Background: The impact of thoracolumbosacral orthosis (TLSO) bracing on sagittal spinopelvic alignment and psychosocial outcomes in adolescent idiopathic scoliosis (AIS) remains debated. Methods: This retrospective comparative study included 120 girls (10–18 years) with AIS (baseline Cobb angle 20–40°) and skeletal immaturity (Risser 0–1). Patients were managed with a thoracolumbosacral orthosis (TLSO) brace (n = 60) or observation alone (n = 60). Standing posteroanterior and lateral full-spine radiographs were obtained at baseline and at 24 ± 6 months; follow-up radiographs were acquired out of brace after a standardized 48 h brace-free interval. They were used to measure coronal and sagittal spinopelvic parameters. Patient-reported outcomes included the Scoliosis Research Society-22r (SRS-22r), Pediatric Quality of Life Inventory (PedsQL), Spinal Appearance Questionnaire (SAQ), Trunk Appearance Perception Scale (TAPS), and Beck Depression Inventory (BDI). The primary endpoint was curve progression (≥5° increase or exceeding 40°) at 24 months. Multivariable regression was used to adjust for baseline Cobb angle and maturity. Mean follow-up was 24 ± 6 months. Results: Mean Cobb change was +1.2° in the brace group vs. +7.3° in the observation group (group × time interaction p < 0.001). Progression (≥5°) occurred in 15% vs. 45%, respectively, and 18% of observed patients exceeded 40° (risk ratio 0.33, 95% CI 0.17–0.65; number needed to treat 4, 95% CI 3–7). Sagittal spinopelvic parameters showed no significant group-by-time interaction. No significant between-group differences were observed in SRS-22r, PedsQL, SAQ, TAPS, or BDI at baseline or follow-up. Patients with curve progression exhibited worse appearance-related scores. In multivariable analysis, depressive symptoms were the strongest determinant of PedsQL (β = −0.55, p < 0.001). Conclusions: Brace treatment was associated with reduced curve progression in girls with moderate AIS. Over approximately two years of follow-up, we did not observe clinically relevant between-group differences in sagittal spinopelvic alignment or psychosocial patient-reported outcomes. Given the retrospective, non-randomized design and self-reported adherence, psychosocial findings should be interpreted cautiously and require confirmation in prospective, objectively monitored, psychologically informed bracing studies.

Background: To evaluate D-dimer levels in patients with slipped capital femoral epiphysis (SCFE), to investigate their association with disease severity and the development of contralateral slip, and to assess their contribution to existing predictive models. Methods: In this single-center retrospective cohort study, 25 patients with unilateral SCFE diagnosed between January 2020 and April 2024 were included. The control group consisted of age- and sex-matched obese individuals and healthy subjects with normal body mass index (BMI). Clinical variables (age, sex, BMI, stability according to the Loder classification, and chronicity); laboratory parameters [complete blood count, neutrophil-to-lymphocyte ratio (NLR), inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer]; and radiographic measurements [Southwick angle, interhip angle difference, posterior sloping angle (PSA), and modified Oxford bone score (MOBS)] were analyzed. Subgroup analyses based on stability and chronicity were performed, and correlations between D-dimer levels and clinical, laboratory, and radiographic parameters were assessed. Multivariable logistic regression models were constructed to predict contralateral slip, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: D-dimer levels were significantly higher in the SCFE group compared with both obese and healthy control groups ( P <0.001). D-dimer showed positive correlations with CRP and NLR and negative correlations with the MOBS and the interhip Southwick angle difference. Higher D-dimer levels were observed in unstable and acute-on-chronic cases ( P <0.001). During a mean follow-up of 24 months, patients who developed contralateral slip had significantly higher D-dimer levels ( P =0.002). The addition of Southwick angle difference to a baseline model including age and MOBS increased the AUC from 0.73 to 0.80, while further inclusion of D-dimer improved the AUC to 0.87. However, the increase in AUC after addition of D-dimer was not statistically significant according to the paired DeLong test ( P =0.18). Conclusion: D-dimer levels are associated with disease severity and the risk of contralateral slip in SCFE. Incorporation of D-dimer into established clinical and radiographic parameters improved predictive model performance. These findings support the role of inflammatory and microvascular processes in the pathogenesis of SCFE and suggest that D-dimer may serve as a useful adjunct biomarker for risk stratification. Levels of Evidence: Level III—retrospective cohort study.

Background/Objectives: Radioulnar synostosis restricts forearm rotation and is often said to carry psychosocial consequences. That it does so is widely assumed; what has not been tested is whether the extent of those consequences tracks the measures of limb function recorded at follow-up—the assumption implicit in monitoring these children with functional scores alone. We measured psychological symptom scores in affected children and examined what they were related to: the orthopaedic measures available, the aetiology of the synostosis, the child’s own resilience, or the mental state of the parent. Methods: Twenty-four children aged 9–17 years with unilateral, non-syndromic radioulnar synostosis (10 post-traumatic, 14 congenital) attended a single visit at which an orthopaedic examination and psychometric assessment were carried out together. Children completed standardised measures of anxiety and depression, quality of life and self-appraised resilience. Parents provided proxy reports of the child’s anxiety and depressive symptoms and quality of life and, separately, reported their own symptoms on the DASS-21. All analyses were exploratory. Results: Quality of life fell below the international reference mean (KIDSCREEN-10 T-score 43.1, 95% CI: 40.5 to 45.6). Symptom scores were associated with the child’s self-appraised resilience (rho = −0.84, 95% CI: −0.93 to −0.62) and with parental anxiety (rho = 0.79, 95% CI: 0.59 to 0.90). Each association persisted in this sample when the other was included as a covariate along with age (−0.79 and 0.82), but this cannot establish independent effects with 24 observations. None of the measured elbow or shoulder parameters showed a statistically supported association with symptom scores after adjustment for age; forearm rotation was absent on examination in every participant, all of whom had radiographically confirmed complete synostosis, so the motion arc could not differentiate severity between participants. Child and parent reports correlated strongly (rho = 0.80) and differed by 0.1 points on average. No difference between the two aetiological groups was detected on any psychometric measure in this small sample, although the groups differed in total shoulder rotation (182.1° vs. 158.0°, p = 0.001, independent of age). Conclusions: In this sample, psychological symptom scores were associated with self-appraised resilience and parental anxiety. No statistically supported age-adjusted association was detected with the measured elbow or shoulder parameters, although the imprecise estimates do not exclude associations of potential clinical interest; because disease-specific functional impairment was not measured, its relationship with psychological symptoms remains unresolved. These exploratory findings support considering psychological assessment alongside functional evaluation, with attention on parental mental health. Disease-specific and task-based measures of functional limitation remain to be examined.