Bone & Joint Open最新文献

{"title":"Pain control following total hip arthroplasty: a prospective randomized controlled trial comparing spinal anaesthesia without adjuncts versus fascia iliaca block versus pericapsular nerve group block versus local anaesthetic infiltration.","authors":"J Patrick Park, Kevin Yan Zhao, Tanya Cierson, Bardia Barimani, Eric Belzile, De Q Tran, Anthony Albers","doi":"10.1302/2633-1462.75.BJO-2026-0003.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2026-0003.R1","url":null,"abstract":"<p><strong>Aims: </strong>Postoperative pain management for total hip arthroplasty (THA) remains an area for improvement. This study compared the impact of suprainguinal fascia iliaca block (FIB) versus local anaesthetic infiltration (LAI), versus pericapsular nerve group (PENG) block, and versus spinal anaesthesia alone, on early postoperative pain in patients who underwent inpatient primary THA.</p><p><strong>Methods: </strong>This was a single-centre, assessor- and participant-blinded randomized controlled trial. A total of 240 patients undergoing THA under spinal anaesthesia were randomized to LAI, FIB, PENG block, or control in a 1:1:1:1 ratio. The primary outcome was pain at four hours postoperatively (visual analogue scale (VAS)). Secondary outcomes included VAS at other timepoints, opioid consumption, patient satisfaction, and length of hospital stay (LOS). A VAS difference of 2 cm was considered clinically significant.</p><p><strong>Results: </strong>A total of 240 participants were randomized, with 222 in the final analysis. Only LAI (mean VAS 1.6 (SD 2.2)) significantly decreased postoperative pain compared with the control group (mean VAS 3.0 (SD 2.7); p = 0.004) at four hours. VAS at four hours was not significantly different between LAI, FIB, and PENG block groups in direct comparisons. FIB (23.3 mg morphine equivalents (MEQ) (SD 18.4), p = 0.001) and LAI (22.2 mg MEQ (SD 18.7), p = 0.001) significantly decreased opioid consumption compared with the control group (36.7 mg MEQ (SD 24.5)) at 24 hours postoperatively. The same was found at 48 hours postoperatively. LAI significantly improved patient satisfaction scores at four hours compared with the control group (1.3 (SD 0.6) vs 1.9 (SD 1.2), p = 0.043). There was no difference in LOS between study groups. One patient had femoral nerve motor deficit following PENG block, with full recovery at six months postoperatively.</p><p><strong>Conclusion: </strong>LAI combined with spinal anaesthesia reduced early postoperative pain and improved patient satisfaction with pain control compared with spinal anaesthesia alone. LAI and FIB both decreased opioid consumption in the first 24 and 48 hours.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"601-612"},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factor research: why it matters in orthopaedics and how we do it better.","authors":"Zaid A Hamoodi, Richard D Riley, Gary S Collins, Lianne Kearsley-Fleet, Jamie C Sergeant, Adam C Watts","doi":"10.1302/2633-1462.75.BJO-2025-0385.R1","DOIUrl":"10.1302/2633-1462.75.BJO-2025-0385.R1","url":null,"abstract":"<p><p>By studying and predicting health outcomes, prognosis research can inform joint decision-making between a patient and clinician, and help to improve future health and care. The scope of prognosis research is broad. It can describe the natural history of a condition; identify prognostic factors (variables associated with future outcomes); develop and validate prediction models for estimating an individual's outcome risk; and identify intervention effects that vary by specified individual characteristics. Research on prognostic factors enables personalized treatment, as it helps identify patient risk profiles that guide clinical decisions, trial design, and resource allocation, and it is a stepping stone into developing prognostic models for individualized risk predictions. However, it is imperative for prognosis research to have high standards of study design, analysis, and reporting. Inadequately executed research can lead to misleading prognostic information, resulting in inappropriate treatment or advice for some patients. A better understanding of the fundamentals of modern prognosis research methods can empower clinicians to more accurately appraise research findings in this field. This will lead to the identification and