The attitudes of orthopaedic surgeons regarding radiology reporting is not well-described in the literature. We surveyed Orthopaedic Surgeons in Australia and New Zealand to assess if they routinely review formal radiology reports. An anonymized, 14 question online survey was distributed to consultant surgeons of the Australian and New Zealand Orthopaedic Associations (AOA, NZOA). Two hundred respondents completed the survey (Total number of Fellows: 283 NZOA, 1185 AOA). 18.5% of respondents always reviewed the formal Radiology report, 44.5% most of the time, 35% sometimes and 2% never. By imaging modality, MRI reports were the most frequently reviewed (92%), followed by ultrasound (74%) and nuclear medicine (63%). Only 10% of surgeons consulted formal reports for plain radiography. 55% of surgeons were still likely to disagree with the MRI report, followed by 46% for plain radiography. In cases of disagreement, only 21% of surgeons would always contact the reporting radiologist. The majority of Surgeons (85.5%) think there should be more collaboration between the disciplines, although only 50.5% had regular attendance of a Radiologist at their departmental audit. This survey reveals that the majority of orthopaedic surgeons are not routinely reading radiology reports. This points towards a need for further interdisciplinary collaboration. To our knowledge, this is the first survey directly assessing attitudes of orthopaedic surgeons towards radiology reports

Cartilage lesions vary in the spectrum from benign enchondromas to highly malignant dedifferentiated chondrosarcomas. From the treatment perspective, enchondromas are observed, Grade 1 chondrosarcomas are curetted like aggressive benign tumors, and rest are resected like other sarcomas. Although biopsy for tissue diagnosis is the gold standard for diagnosis and grade determination in chondrosarcoma, tumor heterogeneity limits the grading in patients following a biopsy. In the absence of definite pre-treatment grading, a surgeon is therefore often in a dilemma when deciding the best treatment option. Radiology has identified aggressive features and aggressiveness scores have been used to try and grade these tumors based on the imaging characteristics but there have been very few published reports with a uniform group and large number of cases to derive a consistent scoring and correlation. The authors asked these study questions :(1) Does Radiology Aggressiveness and its Score correlate with the grade of chondrosarcoma? (2) Can a cut off Radiology Agressiveness Score value be used to guide the clinician and add value to needle biopsy information in offering histological grade dependent management?. A retrospective analysis of patients with long bone extremity intraosseous primary chondrosarcomas were correlated with the final histology grade for the operated patients and Radiological parameters with 9 parameters identified a priori and from published literature (radiology aggressiveness scores - RAS) were evaluated and tabulated. 137 patients were identified and 2 patients were eliminated for prior surgical intervention. All patients had tissue diagnosis available and pre-treatment local radiology investigations (radiographs and/or CT scans and MRI scans) to define the RAS parameters. Spearman correlation has indicated that there was a significant positive association between RAS and final histology grading of long bone primary intraosseous chondrosarcomas. We expect higher RAS values will provide grading information in patients with inconclusive pre-surgery biopsy to tumor grades and aid in correct grade dependant surgical management of the lesion. Prediction of dedifferentiated chondrosarcoma from higher RAS will be attempted and a correlation to obtain a RAS cut off, although this may be challenging to achieve due to the overlap of features across the intermediate grade, high grade and dedifferentiated grades. Radiology Aggressiveness correlates with the histologic grade in long bone extremity primary chondrosarcomas and the correlation of radiology and biopsy can aid in treatment planning by guiding us towards a low-grade neoplasm which may be dealt with intralesional extended curettage or high-grade lesion which need to be resected. Standalone RAS may not solve the grading dilemma of primary long bone intraosseous chondrosarcomas as the need for tissue diagnosis for confirming atypical cartilaginous neoplasm cannot be eliminated, however in the event of a needle biopsy grade or inconclusive open biopsy it may guide us towards a correlational diagnosis along with radiology and pathology for grade based management of the chondrosarcoma

