Randomised trial of genetic testing and targeted intervention to prevent the development and progression of Paget's disease of bone.

Introduction: Paget's disease of bone (PDB) frequently presents at an advanced stage with irreversible skeletal damage. Clinical outcomes might be improved by earlier diagnosis and prophylactic treatment.

Methods: We randomised 222 individuals at increased risk of PDB because of pathogenic variants to receive 5 mg zoledronic acid (ZA) or placebo.

Which treatment provides the best neurological outcomes in acute spinal cord injury?

Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial.

The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain.

Aims: The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE).

Methods: This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period.

The British Orthopaedic Surgery Surveillance study: Perthes' disease: the epidemiology and two-year outcomes from a prospective cohort in Great Britain.

Aims: The aim of this study was to evaluate the epidemiology and treatment of Perthes' disease of the hip.

Methods: This was an anonymized comprehensive cohort study of Perthes' disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children's hip disease in the UK participated over an 18-month period.

Lateral lumbar interbody fusion in adult spine deformity - A review of literature.

Introduction: Surgery for adult spine deformity presents a challenging issue for spinal surgeons with high morbidity rates reported in the literature. The minimally invasive lateral approach aims at reducing these complications while maintaining similar outcomes as associated with open spinal surgeries. The aim of this paper is to review the literature on the use of lateral lumbar interbody fusion in the cases of adult spinal deformity.

Barriers to recruitment to an orthopaedic randomized controlled trial comparing two surgical procedures for ankle arthritis : a qualitative study.

Aims: A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial.

Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties.

Aims: This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes.

Methods: Patients were recruited from 11 specialist centres between June 2016 and November 2019.

Healthcare utilisation in children with SMA type 1 treated with nusinersen: a single centre retrospective review.

Background: Nusinersen has been used to treat spinal muscular atrophy type 1 (SMA1) in the UK since 2017. While initial trials showed neuromuscular benefit from treating SMA1, there is little information on the respiratory effects of nusinersen. We aimed to look at the respiratory care, hospital utilisation and associated costs in newly treated SMA1.

Zoledronate in the prevention of Paget's (ZiPP): protocol for a randomised trial of genetic testing and targeted zoledronic acid therapy to prevent -mediated Paget's disease of bone.

Introduction: Paget's disease of bone (PDB) is characterised by increased and disorganised bone remodelling affecting one or more skeletal sites. Complications include bone pain, deformity, deafness and pathological fractures. Mutations in sequestosome-1 () are strongly associated with the development of PDB.

Understanding frames: A qualitative exploration of standing frame use for young people with cerebral palsy in educational settings.

Background: Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Most young people with cerebral palsy in the United Kingdom, who use standing frames, use them at nursery or school, rather than at home. In this paper we report professionals' and parents' experiences and views of standing frame use specifically in educational settings.

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.

Standing frames for children with cerebral palsy: a mixed-methods feasibility study.

Background: Standing frames are recommended as part of postural management for young people with cerebral palsy (CP) Gross Motor Function Classification System (GMFCS) level IV or V. They may have a variety of benefits, including improving bone mineral density, gastrointestinal function and social participation. The NHS needs to know if these benefits are real, given the cost implications of use and the reported negative effects (e.

Sternoclavicular joint.

The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.

Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy.

Background: Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Although the rationale for standing frame use and the associated challenges have been described, little attention has been given to the users' experiences. The aim of the current study was to explore young people's positive and negative experiences, and attitudes regarding standing frame use.

Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy.

Background: Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g.

Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study.

Objective: To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards.

Design: A mixed methods approach utilising the Delphi technique and focus groups.

Setting: Five spinal centres across the UK.

Periprosthetic femoral fracture due to biodegradable cement restrictor.

Biodegradable materials are gaining popularity in orthopedics. Despite finding use in different areas of orthopedic surgery, they do not come without disadvantages such as foreign body reactions, granulomatous reactions, and sterile sinus formation in bone. We report a case of a patient who sustained a periprosthetic fracture seen at the tip of a cemented femoral stem approximately 5 years postsurgery, secondary to the use of a biodegradable cement restrictor.

The biomechanics of pathological gait - from muscle to movement.

Clinicians face the daily challenge of assessing and treating patients with gait problems. Musculoskeletal models appear to show potential for assisting with the understanding of complex pathological movements, however they are also complex and reliant on multiple assumptions in order to maintain stability. This paper breaks down the process by which muscles produce movement into a series of steps.

McArdle disease: a clinical review.

Methods: The clinical phenotype of 45 genetically confirmed McArdle patients is described.

Results: In the majority of patients (84%), the onset of symptoms was from early childhood but diagnosis was frequently delayed until after 30 years of age. Not all patients could recognise a second wind although it was always seen with exercise assessment.

Peripatetic intravenous service for metabolic bone disease: case study in patient centred-care for new NHS.

Objective: To develop a 'close to patient' peripatetic intravenous service (PIVS) for delivery of specialist osteoporosis care in a community setting without increasing cost and with a reduced carbon footprint.

Research Design And Methods: Cost and feasibility of a PIVS for intravenous (i.v.

Nursing and nurses: the image and the reality.

This article describes national and regional processes, and the evidence base developed from a series of engagement and involvement events across the NHS, to develop an effective marketing campaign and a framework for regional strategies to recruit and retain nurses. The consultation and engagement process was also designed to ensure that the campaign would be supported by the workforce. It will be of interest to the independent and voluntary sectors and, while relating to English strategy and policy, it is pertinent to the whole of the UK and internationally.

Disc cell clusters in pathological human intervertebral discs are associated with increased stress protein immunostaining.

Intervertebral disc (IVD) cells within the annulus fibrosus (AF) and nucleus pulposus (NP) maintain distinct functional extracellular matrices and operate within a potentially noxious and stressful environment. How disc cells respond to stress and whether stress is responsible for triggering degeneration is unknown. Disc cell proliferation and cluster formation are most marked in degenerate IVDs, possibly indicating attempts at matrix repair.