implementation of high-quality prognostic research findings, to improve healthcare and patient outcomes. However, prognostic research in orthopaedics often exhibits poor methodology, inconsistent reporting, and over-reliance on statistical significance. Recent advances in methodological guidance have provided important recommendations for study design, analysis, and reporting. Accurate interpretation requires adjusted analyses that consider known prognostic factors to prevent misleading conclusions. Key components include study registration, sample size planning, clear protocols and transparent reporting. Following these principles can greatly enhance the quality and clinical relevance of trauma and orthopaedic research. This overview introduces types of prognosis studies and then focuses on prognostic factor research and its importance within the field of Trauma and Orthopaedics (T&O). It outlines the latest advances, identifies current limitations, and directs readers towards best practices that should be adopted by researchers.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"613-618"},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of strategies for spinal casting in early onset scoliosis : five-year progression-free survival analysis.","authors":"Jennifer A Dermott, Dorothy J Kim, Lily S Switzer, Emma B Nadler, Mark W Camp, David E Lebel","doi":"10.1302/2633-1462.75.BJO-2025-0328.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.75.BJO-2025-0328.R1","url":null,"abstract":"<p><strong>Aims: </strong>Spinal casting is accepted as a surgical delay strategy in the management of early onset scoliosis (EOS). There is no consensus on protocol to optimize outcomes. This study compares the five-year outcomes of intermittent casting (IC) with continuous casting (CC) strategies, focusing on deformity control.</p><p><strong>Methods: </strong>This was a progression-free survival analysis informed by retrospective chart review of all EOS patients who had spinal casting between January 2002 and August 2025. IC was defined as two to three casts applied over six months, followed by bracing and single repeat casts if progression was noted. CC was defined as the repeat application of casts every 12 to 16 weeks, over a period > one year. Patients with < 12-month follow-up or with congenital aetiology were excluded. The primary outcome was curve progression > 5° or transition to surgery. Kaplan-Meier analysis with log-rank test compared the efficacy of each strategy to halt curve progression or delay surgery. Cox proportional hazards model was used to estimate the adjusted hazard ratio (aHR) between strategies. In-cast correction and complications related to casting were recorded.</p><p><strong>Results: </strong>Overall, 59% (n = 30) underwent IC and 41% (n = 21) CC. Groups were similar at baseline in sex, age, aetiology, and index curve magnitude (mean 64° (SD 15°)). The five-year progression-free survival rate was 47% (95% CI 33.7 to 66.0), which did not differ by casting strategy (p = 0.095). In-cast correction was stable with CC, whereas less correction was achieved over time with IC (p = 0.004). The adjusted risk of progression decreased with greater correction in first cast (aHR 0.48, 95% CI 0.28 to 0.83, p = 0.009) and increased with larger index curve magnitudes (aHR 3.01, 95% CI 1.48 to 6.12, p = 0.002). Each group had one complication.</p><p><strong>Conclusion: </strong>There is not a distinct advantage with a CC strategy over an IC strategy with both offering deformity control and meaningful delays in surgery for EOS patients. The long-term implications of ongoing in-cast correction seen with CC are yet to be determined.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 5","pages":"593-600"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does integrating pelvic tilt change from sitting to standing in functional 3D planning enhance early complications of robotic-assisted total hip arthroplasty?","authors":"Pascal Kouyoumdjian, Anthony Marquant, Thomas Grosso, Remy Coulomb","doi":"10.1302/2633-1462.74.BJO-2025-0381.