Bone & Joint Open最新文献

{"title":"Antibacterial hydrogel coating is associated with lower complication risks after complex high-risk primary and cementless hip revision arthroplasty : a retrospective matched cohort study.","authors":"Benjamin T K Ding, Rocco D'Apolito, Lucia Sciamanna, Luigi Zagra","doi":"10.1302/2633-1462.66.BJO-2025-0004.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2025-0004.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to verify the hypothesis that an antibiotic-loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).</p><p><strong>Methods: </strong>This was a retrospective, 1:1 matched cohort study of 238 patients, treated with cementless implants coated with and without DAC. A subgroup analysis was also conducted of patients undergoing second-stage revision THA for periprosthetic joint infection (PJI). Reinfection rates within two years, complications necessitating surgical intervention, and radiological analysis for aseptic loosening were assessed.</p><p><strong>Results: </strong>Overall, the mean age of the patients was 68.3 years (SD 11.5), with 39 (32.8%) McPherson class A, 64 (53.8%) class B, and 16 (13.4%) class C. Four (3.4%) patients in the DAC group developed complications including one PJI and one delayed wound healing, while 13 (10.9%) patients in the control group developed complications, including five PJIs and three delayed wound healing (p = 0.032). PJI rates (p = 0.136) and delayed wound healing rates (p = 0.337) were not statistically significant. For second-stage revision THA, for PJI there were 86 patients in the DAC group and 45 in the control group. One patient (1.2%) in the DAC group developed complications with no recurrences of infection or delayed wound healing, while ten patients (22.2%) in the control group developed complications including four recurrent PJI and one delayed wound healing (p = 0.003). Recurrent PJI rates were statistically significant (p = 0.005), while delayed wound healing rates were not (p = 0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% compared with 6.7%; p = 0.015). No local or systemic side effects related to the DAC hydrogel coating were observed.</p><p><strong>Conclusion: </strong>Antibiotic-impregnated hydrogel coatings on cementless implants appear to be associated with decreased complication rates after complex primary or revision THA. For second-stage revision THA for PJI, it is also associated with reduced risk of reinfection and aseptic loosening.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"15-23"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192350","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":"Radiological results of the Bernese periacetabular osteotomy performed before closure of the triradiate cartilage.","authors":"Reinhold Ganz, Stefan Blümel, Alisa Schleicher, Felix Öttl, Vincent A Stadelmann, Michael Leunig","doi":"10.1302/2633-1462.66.BJO-2024-0204.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0204.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Bernese periacetabular osteotomy (PAO) is typically not performed until after the growth plates have closed in late adolescence, as the osteotomy crosses the posterior branch of the triradiate cartilage, which could potentially cause deformities similar to post-traumatic dysplasia, a condition observed following pelvic fractures in childhood. The aim of this study was to retrospectively analyze on radiographs whether the PAO, when performed in children with open growth plates, affects acetabular development.</p><p><strong>Methods: </strong>We retrospectively reviewed the radiological outcomes of 23 hips (20 patients) with a mean age of 10.7 years (SD 1.8; 5.7 to 12.7). Preoperative, three-months postoperative, and latest follow-up measurements (after growth plate closure) were assessed for the following parameters: lateral centre-edge angle (LCE), acetabular index (AI), head extrusion (HE) index, femoral head (FH) lateralization, and teardrop thickness. We also compared the age at triradiate cartilage closure between the operated and nonoperated hips.</p><p><strong>Results: </strong>The mean follow-up was 5.2 years (SD 3.7; 0.6 to 12.7). Preoperatively, over 80% of the hips showed pathological measurements, which improved significantly post-PAO. None of the hips had pathological measurements after surgery. All acetabular angles showed significant improvement post-PAO (LCE from 14° (SD 8°) to 38° (SD 11°); AI from 20° (SD 8°) to 7° (SD 4°); and HE index from 32° (SD 9°) to 8° (SD 8°)). Acetabular moulding was physiological with little FH lateralization (from 9° (SD 9°) to 11.7° (SD 4.8°)), and a small increase in teardrop width (4.7 mm (SD 1) to 8.2 mm (SD 4.4)). Few complications were observed: one case of osteoarthritis (OA); one case of transient sciatic nerve irritation that resolved; one case of interfering osteosynthesis material that was removed; and one case requiring an additional valgus intertrochanteric osteotomy. All complications resolved without further issues.