Purpose: Despite advances of three-dimensional imaging pelvic radiographs remain the cornerstone in the evaluation of the hip joint. However, large inter- and intra-rater variabilities were reported due to subjective landmark setting. Artificial intelligence (AI)–powered software applications could improve the reproducibility of pelvic radiograph evaluation by providing standardized measurements. The aim of this study was to evaluate the reliability and agreement of a newly developed AI algorithm for the evaluation of pelvic radiographs. Methods: Three-hundred pelvic radiographs from 280 patients with different degrees of acetabular coverage and osteoarthritis (Tönnis Grade 0 to 3) were evaluated. Reliability and agreement between manual measurements and the outputs of the AI software were assessed for the lateral-center-edge (LCE) angle, neck-shaft angle, sharp angle, acetabular index, as well as the femoral head extrusion index. Results: The AI software provided reliable results in 94.3% (283/300). The ICC values ranged between 0.73 for the Acetabular Index to 0.80 for the LCE Angle. Agreement between readers and AI outputs, given by the standard error of measurement (SEM), was good for hips with normal coverage (LCE-SEM: 3.4°) and no osteoarthritis (LCE-SEM: 3.3°) and worse for hips with undercoverage (LCE-SEM: 5.2°) or severe osteoarthritis (LCE-SEM: 5.1°). Conclusion: AI-powered applications are a reliable alternative to manual evaluation of pelvic radiographs. While being accurate for patients with normal acetabular coverage and mild signs of osteoarthritis, it needs improvement in the evaluation of patients with hip dysplasia and severe osteoarthritis.

Purpose: Hip fractures are one of the most common disabling fractures in elderly people and peri-operative management has advanced considerably over the past decades. The purpose of this study was to evaluate the change of scientific focus by creating a top 50 list of the most influential papers on this topic. Methods: The Clarivate Web of Science Search was used to identify the most cited articles. The used search phrase was [(hip OR pertrochanteric OR (femoral neck)) AND fracture AND (surgery OR treatment)]. The number of citations, citation density, study type, study design, published year, fracture type, country, evidence level and published journal were recorded. Results: The top 50 articles were published between 1973 and 2014 and cited between 88 and 496 times. The mean citation density increased noticeably after the year 2000, representing the knowledge gain of the last 20 years. The topics surgical treatment (n = 19), risk factor assessment (n = 19), perioperative hemodynamic management (n = 7), additional treatment (n = 4) and general reviews (n = 1) were covered. Twenty-five articles were published from institutions in Europe, 24 from institutions in North America and one from an institution in Asia. Conclusion: While studies about surgical treatment options and risk factor assessment have been historically important, there was a rise of articles about additional treatment options for osteoporosis and the optimal postoperative care after the year 2005. The presented lists and map of citation classics give an overview of the most influential studies on hip fractures.

Intramedullary lengthening, in cases of extensive humeral shortening, offers the advantages of preventing external-fixator-associated problems. The humeral cavity, as the main parameter in nailing, however, has been neglected in recent literature. It was hypothesized that available implants might be too large and therefore increase the risk of intraoperative fractures. The aim of this cross-sectional study was to describe the humeral canal and how it might affect the choice of implant and the surgical approach. Thirty humeri (15 female, 15 male) from clinical patients and anatomical specimens were studied. Specifically, the medullary cavity width (MCW), cortical thickness (CoT), and the course of the medullary canal were examined. The smallest MCW diameters were found at the distal third of the humeral shaft with mean diameters of 10.15 ± 1.96 mm. CoTs of female humeri were significantly smaller than those of male humeri (p < 0.001). The mean angles of the pro- and recurvatum were 4.01 ± 1.68° and 10.03 ± 2.25°, and the mean valgus bending was 3.37 ± 1.58°. Before implanting a straight lengthening nail into a doubly curved humerus, X-rays and, in selected cases, CT-scans should be performed. The unique size and course of the humeral canal favors an antegrade approach in cases of intramedullary lengthening.

Background and Objectives: Sinus tarsi syndrome (STS) is defined as pain located at the lateral opening of the tarsal sinus. The exact etiology of sinus tarsi syndrome is not completely understood. Some do not believe it to be a true pathology. This review aims to clarify the definition of sinus tarsi syndrome to better understand the underlying pathologies. We further propose an algorithm to evaluate sinus tarsi pain and provide advice for consecutive treatment options. Design: This is a narrative review. By searching PubMed, the available current literature was reviewed. Articles were critically analyzed to determine the pathoanatomy, biomechanics, and etiology of sinus tarsi pain. Algorithms for clinical evaluation, diagnosis, and treatment were also recorded. Finally, the authors approach to evaluating and treating sinus tarsi pain was included in this review. Results: Reviewing the available literature, STS seems to be a catch-all phrase used to describe any pain in this anatomic region. Many causes of sinus tarsi pain were listed, including impingement, subtalar instability, and many other pathologies around the ankle. Conclusions: A thorough evaluation of patients presenting with pain in the sinus tarsi or instability of the hindfoot is essential to determining the underlying cause. When the cause of pain is still not clear after clinical exam and radiologic assessment, subtalar arthroscopy can be helpful as both a diagnostic and treatment tool. We propose that the term of STS should be avoided and that a more accurate diagnosis be used when possible. Once a diagnosis is made, appropriate treatment can be initiated.