Aims. Distraction osteogenesis with intramedullary lengthening devices has undergone rapid development in the past decade with implant enhancement. In this first single-centre matched-pair analysis we focus on the comparison of treatment with the PRECICE and STRYDE intramedullary lengthening devices and aim to clarify any clinical and radiological differences. Methods. A single-centre 2:1 matched-pair retrospective analysis of 42 patients treated with the STRYDE and 82 patients treated with the PRECICE nail between May 2013 and November 2020 was conducted. Clinical and lengthening parameters were compared while focusing radiological assessment on osseous alterations related to the nail’s telescopic junction and locking bolts at four different stages. Results. Osteolysis next to the telescopic junction was observed in 31/48 segments (65%) lengthened with the STRYDE nail before implant removal compared to 1/91 segment (1%) in the PRECICE cohort. In the STRYDE cohort, osteolysis initially increased, but decreased or resolved in almost all lengthened segments (86%) after implant removal. Implant failure was observed in 9/48 STRYDE (19%) and in 8/92 PRECICE nails (9%). Breakage of the distal locking bolts was found in 5/48 STRYDE nails (10%) compared to none in the PRECICE cohort. Treatment-associated pain was generally recorded as mild and found in 30/48 patients (63%) and 39/92 (42%) in the STRYDE and PRECICE cohorts, respectively. Temporary range of motion (ROM) limitations under distraction were registered in 17/48 (35%) segments treated with the STRYDE and 35/92 segments (38%) treated with the PRECICE nail. Conclusion. Osteolysis and periosteal reaction, implant breakage, and pain during lengthening and consolidation is more likely in patients treated with the STRYDE nail compared to the PRECICE nail. Temporary ROM limitations during lengthening occurred independent of the applied device. Implant-related osseous alterations seem to remodel after implant removal. Cite this article: Bone Joint J 2023;105-B(1):88–96

Background. Accurate and reproducible radiological assessment of shoulder replacement prostheses over time is important for identifying failure or to provide reassurance. A number of clearly defined radiological parameters have been described to help standardise the radiological assessment of prostheses. To our knowledge, this is the first study conducted to test the reproducibility and reliability of these measurements. Aim. The aim of this work was to test intraobserver reproducibility and interobserver reliability in the measurement of humeral component orientation (HCO), humeral head offset (HHO), humeral head size (HHS), humeral head height (HHH), and acromiohumeral distance (AHD.). Materials and methods. A cohort of 67 patients who had previously undergone shoulder replacement was identified. Two independent reviewers studied the same AP radiograph of each patient on two occasions, at an interval of one month. Results. There was strong agreement for measurements of humeral head size (ICC=0.83), moderate agreement for humeral head offset (0.66), humeral head height (0.68) and acromio-humeral distance (0.66) and fair agreement for humeral component orientation (0.44). Conclusions. Interobserver reliability and intraobserver reproducibility of radiological measurements are important factors to consider when designing longitudinal or multi-centre studies of shoulder replacement prostheses