</p><p><strong>Conclusion: </strong>Our data on the use of PAO in patients with an open growth plate are encouraging with normalization of acetabular coverage parameters and only minor alterations of acetabular development, and may support its use in children six years old and older.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"24-32"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192353","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":"Re-revision risk of modular and monobloc revision stems after revision hip arthroplasty.","authors":"Michael Morlock, Yinan Wu, Alexander Grimberg, Klaus-Peter Günther, Carsten Perka","doi":"10.1302/2633-1462.66.BJO-2024-0201.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0201.R1","url":null,"abstract":"<p><strong>Aims: </strong>Modular revision stem fracture is a rare but difficult complication after hip arthroplasty revision. The purpose of this German Arthroplasty Registry (EPRD)-based study was to investigate whether the overall re-revision rate and the re-revision reasons of modular revision stems compared with monobloc stems are different.</p><p><strong>Methods: </strong>A total of 291 re-revisions occurring within five years after implantation of a revision stem (n = 2,039) documented in the EPRD were analyzed using Kaplan-Meier survival analysis and Cox regression. Stem type (modular: n = 1,026, monobloc: n = 1,013) and revision reason were investigated as independent variables, while BMI, sex, age, hospitals' annual revision volume, and Elixhauser score were treated as confounding variables. Cases with an infection at index surgery were analyzed separately.</p><p><strong>Results: </strong>Re-revision risk after five years was similar for either stem type (modular: 18.7% ( 95% CI 15.9 to 21.9); monobloc: 15.6% (95% CI 13.2 to 18.4); p = 0.200). One stem fracture of a modular revision stem was reported. The main reasons for re-revision were infection (modular/monobloc: 50%/60% of all revisions; p = 0.200), dislocation (19.8%/9.6%; p = 0.045), and loosening (12.2%/11.4%; p > 0.999). An Elixhauser score of 4 and above was associated with a higher hazard ratio (HR) for re-revision for either stem type (modular/monobloc: HR 2.01; p = 0.026/HR 2.44; p = 0.004), as well as a BMI category above 25/40 (modular/monobloc: HR 1.73 to 3.25; all p < 0.025/HR 3.61; p < 0.001). An infected index surgery increased the re-revision risk after one year to 26.0% (95% CI 22.2% to 30.3%) compared with 8.3% for noninfected cases (95% CI 7.0% to 9.8%) (p < 0.001) independent of stem type.</p><p><strong>Conclusion: </strong>A high BMI increases the HR for revision for either stem design but not due to mechanical implant failure. Infection at the index operation increases re-revision risk significantly, and is also the dominant reason for re-revision independent of stem type.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"1-6"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192354","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":"Management of chronic pelvic discontinuity during revision hip arthroplasty using the 'acetabular distraction technique' : clinical and radiological outcomes from a two-centre study with a minimum two-year follow-up.","authors":"Rajesh Malhotra, Apurve Parameswaran, Deepak Gautam, Sahil Batra, Sunil Apsingi, Vinay K Ponnala, Krishna K Eachempati","doi":"10.1302/2633-1462.66.BJO-2024-0199.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0199.R1","url":null,"abstract":"<p><strong>Aims: </strong>Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiological outcomes and complications of the 'acetabular distraction technique' for the management of CPD during revision hip arthroplasty.</p><p><strong>Methods: </strong>Patients with CPD, who underwent acetabular revision between January 2014 and April 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, preoperative acetabular bone loss, duration of follow-up, clinical and radiological outcomes, and survivorship were evaluated.</p><p><strong>Results: </strong>In all, 46 patients with a mean follow-up of 34.4 months (24 to 120) were available for evaluation. There were 25 male (54.3%) and 21 female (45.7%) patients, with a mean age of 58.1 years (40 to 81) at the time of revision surgery. Based on the Paprosky classification for acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type IIIB, IIIA, and IIC defects, respectively. All patients were managed using the Trabecular Metal Acetabular Revision System; 16 patients required additional Trabecular Metal augments. The mean Harris Hip Score improved from 50.1 (34.3 to 59.8) preoperatively to 86.6 (74.8 to 91.8) at the last follow-up (p < 0.001). Of the 46 patients studied, 34 were able to walk unaided, whereas 12 required a walking stick. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 patients (78.3%) showed healing of the pelvic discontinuity through bony bridging. The overall cup survivorship was 97.8%, while the three-year survivorship free from any re-revision was 94.1% based on a Kaplan-Meier survival plot.</p><p><strong>Conclusion: </strong>The acetabular distraction technique results in good clinical and radiological outcomes in the management of CPD during revision hip arthroplasty.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"7-14"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192351","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":"Predicting early return to sport after periacetabular osteotomy : a machine-learning approach.","authors":"Lars Nonnenmacher, Maximilian Fischer, Lars Kaderali, Georgi I Wassilew","doi":"10.1302/2633-1462.66.BJO-2024-0257.R1","DOIUrl":"10.1302/2633-1462.66.BJO-2024-0257.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periacetabular osteotomy (PAO) is the primary surgical treatment for developmental dysplasia of the hip (DDH), providing considerable pain relief and improved joint function. Return to sport (RTS) is a key outcome for young, active patients. This study aimed to identify preoperative predictors of RTS timing and develop a machine-learning-based prediction model to optimize patient counselling.</p><p><strong>Methods: </strong>This retrospective analysis of prospectively collected data included 235 patients who underwent PAO between January 2019 and December 2023. Preoperative variables, including demographic, functional, and psychological assessments, were analyzed. RTS was assessed at three, six, and 12 months postoperatively. Logistic regression with recursive feature elimination and a conditional inference tree (ctree) model were used to identify predictors of RTS.</p><p><strong>Results: </strong>At three months, 102 patients (43%) had returned to sports, increasing to 182 (77%) at six months and 223 (95%) at 12 months. Key predictors of early RTS included the minimally invasive surgical approach, higher preoperative physical activity (≥ two sessions/week), lower anxiety scores, and higher Hip disability and Osteoarthritis Outcome Score (HOOS) pain scores. Male sex and older age were associated with delayed RTS. The ctree model stratified patients based on their likelihood of early RTS, providing an individualized prognosis.</p><p><strong>Conclusion: </strong>PAO enables early RTS in over 90% of patients within the first year. The use of a minimally invasive approach allowing immediate active hip flexion, higher preoperative activity levels, and lower anxiety scores significantly improves RTS timing. The machine-learning model provides precise, individualized RTS predictions, offering a valuable tool for patient counselling and rehabilitation planning.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 6 Supple B","pages":"33-42"},"PeriodicalIF":2.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192352","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":"Factors contributing to bracing success in juvenile idiopathic scoliosis and current limitations : a systematic review and meta-analysis.","authors":"Kai Him Ambrose Chan, Kai Chun Augustine Chan, Elijah Maliwat, Jason Pui Yin Cheung, Prudence Wing Hang Cheung","doi":"10.1302/2633-1462.65.BJO-2024-0271.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0271.R1","url":null,"abstract":"<p><strong>Aims: </strong>There is a general lack of guidelines on nonoperative treatment in juvenile idiopathic scoliosis (JIS). This review aims to explore factors determining bracing success in JIS and to identify limitations in current literature.</p><p><strong>Methods: </strong>A literature search was conducted according to the PRISMA 2020 guidelines. Data extraction focused on the factors affecting bracing success, including pre-brace curve magnitude in Cobb angle, curve type, pre-brace rib vertebral angle difference, in-brace correction, brace type, brace-wear compliance, the time of brace initiation, and bracing duration. Bracing success is defined as 1) avoidance of corrective surgical intervention (curve exceeding 45° at maturity) and/or 2) major curve Cobb angle of < 5° progression at maturity. Meta-analysis was performed for individual factors.