Scientific misconduct: Plagiarism and non-compliance with disclosure of interest: Retrospective analysis of 1 year's submissions to Orthopaedics & Traumatology: Surgery & Research.

INTRODUCTION: Authors submitting to Orthopaedics & Traumatology: Surgery & Research (OTSR) must fulfill the criteria of scientific integrity (SI), including issues of plagiarism and disclosure of interest. These data have not been assessed for OTSR and we therefore conducted a retrospective study of (1) potential plagiarism rates, (2) deficient disclosure of interest (for French authors), and (3) correlation between the two. HYPOTHESIS: Suspected plagiarism rates exceed 20% and the non-disclosure rate exceeds 80%. MATERIAL AND METHODS: We analyzed 1 year's submissions to OTSR: January 24, 2022 to January 23, 2023. Articles were checked for plagiarism, using iThenticate software (Turnitin, Oakland, CA, USA), with a threshold of > 20% matching. Conflicts of interest, for French authors, investigated on the French Ministry of Health Transparence website (www.transparence.sante.gouv.fr), with non-disclosure defined by undeclared amounts exceeding €1000. RESULTS: In total, 851 submissions were analyzed. iThenticate identified 152 (17.7%) with > 20% matching to an already published article. This likely plagiarism varied (p<0.01) between geographic origins of submissions. In the 289 submissions by French authors, there were 275 (95%) failures to report amounts exceeding €1000. Combined non-disclosure and plagiarism was found in only 3 articles submitted by French authors (3/289: 1.03%). DISCUSSION: OTSR applies the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals (www.icmje.org), adheres to the guidelines of the Committee On Publication Ethics (COPE) and the French Health Authority (HAS), and has an ethics committee. Plagiarism is a major SI breach, suspected in 20% of submissions. Also, 95% of French authors failed to properly disclose their interests on submitting an article, although this declaration is mandatory in France and is an integral aspect of SI. There are also other forms of misconduct, such as failure to comply with the French "Jardé" law on research involving human subjects, failure to obtain review board approval, unjustified claims to authorship or deficient archiving, that were not analyzed here. CONCLUSIONS: Although overall plagiarism rates were under 20% for submissions to OTSR, some geographic areas were more concerned than others. Also, despite reminders by the editorial board, only 5% of French authors made full disclosures; this is a major breach of SI, requiring correction on the part of French authors. LEVEL OF EVIDENCE: IV; retrospective study.

Early Detection of Progressive Adolescent Idiopathic Scoliosis: A Severity Index.

STUDY DESIGN: Early detection of progressive adolescent idiopathic scoliosis (AIS) was assessed based on 3D quantification of the deformity. OBJECTIVE: Based on 3D quantitative description of scoliosis curves, the aim is to assess a specific phenotype that could be an early detectable severity index for progressive AIS. SUMMARY OF BACKGROUND DATA: Early detection of progressive scoliosis is important for adapted treatment to limit progression. However, progression risk assessment is mainly based on the follow up, waiting for signs of rapid progression that generally occur during the growth peak. METHODS: Sixty-five mild scoliosis (16 boys, 49 girls, Cobb Angle between 10 and 20°) with a Risser between 0 and 2 were followed from their first examination until a decision was made by the clinician, either considering the spine as stable at the end of growth (26 patients) or planning to brace because of progression (39 patients). Calibrated biplanar x-rays were performed and 3D reconstructions of the spine allowed calculating six local parameters related to main curve deformity. For progressive curve 3D phenotype assessment, data were compared with those previously assessed for 30 severe scoliosis (Cobb Angle > 35°), 17 scoliosis before brace (Cobb Angle > 29°) and 53 spines of nonscoliosis subjects. A predictive discriminant analysis was performed to assess similarity of mild scoliosis curves either to those of scoliosis or nonscoliosis spines, yielding a severity index (S-index). S-index value at first examination was compared with clinical outcome. RESULTS: At the first exam, 53 out of 65 predictions (82%) were in agreement with actual clinical outcome. Approximately, 89% of the curves that were predicted as progressive proved accurate. CONCLUSION: Although still requiring large scale validation, results are promising for early detection of progressive curves. LEVEL OF EVIDENCE: 2.