Introduction. Surgical planning for Patient Specific Instrumentation (PSI) in total knee arthroplasty (TKA) is based on static non-functional imaging (CT or MRI). Component alignment is determined prior to any assessment of clinical soft tissue laxity. This leads to surgical planning where assumptions of correctability of preoperative deformity are false and a need for intraoperative variation or abandonment of the PSI blocks occurs. The aim of this study is to determine whether functional radiology complements pre-surgical planning by identifying non-predictable patient variation in laxity. Method. Pre-operative CT's, standing radiographs and functional radiographs assessing coronal laxity at 20° flexion were collected for 20 patients. Varus/valgus laxity was assessed using the TELOS stress device (TELOS GmbH, Marburg, Germany, see Figure 1). The varus/valgus load was incrementally increased to either a maximum load of 150N or until the patient could not tolerate the discomfort. Radiographs were taken whilst the knee was held in the stressed position. CT scans were segmented and anatomical points landmarked. 2D–3D pose estimations were performed using the femur and tibia against the radiographs to determine knee alignment with each functional radiograph and so characterise the varus/valgus laxity. Results. The mean coronal alignment on CT and standing radiographs were 3.8° varus (SD, 5.6°) and 4.3° varus (SD, 6.7°) respectively. Of these, 5 of the knees were valgus aligned and 15 varus aligned in both standing and CT positions. The varus group had a mean of 5.9° in CT and 6.9° varus standing, while the valgus group had means of 4.4° valgus and 5.4° valgus in standing, indicating a collapse into further coronal malalignment while weightbearing. Each knee in the group had a laxity envelope calculated from the varus and valgus stressed radiographs. In the varus knees, the envelope ranged from 11.0° to 1.0° degree, with a mean of 5.1° (SD, 2.4°). In the valgus knees, the envelope ranged from 10.0° to 5.0° degrees, with a mean of 6.6° (SD, 2.3°), though this difference did not reach statistical significance. Using ±3° of neutral alignment as an indicator of correctable deformity, 7 of the 15 varus knees did not have a correctable deformity, while all of the valgus did. As determined by laxity limits, the CT and standing alignments were not well centered within their functional radiology groups. Specifically, for the valgus knees, 2 were near the valgus limit (lower quartile) of their laxity envelope, while for the varus knees, 9 were near their varus limit (upper quartile) and 2 at the valgus limit. In total, 65% of the knees did not have their standing alignment well centered on their functional laxity imits. Conclusions. Varus/valgus laxity in TKA appears to be subject specific and divorced from static radiological parameters. Surgical planning without reproducible clinical assessments of coronal laxity may not be sufficient to obtain a balanced TKA while avoiding ligament releases. Functional radiographs may be a viable method to individualise and refine the surgical plan in TKA on a per patient basis, incorporating objective information normally only available during the surgery itself. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Background. Patellar instability is a complex, multi-factorial disorder. Radiological assessment is regarded as an important part of the management of this population. The purpose of this study was to determine the intra- and inter-rater reliability of common radiological measurements used to evaluate patellar instability. Methods. One hundred and fifty x-rays from 51 individuals were reviewed by five reviewers: two orthopaedic trainees, a radiological trainee, a consultant radiologist and an orthopaedic physiotherapist. Radiological measurements assessed included patellar shape, sulcus angle, congruence angle, lateral patellofemoral angle (LPA), lateral patellar displacement (LPD), lateral displacement measurement (LDM), boss height, and patellar height ratios (Caton-Deschamps, Blackburne-Peel, Insall-Salvati). All assessors were provided with a summary document outlining the method of assessing each measurement. Bland-Altman analyses were adopted to assess intra- and inter-rater reliability. Results. The results indicated generally low measurement error on intra-rater reliability assessment, particularly for LPD (within-subject variance 0.7mm to 3.7mm), LDM (0.7mm to 3.5mm) and boss height (0.4mm to 1.6mm) for all assessors. There was greater measurement error for the calculation of sulcus angle (0.7° to 10.6°), congruence angle (0.8° to 18.4°) and LPA (0.8° to 16.5°). Whilst the inter-rater reliability between assessors indicated a low mean difference for assessments of patellar height measurements (0.0° to 0.6°), there was greater variability for LPA (0.1° to 3.6°), LPD (0.2mm to 4.6mm) and LDM (0.1mm to 4.0mm), with wide 95% limits of agreement for all measurements indicated poor precision. Conclusions. Many of the standard measurements used to assess the patellofemoral joint on plain radiographs have poor precision. Intra-rater reliability may be related to experience but it seems likely that to achieve good inter-rater reliability, specific training may be required to calibrate observers. More formal training in the technique of radiological measurement for those who were inexperienced might have improved the inter-rater reliability

Introduction. Cup malposition in hip arthroplasty and hip resurfacing is associated with instability, accelerated wear, and the need for revision. The current study assesses the validity of intraoperative assessment using a specialized software to analyze intraoperative radiographs. Methods. Cup orientation as measured on intraoperative radiography using the RadLink Galileo Positioning System was assessed in 10 patients. These radiographs were measured by personnel trained to support the system. The results were compared to cup orientation measured by CT. Cup orientation on CT was measured by first identifying the Anterior Pelvic Plane Coordinate system landmarks on a 3D surface model. A multiplanar reconstruction module then allowed for the creation of a plane parallel with the opening plane of the acetabulum. The orientation of the cup opening plane in the AP Plane coordinate space was then calculated. The same definition of cup orientation was used for both methodologies. Results. As compared to direct measurement using CT, the intraoperative radiograph system underestimated anteversion by an average of 8.0 degrees and overestimated cup inclination by 2.9 degrees. The radiographic measurement error in anteversion ranged from −27.4 to +4.0. degrees and for inclination ranged from −2.0 to +5.3 degrees. Conclusion. The use of an intraoperative radiological assessment system is relatively reliable in estimating the inclination of the acetabular component. Anteversion of the acetabular component is extremely poorly assessed by the system