</p><p><strong>Results: </strong>After initial and full-text screening, 16 articles were included in the review. Pooled odds ratio (OR) from eight studies and 560 patients using the threshold of Cobb angle of 30° revealed that patients with pre-brace curve < 30° were associated with bracing success (odds ratio (OR) 3.58; 95% CI 2.26 to 5.65; p < 0.001; I² = 0.08). Major thoracic curves were associated with reduced likelihood of bracing success compared to thoracolumbar/lumbar curves (OR 0.49; 95% CI 0.28 to 0.86; p = 0.010; I² = 0.35). Full-time compliance was significantly associated with bracing success (OR 5.22; 95% CI 2.24 to 12.19; p < 0.001; I² = 0.76).</p><p><strong>Conclusion: </strong>This review identified that a pre-brace major Cobb angle < 30° and full-time compliance of at least 18 to 20 hours/day are prognostic factors favourable for bracing success, while presence of thoracic curves is prognostic for unfavourable brace outcome. Longer bracing duration does not translate to a higher success rate. Clinicians should devise more efforts to modify patient compliance in order to achieve optimal brace outcomes. The general lack of high-quality evidence and heterogeneity of results in existing studies indicates the need for further rigorous research on JIS.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"590-608"},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175131","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 impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures : a biomechanical study.","authors":"Magnus Høgevold, Carl E Alm, Bryan J Wright, Lydia Ragan, Frede Frihagen, Stephan M H Röhrl, Jan E Madsen, Jan E Brattgjerd","doi":"10.1302/2633-1462.65.BJO-2024-0266.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0266.R1","url":null,"abstract":"<p><strong>Aims: </strong>Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteristics contribute to lateral wall fractures remains unclear. Accordingly, we examined the impact on failure by incremental decrease of both lateral wall thickness and lesser trochanter attachment in trochanteric fracture fixation using a SHS ex vivo.</p><p><strong>Methods: </strong>We tested 14 pairs of embalmed femora, randomly assigned to four osteotomy groups, each representing a specific 31A1 or 31A2 fracture pattern according to the AO/Orthopaedic Trauma Association (OTA) classification. After fixation with a SHS, the specimens underwent quasi-static and dynamic axial compression until failure. Outcome measures included stiffness, deformation, load to failure, and failure pattern following a set protocol.</p><p><strong>Results: </strong>We found lateral wall fractures in ten out of 28 specimens. Specimens with a thin lateral wall and a detached lesser trochanter exhibited both a significantly higher rate of lateral wall fractures (5/7 vs 5/21, p = 0.023) and a lower load to failure than specimens with only one or none of these characteristics (1,673 N (SD 810) vs 2,922 N (SD 897), p = 0.003). The specimens with a detached lesser trochanter themselves demonstrated a significantly higher rate of lateral wall fractures than those with an attached lesser trochanter (9/14 vs 1/14, p = 0.004).</p><p><strong>Conclusion: </strong>Our findings emphasize the role of a detached lesser trochanter in initiating lateral wall fractures, with a reduction in load to failure when combined with reduced lateral wall thickness. Biomechanically, this suggests a failure mechanism whereby placing a load-sharing implant could overload a fragile lateral wall in unstable trochanteric fractures.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"582-589"},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175133","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":"AI and machine learning in paediatric spine deformity surgery.","authors":"Mohsin Khan, Kaustubh Ahuja, Athanasios I Tsirikos","doi":"10.1302/2633-1462.65.BJO-2024-0089.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0089.R1","url":null,"abstract":"<p><p>Paediatric spine deformity surgery is a high-stakes procedure. It demands the surgeon to have exceptional anatomical knowledge and precise visuospatial awareness. There is increasing demand for precision medicine, which rapid advancements in computational technologies have made possible with the recent explosion of AI and machine learning (ML). We present the surgical and ethical applications of AI and ML in diagnosis, prognosis, image processing, and outcomes in the field of paediatric spine deformity.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"569-581"},"PeriodicalIF":2.