Bone & Joint Open最新文献

{"title":"Revision of reverse shoulder arthroplasty by indication : a National Joint Registry study.","authors":"Olivia O'Malley, Andrew Davies, Mansour T A Sharabani, Amar Rangan, Sanjeeve Sabharwal, Peter Reilly","doi":"10.1302/2633-1462.66.BJO-2025-0017.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0017.R1","url":null,"abstract":"<p><strong>Aims: </strong>Reverse shoulder arthroplasty (RSA), initially designed for cuff tear arthropathy (CTA), is now the most common choice of shoulder arthroplasty in both elective and trauma settings in the UK. Its use has rapidly increased for several indications, including osteoarthritis (OA) with an intact rotator cuff, acute trauma, and trauma sequalae. This study aims to review the revision rates of RSA by indication to assess how the implant is performing for indications for which it was not primarily designed.</p><p><strong>Methods: </strong>Data from the National Joint Registry were obtained from 1 April 2012 to 31 March 2022. Data were linked to Hospital Episode Statistics for England and National Mortality Data. RSAs were identified and sorted into mutually exclusive groups by indication. The primary outcome was first revision and the secondary outcome was non-revision reoperation.</p><p><strong>Results: </strong>The revision rates for RSA for CTA were 1.53% (95% CI 1.31 to 1.78) at one year, 3.21% (95% CI 2.86 to 3.60) at five years, and 4.97% (95% CI 4.23 to 5.84) at nine years. For primary OA, they were 1.21% (95% CI 0.95 to 1.54) at one year, 2.71% (95% CI 2.25 to 3.37) at five years, and 5.00% (95% CI 3.62 to 6.88) at nine years. For trauma, they were 1.51% (95% CI 1.15 to 1.99) at one year and 2.67% (95% CI 2.07 to 3.43) at five years. For trauma sequalae, they were 4.25% (95% CI 3.4 to 5.29) at one year and 7.12% (95% CI 5.90 to 8.59) at five years. Between indications, the revision rates were not statistically different except for trauma sequalae, which had a significantly increased risk of revision (p ≤ 0.001). Incidence of non-revision reoperation across the cohort was 1.1% (n = 283 patients), with the most common being manipulation under anaesthesia with or without capsular release (42.03%, n = 124) followed by subacromial decompression (21.02%, n = 62).</p><p><strong>Conclusion: </strong>This study reports on the range of indications for which RSA is being used in the UK. It demonstrated that, based on the largest analysis of RSA across a range of indications, the revision rates and secondary surgery rates are broadly similar except for trauma sequalae.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"691-699"},"PeriodicalIF":2.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276157","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 role of weaning in brace treatment for developmental dysplasia of the hip : time to define best practice?","authors":"Joanna Craven, Ioan Davies, Daniel C Perry","doi":"10.1302/2633-1462.66.BJO-2025-0053.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0053.R1","url":null,"abstract":"<p><strong>Aims: </strong>In infants aged under six months with developmental dysplasia of the hip (DDH), the use of a removable brace is considered the gold-standard treatment. However, considerable variation exists for brace removal after 'successful' treatment. Some clinicians support immediate cessation, while others prefer weaning of the brace. This study aimed to explore clinicians' understanding of weaning, and to identify current practices and the rationale behind different approaches, in order to inform the design of a future randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A survey was developed using Google Forms and disseminated via professional networks, social media, and the British Society of Children's Orthopaedic Surgery mailing list. It targeted clinicians involved in DDH care, gathering information on demographics, treatment protocols, criteria for removal, and weaning practices. Quantitative and qualitative data were analyzed to identify patterns and variability.</p><p><strong>Results: </strong>In total, 139 clinicians from 25 countries responded, with 50% from the UK. Most respondents (87.8%) followed a protocol for brace treatment, with considerable variation in definition and implementation of weaning. 'Weaning' was most commonly defined as a gradual reduction in brace wear over time (n = 103, 74.1%). Overall, 47.4% of respondents (n = 65) reported never weaning, 39.4% (n = 54) always wean, and 13.1% (n = 18) varied their approach. Among clinicians who always wean, the most common approach involved gradually reducing the hours per day over several weeks (n = 28, 51.9%). However, for those who sometimes wean, the most frequent practice was night-time only wear (n = 8, 44.4%). Durations of weaning differed, although the majority of clinicians reported weaning periods from two to six weeks. There is broad support for a future RCT, with 75.9% (n = 105) expressing a willingness to participate.</p><p><strong>Conclusion: </strong>This survey highlights considerable variability in weaning practices for brace treatment in DDH, and underscores the need for standardized terminology and protocols. These findings provide a foundation for designing a RCT to evaluate weaning compared with immediate brace cessation, ultimately informing evidence-based guidelines.