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.74.BJO-2025-0381.R1","url":null,"abstract":"<p><strong>Aims: </strong>While robotic-assisted total hip arthroplasty (THA) improves implant positioning accuracy, it often overlooks dynamic lumbopelvic parameters, such as pelvic tilt changes between sitting and standing. These factors are increasingly recognized as critical in preventing early complications, such as impingement and dislocation. The aim was to determine whether integrating pelvic tilt variations into functional 3D planning reduces complications and improves outcomes following THA.</p><p><strong>Methods: </strong>In this retrospective cohort study, 656 patients underwent robotic-assisted THA using either conventional CT-based planning (V3) or functional kinematic-based planning (V4). The V4 group incorporated lumbopelvic kinematics, specifically pelvic tilt in seated and standing positions, into implant planning via a collision model. Outcomes at ≥ one year included complication rates (dislocations, periprosthetic fractures, reoperations) and functional outcomes (visual analogue scale, Harris Hip Score, Oxford Hip Score, Forgotten Joint Score).</p><p><strong>Results: </strong>Compared with V3, the V4 group had significantly fewer overall complications (2.8% vs 8.4%, p = 0.007), no dislocations (0% vs 1.7%, p = 0.048), and fewer reoperations (p = 0.017). Reoperation-free survival at two years was higher in the V4 group (97.2% vs 94.1%). Functional outcomes were significantly improved across all scores, with more patients achieving patient acceptable symptom state thresholds (p < 0.05). In multivariate analysis, functional planning (V4) was the only independent protective factor against reoperation, while age, sex, BMI, American Society of Anesthesiologists grade, smoking, approach, and insert type were not significantly associated.</p><p><strong>Conclusion: </strong>Functional planning that incorporates the kinematics of the lumbopelvic complex (V4) was the only independent protective factor against reoperation, highlighting the importance of integrating lumbopelvic dynamics into robotic-assisted THA.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"584-592"},"PeriodicalIF":3.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curve in periacetabular osteotomy for developmental dysplasia of the hip : a systematic review and meta-analysis.","authors":"Nikolai Ramadanov, Maximilian Heinz, Maximilian Voss, Robert Hable, Roland Becker, Sufian S Ahmad","doi":"10.1302/2633-1462.74.BJO-2025-0371.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.74.BJO-2025-0371.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) is technically demanding with an assumed steep learning curve. This systematic review and meta-analysis evaluated how surgeon experience influences operative efficiency, perioperative morbidity, radiological correction, and conversion to total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH).</p><p><strong>Methods: </strong>A systematic search of five databases identified studies comparing early with late PAO experience phases. Random-effects meta-analyses (Sidik-Jonkman with Hartung-Knapp adjustment) were performed for continuous (mean difference (MD)) and binary (odds ratios (ORs)) outcomes. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE).</p><p><strong>Results: </strong>In all, seven studies (499 patients, 556 hips) were included. Late-phase PAOs had significantly shorter operative times (MD -74.58 minutes, 95% CI -136.52 to -12.65). No significant differences were found for blood loss, complications, THA conversion, or radiological correction. Heterogeneity was high for operating time and blood loss, and most studies showed moderate risk of bias.</p><p><strong>Conclusion: </strong>Surgeon experience substantially improves operative efficiency in PAO, while complications, blood loss, radiological accuracy, and early THA conversion appear largely unaffected, likely reflecting structured supervision and high-volume training environments. The lack of significant differences in complications and radiological correction suggests that structured mentorship and centralized hip preservation programmes may mitigate early-phase risk. Standardized, prospective studies are needed to define proficiency thresholds and optimize training in hip preservation surgery.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"574-583"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative education on early outcomes following hip and knee arthroplasty : a 21,000-patient multicentre NHS analysis.","authors":"Kashif I Ahmad, Antonio Eleuteri, Tom Jenks, Phillipa Thorpe","doi":"10.1302/2633-1462.74.BJO-2025-0259.