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128848","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 protocol for a multicentre prospective randomized noninferiority trial of surgical reduction versus non-surgical casting for displaced distal radius fractures in children : Children's Radius Acute Fracture Fixation Trial (CRAFFT) protocol.","authors":"Daniel C Perry, Juul Achten, James Mason, Daphne Kounail, Nicolas Nicolaou, David Metcalfe, Mark Lyttle, Elizabeth Tutton, Duncan Appelbe, Phoebe Gibson, Matthew L Costa","doi":"10.1302/2633-1462.65.BJO-2024-0260","DOIUrl":"10.1302/2633-1462.65.BJO-2024-0260","url":null,"abstract":"<p><strong>Aims: </strong>The remarkable capacity for distal radius fractures in children to remodel raises questions about the necessity and extent of the intervention required to achieve anatomical alignment. The British Society of Children's Orthopaedic Surgery prioritized this uncertainty as one of their most important research questions. This is the protocol for a randomized, controlled, multicentre, prospective, noninferiority trial of non-surgical casting versus surgical reduction for severely displaced fractures of the distal radius in children: the Children's Radius Acute Fracture Fixation Trial.</p><p><strong>Methods: </strong>Children aged four to ten years old inclusive, who have sustained a severely displaced distal radius fracture, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Score, pain measured using the Wong-Baker FACES Pain Scale, and quality of life (QoL) assessed with the EuroQol five-dimension questionnaire for younger participants will be collected. Each patient will be randomly allocated (1:1), stratified using a minimization algorithm by centre, fracture type at presentation (completely off-ended or incompletely off-ended), fracture location (metaphyseal or physeal), and age group (four to six years or seven to ten years) to either a regimen of non-surgical casting or surgical reduction.</p><p><strong>Conclusion: </strong>At six weeks, and three, six, and 12 months, data on function, pain, QoL, cosmesis, and satisfaction with care will be collected. After completion of the main phase of the study, patients will be followed up for a further two years. Up to one year after randomization, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the PROMIS Upper Extremity Score at three months post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardians.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"560-568"},"PeriodicalIF":2.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128795","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":"Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas.","authors":"Simon Tournemine, Sylvie Bonvalot, Jean-Yves Mary, Dimosthenis Andreou, David Biau","doi":"10.1302/2633-1462.65.BJO-2025-0026.R1","DOIUrl":"10.1302/2633-1462.65.BJO-2025-0026.R1","url":null,"abstract":"<p><strong>Aims: </strong>In this study, we explore whether neoadjuvant chemotherapy influences the surgical resection strategy devised by surgeons for high-grade soft-tissue sarcoma.</p><p><strong>Methods: </strong>A total of 12 experienced soft-tissue sarcoma surgeons rated patients who underwent neoadjuvant chemotherapy for a soft-tissue sarcoma of the thigh. Cases were randomly assigned to surgeons, such that each surgeon rated three out of the 12 cases, and each case was rated by three out of 12 surgeons (n = 36 ratings before and after chemotherapy). Surgeons were asked which surgical technique they would use: amputation; and if not, resection or dissection of critical anatomical structures in close proximity to the tumour (sciatic nerve, femoral artery, and femur). Pre- and post-chemotherapy ratings were then compared to test if chemotherapy changed the surgery aggressiveness anticipated by the surgeons.</p><p><strong>Results: </strong>Tumour volume increased in 9/12 cases (75%). Ratings as amputation were discordant in 5/36 cases (14%) before and after chemotherapy. The surgical technique planned by surgeons before and after chemotherapy regarding critical anatomical structures were discordant in five (14%), eight (22%), and six of 36 ratings (17%) for the sciatic nerve, the femoral artery, and the femur, respectively. Overall, a similarly aggressive surgery was planned by surgeons in nine, six, and eight cases for the sciatic nerve, the femoral artery, and the femur, respectively, which is significantly more than that expected due to chance alone. A more aggressive surgery was anticipated in five of 36 cases (14%).</p><p><strong>Conclusion: </strong>Despite tumour growth being observed in 75% of cases, the surgical resection strategy devised after neoadjuvant chemotherapy remained notably similar to the one devised prior to neoadjuvant chemotherapy for critical anatomical structures. However, 'switchers', namely patients identified as being at risk of needing an amputation if the tumour experiences slight growth, should undergo conservative surgery initially, followed by chemotherapy.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 5","pages":"553-559"},"PeriodicalIF":2.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080999","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}