The change on vertebral axial rotation after posterior instrumentation of idiopathic scoliosis.

PURPOSE: Agreement between the correction objectives and the instrumentation strategies remains controversial in idiopathic scoliosis. Most studies have focus on the frontal and sagittal plane. The goal of this study was to evaluate the change on vertebral axial rotation after posterior instrumentation in fused and unfused segments. METHODS: Fourteen patients operated on for idiopathic scoliosis were prospectively included. Fusion and instrumentation were done by posterior approach. All patients had a pre-operative and a 10-day post-operative radiological evaluation with the EOS system. Axial orientation of the vertebrae with special interest to the apical, junctional, and unfused areas was obtained thanks to the reconstruction software. RESULTS: Mean apical vertebra axial rotation statistically decreased from 21° pre-operatively to 13° post-operatively. But, there were no statistically significant differences between pre-operative and post-operative mean axial intervertebral rotations in the main curve and axial rotation of the non-instrumented lower counter curve. CONCLUSIONS: 3D analysis of the spine in standing position is a great advancement for post-operative analysis of adolescent idiopathic scoliosis (AIS) corrections. This study confirmed that actual instrumentations are able to achieve "en bloc" 3D correction of the spine but not intervertebral axial rotation correction.

Tridimensional trunk surface acquisition for brace manufacturing in idiopathic scoliosis.

INTRODUCTION: Brace manufacturing for idiopathic scoliosis requires trunk surface acquisition. Two methods are currently available to design the trunk shape: craft made technique based on a plaster mold and computer-aided design with 3-D reconstruction of the trunk by optical scanning. The objective of the present review was to compare these two methods. METHODOLOGY: We describe the different steps to design and manufacture braces used for spinal deformities. RESULTS: Our prospective evaluation showed good results in terms of the correction achieved and regarding patients' in-brace comfort. DISCUSSION: Optical scanning for computer-aided design and manufacturing (CAD-CAM) of trunk orthoses have proven their effectiveness. These technologies may help in monitoring conservative treatment and may enhance the brace interaction with the spinal deformity when orthopedic treatment is indicated.

Predicting intraoperative feasibility of combined TES-mMEP and cSSEP monitoring during scoliosis surgery based on preoperative neurophysiological assessment.

BACKGROUND CONTEXT: Combined monitoring of muscle motor evoked potentials elicited by transcranial electric stimulation (TES-mMEP) and cortical somatosensory evoked potentials (cSSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, TES-mMEP/cSSEP is not always feasible. Predictors of feasibility would help to plan the monitoring strategy. PURPOSE: To identify predictors of the feasibility of TES-mMEP/cSSEP during scoliosis surgery. STUDY DESIGN/SETTING: Prospective cohort study in a clinical neurophysiology unit and pediatric orthopedic department of a French university hospital. PATIENT SAMPLE: A total of 103 children aged 2 to 19 years scheduled for scoliosis surgery. OUTCOME MEASURES: Feasibility rate of intraoperative TES-mMEP/cSSEP monitoring. METHODS: All patients underwent a preoperative neurological evaluation and preoperative mMEP and cSSEP recordings at both legs. For each factor associated with feasibility, we computed sensitivity, specificity, positive predictive value (PPV), and negative predictive value. A decision tree was designed. RESULTS: Presence of any of the following factors was associated with 100% feasibility, 100% specificity, and 100% PPV: idiopathic scoliosis, normal preoperative neurological findings, and normal preoperative mMEP and cSSEP recordings. Feasibility was 0% in the eight patients with no recordable mMEPs or cSSEPs during preoperative testing. A decision tree involving three screening steps can be used to identify patients in whom intraoperative TES-mMEP/cSSEP is feasible. CONCLUSIONS: Preoperative neurological and neurophysiological assessments are helpful for identifying patients who can be successfully monitored by TES-mMEP/cSSEP during scoliosis surgery.

Surgical management of thoracolumbar kyphosis in mucopolysaccharidosis type 1 in a reference center.

PURPOSE: Mucopolysaccharidosis (MPS) I is a rare autosomal recessive lysosomal storage disease. Thoracolumbar kyphosis is an early characteristic feature of the disease. Ossification failure in the anterosuperior quadrant of the vertebral body results in anterior dislocation. This study describes the surgical management of thoracolumbar kyphosis in MPS IH (Hurler syndrome) in a national reference center. METHODS: Among 72 MPS I patients followed in our institution, we treated surgically 14 MPS IH patients with severe thoracolumbar kyphosis. The decision was made after documented deformity progression. Mean age at surgery was 8 (3.5-15) years. Sagittal imbalance of the trunk was constant. One patient underwent extended fusion for associated scoliosis. We retrospectively reviewed 13 patients who underwent selective circumferential fusion at the thoracolumbar level. RESULTS: Average preoperative kyphosis was +57.5°(+30°; +90°). Surgical correction of the kyphosis was about 66 % and maintained at final follow-up. Fusion was obtained in all patients. Two patients required revision surgery consecutively to a previous posterior-only fusion, as a significant loss of correction occurred. One patient presented delayed neurologic deficit secondarily to cardiac embolism. One patient died postoperatively from cardiorespiratory failure. CONCLUSION: Surgery is necessary when kyphosis is progressive despite orthopedic management, aggravating the multifactorial trunk imbalance. Regarding our experience, circumferential arthrodesis should be recommended to achieve stable correction. Surgical management requires a multidisciplinary approach due to multisystemic failure and neurological risks specific to metabolic disorders.

Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: a case series and meta-analysis.

PURPOSE: A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect. METHOD: The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated. RESULTS: In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology. CONCLUSION: The authors confirmed that segmental bone reconstruction is possible in CPT using Masquelet's procedure. In the literature, the success rate of the application of rhBMP in CPT appears to be lower than the healing rate usually reported without BMP. Nevertheless, the strict selection of patients, limited number of cases, and their heterogeneity make interpreting the results difficult. However, the theoretical risk which the children are exposed to during the use of BMP makes rigorous selection of the indications necessary. Finally, the interest of rhBMP2 application in Masquelet's procedure remained to be proven.

Bone metabolism in oxalosis: a single-center study using new imaging techniques and biomarkers.

The deposition of calcium oxalate crystals in the kidney and bone is a hallmark of primary hyperoxaluria type 1 (PH1). We report here an evaluation of the bone status of 12 PH1 children based on bone biomarkers [parathyroid hormone, vitamin D, fibroblast growth factor 23 (FGF23)] and radiological assessments (skeletal age, three-dimensional high-resolution peripheral quantitative computed tomography, HR-pQCT) carried out within the framework of a cross-sectional single-center study. The controls consisted of healthy and children with chronic kidney disease already enrolled in local bone and mineral metabolism studies. The mean age (+ or - standard deviation) age of the patients was 99 (+ or - 63) months. Six children suffered from fracture. Bone maturation was accelerated in five patients, four of whom were <5 years. The combination of new imaging techniques and biomarkers highlighted new and unexplained features of PH1: advanced skeletal age in young PH1 patients, increased FGF23 levels and decreased total volumetric bone mineral density with bone microarchitecture alteration.

Nicolas Andry de Bois-Regard (Lyon 1658-Paris 1742): the inventor of the word "orthopaedics" and the father of parasitology.

This is an historical essay about Nicolas Andry, a French medical doctor (Lyon 1658-Paris 1742) who wrote in 1741 the famous book called "L'orthopedie", which was soon after translated into English (1742) "Orthopaedia or the art of correcting and preventing deformities in children". His life and works are detailed as the containment of the book composed of two volumes and many engravings (the crooked tree has become the symbol of numerous orthopaedic societies around the world). A discussion of semantics (ORTHO-PEDIE) and evolution of the meaning of this word is also discussed.

Nephronophthisis-like nephritis associated with fibrous dysplasia of bone.

Nephronophthisis is a chronic tubulointerstitial nephritis with autosomal recessive inheritance whose evolution to end-stage renal disease is insidious but constant. Fibrous dysplasia of bone is characterized by focal replacement of normal bone and marrow with abnormal bone and fibrous tissue. We report on a young boy initially diagnosed with fibrous dysplasia of bone, who underwent renal investigation because of treatment with pamidronate. He presented with mild proteinuria (albuminuria/creatininuria 19 mg/mmol) and decreased glomerular filtration rate (GFR) (79 ml/min per 1.73 m(2) body surface area) leading to kidney biopsy, which showed nephronophthisis-like lesions, but neither NPHP1 gene deletion nor UMOD (uromodulin) mutation were identified. No association between fibrous dysplasia of bone and nephronophthisis has yet been described. Nephronophthisis-like nephritis associated with fibrous dysplasia of bone might represent a possible new syndrome in the nephronophthisis and medullary cystic kidney disease complex. However, a fortuitous association between these two conditions is also possible.

Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus.

BACKGROUND: Panton-Valentine leukocidin (PVL) is a necrotizing toxin secreted by Staphylococcus aureus. PVL-positive S. aureus osteomyelitis and arthritis have been described. METHODS: We analyzed demographic, clinical, laboratory, microbiologic, and imaging data in a study group of 14 pediatric cases with PVL-positive S. aureus osteomyelitis and arthritis diagnosed between 2001 and 2005 and compared results with a control group of 17 pediatric cases of PVL-negative S. aureus osteomyelitis and arthritis treated in our institution during the same period. Treatments and outcome were studied. RESULTS: The severity of PVL-positive S. aureus bone and joint infections was indicated by the presence of severe sepsis in all cases and of septic shock in 6 of the 14 patients. By comparison, severe sepsis was not noted in the control group (P = 0.004). On admission, the median C-reactive protein value was significantly higher in the study group (202.6 mg/L versus 83 mg/L in the control group; P = 0.001). Eleven patients with PVL-positive infection had local extension of the infection by magnetic resonance imaging and 7 patients had severe deep-seated infectious complications by computed tomography. By contrast only 1 patient in the control group presented with bone abscess without extension and none had deep-seated infection (P < 0.001). The median length of hospitalization was 45.5 days in the study group versus 13 days in the control group (P < 0.001). The median duration of intravenous antibacterial chemotherapy was 48 days versus 11.3 days in the control group (P < 0.001). Ten patients (71%) of the study group required surgical procedures with a mean of 3 procedures (range, 1-5) whereas 3 patients (17%) of the control group required 1 surgical drainage each (P = 0.002). All the patients survived, but only 2 patients of the study group were free of long-term complications, whereas there were no long-term complications noted in the control group. CONCLUSION: PVL-positive S. aureus bone and joint infection is severe and requires prolonged treatment. Local complications are more frequent and often need repeated surgical drainage.

Focal fibrocartilaginous dysplasia ("fibrous periosteal inclusion"): an additional series of eleven cases and literature review.

Focal fibrocartilaginous dysplasia (FFCD) is a benign condition first described in 1985 as a cause of tibia vara. We are reporting on 11 cases. The lesions involved proximal tibia (9 cases), distal femur (1 case), and distal ulna (1 case). We believe that this entity represents a bony anchor preventing natural sliding of the periosteum during growth (an "epiphysiodesis-like" effect). For the tibia, we believe this is the pes anserinus. We are suggesting that this entity be called a "fibrous periostal inclusion." Treatment indications result from this concept: (1) for tibial lesions with a metaphyseal-diaphyseal angle less than 20 degrees observation for 6 to 12 months; (2) if the deformity improves, the tether likely broke spontaneously, and no treatment is required; and (3) curettage early if the deformity worsens. This will be followed by rapid correction into physiological valgus (tibia) and prevent the need for osteotomy. Early curettage for other less common locations is recommended.

Aneurysmal bone cysts of the pelvis in children: a multicenter study and literature review.

The authors analyzed a series of 15 pelvic aneurysmal bone cysts (9 boys and 6 girls) in children and adolescents who were reviewed with an average follow-up of 50.3 months. Pain and limp were the main symptoms. Four patients had no treatment after the open biopsy. Eleven patients were treated with curettage. Preoperative selective arterial embolization was performed in three cases before curettage. Two recurrences were noted after curettage; recurrences were treated successfully with further curettage. As a result, the authors recommend curettage; more aggressive operative intervention does not appear to be indicated. No major intraoperative vascular complications occurred. Spontaneous healing in a few cases (even in active or aggressive lesions) argues for clinical and radiologic observation after biopsy when possible. In case of a propitious evolution, observation must be continued and surgery might be avoided, but if the lesion increases, treatment must be proposed.