Purpose. The majority (73%) of orthopaedic surgeons in Canada prefer using semitendinosus-gracilis (STG) autograft for ACL reconstruction. However, there is large variation in tendon size between individuals which makes pre-operative estimation of graft size unpredictable. Inadequate graft size may require an alternative source of graft tissue that should be planned prior to surgery. The purpose of this study is to determine if clinical anthropometric data and MRI measurements of STG tendons can be used to predict hamstring graft size. Method. One-hundred and fourteen patients with ACL deficiency awaiting reconstruction using hamstring autograft were retrospectively evaluated. The following information was obtained from patient charts: height, weight, body mass index (BMI), age, and gender. Cross-sectional area (CSA) of gracilis (G) and semitendinosus (ST) tendons were determined from pre-operative MRI scans using NIH ImageJ analysis software. Actual STG graft diameters were obtained from operative reports. Correlations between patient height, weight, BMI, age, gender, ST-CSA, G-CSA, STG-CSA and intraoperative graft size were calculated to determine the association between these variables. Multiple stepwise regression was performed to assess the predictive value of these variables to intraoperative graft diameter. In addition, three investigators with no radiological experience made independent measurements of the ST and G tendons to determine the inter-rater reliability (ICC) of MRI measurements. Results. All variables were independently correlated with intraoperative graft size (p<0.001). However, based on multiple stepwise regression analysis, only models including STG-CSA (r2=.212; p<.001); STG-CSA and sex (r2=.285; p<.001); and STG-CSA, sex and weight (r2=.294; p<.001) were found to be significant predictors of graft size (when co-variation in other factors was controlled). Inter-class correlation coefficients demonstrated very high agreement between raters for measurements of the ST, G and STG (.816, .827, .863, respectively). Conclusion. Measurement of tendon CSA from MRI images is very reliable. A model including STG-CSA, sex and weight was found to be strongly predictive of hamstring graft diameter for ACL reconstruction. This model may enhance our ability to predict adequate graft size and identify instances that other graft tissues may be a better option. The results of this study may improve pre-operative planning for ACL reconstruction

This study reports the mid-term results of a large bearing hybrid metal on metal total hip replacement (MOMHTHR) in 199 hips (185 patients) with mean follow up of 62 months. Clinical, radiological, metal ion and retrieval analysis were performed. Seventeen patients (8.6%) had undergone revision, and a further fourteen are awaiting surgery (defined in combination as failures). Twenty one (68%) failures were females. All revisions and ten (71%) awaiting revision were symptomatic. Twenty four failures (86%) showed progressive radiological changes. Fourteen revision cases showed evidence of adverse reactions to metal debris (ARMD). The failure cohort had significantly higher whole blood cobalt ion levels (p=0.001), but no significant difference in cup size (p=0.77), inclination (p=0.38) or cup version (p=0.12) compared to the non revised cohort. Female gender was associated with increased risk of failure (p=0.04). Multifactorial analysis demonstrated isolated raised Co levels in the absence of symptoms or XR changes were not predictive of failure (p=0.675). However the presence of pain (p<0.001) and XR changes (p<0.001) in isolation were significant predictors of failure. Wear analysis (n=5) demonstrated increased wear at the trunnion/head interface (mean out of roundness measurements 34.5 microns (normal range 8–10 microns) with normal wear levels at the articulating surfaces. Macroscopically corrosion was evident at the proximal and distal stem surfaces. Cumulative survival rate, with revision for any reason was 92.4% (95%CI: 87.4–95.4) at 5 years. Including those awaiting surgery, the revision rate would be 15.1% with 89.6% (95% CI: 83.9–93.4). Cumulative survival at 5 years. This MOMHTHR series has demonstrated unacceptable high failure rates with evidence of high wear at the head/trunnion interface and passive corrosion to the stem surface. Female gender was an independent risk factor of failure. Metal ion levels remain a useful aspect of the investigation work up but in isolation are not predictive of failure