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0259.R1","url":null,"abstract":"<p><strong>Aims: </strong>Preoperative education is routinely integrated into enhanced recovery pathways for hip and knee arthroplasty, yet its independent effect on early outcomes remains uncertain. This study examined whether completion of structured preoperative education was associated with length of stay (LOS), early mobilization, and 30-day readmission, adjusting for patient risk factors including frailty.</p><p><strong>Methods: </strong>A retrospective study was performed using routinely collected data from adults undergoing elective primary hip or knee arthroplasty across 17 NHS and independent hospitals (2019 to 2024). Completion of preoperative education (Advancing Quality measure HK-07) was the primary exposure. LOS and 30-day readmission were primary outcomes; early mobilization within 24 hours (HK-05) was secondary. Multivariable regression models were adjusted for age, sex, procedure type, comorbidity category, and Hospital Frailty Risk Score, with restricted cubic splines for non-linear age effects and cluster-robust estimation for site variation.</p><p><strong>Results: </strong>Of 21,225 included patients, 93.4% completed preoperative education and 97.2% mobilized within 24 hours. Completion of education was associated with a modest reduction in LOS, with the greatest effect observed in younger patients and attenuation beyond 70 years of age. No significant associations were observed between education and 30-day readmission, whereas completion of education was associated with early mobilization. Increasing frailty and comorbidity were associated with longer LOS and higher readmission risk.</p><p><strong>Conclusion: </strong>Preoperative education is associated with a shorter hospital stay for younger and lower-risk patients but does not appear to influence 30-day readmission. Frailty and comorbidity remain dominant drivers of outcome variation. Education should be considered one component of perioperative care, and additional tailored support may be required for older and frailer individuals.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"566-573"},"PeriodicalIF":3.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total knee arthroplasty with metaphyseal sleeves for acute tibial plateau fractures.","authors":"Katie Wang, Vishwa Suravaram, Christopher W Jones, Gareth H Prosser, Thomas A Bucher, Piers Yates","doi":"10.1302/2633-1462.74.BJO-2026-0032.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2026-0032.R1","url":null,"abstract":"<p><strong>Aims: </strong>Total knee arthroplasty (TKA) allows immediate weightbearing and avoids challenges associated with secondary arthroplasty following conservative management or failed fixation of tibial plateau fractures (TPFs). Metaphyseal sleeves may overcome the limitations of conventional implants by addressing issues of deficient bone stock and inadequate proximal fixation in the fracture zone.</p><p><strong>Methods: </strong>We conducted a retrospective case series of patients undergoing TKA with metaphyseal sleeves for acute TPFs at a single tertiary centre between January 2019 and June 2025. Demographic details, injury characteristics, clinical outcomes, and complications were extracted from electronic records.</p><p><strong>Results: </strong>A total of 16 patients were included (mean age 73.8 years (SD 6.0), 93.8% female). Of these patients (87.5% (n = 14/16) were osteoporotic, and 37.5% (n = 6/16) had pre-existing osteoarthritis. The median follow-up was 12 months (IQR 3 to 72). Immediate weightbearing was achieved in all. Radiographs in all patients showed metaphyseal sleeve integration and no subsidence by three months. One patient was followed up at six years showing no adverse radiological signs. Mean knee range of motion improved from 90.7° at sixweeks to 108.1° at final follow-up. Complications occurred in 25.0% of patients (n = 4/16), most commonly wound-related (n = 2/16). Two patients (12.5%) required further surgical intervention.