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"685-690"},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267444","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":"Development of a multicentre cohort study to understand the role of MRI and ultrasound in the diagnosis of acute haematogenous bone and joint infection in children (the PIC Bone study) : a study protocol.","authors":"Marie-Caroline Nogaro, Stuart Hartshorn, Mariea Brady, Amaka Offiah, Saul Faust, Gregory Firth, Jie Ma, Paula Dhiman, Joanna O'Mahoney, Loretta Davies, Catherine Spowart, Amy Moscrop, Bridget Young, Catrin Tudur-Smith, Gary Collins, Daniel C Perry, Tim Theologis","doi":"10.1302/2633-1462.66.BJO-2024-0277","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0277","url":null,"abstract":"<p><strong>Aims: </strong>Bone and joint infections (BJI) in children are rare but can be serious. Differentiating BJI from other conditions with similar symptoms is critical. Advanced imaging (ultrasound scans (USS) and MRI) is often required to confirm the diagnosis. The differing merits of imaging type and regional variation in access to advanced imaging can lead to diagnostic uncertainty and treatment variation. The aim of this study is to evaluate the diagnostic accuracy of MRI and USS for the investigation of BJI in children, and develop and validate prediction models to aid the diagnosis of BJI in children. A nested qualitative sub-study will explore acceptability of the imaging to children, parents, and health practitioners.</p><p><strong>Methods: </strong>A multicentre retrospective cohort of children (aged < 16 years) with suspected diagnosis of BJI will be used to estimate the diagnostic accuracy of the two imaging methods and develop the prediction models. The models will be evaluated in a second cohort of prospectively recruited children. Diagnostic test accuracy will be estimated overall, and separately for children aged under and over five years. The prediction models will be fit using logistic regression, with candidate predictors chosen based on clinical plausibility and from a review of the literature. Continuous predictors will be examined for non-linearity with confirmed BJI using fractional polynomials. Multiple imputation will be used to replace missing values. Internal validation will be carried out using bootstrapping. Model performance will be assessed with discrimination and calibration.</p><p><strong>Discussion: </strong>Ethical approval for this study (registration: ISRCTN15471635) was granted (REC reference 23/WM/0027). Informed consent is being obtained from participants in the prospective cohort and the qualitative sub-study. Study findings will be published in an open access journal and presented at relevant national and international conferences. Relevant charities and associations are being engaged to promote awareness of the project.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"677-684"},"PeriodicalIF":2.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259054","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 nutritional impairment on physical function early after total hip arthroplasty.","authors":"Tsutomu Fujita, Satoshi Hamai, Toshimi Konishi, Kazuya Okazawa, Yuki Nasu, Daisuke Hara, Shinya Kawahara, Ryosuke Yamaguchi, Taishi Sato, Ken Utsunomiya, Goro Motomura, Kenichi Kawaguchi, Yasuharu Nakashima","doi":"10.1302/2633-1462.66.BJO-2024-0261.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0261.R1","url":null,"abstract":"<p><strong>Aims: </strong>To investigate whether preoperative nutritional status, assessed by the Geriatric Nutritional Risk Index (GNRI), predicts postoperative physical function following total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A total of 681 patients (87 males, 594 females; mean age 65.3 years (SD 10.2)) who underwent unilateral primary THA for hip osteoarthritis were included. GNRI was calculated from preoperative serum albumin levels, categorizing patients into three groups: normal nutrition (GNRI ≥ 98), moderate malnutrition (92 ≤ GNRI < 98), and severe malnutrition (GNRI < 92). Physical function, including hip joint range of motion, muscle strength (hip abduction, knee extension), leg length difference, and comfortable walking speed, was assessed preoperatively and at discharge. Group comparisons were made based on GNRI scores, and a multiple regression analysis was conducted using preoperative muscle strength ratio and postoperative comfortable walking speed as outcome variables. Receiver operating characteristic curves determined a preoperative GNRI cut-off value for achieving a postoperative comfortable walking speed of 0.8 m/s.</p><p><strong>Results: </strong>The moderate and severe malnutrition comprised 68 (10%) and 19 (3%) patients with GNRI: 92 ≤ GNRI < 98 and < 92, respectively, whereas 594 (87%) were in the normal nutrition (GNRI ≥ 98). Patients with malnutrition demonstrated significantly lower preoperative muscle strength and pre- and postoperative muscle strength ratios (p < 0.001). Preoperative GNRI was a significant predictor of hip abductor muscle strength (p = 0.031) and postoperative comfortable walking speed (p < 0.001). The determined preoperative GNRI cut-off score for achieving a postoperative comfortable walking speed of 0.8 m/s was 98.