Introduction. Pedicle subtraction osteotomy is a powerful technique for correcting sagittal imbalance in ankylosing spondylitis. There has been significant perioperative morbidity associated with this technique in the peer review literature. We present the Royal National Orthopaedic Hospital experience with a single surgeon retrospective study that was conducted to evaluate the outcomes in patients who underwent lumbar pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Method. Twenty seven patients underwent a lumbar pedicle subtraction osteotomy and adjacent level posterior instrumentation between 1995 and 2010. There were 18 males and 9 females in the study. Events during the peri-operative course and post-operative complications were recorded. The radiological outcome and patient satisfaction were analysed with mean follow-up of one and a half years. Results. The mean operative time was three and half hours and the mean blood loss was 2290mls. Final follow-up radiograph showed an increase in lumbar lordosis angle from 17 degrees to 45 degrees. The sagittal imbalance improved by 85mm with the operation. Complications included loosening in two patients, one transient neurologic deficit and one infective non-union occurred overall. There were no mortalities from the surgery. Two patients developed junctional kyphosis and required a repeat operation. There was an improvement in the Oswestry Disability Score from a mean of 29 to 16 after the surgey. All (100%) of the patients were satisfied with the results of the procedure and would recommend the surgey to others. Conclusion. The study shows that pedicle subtraction extension osteotomy is effective for the correction of kyphotic deformity in ankylosing spondylitis

Background. The current treatment options available for Trapezio-metacarpal arthritis are injection, splint and ultimately surgery. The injections are predominantly done by General practitioners and no data is available to specialist. Aim. To investigate accuracy of injection and efficacy of injection in terms of short and long term pain relief. Methods. We recruited 25 patients during March 2010 - January 2011. All of these patients had AP, Lat, and special Roberts radiographs. The technique involved palpating and surface marking Trapezio-metacarpal joint in the theatre. Under fluoroscopy, needle placement was performed while the operator was blinded from the screen. The location of needle was confirmed and then operator was allowed visualize the position of needle. Every movement of needle or the thumb to get the needle in joint was considered as an attempt. All had premixed Local anaesthetic and Depomedrone injection in to the joint. Accuracy was confirmed by operator and patient. We recorded patient demographics, number of attempts required for correct needle placement, pre and 10 minutes post-injection visual analogue scale (VAS) pain score, and Nelson Score (NS)before and six weeks after injection. Results. Mean age was 60(range 46–90). M:F(23:2). Dominant hand was affected in 14 cases. CMC J OA ranged from grade 2–4. First attempt was successful in 6 cases. Mean attempts required for accurate injection was 3(range 0–4). Mean pain pre-injection VAS was 7(range 4–10), 10 minutes following injection 0.5(range 0–4) and at 6 weeks 5(range 3–10). Mean pre-operative NS was 29.6(range 14–65) and at 6 weeks 32.4(range 14–55). The difference was not statistically significant (paired t test, p=0.24). Conclusion. Our results suggest that blind injection of thumb CMCJ may not be accurate as it requires assessment and appreciation of surface anatomy. Accuracy can be definitely improved by radiological guided injection. Limitations. Small number and short follow up

Purpose

The outcome of idiopathic chondrolysis in South Africa has been reported as a progressive downhill course resulting in a painful, stiff hip (Jones 1971, Sparks&Dall 1982). The cause of the disease remains unknown. Theories suggested are mechanical (decreased movement with loss of synovial nutrition; increased joint pressure) and an auto-immune response in genetically predisposed individuals. Our experience with continuous passive motion (CPM) and anti-inflammatory treatment has been disappointing.

Total Hip Replacement (THR) accounts among the successful procedures in orthopaedic surgery. It is reported that survival rate of implants can be as high as 93% at 20 years]. Nevertheless limb length inequality may result being the cause of major discomfort and dissatisfaction for patients. Additionally limb length inequality may also be recognised as a source of an abnormal force transmission through the replaced joint, contributing to early loosening and failure of the implants. Not only limb length but also restoration of best possible femoral offset is critical to stability and long term result of the procedure.

The main objective of our study was to assess the accuracy of determining limb length and offset changes intra-operatively by using a navigation-based measurement technique (Brainlab Navigaton System). Further we examined how many measurements were within a target accuracy interval of [−3mm, +3mm] when compared to values as provided by the implant manufacturer for trial neck (standard and high offset) and ball heads lengths.

We have enrolled 60 consecutive patients between November 2010 and November 2011 with primary or secondary coxarthritis requiring total hip replacement. All patients received the Trilock stem and Pinnacle cup with cross linked PE Marathon and Biolox ceramic heads (36 mm)

The analysis is the result of a prospective comparative study. Inclusion criteria of the study were: Patients with primary or secondary osteoarthritis, patients requiring primary arthroplasty at the time of index surgery, patients operated in the timeframe between November 2010 and November 2011

The primary objective of the study was the validation of the accuracy of intraoperative limb length and offset measurement with the aid of BrainLab navigation while changing trial components such as neck (standard and high offset) and trial heads (different lengths) as reported in their nominal values by the manufacturer. Each patient has undergone the following measurements: Intraoperative navigation measurement with BrainLab Navigation System for limb length and offset determination. Patients demographics: 60 consecutive patients, 12 males, 48 females, mean age 67.83 (37 – 84) mean BMI (26.26);Navigation measurements.