</p><p><strong>Conclusion: </strong>TKA with metaphyseal sleeves has a role in selected elderly patients with TPF not amenable to reconstruction. It addresses fixation failure in TPF and enables early mobilization with acceptable outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"557-565"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cement mantle thickness in total knee arthroplasty more closely associated with tibial bone density than cement viscosity : findings from a randomized controlled trial.","authors":"Yoshinori Mikashima, Hitoshi Imamura, Koichiro Yano, Katsunori Ikari, Hiroshi Takagi, Ken Okazaki","doi":"10.1302/2633-1462.74.BJO-2025-0348.R2","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0348.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aims were to assess the influence of tibial bone mineral density (BMD) and cement viscosity on cement mantle thickness in total knee arthroplasty (TKA), and to determine whether BMD is a more dominant factor than cement viscosity in achieving optimal cement penetration.</p><p><strong>Methods: </strong>A prospective, randomized controlled trial involving 117 knees from 130 patients undergoing primary TKA was conducted. Patients were allocated to receive either medium-viscosity cement (Group M) or high-viscosity cement (Group H). Cement mantle thickness was measured radiologically at predefined tibial zones using the Modern Knee Society Radiographic Evaluation System. Preoperative tibial BMD was assessed via CT-based quantification. Correlations between tibial BMD and mantle thickness were analyzed, and a cutoff tibial BMD value for achieving ≥ 2.1 mm mantle thickness was determined. This threshold was based on previous findings suggesting that a cement mantle thickness of at least 2.1 mm may help reduce the incidence of radiolucent lines around the tibial component.</p><p><strong>Results: </strong>No significant differences in mantle thickness were observed between groups at peripheral zones. However, Group H showed significantly greater thickness at central zones (Zone 3 medial (M) (p = 0.001); Zone 3 lateral (L) (p = 0.001); Zone 3 anterior (A) (p=0.001); and Zone 3 posterior (P) ( p = 0.001). Strong negative correlations were found between tibial BMD and mantle thickness in both groups (r = -0.64 to -0.70). The cutoff tibial BMD value to achieve ≥ 2.1 mm mantle thickness was 78.4 HA/cm³. The intra- and inter-rater reliability of the radiological measurements were acceptable (interclass correlation coefficient 0.77 and 0.68, respectively).</p><p><strong>Conclusion: </strong>Cement penetration beneath the tibial tray is more closely associated with tibial BMD than with cement viscosity. In patients with extremely dense bone, alternative fixation strategies such as cementless fixation or enhanced drilling should be considered.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"549-556"},"PeriodicalIF":3.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HipScreen: a valid mobile app to measure hip migration in children with cerebral palsy in the community setting.","authors":"Akib M Khan, John Amen, Oliver Perkins, Konstantinos Kafchitsas, Stephen J Cooke, Michail Kokkinakis, Laura Ball, Andre King, Sophie Billingham, Joel Bowpitt, Alexandra Webster, Sunita Dhindsa, Anita Patel, Lucy Clough, Ola Pieno, Beckie Corps, Rachel Heayberd, Suzi Davenport, Claire Wicks, Jill Cadwgan","doi":"10.1302/2633-1462.74.BJO-2025-0322.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0322.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Reimers migration percentage (MP) is the gold-standard radiological parameter used to aid decision-making regarding surgical management of hip displacement in cerebral palsy (CP). Accurate measurement is important to risk stratify patients and allow timely onward referral from community teams to paediatric orthopaedic services. We performed a study to determine whether experts and novices could use a free smartphone app (HipScreen (HS) app) as a valid method for measuring MP in CP.</p><p><strong>Methods: </strong>Using the HS app, two groups measured MP in 20 pelvis radiographs (40 hips) at weeks 0 and 2. The 'inexperienced' group included four community physiotherapists with no CP experience. The 'experienced' group included four community physiotherapists and two paediatricians with CP experience. All participants watched the tutorial videos on the HS app website. HS app measurements were then compared with gold-standard picture archiving and communication system (PACS) measurements conducted by a senior paediatric orthopaedic surgeon. Modified Pearson correlation (r) was used to determine inter-rater reliability between HS app and PACS measurements. Intraclass correlation coefficient (ICC) was then used to assess intrarater reliability. The mean absolute deviation (MAD) was calculated to compare raters with the gold standard.