Recurrence of aneurysmal bone cysts in young children: a multicentre study.

Some authors have reported that the clinical and pathologic behaviour of aneurysmal bone cysts (ABCs) is more aggressive in younger patients and that younger patients have more tumour recurrence. The authors carried out a retrospective, multicentred paediatric population-based analysis of 21 patients (14 boys and seven girls), 5 years of age or younger, with primary ABCs. Only patients with a minimum follow-up of 2 years were included. The most common operation was curettage (14 cases). Methylprednisolone acetate injection was used in two cases (failure in the initial diagnosis before biopsy) with negative results. An Ethibloc (Ethnor Laboratories/Ethicon, Norderstedt, Germany) injection was employed in four cases. There were five recurrences. Three lesions recurred once, one lesion recurred three times and one recurred six times. These recurrences occurred in two cases after methylprednisolone acetate injection, after Ethibloc (Ethnor Laboratories/Ethicon) injection (one case) and, after curettage (two cases). ABCs in children, 5 years of age or younger, do not seem to be more aggressive than in older children. Curettage is a surgical procedure that can be used even in young children. Of course, recurrence is always possible but the recurrence rate is not unacceptable. More aggressive operative intervention does not appear to be indicated.

Orthoses for mild scoliosis: a prospective study comparing traditional plaster mold manufacturing with fast, noncontact, 3-dimensional acquisition.

STUDY DESIGN: A prospective comparison of 2 different methods to make orthoses in mild scoliosis. OBJECTIVE: To evaluate the therapeutic efficiency of orthoses made by a computer-aided design procedure. SUMMARY OF BACKGROUND DATA: It is now possible to make orthoses by a computer-aided design procedure. In order to evaluate this new method, we carried out a comparative study between the traditional and computer-aided design-manufactured orthoses. METHODS: In this prospective study, we compared the 2 methods by studying the cases of 30 adolescents with mild scoliosis. For each patient requiring orthopaedic treatment, we made 2 ortheses: 1 using the traditional method and 1 using the computer-aided design method. There were 26 girls and 4 boys whose average age was 13 years and 3 months. Each body jacket was successively used in random order following the same protocol. Neither the prescriber nor the patient knew the origin of the orthosis used. The final choice of the orthosis was made using 3 criteria: first, improvement of the scoliotic curves on the frontal and lateral radiologic planes, and second, the patient's impression of comfort. RESULTS: For the 30 cases, 13 traditional and 16 computer-aided design body jackets were chosen. In 1 case, no significant difference allowed us to chose one body jacket rather than the other. For the frontal radiologic correction, the better results were obtained 3 times with the computer-aided design body jacket, 5 times with the traditional one, and in 22 cases, the results were equivalent. For the lateral radiologic correction, the better results were obtained 11 times with the computer-aided design body jacket, 3 times with the traditional one, and in 16 cases, the results were equivalent. For the comfort of the 2 body jackets for each patient, the better results were obtained 12 times with the computer-aided design body jacket, 8 times with the traditional one, and in 10 cases, the results were equivalent. CONCLUSION: Based on our results, we believe that the computer-aided design procedure is equally efficient to traditional method for mild scoliotic curves.

Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review.

The purpose of this study was to review the demographic data of children and adolescents with aneurysmal bone cysts (ABCs). The authors performed a retrospective, multicenter, pediatric population-based analysis of 156 patients with primary ABCs. Only patients with histologic confirmation of the diagnosis were included. A review of French and English literature of 255 children and adolescents was included regarding sex, location of the lesion and age at diagnosis. There were 212 boys and 199 girls with a median age at diagnosis of 10.2 years (range, 1.5-17 years). Forty-four patients were under 5 years of age; 111 patients were between 5 and 10 years of age, and 139 were older than 10 years of age. The femur, tibia, spine, humerus, pelvis and fibula were the most common locations. In 256 cases (62.7%), ABCs occurred in long bones. We also studied the data and location of 161 ABCs of the mobile spine (13 cases from our series and 148 from the literature review). There were 48 ABCs in the cervical spine, 48 in the thoracic spine, and 65 in the lumbar spine. We found no main differences in site distribution and sex, between the children and the general population.