Measurements obtained intraoperatively with the aid of BrainLab navigation system showed a consistent and remarkable reproducibility between the data obtained and the differences expressed in mm between the different trial components as specified by the manufacturer, i.e. it was possible to consistently reproduce the length and offset variations when changing trial component from standard to high offset for the neck and for the different ball heads lenghts.

Results show a mean difference of −0,17 mm e 0,14 mm for offset and limb length measurement respectively (SD +/− 1,24 mm), among nominal values of trial components and those recorded with navigation.

In this study we have approached the issue of limb lenght and offset determination as an intaroperative challenge that should be accurate, reproducible and provide vital information for leg length and offset determination at the moment of surgery. Intraoperative assessment of length and offset with the aid of BrainLab navigation system has proven to be a valid and accurate tool by matching the difference in measurements in an objective way i.e. by assessing and recording these differences when trial components such as neck and ball heads where changed intraoperatively. Data recorded have been compared with the nominal values for the different trial components provided by the manufacturer.

The results show mean differences of −0.17 mm and 0.14 mm for offset and length respectively (SD ±1.24 mm) between navigation and the nominal values of the trial components as per specifications.

We can therefore conclude that BrainLab navigation system is a valid, precise and reproducible tool for intraoperative limb length and offset assessment during Total Hip Arthroplasty.

Aims

Will Hydroxyapatite ceramic coated (HAC) arthroplasty perform well in patients under the age of fifty?

Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. To be a valid predictor of disease and management, radiographic evaluation should include frontal and lateral views of the spine and a complete view of the pelvis, leading to accurate Cobb angle measurements and Risser staging. The study objectives were to determine 1) the adequacy of index images to inform treatment decisions at initial consultation by generating a score and 2) the utility of index radiology reports for appropriate triage decisions, by comparing reports to corresponding images. We conducted a retrospective chart and radiographic review including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1-April 30, 2021. A score was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity (view of full spine, coronal=two, lateral=one, pelvis=one, ribcage=one). Index images were considered inadequate if repeat imaging was necessary. Comparisons were made between index radiology report, associated imaging, and new imaging if obtained at initial consultation. Major discrepancies were defined by inter-reader difference >15°, discordant Risser staging, or inaccuracies that led to inappropriate triage decisions. Location of index imaging, hospital versus community-based private clinic, was evaluated as a risk factor for inadequate or discrepant imaging. There were 94 patients reviewed with 79% (n=74) requiring repeat imaging at initial consultation, of which 74% (n=55) were due to insufficient quality and/or visualization of the sagittal profile, pelvis or ribcage. Of index images available for review at initial consult (n=80), 41.2% scored five out of five and 32.5% scored two or below. New imaging showed that 50.0% of those patients had not been triaged appropriately, compared to 18.2% of patients with a full score. Comparing index radiology reports to initial visit evaluation with <60 days between imaging (n=49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients, with 18.4% (95% CI 10.0, 31.4) categorized as major discrepancies. Risser stage was reported in only 14% of index radiology reports. In 13.8% (n=13) of the total cohort, surgical or brace treatment was recommended when not predicted based on index radiology report. Repeat radiograph (p=0.001, OR=8.38) and discrepancies (p=0.02, OR=7.96) were increased when index imaging was obtained at community-based private clinic compared to at a hospital. Re-evaluation of available index imaging demonstrated that 24.6% (95% CI 15.2, 37.1) of Cobb angles were mis-reported by six to 21 degrees. Most pre-referral paediatric spine radiographs are inadequate for idiopathic scoliosis evaluation. Standardization of spine imaging and reporting should improve measurement accuracy, facilitate triage and decrease unnecessary radiation exposure

