OrthoQB

Evidence library

The trials, meta-analyses and guidelines that shape orthopaedic diagnosis and management, each summarised in one screen: what it asked, what it found, and how it changed practice. Every citation is checked against PubMed.

AllDiagnosisManagementPrognosisPrevention
All topicsShoulderElbowWristHandPeripheral nerveHip (young adult & sports)Hip arthroplastyKnee soft tissue & sportsKnee arthroplastyFoot & ankleSpineUpper limb traumaPelvis & acetabulumLower limb traumaMajor trauma & polytraumaFracture clinic & non-operative carePost-op care & complicationsOperative technique & equipmentInfectionPaediatricsTumoursRheumatology & metabolic boneBasic scienceResearch, statistics & guidelines
Denosumab in GCT (phase 2)The Lancet. Oncology 2010
Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study.
86% of evaluable patients responded, including every patient assessed histologically (near-elimination of giant cells); serious adverse events were uncommon and none was judged treatment related.
Cohort studyManagementTumours
SINSSpine 2010
A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.
Combines six clinical and radiological components into a weighted score that classes lesions as stable, potentially unstable or unstable, with the higher categories prompting a spinal surgical opinion.
OtherDiagnosisTumours
Patchell MSCC trialLancet (London, England) 2005
Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.
Significantly more surgical patients were ambulatory after treatment (84% versus 57%) and they retained walking ability for longer, with reduced steroid and opioid requirements.
Randomised trialManagementTumours
Revised Tokuhashi scoreSpine 2005
A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis.
Scores of 0-8 predicted survival under 6 months, 9-11 at least 6 months and 12-15 at least 1 year, and predicted prognosis agreed well with actual survival.
Cohort studyPrognosisTumours
Preop vs postop RT in STS (NCIC SR2)Lancet (London, England) 2002
Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial.
Preoperative radiotherapy roughly doubled wound complications (35% versus 17%, significant); tumour size and site were also risk factors, and overall survival was marginally better with preoperative treatment.
Randomised trialManagementTumours
Hazards of biopsy revisitedThe Journal of bone and joint surgery. American volume 1996
The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society.
Biopsy problems (diagnostic errors, complications, altered treatment and unnecessary amputation) were significantly more frequent when biopsy was done at a referring institution than at a treating centre.
Cohort studyDiagnosisTumours
Mirels scoreClinical orthopaedics and related research 1989
Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures.
Lesions that fractured had a higher mean score than those that did not (10 versus 7), and fracture risk climbed as the score rose above 7; Mirels proposed that lesions scoring 7 or less can be irradiated safely, whereas higher scores merit prophylactic fixation before radiotherapy.
Cohort studyPrognosisTumours
Enneking stagingClinical orthopaedics and related research 1980
A system for the surgical staging of musculoskeletal sarcoma.
Stage I (low grade), II (high grade) and III (metastatic), each subdivided into A (intracompartmental) and B (extracompartmental), stratified prognosis and linked to defined surgical margins (intralesional, marginal, wide, radical).
OtherPrognosisTumours