Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Exploring the role of artificial intelligence in orthopedic medical education: A narrative review","authors":"Lakshmana S. Das ,&nbsp;Deepanjan Das ,&nbsp;Denish Chandrakar ,&nbsp;Prashant Bhavani ,&nbsp;Amol Dubepuria ,&nbsp;Sitanshu Barik","doi":"10.1016/j.jcot.2025.103100","DOIUrl":"10.1016/j.jcot.2025.103100","url":null,"abstract":"<div><div>Artificial intelligence (AI) is transforming orthopedic medical education by enhancing diagnostic accuracy, surgical training, and personalized learning. This narrative review explores AI's applications, including machine learning (ML) and computer vision for interpreting imaging studies, virtual reality (VR) and augmented reality (AR) for immersive surgical simulations, and natural language processing (NLP) for streamlining clinical workflows. AI-powered tools offer objective feedback, adaptive learning modules, and risk-free environments for skill acquisition, bridging gaps in traditional training methods. However, challenges such as data privacy, algorithmic bias, and the need for robust validation remain. Ethical considerations, including patient trust and trainee over-reliance on AI, must also be addressed. Despite these barriers, AI democratizes access to high-quality education, particularly in resource-limited settings, through cloud-based platforms and mobile applications. The future of AI in orthopedics is promising, with advancements in predictive analytics, robotic-assisted surgery, and haptic feedback technologies poised to further revolutionize training. Collaborative efforts among educators, clinicians, and developers are essential to ensure responsible integration. This review highlights AI's potential to reshape orthopedic education while emphasizing the importance of preserving the mentor-trainee relationship and fostering evidence-based adoption.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103100"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine post-operative full blood count assessment is not necessary in elective hip and knee arthroplasty: A prospective cohort study","authors":"David Moore ,&nbsp;Henry Turner ,&nbsp;Jess Rotaru ,&nbsp;Ciara Doran ,&nbsp;James Cashman","doi":"10.1016/j.jcot.2025.103099","DOIUrl":"10.1016/j.jcot.2025.103099","url":null,"abstract":"<div><h3>Background</h3><div>Hip and knee arthroplasty are among the commonest orthopaedic procedures performed worldwide and can be associated with significant blood loss. Routine haemoglobin sampling increases transfusion rates without an overall reduction in morbidity and mortality, yet providers commonly adopt an absolute numerical value as warranting transfusion post-operatively. Our aim was to establish what proportion of patients had a significant reduction in haemoglobin requiring transfusion thus assessing the necessity of routine post-operative haemoglobin assessment in an inpatient and outpatient patient cohort undergoing total joint replacement.</div></div><div><h3>Methods</h3><div>We performed a review of prospectively collected data in an institutional database of all primary elective hip and knee arthroplasty cases performed by a single surgeon at an urban tertiary referral centre from 2018 to 2023. We assessed pre-operative and post-operative variables amongst patients to identify predictors for transfusion following surgery. All statistics were performed using Stata release 17.</div></div><div><h3>Results</h3><div>490 elective primary hip or knee arthroplasty procedures were performed within the six year period of which the mean drop in haemoglobin was 2.1 g/dL (SD 1.0, Range −5.6 to +1) post-operatively. Four patients (0.8 %) had a haemoglobin drop below 8 g/dL and 19 (3.9 %) had a level below 9 g/dL, however only 4 patients (0.8 %) required allogenic blood transfusion. One hundred and six patients (21.9 %) underwent day-case arthroplasty of which there was no re-admissions or complications within 90 days of surgery.</div></div><div><h3>Conclusion</h3><div>The routine monitoring of haemoglobin following elective TJA is costly and unnecessary whilst not contributing to actionable information. We recommend that patients with a pre-operative level greater than 11 g/dL may not require routine post-operative full blood count as mean drop in haemoglobin of less than 3 g/dL can be expected. We continue to advocate that day-case arthroplasty is safe in appropriately selected patients as defined by ASA grade at anaesthetic pre-assessment.