The purpose of this study was to investigate the effectiveness of casting in achieving acceptable radiological parameters for unstable ankle injuries. This retrospective observational cohort study was conducted involving the retrieval of X-rays of all ankles taken over a 2 year period in an urban setting to investigate the radiological outcomes of cast management for unstable ankle fractures using four acceptable parameters measured on a single X- ray at union. The Picture Archiving and Communication System (PACS) was used, the X-rays were measured by a single observer. From the 1st of January 2020 to the 31st of December 2021, a total of 1043 ankle fractures were treated at the three hospitals with a male to female ratio of 1:1.7. Of the 628 unstable ankle injuries, 19% of patients were lost to follow up. 190 were managed conservatively with casts, requiring an average of 4 manipulations, with a malunion rate of 23.2%. Unstable ankle injuries that were treated surgically from the outset and those who failed conservative management and subsequently converted to surgery had a malunion rate of 8.1% and 11.0% respectively. Unstable ankle fractures pose a challenge with a high rate of radiological malunion, regardless of the treatment Casting surgery from the outset or converted to surgery, with rates of 23% and 8% and 11% respectively. In this multivariate analysis we found that conservative management was the only factor influencing the incidence of malunion, age, sex and type of fracture did not have a scientific significant influence

Aims. Limb-lengthening nails have largely replaced external fixation in limb-lengthening and reconstructive surgery. However, the adverse events and high prevalence of radiological changes recently noted with the STRYDE lengthening nail have raised concerns about the use of internal lengthening nails. The aim of this study was to compare the prevalence of radiological bone abnormalities between STRYDE, PRECICE, and FITBONE nails prior to nail removal. Methods. This was a retrospective case series from three centres. Patients were included if they had either of the three limb-lengthening nails (STYDE, PRECICE, or FITBONE) removed. Standard orthogonal radiographs immediately prior to nail removal were examined for bone abnormalities at the junction of the telescoping nail parts. Results. In total, 306 patients (168 male, 138 female) had 366 limb-lengthening nails removed. The mean time from nail insertion to radiological evaluation was 434 days (36 to 3,015). Overall, 77% of STRYDE nails (20/26) had bone abnormalities at the interface compared with only 2% of FITBONE (4/242) and 1% of PRECICE nails (1/98; p < 0.001). Focal osteolysis in conjunction with periosteal reaction at the telescoping interface was only observed in STRYDE nails. Conclusion. Bone abnormalities at the interface of telescoping nail parts were seen in the majority of STRYDE nails, but only very rarely with FITBONE or PRECICE nails. We conclude that the low prevalence of radiological changes at the junctional interface of 242 FITBONE and 98 PRECICE nails at the time of nail removal does not warrant clinical concerns. Cite this article: Bone Joint J 2021;103-B(11):1731–1735

Introduction. The purpose of this study is to evaluate the radiological and clinical outcomes in Northern Ireland of free vascularised fibular bone grafting for the treatment of humeral bone loss secondary to osteomyelitis. Upper limb skeletal bone loss due to osteomyelitis is a devastating and challenging complication to manage for both surgeon and patient. Patients can be left with life altering disability and functional impairment. This limb threatening complication raises the question of salvage versus amputation and the associated risk and benefits of each. Free vascularised fibula grafting is a recognised treatment option for large skeletal defects in long bones but is not without significant risk. The benefit of vascularised over non-vascularised fibula grafts include preservation of blood supply lending itself to improved remodeling and osteointegration. Materials & Methods. Sixteen patients in Northern Ireland had free vascularised fibula grafting. Inclusion criteria included grafting to humeral defects secondary to osteomyelitis. Six patients were included in this study. Patients were contacted to complete DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires as our primary outcome measure. Secondary outcome measures included radiological evaluation of osteointegration and associated operative complications. Complications were assessed via review of Electronic Care Record outpatient and in-patient documents

Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries. This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin traction followed by spica cast. They were regularly followed up with clinical and radiological examination to look out for signs of healing and any complications. TENS was removed at 4–9 months’ time in all Group A patients. Group A patients had a statistically significant less hospital stay, immobilisation period, time to full weight bearing and radiological union. Rotational malunions were significantly lower in Group A (p-value 0.0379) while there was no statistically significant difference in angular malunion in coronal and sagittal plane at final follow up. Complications unique to group A were skin necrosis and infection. We conclude that TENS is better modality for treatment of shaft of femur fractures in patients of 4–6 years age as they significantly reduce the hospital stay, immobilization period and rotational malalignment

The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes. The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence. Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population. These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures