Max Reijman

Background: Adolescent idiopathic scoliosis (AIS) requires follow-up during growth to detect progression, resulting in a burden of care. The Scolioscoop ^® V3 was developed as an alternative to the Bunnell Scoliometer, to facilitate home monitoring by parents/caregivers. Aim: This study evaluated the accuracy and precision of the Scolioscoop ^® V3 compared with the gold standard, both in the outpatient clinic and in the home setting. Methods: A single-center cross-sectional validation study and a multicenter prospective longitudinal study were combined. Scolioscoop ^® measurements performed by healthcare professionals and parents/caregivers were compared with Bunnell Scoliometer measurements. Accuracy and precision were assessed using intraclass correlation coefficients (ICC) and Bland–Altman analyses. Results: 92 patients with AIS were included. Measurements performed with the Scolioscoop ^® V3 by healthcare professionals demonstrated an excellent correlation with the Bunnell Scoliometer (ICC 0.92, 95% CI 0.88 to 0.95). Measurements with the Scolioscoop ^® V3 performed by parents/caregivers showed a moderate correlation in the outpatient clinic ( ICC 0.57, 95% CI 0.40 to 0.70), whereas the correlation was poor for unsupervised measurements at home at 6- and 12-month follow-up (ICC − 0.19, 95% CI -0.52–0.19 and ICC 0.26, 95% CI -0.29–0.68), respectively). The response rates were 50.4% (29 patients) and 24.5% (14 patients) at 6 and 12 months respectively. Conclusion: The Scolioscoop ^® V3 demonstrated excellent agreement with the Bunnell Scoliometer when used by trained healthcare professionals. However, home measurements showed limited reliability, indicating user dependence. Future research should focus on improving usability and supporting effective self-assessment.

Background: Cerebral palsy (CP) often causes progressive hip migration in severely affected children, leading to pain and reduced quality of life. Adductor tenotomies are commonly performed to prevent progressive hip migration. This study evaluated success rates, complications, and predictors of failure after adductor tenotomies in 5 national CP centers in the Netherlands. Methods: We conducted a retrospective multicenter cohort study of children with CP aged 1 to 12 years who underwent adductor tenotomies, with or without psoas releases, between 2010 and 2020. Patients with prior hip surgery, non-CP diagnoses, or insufficient follow-up (<4 y) were excluded. The primary outcome was treatment success at 4 years of follow-up, defined as the absence of secondary surgery for hip migration or a migration percentage below 50%. Secondary outcomes included predictors of failure, complications, and timing of secondary surgery. Kaplan-Meier survival curves and generalized estimating equation logistic regression were used to evaluate outcomes. Results: A total of 109 hips (55 children) were included. Overall, the success rate was 51.4%. The median time to failure was 2.0 years (IQR: 1.3 to 3.3). Preoperative migration percentage (MP) [odds ratio (OR)=1.1, 95% CI: 1.1-1.2] and not performing a psoas release (OR=7.3, 95% CI: 1.8-30.0) were the strongest independent predictors for failure. No failures occurred when the preoperative MP was 50% had a 75.9% failure rate, with a median time to failure of 1.4 years (IQR: 0.9 to 2.6). Without a psoas release, the odds of failure increase significantly. The complication rate was 3.7% in this cohort. Conclusions: The success rate of adductor tenotomies in the treatment of hip migration was 51.4%. Higher preoperative MP strongly predicted a poorer outcome, and this procedure, as the solitary surgical procedure to manage hip migration, should be avoided when the preoperative MP exceeds 50%. Performing routine psoas release with the adductor tenotomies appears to improve surgical outcomes. Level of Evidence: Level IV.

Purpose: Screening for adolescent idiopathic scoliosis (AIS) using the Adam Forward Bending Test (AFBT) remains controversial, resulting in the discontinuation of scoliosis screening in the Netherlands. This study aims to validate the Scolioscope, a simplified version of the Scoliometer, for detecting scoliosis in a home setting. Methods: A validation study was conducted at the orthopedic outpatient clinic of Erasmus Medical Center Sophia Children's Hospital in Rotterdam, the Netherlands. Patients aged 9–18 years with or without AIS and capable of performing the AFBT were included. The Scolioscope measurement of the parents was compared with the Scoliometer measured by an orthopedic surgeon. After unsatisfactory results with the initial Scolioscope version, a revised version was developed and tested. Results: Among 100 patients included in the study, 79 had scoliosis. The revised version of the Scolioscope demonstrated a positive predictive value of 97%, a negative predictive value of 89%, sensitivity of 94%, and specificity of 94%. Parental measurements showed no variation, with an intra-observer reliability kappa value of 1. Conclusion: The Scolioscope demonstrates high diagnostic accuracy and precision, making it suitable for use in at-home scoliosis screening programs.

Purpose: Proximal fixation in adolescent idiopathic scoliosis (AIS) surgery is a matter of discussion. All screw (AS) constructs provide better coronal correction than hybrid constructs, but high thoracic pedicle screw placement can be challenging. This study investigated whether an AS-construct provides better correction than a proximal double hook-claw (PH) construct. Methods: AIS patients undergoing posterior spinal fusion (PSF) were randomized to AS-construct or PH-construct from 2016 to 2020 with a two-year follow-up. Primary outcome is the main thoracic (MT) Cobb angle correction after two years. Secondary outcomes are thoracic kyphosis (TK), proximal junctional angle (PJA), proximal thoracic (PT) Cobb angle, SRS-22r, and complications after two years. Results: 60 patients (30 AS, 30 PH) were included. No baseline differences were found. Preoperative MT Cobb angle was 62° ± 11° (AS) vs. 65° ± 12° (PH). There was no statistical difference in MT Cobb angle after two years: 25° ± 9° (AS) vs. 27° ± 7° (PH) (p = 0.247). No difference in PT Cobb angle was found: 20° ± 9° (AS) vs. 21° ± 9° (PH) and TK: 23° ± 9° (AS) vs. 22° ± 7° (PH). SRS-22r improved in both groups with no statistical difference: 3.9 ± 0.5 to 4.3 ± 0.5 (AS) vs. 3.7 ± 0.5 to 4.3 ± 0.5 (PH). There were 13 complications (ten patients) in AS group and 17 (13 patients) in PH group, including 1 major complication in each group (deep wound infection). Conclusion: AS-construct does not provide better coronal Cobb correction after two years after surgery. A PH-construct is a reliable and safe option for proximal fixation AIS patients. TRN: NTR-NL5552 (2016). Trial registration: Overview of medical research in the Netherlands (OMON): NL-OMON43852.

Background: Hip migration is a common comorbidity in children with cerebral palsy (CP) and can progress to complete hip dislocation, resulting in a reduced quality of life. Structured surveillance programs designed to prevent complete hip dislocation have demonstrated success regarding the early identification of hip migration. The objectives of this study are to determine whether there is a correlation between hip abduction in flexion (AIF) and migration percentage (MP) and to determine if there are clear cutoff values for hip abduction in flexion that are associated with progressive hip migration. Methods: This retrospective study evaluated children at our neuromuscular clinic between 2018 and 2022. We included children diagnosed with spastic CP for whom hip radiographs and concurrent physical examinations were available. The outcomes were assessed using AIF as a measure of range of motion and migration percentage according to Reimers. Results: In total, 83 patients were included, with a mean MP of 30.7% and a median AIF of 40 degrees. Mixed-effects modeling revealed a significant correlation between MP and AIF (β = −0.51, p < 0.001). Using generalized linear mixed-effects models and ROC analysis, we established a cutoff value of 40 degrees for AIF in predicting MP above 30%, with a sensitivity of 94.5% and a specificity of 80%. Conclusions: A negative correlation between AIF and MP was found, indicating that as AIF decreases, MP increases. Furthermore, a distinct cutoff value of 40° for AIF in progressive hip migration was found, which can guide timely referrals and early imaging.

Introduction: Successfully reduced distal radius fractures (DRFs) often redisplace while casted. Poor cast moulding might be a risk factor for redisplacement of DRFs. This study aims to assess whether cast moulding quality, as determined by casting indices, impact the risk of redisplacement. Also, we assessed the influence of the cast applicant and the material used on the redisplacement risk. Materials and methods: We retrospectively reviewed cases from a prospective cohort (trial registration NL8311). We included 172 adequately reduced and circumferentially casted DRFs with a complete two-week radiographic follow-up. Fracture alignment was measured on all radiographs (trauma, post-reduction and follow-up) in accordance with the Dutch guideline for DRFs. When unacceptably aligned after 2 weeks, the DRF was labelled as redisplaced. Cast moulding quality was measured using the Three Point Index (TPI), Cast Index (CI) and Gap Index (GI). A TPI > 0.8, CI > 0.7 and GI > 0.15 implicates poor cast moulding. Multivariable logistic regression was used to examine the influence of cast moulding quality, cast applicant and casting material on the redisplacement risk. We corrected for patient age, intra-articular involvement, the degree of radial inclination and radial shortening. Results: Redisplacement occurred in 40% of DRFs. The mean index scores were poor (TPI 0.94, CI 0.85, GI 0.22), indicating generally suboptimal cast moulding quality. None of the cast indices were significantly associated to redisplacement (OR [95% CI]: TPI 1.2 [0.6 to 2.5], CI 2.4 [0.7 to 15.7], GI 1.6 [0.7 to 4.0]). DRFs casted by nurse practitioners had significantly lower odds of redisplacement compared to those casted by emergency room nurses. Type of casting (synthetic versus plaster of Paris) was not associated with redisplacement. Conclusions: Cast moulding quality, measured using cast indices, is not associated with redisplacement of reduced DRFs. Casts applied by nurse practitioners redisplaced significantly less often. Level of Evidence: Therapeutic Studies level III