</div></div><div><h3>Level of evidence</h3><div>Level II – Prospective cohort study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103099"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking effective decision-making and critical thinking in orthopaedics: Insights from a narrative review","authors":"A.S.P.V.S. Saketh ,&nbsp;Krishna Subramanyam ,&nbsp;Satvik N. Pai ,&nbsp;Karthika Padmavathy ,&nbsp;Karthick Rangasamy ,&nbsp;Purushothaman Muthukanagaraj","doi":"10.1016/j.jcot.2025.103098","DOIUrl":"10.1016/j.jcot.2025.103098","url":null,"abstract":"<div><h3>Background</h3><div>Clinical decision-making and critical thinking are vital in orthopaedic practice, directly impacting patient outcomes. Surgeons often face complex cases requiring both experience and systematic reasoning to ensure the best treatment approach. This review aims to explore the factors influencing decision-making in orthopaedics, focusing on the role of critical thinking in enhancing clinical choices. It examines decision-making frameworks, cognitive biases, and the importance of evidence-based practices. Additionally, the review discusses the increasing role of artificial intelligence (AI) and decision support systems in aiding clinical decisions.</div></div><div><h3>Methods</h3><div>This review analyzes peer-reviewed literature published from 2011 to 2024, covering case studies, surveys, qualitative research, and systematic reviews. Databases like PubMed, Scopus, Web of Science (WoS), and Google Scholar were used to source relevant articles. The focus was on decision-making frameworks, cognitive biases, and AI integration in orthopaedics, particularly studies on AI and data analytics in improving decision support systems.</div></div><div><h3>Results</h3><div>Structured decision-making frameworks and mentorship play a key role in enhancing critical thinking. Cognitive biases, such as confirmation and anchoring bias, are significant challenges. AI and evidence-based guidelines help improve clinical decisions by offering data-driven insights.</div></div><div><h3>Conclusions</h3><div>Optimizing clinical decision-making requires structured education, critical thinking development, and AI integration to improve patient outcomes and streamline decision-making.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103098"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Anterior Approach for Total Hip Arthroplasty in bony ankylosis of hips - comparison with historical series performed by posterior approach","authors":"Rajesh Malhotra ,&nbsp;Vikrant Manhas ,&nbsp;Sahil Batra ,&nbsp;Arpit Sahu ,&nbsp;Deepak Gautam","doi":"10.1016/j.jcot.2025.103103","DOIUrl":"10.1016/j.jcot.2025.103103","url":null,"abstract":"<div><h3>Introduction</h3><div>We performed a retrospective study to assess the intraoperative course and postoperative outcome of Direct Anterior Approach (DAA) in supine position for Total Hip Arthroplasty (THA) in bony ankylosis of hips and compare with historical series of THA in bony ankylosis performed by posterior approach.</div></div><div><h3>Methods</h3><div>Inpatient details with intra and post operative data were retrieved from the service arthroplasty register and medical records. All patients were followed up till a minimum of 2 years post-surgery with x-rays and clinical score.</div></div><div><h3>Results</h3><div>Twenty-two patients (28 hips), all males (mean age 33.5 years), underwent THA via DAA in 16 unilateral and 6 bilateral hips. There was no opioids requirement beyond 48 h of surgery with mean hospital stay of 3.6 days for both the groups. The Harris Hip Score improved from preoperative 32 to 88.4 at 2 years. All the hips were stable at 2 years with no radiolucencies and/or component migration/position change. Comparison with the historical series (n = 54 &amp; n = 41), revealed no dislocation, no nerve symptoms and no infection in any of the patients in either series.</div></div><div><h3>Discussion &amp; conclusion</h3><div>Although technically demanding, the preliminary result of THA by DAA in bony ankylosis of hips is promising. Even in this small cohort, the less analgesic requirement, less hospital stay and no incidence of dislocation should be considered as the advantages of DAA when compared to posterior approach.