</p><p><strong>Results: </strong>HS app measurements in the experienced and inexperienced groups showed highly significant correlation with the gold-standard measurements (p < 0.001). There were no significant differences between intra- or inter-group measurements at weeks 0 and 2 with <i>r</i> > 0.86 and p < 0.001. Both inter- and intra-rater reliability were excellent with ICC > 0.9. There was no statistically significant difference in the MAD within individual measurements and compared with the gold standard.</p><p><strong>Conclusion: </strong>The HS app is accurate in measuring MP in CP when used by non-specialists and specialists. Non-specialists do not require additional supplementary training. These findings suggest app efficacy and safety in regional and national hip surveillance programmes for children with CP.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"540-548"},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Children's Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project : a national prospective trainee-led collaborative audit of practice.","authors":"Lysander J Gourbault, Robert Whitham, Andrew Womersley, Erin Jones, Alexander Christie, Luke Duggleby, William Guy Atherton, Ben Doughty, Isabella Smith, Abdul Rahman Hassan, Will Levitt, Angharad Davies, Charlotte Carpenter, Shahtajarab Saltanat, Pranai Buddhdev, Hannah Lennox-Warburton, Eoghan Donnelly, Kate Kim, Jowad Farooq, Claire Spolton Dean, Caroline Edwards, Mohamed Mahmoud, Andrew Stone, Adekinte Oyekan, Azal Jalgaonkar, Christopher To, Alex Hunt, Madeleine Garner, Alice Campion, Megan Sison, Sarah Irby, Michael Price, Lokesh Sharoff, Rebecca Worley, Hyder Tahir, Andrew Bircher, Nitin Modi, Emma Theobald, Ahmed Genena, Daniel Carter, Lydia Milnes, Tobias Roberts, Ashish Vasudev, Dylan Green, Alexander Boucher, Ethan Caruana, Omar Khokhar, Prem Kumar, Hamza Rahman, Sheena Seewoonarain, Ruben Thumbadoo, Sophie Forster, Ramanan Vadivelu, Lorna Bagshaw, Bobin Varghese, Srikiran Thalanki, Aubrey Conrad Franco, Laveeza Hamid, Ignatius Liew, Jordon Robinson, Ishani Gurung, Peter Figg, Rob Moverley, Greg Neal-Smith, Kunjan Barot, Thet Paing Oo, Joseph Hanger, Matthew Larsen, Alice Jones, Laura Lougher, Matthew Flintoft-Burt, Spilios Dellis, Tamer Kamal, Sunil Bajaj, Kamalpreet Chema, Moritz Lebe, Gaurav Bhandari, Edward Jeans, Kyle James, Tom Barrow, Leticia Fernandez, Takura Razemba, Russell Hawkins, Kerry Anderson, Laura Tillotson, William Thomas, Eleanor Burden, Sujit Kadambande, Ibrahim Khalil Ibrahim, Mannix O'Boyle, Louise McCormack, Janine O'Donnell, Emily Baird, Fiona MacDonald, Joanna Aithie, Patrick Robinson, Joe Esland, Andrew Keightley, Aman Jain, Dev Thakker, Mayur Nayak, Leticia Caamina, Tom Barrow, David Discalicau, Zoe Lockton, Amjad Burgan, Greg Morris, Rajeev Bansal, Maneesh Sinha, Omar Mostafa, Usman Ishaq, Ahmed Elmorsy, Alex Thomas, Portia Ross, Kanthan Theivendran, Tahir Khaleeq, Edward Lindisfarne, Rohit Gangadharan, Gajendiran Thiruchandran, Khaled Youssef, Andrzej Tober, Nirav Shah, Amir Varasteh, Abhijit Bajracharya, Ahmed Lashin, Max Mifsud, Thomas Lloyd, Christian Kirk, Thomas Ball, Jonathan Sheen, Smriti Kapoor, Iolo Thomas Jones, Douglas Donnachie, Kelly Clamp, Dan Westacott, James Miller, Elizabeth Hedge, Austin Gomindes, Lisa Amour, Jaffar Ibrahim, Jonathan Dwyer, Madeleine Bickley, Emily Fulcher, Ajay Kumar Chourasia, Sherif Hosny, Mohamed Hashem, Agneish Dutta, Darren Leong, Kim Fergurson, Amy Haddock, Minaal Malik, Amir Varasteh, Louise Cruz, Lydia Jenkins, Jamie East, Charlie Oxley","doi":"10.1302/2633-1462.74.BJO-2025-0338.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0338.R1","url":null,"abstract":"<p><strong>Aims: </strong>This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally.</p><p><strong>Methods: </strong>This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital.</p><p><strong>Results: </strong>Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge.</p><p><strong>Conclusion: </strong>This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"531-539"},"PeriodicalIF":3.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}