We previously reported that osteoblasts at the curve apex in adolescent idiopathic scoliosis (AIS) exhibit a differential phenotype, compared to non-curve osteoblasts(1). However, the Hueter-Volkmann principle on vertebral body growth in spinal deformities (2) suggests this could be secondary to altered biomechanics. This study examined whether non-curve osteoblasts subjected to mechanical strain resemble the transcriptomic phenotype of curve apex osteoblasts.

Facet spinal tissue was collected perioperatively from three sites, (i) the concave and (ii) convex side at the curve apex and (iii) from outside the curve (non-curve) from six AIS female patients (age 13–18 years; NRES 19/WM/0083). Non-curve osteoblasts were subjected to strain using a 4-point bending device. Osteoblast phenotype was determined by RNA sequencing and bioinformatic pathway analysis.

RNAseq revealed that curve apex osteoblasts exhibited a differential transcriptome, with 1014 and 1301 differentially expressed genes (DEGs; p<0.05, fold-change >1.5) between convex/non-curve and concave/non-curve sites respectively. Non-curve osteoblasts subjected to strain showed increased protein expression of the mechanoresponsive biomarkers COX2 and C-Fos. Comparing unstimulated vs strain-induced non-curve osteoblasts, 423 DEGs were identified (p<0.05, fold-change >1.5). Of these DEGs, only 5% and 6% were common to the DEGs found at either side of the curve apex, compared to non-curve cells. Bioinformatic analysis of these strain-induced DEGs revealed a different array of canonical signalling pathways and cellular processes, to those significantly affected in cells at the curve apex.

Mechanical strain of AIS osteoblasts in vitro did not induce the differential transcriptomic phenotype of AIS osteoblasts at the curve apex.

Purpose

To determine if clinical outcomes are correlated with center of rotation (COR) in patients implanted with a viscoelastic total disc replacement (VTDR).

Aims

Accurate knowledge of the normal shoulder range of movement (ROM) is imperative for evaluating pathology and clinical success. However, in orthopaedic texts, the quoted normal shoulder ROM has significant variation. Furthermore we suspect there is a high incidence of intra and inter observer error during shoulder ROM examination.

The aims of our study were thus:

To perform a literature review and record the published values for normal shoulder ROM. Subsequently, to calculate the average of these published values.

To perform visual and goniometer measurement of shoulder ROM in 10 volunteers and assess the agreement between the two methods.

Introduction: Ilizarov frames are widely used as an external fixation system. Whether applied for trauma, bone transport or deformity-correction they are usually applied for a minimum of three months and can be used for over a year. The psychological and lifestyle impact of frames has been shown to be significant.

Purpose: We examined the informational needs of patients with Ilizarov frames pre and post-operatively. We then assessed how these needs are met by the provision of a nurse-led support group.

Methods: All patients with Ilizarov frames applied at Hope Hospital, Manchester were contacted by postal questionnaire. Questions were asked about preparation before surgery, changes to lifestyle and information received. Specific questions were asked about attendance at the nurse-led Ilizarov support group.

Results: Thirty-seven patients replied. Twenty-two had frames on and fifteen had recently had them removed. Most patients reported feeling well prepared before surgery regarding the likely impact on their lives. Two-thirds (twenty-five) felt they had received adequate information. Three-quarters (twenty-six) patients had attended the Ilizarov support group and most (twenty-one) had attended the group pre¬operatively. Over three-quarters of patients agreed they would attend the group with a “frame problem” before attending their own GP. All patients found the group supportive and felt comfortable discussing their problems.

Conclusion: The Ilizarov Support Group is a useful resource for people with frames. The group atmosphere is supportive to patients and it is a valuable problem-solving environment. It helps patients prepare for their surgery and reduces attendance to primary care providers for frame related problems. We suggest other Ilizarov units may benefit from the provision of such a service.