Background: Prior to total hip and knee arthroplasty (THA/TKA), patients with low socioeconomic status (SES) report worse Patient-Reported Outcome Measures (PROMs), persisting postoperatively. This study explores which self-reported PROMs and their specific domains are most involved. Methods: We obtained data from the Dutch Arthroplasty Registry (2014–2022), including over 100,000 THA/TKA patients with complete preoperative and 12-month follow-up PROMs. The EQ-5D-3L and EQ-5D-5L, EQ Visual Analogue Scale (VAS), Oxford Hip and Oxford Knee Score (OHS/OKS), and Numerical Rating Scales (NRS) for pain and satisfaction (TKA only, at 12-month follow-up) were obtained. The PROMs were transformed to a 0-100 scale for direct comparison. A SES-indicator based on neighborhood income, unemployment rate, and education level was divided into quintiles, which are equal groups representing 20% of the Dutch population, and was ranked from least to most deprived. Through linear regression we contrasted the most and least deprived groups, adjusting for patient and surgical characteristics. The contribution (percentage) of each domain to the overall health inequalities was estimated for the EQ-5D’s and the OHS/OKS. Results: In TKA patients, the most compared to the least deprived group had a lower preoperative EQ-5D-3L score: -2.1 [95% confidence interval − 2.6, -1.6], p < 0.001. At 12-month follow-up, the difference was smaller: EQ-5D-3L 1.3 [-1.9, -0.7], p < 0.001. A larger difference between the most and least deprived was present in OKS (preoperatively: -4.3 [-5.3, -3.4], p < 0.001; 12-month: -1.8 [-2.5, -1.2], p < 0.001). The difference in EQ VAS was smaller (preoperatively: -0.8 [-1.5, -0.1], p = 0.024; 12-month: -0.5 [-1.2, 0.1], p = 0.108). The difference in NRS pain (in rest) was comparable to those in EQ-5D-3L and OKS (preoperatively: -4.5 [-5.4, -3.5], p < 0.001; 12-month: -2.7 [-3.5, -1.9], p < 0.001), while no difference between the most and least deprived in NRS satisfaction was observed at 12 months. For EQ-5D-3L, the domain usual activities accounted for up to 46% of the difference between SES groups, while anxiety/depression played a limited role (up to 17%). For OHS/OKS, functioning contributed most in THA (up to 61%) and pain contributed most in TKA (up to 68%). Differences in PROM scores between SES groups, and how these differences compared across PROMs, were similar in THA patients. Overall, the EQ-5D-5L produced similar patterns compared to the EQ-5D-3L. Conclusions: Deprived THA/TKA patients have poorer pre- and postoperative health, which was primarily related to worse functioning and pain; the clinical relevance of these differences remain uncertain. These differences did not translate into worse overall health (EQ VAS) or into higher dissatisfaction among deprived patients. Future research should investigate whether the EQ VAS and satisfaction measure reflected health differences between SES groups or were biased by reporting heterogeneity, where respondents interpreted the wording differently.

Background: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes. Patients and methods: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial. Patients were randomized to 3-day bandaging or 2-week casting. Questionnaires, physical examination, and radiographs were performed at 2 weeks and 1 year. Additional questionnaires were sent after inclusion, 6 weeks, and 3 months. Our primary outcome was the adjusted estimated difference between groups of the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months (natural logarithm of the margin of noninferiority = 2.0). Secondary outcomes included the QDASH score, Patient-Rated Hand/Wrist Evaluation Score, visual analog scale pain, wrist range of motion, patient satisfaction, and complications during follow-up. Results: Of the 180 patients (91 bandaging and 89 casting), 16 had scaphoid fractures and there were no scaphoid nonunions. Functional outcome in the bandaging group was noninferior at 3 months compared with the casting group [adjusted estimated difference QDASH score 0.30 (95% CI 0.02–0.62)]. All other patient-reported function and pain scores were not significantly different between groups. Range of motion at 2 weeks was better in the bandaging group, and they were more satisfied with the treatment than the casting group. Conclusions: Casting for suspected scaphoid fractures but normal initial radiographs can be avoided because bandaging seems to be an alternative treatment option when patients are reevaluated after 2 weeks. Level of evidence Level II. Trial registration Trial registered at the Trialregister on 2018-02-28 on www.trialregister.nl, NTR7164