain and/or morphine consumption included inserting popliteal catheters using ultrasound instead of nerve stimulation guidance, perineural dexamethasone, and adding continuous femoral blockade to continuous popliteal blockade. Using more than one analgesic was generally more effective than using a single agent. Only two studies examined longer term pain management. One found no difference in pain levels and opioid consumption at two weeks with perineural or systemic dexamethasone use. The other found that pain with activity was significantly reduced at six months postoperatively with the addition of a femoral catheter infusion to a popliteal catheter infusion. For the second aim, only two studies of the 747 identified were selected. One prospective observational study defined CPP as moderate-to-severe pain at one year after foot and ankle surgery, and reported 21% and 43% of patients as meeting their definition at rest and with activity, respectively. The other study was a systematic review that reported 23–60% of patients experienced residual pain after total ankle arthroplasty. There is no standardized definition of CPP in this population, and incidence and prevalence are rarely reported and vary largely based on definition. Although regional anesthesia may be effective at reducing in-hospital pain and opioid consumption, evidence is very limited regarding longer-term pain management and associated outcomes following elective mid/hindfoot and ankle surgery

Background. Distal radius fractures are common injuries but no clear consensus regarding optimal management of unstable fractures exists. Open reduction and internal fixation with volar plates is an increasingly popular but the associated complication rate can be 10%. Intramedullary nails are an alternative offering the potential advantages of reduced risk of tendon injury and intra-articular screw penetration. This article systematically reviews the published literature evaluating the biomechanics, outcomes and complications of intramedullary nails in the management of distal radius fractures. Methods. A systematic review of Medline and EMBASE databases was performed for studies reporting the biomechanics, functional outcome or complications following intramedullary nailing of distal radius fractures. Critical appraisal was performed with respect to validated quality assessment scales. Results. 16 studies were included for review. The biomechanical studies concluded that intramedullary nails had at least comparable strength to locking plates. The clinical studies reported that IM nailing was associated with comparable ROM, functional outcome and grip strength to alternative fixation techniques. However, the mean complication rate was 17.6% (range 0 to 50%) with the most common complication being neurapraxia of the superficial radial nerve in 9.5%. Conclusion. This systematic review of pooled data from published series has shown that IM nailing can give comparable clinical results to current treatment modalities in extra-articular and simple intra-articular distal radius fractures. However the evidence is insufficient to determine whether IM nailing has any clinically important advantage over well-established alternatives. The complication rate reported is higher than that in contemporary studies for volar plating and this raises concerns about the role of this technique particularly when comparative studies have failed to show any major advantage to its use. Further adequately powered RCTs comparing the technique to both volar plates and percutaneous wire fixation are required. Level of evidence. IIa – systematic review of cohort studies. Conflict of Interests. The authors confirm that they have no relevant financial disclosures or conflicts of interest. Ethical approval was not sought as this was a systematic review

There are well-established guidelines for musculoskeletal and connective tissue disorders in the assessment of potential recruits. There have been no critical appraisals of the application of these guidelines since their recent revision. The aim of this study was to examine whether common presenting conditions are covered by the guidelines and whether there was adherence by the assessor to the recommended outcome. We reviewed 110 potential recruits presenting to an Orthopaedic Consultant. There were a number of conditions not covered and a few occasions when the decision seemed contrary to the guidelines. In particular we think more consideration is needed of congenital deformities

Aims. A systematic review of the available literature comparing the outcomes of radiofrequency denervation to sham procedure in treating chronic low back pain caused by lumber zygapophysial joint pathology. Methods. Medline and EMBASE databases were searched for English language articles from 2005 to July 2010. Articles were considered for review if they satisfied the inclusion criteria: Randomised Controlled Trials(RCT) comparing radiofrequency neurotomy(RFN) to a ‘placebo’ procedure in patients with chronic low back pain caused by facet joint osteoarthritis. Adult patients of both sexes above 17 years of age who complained of continuous low back pain for more than 6 months with focal tenderness over the facet joints. Outcome measures of interest are pain improvement, physical activity, analgesic use, quality of life variables, range of motion of the lumbar spine and hip movement. Critical appraisal of the selected studies was carried out using the CASP appraisal tool for RCT. Results. Two articles were identified. Both demonstrated a statistically significant improvement in the pain (p<0.05) using a visual analogue scale in the RFN group compared to the sham procedure. Only one trial demonstrated a corresponding reduction in analgesic use. There was no consensus of improvement of quality of life factors in either study as compared to placebo. Conclusion. Radiofrequency denervation is better than sham procedure in treating pain caused by facet joint osteoarthritis with minimal adverse effects in the short term. A higher powered trial using a larger cohort and longer follow up is required to resolve some of the equivocal results. Conflicts of Interest. None. Source of Funding. None