</p><p><strong>Conclusion: </strong>Preoperative GNRI serves as a valuable indicator for improving postoperative muscle strength and comfortable walking speed.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"667-676"},"PeriodicalIF":2.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249991","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":"Cost-effectiveness analysis of robotic-arm assisted versus manual total knee arthroplasty in the UK.","authors":"Gurdeep S Sagoo, Nick D Clement, Yaneth Gil-Rojas, Nawaraj Bhattarai, Steven Galloway, Jenny B Baron, Karen Smith, David J Weir, David J Deehan","doi":"10.1302/2633-1462.66.BJO-2024-0274","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0274","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to estimate the additional cost per quality-adjusted life-year (QALY) of robotic-assisted total knee arthroplasty (rTKA) compared to manually performed total knee arthroplasty (mTKA).</p><p><strong>Methods: </strong>An economic evaluation was undertaken from the UK NHS and personal social services perspective, alongside a randomized controlled trial comparing rTKA and mTKA. Costs were estimated individually using a top-down approach and included all healthcare resources incurred during the trial. Costs were presented in 2021 GBP sterling (£). Responses to the EuroQol five-dimension three-level questionnaire were used to estimate QALYs for each participant. The incremental cost-effectiveness ratio (ICER) was evaluated against the current willingness-to-pay threshold recommended by the National Institute for Health and Care Excellence. Stochastic sensitivity analysis was performed using bootstrapping techniques, and results were shown through the cost-effectiveness acceptability curve and cost-effectiveness plane. Cost-effectiveness over one- and ten-year time horizons were explored using a decision model.</p><p><strong>Results: </strong>There were 100 participants randomized: 50 rTKA and 50 mTKA. Overall, 37 participants (39.4%) had some missing data on either costs or utilities, or on both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient costs of £1,829 (95% CI 421 to 3,238) and an incremental QALY gain of 0.015 (95% CI -0.05 to 0.0796) at one year. The ICER at one year was £123,770. However, rTKA was likely to be cost-effective over a ten-year time horizon, with an ICER of £11,109. All except one of the scenarios (QALY gain reduction to 0.005) explored supported the cost-effectiveness of rTKA over a ten-year time horizon with an ICER below a £20,000 threshold.</p><p><strong>Conclusion: </strong>Over a short one-year time horizon, rTKA was not a cost-effective procedure compared to mTKA. However, when results were extrapolated out to a ten-year time horizon, which would need to be confirmed in future research, rTKA was likely to be cost-effective.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"658-666"},"PeriodicalIF":2.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249990","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":"Functional pelvic tilt frequently differs from the anterior pelvic plane in non-arthritic hip disorders : implications for 3D motion analysis.","authors":"Mark R J Jenkinson, Calvin Cheung, Alastair G Dick, Johan Witt, Jonathan Hutt","doi":"10.1302/2633-1462.66.BJO-2024-0265.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0265.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect the position of the acetabular rim and projected femoral head coverage, but currently the majority of available software standardizes sagittal rotation to the anterior pelvic plane (APP). The study hypothesis was that the APP does not correlate well with patient-specific pelvic position.</p><p><strong>Methods: </strong>In total, 60 patients were selected from an institutional database: 20 with acetabular retroversion (AR), 20 with developmental dysplasia of the hip (DDH), and 20 with cam-type femoroacetabular impingement (FAI). Multiplanar CT reformats were created and the sagittal rotation was aligned to the APP. The sagittal pelvic orientation was then corrected until the anteroposterior (AP) projection mirrored that of their preoperative supine and standing plain radiographs. The change in sagittal pelvic tilt angle required was measured.</p><p><strong>Results: </strong>The mean deviation from the APP in the AR group was 11.55° (SD 4.96°) for supine radiographs and 3.28° (SD 8.66°) for standing radiographs. The mean deviation from the APP in the DDH group was 12.2° (SD 4.26°) for supine radiographs and 6.96° (SD 3.43°) for standing radiographs. The main deviation from the APP in the FAI group was 8.63° (SD 5.21°) for supine radiographs and -1.28° (SD 7.31°) for standing.</p><p><strong>Conclusion: </strong>There is a wide variation in patients' functional pelvic positioning in both supine and standing radiographs, in all different subgroups, which rarely correlates with the APP. Commercial 3D motion analysis may therefore give misleading results for both the extent and location of hip impingement as well as femoral head coverage, which may affect surgical decision-making. Consideration should be given to incorporating this into the software algorithms.