Objectives. Cement augmentation of pedicle screws could be used to improve screw stability, especially in osteoporotic vertebrae. However, little is known concerning the influence of different screw types and amount of cement applied. Therefore, the aim of this biomechanical in vitro study was to evaluate the effect of cement augmentation on the screw pull-out force in osteoporotic vertebrae, comparing different pedicle screws (solid and fenestrated) and cement volumes (0 mL, 1 mL or 3 mL). Materials and Methods. A total of 54 osteoporotic human cadaver thoracic and lumbar vertebrae were instrumented with pedicle screws (uncemented, solid cemented or fenestrated cemented) and augmented with high-viscosity PMMA cement (0 mL, 1 mL or 3 mL). The insertion torque and bone mineral density were determined. Radiographs and CT scans were undertaken to evaluate cement distribution and cement leakage. Pull-out testing was performed with a material testing machine to measure failure load and stiffness. The paired t-test was used to compare the two screws within each vertebra. Results. Mean failure load was significantly greater for fenestrated cemented screws (+622 N; p ⩽ 0.001) and solid cemented screws (+460 N; p ⩽ 0.001) than for uncemented screws. There was no significant difference between the solid and fenestrated cemented screws (p = 0.5). In the lower thoracic vertebrae, 1 mL cement was enough to significantly increase failure load, while 3 mL led to further significant improvement in the upper thoracic, lower thoracic and lumbar regions. Conclusion. Conventional, solid pedicle screws augmented with high-viscosity cement provided comparable screw stability in pull-out testing to that of sophisticated and more expensive fenestrated screws. In terms of cement volume, we recommend the use of at least 1 mL in the thoracic and 3 mL in the lumbar spine. Cite this article: C. I. Leichtle, A. Lorenz, S. Rothstock, J. Happel, F. Walter, T. Shiozawa, U. G. Leichtle. Pull-out strength of cemented solid versus fenestrated pedicle screws in osteoporotic vertebrae. Bone Joint Res 2016;5:419–426

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To explore the synovial expression of mucin 1 (MUC1) and its role in rheumatoid arthritis (RA), as well as the possible downstream mechanisms.

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Alcoholism is a well-known detrimental factor in fracture healing. However, the underlying mechanism of alcohol-inhibited fracture healing remains poorly understood.

Artificial intelligence (AI) is, in essence, the concept of ‘computer thinking’, encompassing methods that train computers to perform and learn from executing certain tasks, called machine learning, and methods to build intricate computer models that both learn and adapt, called complex neural networks. Computer vision is a function of AI by which machine learning and complex neural networks can be applied to enable computers to capture, analyze, and interpret information from clinical images and visual inputs. This annotation summarizes key considerations and future perspectives concerning computer vision, questioning the need for this technology (the ‘why’), the current applications (the ‘what’), and the approach to unlocking its full potential (the ‘how’).

Cite this article: Bone Joint J 2022;104-B(8):911–914.

1. Twenty-eight cases of the infantile and three cases of the adolescent type of tibia vara occurring in West Indian Negroes are reported. 2. The condition is characterised by failure of growth of the postero-medial part of the upper tibial epiphysis. 3. The deformity produced is acute varus at the upper tibia with medial torsion and eventually flexion of the diaphysis on the epiphysis. 4. These deformities are considered to be due to a vicious circle set up by considerable alteration of the lines of force on the medial portion of the upper tibial epiphysial line

Operation on the hips of patients with myelomeningocele is often followed by stiffness or ankylosis. Excision of the upper end of the femur for this condition frequently fails because of extensive new bone formation. Twelve excisions in eight patients are reported. Six of these patients had recently had spinal fusion operations; the consequent loss of ability to compensate for hip stiffness by spinal flexion had made sitting difficult or impossible. Excision or even re-excision of the upper femur failed in most cases. Careful assessment of hip mobility before spinal operations in these patients is essential and osteotomy rather than excision of the upper femur is advised

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Diabetic foot care is a significant burden on the NHS in England. We have conducted a nationwide survey to determine the current participation of orthopaedic surgeons in diabetic foot care in England.

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The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI.