Introduction. Indications for the use of external fixation include damage control orthopaedics, definitive fracture treatment, deformity correction and leg lengthening. Despite many advances in the development of external fixation techniques, pin-tract infection and loosening are still significant complications. They are the most commonly occurring complications during limb lengthening using external fixation, with some studies reporting an incidence of up to 80%. Objectives. The main aim of this systematic review was to investigate HA-coated versus uncoated external fixator pins used in patients undergoing leg lengthening and determine benefits in terms of pin loosening, infection and loss of reduction/malunion. Methods. A systematic literature search of MEDLINE (PubMed), EMBASE and Cochrane library databases was undertaken. Comparative trials investigating HA-coated versus uncoated external fixation pins used in patients undergoing leg lengthening procedures were identified. These were critically appraised as per the CASP (Guyatt et al) and CONSORT guidelines (Schulz et al., 2010). Primary outcome measures included pin loosening and infection. Secondary outcome measures included loss of reduction/malunion. Results. All studies identified had different criteria for defining pin loosening and infection. However, they all demonstrated a statistically significant reduction in loosening with HA-coated pins. Review of the studies included demonstrated insufficient evidence to determine any significant clinical benefit with regards to infection and malunion. Critical appraisal demonstrated average methodological quality of the studies. Conclusion. HA-coating of external fixator pins improves bone fixation and reduces loosening in patients undergoing leg lengthening procedures, but the influence on infection and malunion is not clear

Individuals learn to master new motor skills (such as learning a new surgical technique) by evaluating available feedback to alter future performance. Continuous concurrent augmented feedback is supplementary information presented to the learner throughout the performance of a task. An example of this type of feedback is the visual information provided by computer navigation during arthroplasty surgery. This type of feedback is a potentially powerful tool for learning because it theoretically guides the learner to the correct response, reduces errors, and reinforces correct actions. However, motor learning theory suggests that this type of feedback may impair learning because of development of dependence on the additional feedback or distraction from intrinsic feedback. In the current era of reduced number of training hours it is essential to assess the role of computer navigation on trainees. Our objective was to determine whether computer navigation influences the learning curve of novices performing hip resurfacing arthroplasty. We conducted a systematic review and critical appraisal of the literature. There is some evidence from randomised controlled trials that navigation use by trainees facilitates accurate placement of arthroplasty components compared to conventional instrumentation. There is no evidence that training with computer navigation impairs performance in retention tests (re-testing on same task after an interval of time) or transfer tests (re-testing in different conditions i.e. without concurrent feedback). We conclude that although there are significant limitations of the published literature on this topic there is no available evidence that supports concerns regarding the theoretical detrimental effects of computer navigation on the learning curve of arthroplasty trainees

As there is currently no evidenced-based and systematic way of prioritising people requiring JRS we aimed to develop a clinically relevant system to improve prioritisation of people who may require JRS. An important challenge in this area is to accurately assign a queue position and improve list management. To identify priority criteria areas eight workshops were held with surgeons and patients. Domains derived were pain, activity limitations, psychosocial wellbeing, economic impact and deterioration. Draft questions were developed and refined through structured interviews with patients and consultation with consultants. 38 items survived critical appraisal and were mailed to 600 patients. Eleven items survived clinimetric and statistical item reduction. Validation then included co-administration with standardised questionnaires (960 patients), verification of patient MAPT scores through clinical interview, examination of concordance with surgeon global ratings and test-retest. Ninety-six Victorian surgeons weighted items using Discrete Choice Experiments (DCEs). The DCE scaling generated a scale, which clearly ranked patients across the disease continuum. The MAPT differentiated people on or not on waiting lists (p<0.001), and was highly correlated with other questionnaires, e.g., unweighted-MAPT vs WOMAC (r=0.78), Oxford Hip/Knee (r=0.86/0.75), Quality of Life (r=0.78), Depression (r=0.64), Anxiety (r=0.60), p<0.001 for all. Test-retest was excellent (ICC=0.89, n=90). Cronbachs reliability was also high 0.85. The MAPT is now routinely administered across all Victorian hospitals undertaking arthroplasty where the response rate is generally above 90%. In the hands of clinicians the MAPT has been used to facilitate fast-tracking of patients with the greatest need, monitoring for deterioration in those waiting for surgery or having a trial of non-operative treatment and deferment of surgery for those that may benefit from further non-operative treatments. The MAPT is short, easy to complete and clinically relevant. It is a specific measure of severity of hip/knee arthritis and assigns priority for surgery. It has excellent psychometric and clinimetric properties evidenced by concordance with standard disease-specific and generic scales and widespread use and endorsement across health services

Summary Statement. With increasing emphasis on evidence-based medicine in healthcare, there is global increase in proportion of Level-1 and -2 articles in PUBMED. This study shows the trend of orthopaedic publications from different countries in comparison to other specialties. Introduction. New medical knowledge is expected to improve health through change in existing practices. Articles need to convince readers of the validity of conclusions in order to bring about a change in practice. The last few decades have witnessed an increasing interest in critical appraisal of research aimed at assessing the ‘quality’ of evidence, a trend towards ‘Evidence Based Medicine’. Whether orthopaedic publications are also becoming more evidence-based has hitherto not been reported. This study aimed to compare the trend of publications originating from orthopaedic services versus other specialties, across different countries, with respect to major categories of levels of evidence. Methods. PUBMED was used to collect data on yearly publication of articles, categorised by country, specialty (from author address) and article category (Guideline, Review, Case Report, Comparative Study, Clinical Trial and Meta-Analysis). Results. PUBMED shows 20,572,125 articles published between 1900 and 2010. Of these, 64% were published within the quarter century 1986–2010. Publication type was specified in 25% of articles, of which 8% were review articles, 7% each were case reports and comparative studies while 3% were clinical trials. The top ten countries from which articles originated were US, UK, Japan, Germany, France, Canada, Italy, Australia, Netherlands and Sweden. Comparing the decade of 1990s with 2000s, the number of meta-analyses showed greatest increase from Australia, Japan, Germany, UK and Italy (9.5x-6.1x). When comparing types of articles between the beginning and end of the quarter century, the proportion of clinical trials increased by 2x, guidelines by 5x and meta-analyses/systematic reviews by 28x. There were 121,859 articles from orthopaedic departments/institutes (0.6% of all articles). There was a consistent increase in the proportion of orthopaedic publications from 0.5% to 1.1% over the quarter century; this 231% increase was lower than vascular, cardiothoracic and paediatric surgery but greater than urology, neurosurgery, otolaryngology and obstetrics/gynecology. Among the different types of publications, in orthopaedics the greatest increase between the decades of 1990s and 2000s was in meta-analyses (8.5x) followed by guidelines (5.4x). This increase in number of meta-analyses was higher than other surgical specialties except cardiothoracic and vascular surgery, both of which showed a 13x increase. Among the meta-analyses from surgical specialties, the proportion from orthopaedics and vascular surgery was increasing consistently, with the former now contributing to 13% of all meta-analyses. In comparison, increase in number of clinical trials has been relatively modest for orthopaedics (2.4x), being lower than vascular surgery (3.3x), plastic surgery (2.8x) and neurosurgery (2.6x). Dicussion/Conclusion. The proportion of clinical trials and guidelines was increasing in a linear fashion in the last 25 years, while the proportion of meta-analyses/systematic reviews was increasing logarithmically. Among European countries, Germany, UK and Italy contributed to the highest number of meta-analyses. Publications from orthopaedic departments showed an overall intermediate rate of increase, but meta-analyses/systematic reviews showed a consistently higher increase compared to other surgical specialties. This analysis shows the trend of orthopaedic evidence in published literature and may be used as a guide to future country-specific research directions in the discipline of orthopaedics

The Bone & Joint Journal has published several consensus statements in recent years, many of which have positively influenced clinical practice and policy.^1-13 However, even the most valued consensus statements have limitations, and all ultimately represent Level V evidence. Consensus studies add greatest value where higher-order evidence to aid decision making is ambiguous or lacking. In all settings, care must be taken to critically appraise standards of methodology, with particular attention to potential biases that may influence the conclusions which are drawn.

Cite this article: Bone Joint J 2023;105-B(4):343–346.

The October 2024 Knee Roundup³⁶⁰ looks at: Managing the unexpected: treatment of intraoperative medial collateral ligament injuries; Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: secondary analysis of data from a randomized controlled trial; Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial; Cartilage regeneration and long-term survival in medial knee osteoarthritis patients treated with high tibial osteotomy and osteochondral autologous transfer system; Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes; Long-term outcomes of multiligament knee injuries in American football players.

Aims

The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures.

Aims

To analyze whether the addition of risk-based criteria to clinical examination-based selective ultrasound screening would increase the rates of early detected cases of developmental dysplasia of the hip (DDH) and decrease the rate of late detected cases.