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"651-657"},"PeriodicalIF":2.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235407","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":"Facilitating translation of trial findings into NHS practice : case study of the Support and Treatment After Replacement (STAR) care pathway.","authors":"Wendy Bertram, Vikki Wylde, Tom Woodward, Rachael Gooberman-Hill, Michael R Whitehouse, Nick Howells","doi":"10.1302/2633-1462.66.BJO-2024-0043.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0043.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Support and Treatment After Replacement (STAR) care pathway is a clinically important, cost-effective treatment to improve pain outcomes over one year for people with chronic pain three months after total knee arthroplasty. This work describes the implementation of trial findings in practice at one NHS hospital and the further work undertaken to support national implementation.</p><p><strong>Methods: </strong>Trial findings were presented to NHS managers with a business case for a pilot embedded in usual care. Trial documentation was adapted using the capability, opportunity, motivation, and behaviour (COM-B) model for behaviour change and evidence-based approaches to increase questionnaire responses. Trial sites were contacted to understand their capacity to pilot the intervention.</p><p><strong>Results: </strong>The STAR care pathway was successfully implemented into NHS practice with a screening response rate of 89%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of trained extended scope practitioners was a barrier to implementation. The trial manual and training sessions were adapted into an online training package.</p><p><strong>Conclusion: </strong>The STAR care pathway has been successfully embedded into NHS care at one hospital. A toolkit and online clinician training package supports wider implementation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"644-650"},"PeriodicalIF":2.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226960","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":"Physiotherapy and physical activity in children with Perthes' disease : an international survey of recommendations from paediatric orthopaedic surgeons.","authors":"Yasmin D Hailer, Daniel C Perry, Emily Schaeffer, Jacqueline Li, Kishore Mulpuri","doi":"10.1302/2633-1462.66.BJO-2024-0219.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0219.R1","url":null,"abstract":"<p><strong>Aims: </strong>In the absence of clear and consistent clinical guidelines, this study aims to survey the current international consensus on recommendations for physiotherapy (PT), physical activity (PA), and weightbearing in patients with Perthes' disease. Additionally, the study seeks to identify factors influencing these recommendations, and to determine at which stage possible restrictions on physical activity are typically lifted.</p><p><strong>Methods: </strong>An online international cross-sectional survey using a purpose-designed questionnaire with a general section, and three cases of Perthes' disease, was distributed to surgeons through paediatric orthopaedic societies and research groups.</p><p><strong>Results: </strong>A total of 160 paediatric orthopaedic surgeons from 43 different countries (seven continents) participated. There was general agreement that impaired range of motion (ROM) and pain were important when prescribing PT, while the child's sex was not important. There was disagreement on whether age and Waldenström or Lateral Pillar classification were important factors in determining the need for PT. There was widespread agreement that stretching in the early stages of Perthes' disease was important, although Western and Southern Europe and the British Isles differed. There was considerable disagreement about strengthening exercises. 'Weightbearing as tolerated' in the early and fragmentation stages was generally recommended in the British Isles and Scandinavia (both > 90%), whereas other regions showed large variation. Regarding PA, there was broad agreement in allowing swimming and cycling, and discouraging high-impact activities including school sports in all stages.</p><p><strong>Conclusion: </strong>Maintaining ROM was crucial for most participants, with strong consensus to discourage high-impact activities during initial and fragmentation stages. Swimming and cycling were often allowed, but no clear consensus emerged on weightbearing restrictions or when to resume full activities. Consensus within the British Isles, Scandinavia, and Eastern Europe was high for both for PT and PA, but recommendations differed between countries. Recommendations from the British Isles and Scandinavia were less restrictive than their Eastern European counterparts.