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103103"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of health-related quality of life among major trauma patients discharged from hospitals. A systematic review and meta-analysis","authors":"Zemedu Ferede ,&nbsp;Arpita Das ,&nbsp;Silvia Manzanero ,&nbsp;Vignesh Raman ,&nbsp;Michael Schuetz ,&nbsp;Dylan Flaws","doi":"10.1016/j.jcot.2025.103102","DOIUrl":"10.1016/j.jcot.2025.103102","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in trauma systems that improve survival, long-term recovery outcomes, such as health-related quality of life (HRQOL), are often overlooked. Identifying the factors that predict post-discharge HRQOL can help guide personalized care and prioritize patients who need post-discharge follow-up. This review aimed to synthesize evidence on predictors of post-discharge HRQOL among major trauma patients.</div></div><div><h3>Methods</h3><div>This review was registered with PROSPERO (CRD42024512689) and conducted using searches across databases including PubMed, Embase, Scopus, Cochrane Library, and CINAHL. The Quality in Prognosis Studies (QUIPS) was used to assess risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was applied to assess quality of evidence. The meta-analysis was performed to evaluate the effect of predictor variables on the HRQOL using Stata v-17.</div></div><div><h3>Results</h3><div>Seventeen studies were included (n = 14 prospective, n = 3 retrospective cohort studies), and 7 of these were incorporated into the meta-analysis. The overall risk of bias was moderate in most studies. Older age predicts lower EuroQol 5-Dimensions (EQ-5D) and lower Short Form 36 Health Survey (SF-36) Physical Component Score (PCS), while it predicts a higher SF-36 Mental Component Score (MCS). Meta-analysis showed that female sex predicted lower SF-36-MCS and lower EQ-5D. A lower American Society of Anesthesiology (ASA) score predicted lower EQ-5D, while psychiatric comorbidity predicted lower SF-36-MCS. Higher Injury Severity Score (ISS) predicted poor HRQOL, but not SF-36-MCS and PCS. Traumatic Brain Injury (TBI) predicted poor SF-36-MCS, but other injury locations did not predict long-term HRQOL. While the length of hospital stay showed no predictive effect, most hospital-related factors were reported in only a single study.</div></div><div><h3>Conclusion</h3><div>Predischarge factors, such as age, sex, preexisting conditions, and injury severity, are significant predictors of poor long-term HRQOL. Knowledge of these predischarge factors is important to improve long-term outcomes. Additional research should include hospital treatment and diagnostic factors.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103102"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The journal metrics of reality: Adjusting our gaze beyond the pandemic peak","authors":"Raju Vaishya ,&nbsp;Karthikeyan P. Iyengar","doi":"10.1016/j.jcot.2025.103097","DOIUrl":"10.1016/j.jcot.2025.103097","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103097"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the accuracy of Cuvis™ robot assisted total knee arthroplasty using offset type tensor system in ligament gap balancing","authors":"Woon-Hwa Jung,&nbsp;Minseok Seo,&nbsp;Vaibhav Sahu,&nbsp;Jignesh Tandel","doi":"10.1016/j.jcot.2025.103095","DOIUrl":"10.1016/j.jcot.2025.103095","url":null,"abstract":"<div><h3>Background</h3><div>Conventional total knee arthroplasty (TKA) is a widely accepted and cost effective procedure for treating symptomatic knee osteoarthritis. Despite its success, patient satisfaction rates range from 82 % to 89 %, primarily due to suboptimal functional outcomes, reduced implant longevity, and the need for revision surgeries stemming from component malalignment or soft tissue instability. Robot-assisted total knee arthroplasty (RA-TKA) offers a promising approach to address these challenges.</div></div><div><h3>Aim</h3><div>This study aims to evaluate the accuracy of robot-assisted total knee arthroplasty in achieving optimal ligament gap balancing, based on 159 cases performed in 2023.</div></div><div><h3>Method</h3><div>A total of 159 RA-TKA procedures using the Cuvis™ robot were conducted in 2023, with 9 valgus knees and 150 varus knees. Ligament gaps were measured twice by the robotic system: initially before bone cuts and subsequently after bone cuts. During surgery, an off-set type tensor was used to reassess ligament gaps. Cases exhibiting a discrepancy greater than 3 mm between extension and flexion gaps, as measured by both the tensor and robot, were included for further analysis. Discrepancies between surgeon-measured values and robot-predicted values were also evaluated.</div></div><div><h3>Result</h3><div>Of the 159 cases, 35 demonstrated a ligament gap discrepancy of more than 3 mm, as measured by the tensor. Among these, 24 cases (15 %) exhibited discrepancies between robotic measurements and tensor assessments. All 9 valgus knee cases showed discrepancies, while 15 varus knee cases also displayed discrepancies. The robot recorded 20 errors in ligament gap measurement, 2 errors in balancing, and 2 cases with both errors.</div></div><div><h3>Conclusion</h3><div>While robot-assisted TKA excels in bone cutting accuracy, errors in predicting ligament balancing and gaps remain in some cases. Therefore, caution is advised when adapting surgical strategies intra-operatively, relying solely on the Cuvis™ robotic system's measurements.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103095"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of reverse shoulder arthroplasty in obstetric brachial plexus palsy with suprascapular nerve injury and glenohumeral osteoarthritis","authors":"F. Granata ,&nbsp;S. D'Amato ,&nbsp;S. Cassaro ,&nbsp;C. Burgio ,&nbsp;F. Bosco","doi":"10.1016/j.jcot.2025.103096","DOIUrl":"10.1016/j.jcot.2025.103096","url":null,"abstract":"<div><h3>Background</h3><div>Untreated obstetric brachial plexus palsies (OBPP) present with various upper limb impairments, including muscle weakness, soft tissue contractures, and osteoarticular deformities. Reverse shoulder arthroplasty (RSA) medializes the center of rotation, optimizing deltoid function to compensate for deficits caused by OBPP. This study evaluates the effectiveness of RSA in patients with untreated OBPP involving the suprascapular nerve and end-stage glenohumeral osteoarthritis (OA), focusing on functional and quality-of-life improvements.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on patients with OBPP involving the suprascapular nerve and end-stage glenohumeral OA who underwent RSA. Included patients had significant deficits in the supraspinatus and infraspinatus muscles but preserved deltoid function. Pre- and postoperative assessments included Range of Motion (ROM), Visual Analog Scale (VAS), and Patient-Reported Outcome Measures (PROMs). Data on complications and revision surgeries were also collected.</div></div><div><h3>Results</h3><div>Seven patients (2 males, 5 females; mean age 38.9 ± 14.9 years) with a median follow-up of 3.1 ± 2.2 years were included. Postoperatively, significant improvements were observed in limb function and quality of life, as reflected in the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and Quick Disabilities of the Arm, Shoulder, and Hand (QDASH). Pain levels decreased markedly, and ROM showed a moderate increase. No complications or revision surgeries were reported.</div></div><div><h3>Conclusions</h3><div>RSA is an effective and safe surgical option for patients with untreated OBPP involving the suprascapular nerve and end-stage glenohumeral OA, yielding significant functional and quality-of-life improvements at short- and mid-term follow-up. The absence of complications and revision surgeries further supports its reliability in this challenging patient population.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103096"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological impact of idiopathic clubfoot on Mothers: Insights from the ICCAP questionnaire","authors":"Anil Agarwal,&nbsp;K.S. Ankitha,&nbsp;Varun Garg,&nbsp;Kishmita Sachdeva,&nbsp;Ashish Upadhyay","doi":"10.1016/j.jcot.2025.103094","DOIUrl":"10.1016/j.jcot.2025.103094","url":null,"abstract":"<div><h3>Background</h3><div>Mothers who have a newborn with a physical defect often experience significant psychological distress. We surveyed mothers of children born with clubfoot to understand what parameters of parents’ quality of life and health are primarily affected and the changes thereof at correction of the deformity to guide the counseling process.</div></div><div><h3>Methods</h3><div>The affected mothers were administered the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. The responses were recorded prospectively at the enrolment of the child for treatment (foot with obvious clubfoot deformity) and one month post Achilles tenotomy (foot deformity fully corrected). Statistical analysis involved the use of mean responses for each ICCAP domain and intertreatment comparisons.</div></div><div><h3>Results</h3><div>Results were analyzed for 29 mothers. The affected mothers were largely satisfied (91.4 %) with their first contact with caregivers. The confidence grew significantly following the correction of deformity (scores improving from 4.39 ± 0.59 to 4.74 ± 0.3; p = 0.005). The social support remained strong throughout the Ponseti treatment. The partner relationships (pretreatment 4.57 ± 0.75; post treatment scores 4.48 ± 0.82; p = 0.69) and child acceptance (pretreatment 4.18 ± 0.62; post treatment 4.04 ± 0.59; p = 0.38) were also overall strong although somewhat affected by the casts and bracing protocol. The affected mothers recovered from a sad and depressed state following visualization of corrected deformity (pretreatment scores 3.09 ± 0.92 improving to 2.92 ± 1.04 post treatment; p = 0.52). They however continued to experience fear and anxiety regarding their child's immediate and long-term future (pretreatment scores of 3.42 ± 0.65 deteriorating to 3.56 ± 0.55 at the initiation of bracing; p = 0.34).</div></div><div><h3>Conclusions</h3><div>Mothers of children with clubfoot generally adapted well despite the child's physical deformity. The mother was subjected to early psychological stress which can extend even post correction of deformity. We suggest dedicated counseling of the affected clubfoot parents by the subject experts. The same may require periodic reinforcements during the treatment.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103094"},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of intra-and interobserver reliability analysis of orientation proximal femur physis parameters on radiographs","authors":"Varun Garg ,&nbsp;Anil Agarwal ,&nbsp;Kishmita Sachdeva ,&nbsp;K.S. Ankitha","doi":"10.1016/j.jcot.2025.103093","DOIUrl":"10.1016/j.jcot.2025.103093","url":null,"abstract":"<div><h3>Background</h3><div>The orientation of proximal femur physis is important as it can cause 3-dimensional deformity of the proximal femur. Recently, authors have described various parameters to describe the orientation of proximal femur physis. Therefore, we aim to compare the intra and interobserver reliability of these parameters in this study.</div></div><div><h3>Methods</h3><div>Radiographs of the bilateral hip with the pelvis of children between 1 and 10 years of age were retrieved from the hospital archives to measure the Physeal orientation angle (PO), Physeal tilt angle (PTA), Head shaft angle (HSA), and Alsberg angle (AA). Intra- and inter-observer reliability was tested using Pearson's correlation coefficient and Cronbach's alpha respectively by three independent observers at two separate times, two weeks apart.</div></div><div><h3>Results</h3><div>The total analysis included 179 radiographs, including 378 hips. PO, PTA, HSA, and AA had values ranging from 9.57⁰ -14.04⁰, 19.62°-25.04⁰, 58.75°-65.82⁰, and 24.47⁰ -31.79⁰, respectively, for the six data sets (three observers at two different times).The intra-observer reliability of PO, PTA, HSA, and AA ranged from 0.59- 0.72, 0.9–0.95, 0.91–0.95 and 0.86–0.95 respectively. PO, PTA, HSA, and AA had inter-observer reliability values between 0.79 -0.82, 0.88–0.92, 0.85–0.88, and 0.89–0.92, respectively.</div></div><div><h3>Conclusion</h3><div>The study found that PTA, AA, and HSA have shown good reliability, but they may not accurately represent the true orientation of the capital femoral physis with respect to the femoral neck. For routine follow-up, PO may be a suitable alternative. However, it is not as reliable as other parameters.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103093"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}