West Midlands Deanery

AimsTo elicit and quantify parental preferences for brace weaning strategies in the treatment of developmental dysplasia of the hip (DDH) and explore how parents trade between treatment burden and the risk of further intervention.MethodsA discrete choice experiment (DCE) was developed to assess preferences for timing and duration of weaning, alongside trade-offs related to the risk of further treatment. Parents of infants treated for DDH were recruited via STEPS Worldwide, a patient charity. Parents completed 16 hypothetical scenarios comparing different weaning regimens with immediate cessation. Data were analyzed using conditional logit models. A secondary analysis excluded participants with irrational or disengaged responses. Subgroup analysis explored whether preferences varied by experience.ResultsA total of 195 respondents completed the survey. In the primary analysis, night-time brace wear was preferred over immediate cessation, even when risk remained equal. In the secondary analysis, which excluded internally inconsistent responses, all weaning strategies were significantly less preferred than immediate cessation under equal risk conditions. Parents were willing to accept longer durations of treatment in exchange for reduced risk of subsequent intervention. The minimum acceptable risk reduction required for parents to accept four additional weeks of brace wear, compared with immediate cessation, was 5.8% (night-time bracing), 7.5% (night-time and naps bracing), 8.4% (gradual brace reduction), and 10.0% (daytime bracing). Preferences varied by experience, especially age at diagnosis and prior weaning.ConclusionNight-time-only weaning was the most acceptable weaning strategy. Parents were willing to trade longer brace treatment for a lower risk of further intervention. We were able to quantify the size of the benefit required by families, which may inform research investigating the effectiveness of weaning strategies.Cite this article: Bone Jt Open 2025;6(12):1581–1587.

Objective:This review reports on the radiologic and functional outcomes and complications of managing adult traumatic femur shaft fractures (FSFs) with intramedullary nailing (IMN) in Low-and-Middle-Income Countries (LMICs) and evaluates the quality of existing evidence.Methodology:A thorough literature search was conducted across several databases, including reference lists of selected articles. Screening was done per the PRISMA guidelines. Peer-reviewed articles published in English between January 2011 and December 2022 that reported radiologic or functional outcomes in adults with isolated traumatic FSFs managed with IMN in LMICs were included for review. The quality and level of evidence were assessed using modified Critical Appraisal Skills Program checklists and the modified Oxford Centre for Evidence-Based Medicine criteria.Findings:Forty studies from 13 LMICs were included in this review. The mean time to union was 15.4 weeks, with a mean union rate of 88.1%. Functional outcomes scores showed >70% excellent outcomes. The Radiographic Union Scale in Tibia score and Thoresen criteria were the most used assessment tools. Mean infection rates were 4.8%, and limb shortening (of varying amounts) occurred in 3.5% of patients. The findings revealed variability in measuring and reporting IMN outcomes in FSFs, but overall, the existing evidence was of satisfactory quality.Conclusion:Despite the data limitations, methodological differences, and outcome discrepancies, this review demonstrates a trend favoring IMN for FSFs, with low failure rates in low-resources settings. However, more robust studies using standardized radiographic and functional outcomes measures in LMICs are needed.

To determine the factors associated with an author being female in Veterinary Surgery journal publications from 2002 to 2023. Retrospective observational study. A total of 2881 Veterinary Surgery papers published between 2002 and 2023. Author gender was inferred using the Gender API and verified manually where necessary; only binary categories (male/female) were assigned. Statistical models (frequentist and Bayesian logistic regressions) were used to predict author gender based on publication year, author order (first, second, last), and surgical emphasis. Overall, 36% of the authors were female, with 43% of first authors, 37% of second authors, and 28% of last authors being women. The proportion of female first authors increased from 29% in 2010 to 60% in 2022, while female last authors ranged from 10% in 2002 to 36% in 2023. The likelihood of an author being female was influenced by the publication year, being the last author, and the subject of orthopaedics. Compared with the demographics of the profession, women remain underrepresented in Veterinary Surgery authorships, particularly in senior author positions and orthopaedic papers. The underrepresentation of female authors highlights persistent gender disparities in veterinary surgery research. Further research is required to understand the factors that influence female authorship, so that institutions and journals can implement targeted initiatives to promote gender equity.

Identification of a neonatal horseshoe kidney in the emergency department is uncommon but has implications for future healthcare planning for patients. We present a case of a neonate with bloody diapers who was evaluated with renal point-of-care ultrasound (POCUS) that identified a horseshoe kidney. The ultrasound was remarkable for its clear visualization of the isthmus of the horseshoe kidney in the midline abdomen. Midline interrogation is not part of the routine technique for ultrasound imaging of the kidney but should be considered when the limits of the lower pole of bilateral kidneys are difficult to visualize. This case highlights the importance of understanding normal anatomical landmarks when performing renal POCUS to identify renal anomalies.