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"635-643"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217123","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":"Striving to recover - wrist splint or plaster cast : a qualitative study of patients' experience of recovery after a distal radius fracture.","authors":"Emma Elizabeth Phelps, Elizabeth Tutton, Jenny Gould, Liz Baird, Juul Achten, Matthew L Costa","doi":"10.1302/2633-1462.66.BJO-2025-0033","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0033","url":null,"abstract":"<p><strong>Aims: </strong>We sought to explore patients' experience of early recovery from a fracture of the wrist (distal radius). This study was nested in the DRAFT-CASP randomized controlled trial (RCT), which explores the effectiveness of two treatment pathways for patients with a fracture of the distal radius that does not require manipulation: a plaster cast which is removed in fracture clinic, versus a wrist splint that patients remove themselves without returning to hospital.</p><p><strong>Methods: </strong>Qualitative interviews were undertaken with 21 adults (mean age 58.2 years (SD 13.96), six male), from eight NHS hospitals, four to ten weeks post injury. Interviews were informed by phenomenology and analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>We identified the overarching theme 'striving to recover', which conveys patients' determination to get back to normal after a wrist fracture. To recover, patients needed to be comfortable, to adapt, and to be certain that their wrist was healing. Early in their recovery, they were unable to complete their daily activities, experienced pain, loss of strength, worry, and were cautious about using their wrist. Overall, both treatments were considered acceptable. The splint was advantageous for the freedom and control it provided. The cast was valued for the protection and safety it provided. Both groups required more information and reassurance, but had varied views on the need for follow-up appointments.</p><p><strong>Conclusion: </strong>The splint made life easier for patients and was an acceptable treatment. Patients wanted reassurance that their wrist was healing, but they felt this could be achieved in a variety of ways. Most patients coped without a follow-up appointment. Innovative ways to maximize recovery are required. These include support for patients to, manage their pain and provide comfort, be able to adapt, and feel certain of healing. Sharing patients' experiences may help future patients to make informed treatment and recovery decisions.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"626-634"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209679","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":"Tunnel combinations that should be avoided in anterior cruciate ligament reconstruction : a biomechanical assessment of 15 different combinations of femoral and tibial graft tunnels.","authors":"Salameh Eljaja, Jørgen Tranum-Jensen, Mette Tavlo, Volkert Siersma, Michael Rindom Krogsgaard","doi":"10.1302/2633-1462.66.BJO-2025-0011.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0011.R1","url":null,"abstract":"<p><strong>Aims: </strong>Structured knowledge on the combined effect of various positions of femoral and tibial tunnels in reconstruction of the anterior cruciate ligament (ACL) on knee range of motion, rotatory stability, and anterior translatory laxity is limited. The aim was to test this for 15 regularly used tunnel combinations and identify combinations that should be avoided.</p><p><strong>Methods: </strong>A total of 60 cadaveric knees had the ACL removed and reconstructed. Flexion/extension, tibial rotation, and anterior tibial translation were measured with intact ACL, after ACL resection, and after ACL reconstructions with 15 tunnel combinations, based on five different femoral tunnels and three different tibial tunnels.</p><p><strong>Results: </strong>With a posterior tibial tunnel, the anterior tibial translation and tibial rotation increased when combined with most femoral tunnels. A transtibially positioned femoral tunnel when combined with any tibial tunnel caused flexion deficiency. Any femoral tunnel positioned by anteromedial technique combined with anterior or posterior tibia tunnels caused flexion deficiency. Severe extension deficiency was observed with an anterior tibial tunnel, in particular combined with a transtibially positioned femoral tunnel or an anterior femoral tunnel by anteromedial technique. Least anterior tibial translation combined with normal extension was achieved with a femoral tunnel by anteromedial technique as far posterior as possible, and an anatomically positioned tibial tunnel.</p><p><strong>Conclusion: </strong>In conclusion, tunnel combinations with the steepest (sagittal plane) and/or least oblique (frontal plane) grafts resulted in increased anterior tibial translation and tibial rotation, and should therefore be avoided. Anterior positioning of the graft caused extension deficiency, and there was flexion deficit with most grafts. A femoral tunnel as far posterior as possible by anteromedial technique is preferable in combination with an anatomically positioned tibial tunnel.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6","pages":"618-625"},"PeriodicalIF":2.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200254","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}