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Due to their radiolucency and favourable mechanical properties, carbon fibre nails may be a preferable alternative to titanium nails for oncology patients. We aim to compare the surgical characteristics and short-term results of patients who underwent intramedullary fixation with either a titanium or carbon fibre nail for pathological long-bone fracture.

Of a consecutive series of 70 babies with obstetric traction injury to the brachial plexus we were able to review 40 who had had only conservative treatment. We found that if recovery in the upper roots had not started by three months of age then, at follow-up there was a significant residual functional deficit. In a further 22 babies who showed no recovery of the upper roots by three months, exploration and sural nerve grafting were performed; 20 of these children were reviewed at one year. Good recovery of the deltoid was seen in 80% and of the biceps in 55%, while 25% had good external rotation at the shoulder. We conclude that if there is disruption of the upper roots with no sign of recovery at three months, grafting of these roots provides the best chance of useful recovery

1. Some problems in the early diagnosis and management of congenital dislocation are discussed. 2. In a well-staffed maternity unit one dislocation completely escaped early detection in every 8,000 births over the period 1962 to 1968 inclusive. 3. The complications of early treatment on a Malmö splint are initial failure to obtain reduction, failure to maintain reduction, deformity of the upper femoral epiphysis or metaphysis, and persistent anteversion of the femoral neck. 4. Arthrography suggests that failure of early splintage and deformity of the upper femur are due to attempted reduction in the presence of an inverted limbus. 5. A trial method of treatment of frank displacement in the first year of life has been carried out by combining excision of the inverted limbus with a period in a frog position plaster to correct anteversion. This method avoided changes in the upper femur but failed to correct anteversion in four out of eighteen cases

1. If a vertical load is applied to the head of the femur parallel to its shaft, the upper cortex is stretched and the lower cortex is compressed. The neck breaks from the upper subcapital border to the lesser trochanter. This type of fracture is rarely found clinically. 2. If a compressive force is applied to the area between head and greater trochanter while the head is loaded vertically, a transverse fracture of clinical appearance is produced. If this axial pressure acts along the part of the neck above the central axis a subcapital comminuted fracture results. If the pressure acts below the central axis the result is a transcervical fracture. 3. Strain gauge experiments have shown that axial compression within the upper segment of the neck is produced by the abductor muscles of the hip. Adductor muscles produce a low axial compression. It is suggested that muscular action at the time of injury influences the type of fracture produced by the injury

1. A three-year survey of avascular necrosis of bone has been carried out in a community of some 400 professional divers for shell-fish who had used no modern technique of decompression. 2. Of 301 divers radiographed, 152 (50·5 per cent) had bone lesions. 3. The incidence of bone necrosis increased in proportion to the length of diving experience, being highest in men with over ten years, experience. 4. The incidence was also higher in men who usually dived deeper than thirty metres. 5. There was a high incidence in men with a history of the bends but no significant relationship between the sites of the bends and those of the lesions. 6. Bone lesions were more frequently multiple than solitary. 7. The upper end of the humerus was significantly more affected than the upper end of the femur or tibia, but not significantly more than the lower end of the femur. 8. At the upper ends of the humerus and femur the lesions were more frequently unilateral than bilateral

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The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS).

Objectives. Intramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years. Methods. A total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)). Results. The incidence of cut-out across the sample was 5.6%, with a higher incidence in female patients. A significantly higher risk of this complication was correlated with lag-screw tip positioning in the upper part of the femoral head in the anteroposterior radiological view, posterior in the latero-lateral radiological view, and in the Cleveland peripheral zones. The tip-apex distance and the calcar-referenced tip-apex distance were found to be highly significant predictors of the risk of cut-out at cut-offs of 30.7 mm and 37.3 mm, respectively, but the former appeared more reliable than the latter in predicting the occurrence of this complication. Conclusion. The tip-apex distance remains the most accurate predictor of cut-out, which is significantly greater above a cut-off of 30.7 mm. Cite this article: G. Caruso, M. Bonomo, G. Valpiani, G. Salvatori, A. Gildone, V. Lorusso, L. Massari. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?. Bone Joint Res 2017;6:481–488. DOI: 10.1302/2046-3758.68.BJR-2016-0299.R1

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The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment.

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Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

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Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion.

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The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs).