Evidence library

Recommends diagnosing soft-tissue infection clinically and grading its severity with the IWGDF/IDSA classification, a structured work-up for suspected osteomyelitis (probe-to-bone, plain radiographs, inflammatory markers and MRI where uncertain), deep tissue or bone sampling for culture rather than superficial swabs, and shorter, targeted antibiotic courses.

Immediate MRI was associated with lower mean costs per patient; the saving was not statistically significant at three months but became significant at six months. MRI also picked up significantly more fractures other than the scaphoid and had higher diagnostic accuracy than standard care.

Major criteria (two positive cultures of the same organism, or a sinus tract communicating with the joint) confirm infection, while a weighted minor-criteria score classifies cases as infected, inconclusive or not infected. The new definition outperformed the 2011 MSIS criteria.

Defined confirmatory criteria (fistula, sinus or wound breakdown communicating with bone or implant; purulent drainage or pus; the same pathogen in at least two deep tissue samples; microorganisms on histology) and suggestive criteria (clinical signs, raised markers, imaging, single positive culture) that should prompt further investigation.

Major criteria (sinus tract communicating with the joint, or two positive cultures of the same organism) confirm infection; otherwise weighted minor criteria (serum CRP, D-dimer, ESR; synovial WCC, leucocyte esterase, alpha-defensin, neutrophil percentage, synovial CRP) give a score where 6 or more indicates infection and 2-5 is inconclusive. The new definition showed higher sensitivity than the 2011 MSIS criteria with very high specificity.

Defined FAI syndrome as a motion-related clinical disorder requiring a triad of symptoms, clinical signs and imaging findings (cam or pincer morphology); morphology alone without symptoms is not FAI syndrome.

Immediate total-body CT did not significantly reduce in-hospital mortality compared with a standard imaging approach.

Concluded that atypical femoral fractures behave as stress or insufficiency fractures and revised the case definition: transverse orientation was emphasised, minimal comminution was now allowed, localised periosteal stress reaction became a major feature, and drug and disease associations were removed from the criteria. The relative risk with bisphosphonates is high but the absolute risk is low, rising with long-term use and appearing to fall after the drug is stopped.

Fragility pelvic fractures differ from high-energy pelvic ring injuries and are poorly described by existing systems. Most are minimally displaced and settle without surgery, but some progress to displacement, nonunion and persistent instability; the proposed graded classification links instability to treatment, from minimally invasive fixation to complex reconstruction.

Most individual shoulder tests had limited diagnostic accuracy on their own, and many labral and impingement tests performed poorly.

Male sex, sports injury, snuffbox pain on ulnar deviation within 72 hours and scaphoid tubercle tenderness at two weeks independently predicted fracture. Absence of snuffbox pain on ulnar deviation early on was associated with no fracture, and when all four factors were present the fracture risk was very high.

CT and MRI performed comparably with no significant difference in sensitivity, specificity or accuracy; both were better at excluding than confirming a fracture, and MRI produced more false positives.

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.

The share of patients over 60 rose significantly over the study period. Older patients significantly more often had fractures involving displacement of the anterior column, frequently with a separate quadrilateral plate fragment or roof impaction, while their posterior wall fractures often showed comminution and marginal impaction, features linked to poorer outcomes.

Recommended a well-centred AP pelvis plus lateral views (e.g. cross-table lateral, frog-leg, Dunn) and set out key measures such as lateral centre-edge angle, Tonnis angle, crossover sign and head-neck offset.

The hook test was highly sensitive and specific for complete rupture, outperforming MRI in this series.

Fever was the strongest single predictor and raised CRP was an independent predictor; combining CRP with the Kocher criteria increased the probability of septic arthritis as more predictors were present.

The Lachman test had the best overall sensitivity for ACL rupture, while the pivot shift test was highly specific and useful for ruling the diagnosis in. The anterior drawer test performed better in chronic than acute injuries.

The weighted clinical criteria (CTS-6) correlated well with the judgement of an independent expert panel, providing a consistent clinical definition of CTS.

Described cam (aspherical femoral head-neck junction) and pincer (acetabular over-coverage) impingement and their characteristic patterns of labral and cartilage damage, proposing FAI as a cause of early osteoarthritis.

Sensitivity was almost 100% with low negative likelihood ratios for ankle and midfoot in adults and children, so a negative rule makes fracture very unlikely; specificity was only modest.

Symptomatic patients had significantly larger alpha angles than controls, establishing the alpha angle as a measure of cam morphology.

Radiographic abnormality by age 2 was identical in the two arms, while the ultrasound arm needed significantly less abduction splinting; rates of surgical treatment did not differ significantly.

The derived rule had very high sensitivity for clinically important cervical spine injury while potentially reducing the number of radiographs ordered.

Electrodiagnosis helps localise the lesion and quantify axon loss, but distal conduction persists for a period after transection, so studies are most informative once Wallerian degeneration has occurred; EMG evidence of reinnervation precedes clinical recovery.

The probability of septic arthritis rose steeply with the number of predictors present, being very high when all four were present and very low when none were.

The probability of septic arthritis rose steeply with the number of predictors present, being very high when all four were present and very low when none were.

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.

The rule identified all clinically important fractures in the validation cohort (sensitivity of 100%) and would have reduced the need for knee radiographs substantially.

Extended Ficat-type staging by incorporating MRI findings and quantifying the extent of head involvement, which helps predict progression and guide treatment.

The refined rules detected essentially all clinically significant malleolar and midfoot fractures in validation, while allowing a substantial reduction in radiography.

Transfusion requirement and mortality varied by injury pattern, with anteroposterior compression and combined injuries carrying the highest blood loss and mortality; the authors concluded the classification-based protocols reduced pelvic-related morbidity and mortality.

Class 1 traumatic tears are subdivided by site (central, ulnar, distal and radial attachments), and Class 2 degenerative lesions are graded progressively from TFCC wear through perforation, chondromalacia and lunotriquetral ligament tear to ulnocarpal arthritis, reflecting ulnar impaction.

Showed that correlation coefficients are misleading for judging agreement and proposed a simple graphical approach: plot differences against means and report the mean difference (bias) and limits of agreement derived from the spread of the differences.

Defined four progressive stages of perilunar instability: scapholunate disruption, capitolunate disruption, lunotriquetral disruption and finally volar lunate dislocation.

Showed that the cartilaginous infant hip can be imaged diagnostically with ultrasound, a harmless, cheap and non-invasive method suited to screening, laying the foundation for the later Graf classification.

Introduced the Gustilo-Anderson classification (types I to III) and showed infection risk rose with severity of soft tissue injury, supporting prophylactic antibiotics and leaving severe wounds open.

Described the two-column concept, the iliac and obturator oblique views and radiographic lines needed to read acetabular fractures, forming the basis of the later 10-pattern Letournel classification (5 elementary, 5 associated).

First degree equates to neurapraxia and fifth degree to complete transection; second to fourth degrees subdivide axonotmesis by progressive loss of endoneurial and perineurial continuity, with prognosis worsening as more layers are lost and fourth/fifth degree injuries generally needing surgery.