Ortho Appraised

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises "Minimum 5-Year Follow-up Results: CROSSBAT" published in Foot & Ankle International. The clinical question: for a stable Weber B ankle fracture with no talar shift, does surgery beat a walking boot over five or more years? The long-term data support non-operative management for these stable injuries. 📄 Citation: O'Keefe R, Naylor JM, Symes MJ, Harris IA, Mittal R. Minimum 5-Year Follow-up Results: CROSSBAT (Combined Randomised and Observational Study of Surgery vs No Surgery for Type B Ankle Fracture Treatment). Foot Ankle Int. 2022;43(12):1517–24. DOI: https://doi.org/10.1177/10711007221128562 Key Takeaways: * Long-term (5–8 year) follow-up of a pragmatic Australian RCT with masked outcome assessors and a pre-specified 5-point MCID. * Surgery was not superior on either patient-reported primary outcome; the differences were small and non-significant. * Non-operative care avoided the additional adverse events seen in the surgical arm. * Practice implication: a walking boot is a sound first-line option for isolated Weber B fractures without talar shift. * As with any long-term follow-up, attrition accumulates over the years, so individual figures are best read as part of a consistent overall picture. 🔗 Full paper: https://doi.org/10.1177/10711007221128562 Keywords: Weber B ankle fracture, CROSSBAT trial, non-operative ankle fracture, walking boot, foot and ankle evidence. New episodes every Sunday. Subscribe so you never miss one.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises "Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study)" published in The Lancet. The clinical question: for a displaced medial epicondyle elbow fracture in a child, does surgical fixation deliver better function than non-operative care? Surgery was not shown to be superior, making non-operative care a reasonable option for most. 📄 Citation: Perry DC, Achten J, Zimmermann A, et al. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre, randomised controlled, superiority trial and economic evaluation. Lancet. 2026;407:577–86. DOI: https://doi.org/10.1016/S0140-6736(25)02098-7 Key Takeaways: * Pragmatic multicentre superiority RCT (n=334) with a pre-specified, family-set MCID and a within-trial economic evaluation. * Surgical fixation did not produce a clinically important improvement in arm function over non-operative care. * Because the MCID was pre-specified and powered to, this reads as a genuine "no meaningful benefit" rather than an ambiguous null. * Practice implication: non-operative management is a defensible default for most displaced medial epicondyle fractures. * Outcomes were family-reported and unmasked, with slightly more missing data in the cast arm; the result agrees with a smaller Finnish RCT. 🔗 Full paper: https://doi.org/10.1016/S0140-6736(25)02098-7 Keywords: paediatric elbow fracture, medial epicondyle fracture, SCIENCE trial, surgery versus conservative, children's orthopaedic trauma. New episodes every Sunday. Subscribe so you never miss one.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises the FASHIoN body of work — the UK FASHIoN RCT in The Lancet, the Personalised Hip Therapy protocol paper in the British Journal of Sports Medicine, and the Australian FASHIoN trial in BMC Musculoskeletal Disorders. The clinical question: for femoroacetabular impingement in young adults, does hip arthroscopy beat a structured physiotherapy programme — and why? The answer is nuanced: a real symptom benefit, but no demonstrated disease modification. 📄 Citation: Griffin DR, et al. Hip arthroscopy versus best conservative care for FAI syndrome (UK FASHIoN). Lancet. 2018;391:2225–35. DOI: https://doi.org/10.1016/S0140-6736(18)31202-9 · Wall PDH, et al. Personalised Hip Therapy: development of a non-operative protocol. Br J Sports Med. 2016;50:1217–23. DOI: https://doi.org/10.1136/bjsports-2016-096368 · Hunter DJ, Bennell KL, et al. Australian FASHIoN trial (hip cartilage metabolism). BMC Musculoskelet Disord. 2021;22:697. DOI: https://doi.org/10.1186/s12891-021-04576-z Key Takeaways: * Three linked papers: the UK FASHIoN RCT (n=348), the comparator-protocol paper, and the Australian FASHIoN trial (n=99) using hip cartilage metabolism as its primary outcome. * Hip arthroscopy improved symptoms over conservative care in both trials. * The Australian trial found no benefit to hip cartilage metabolism — the disease-modification rationale was not supported. * Practice implication: offer surgery for symptom relief rather than to alter the joint's natural history; well-delivered physiotherapy is a legitimate comparator. * The magnitude of the symptom benefit is modest and depends on how well the conservative arm is delivered. 🔗 Full papers: https://doi.org/10.1016/S0140-6736(18)31202-9 · https://doi.org/10.1136/bjsports-2016-096368 · https://doi.org/10.1186/s12891-021-04576-z Keywords: femoroacetabular impingement, hip arthroscopy, FASHIoN trial, personalised hip therapy, hip preservation. New episodes every Sunday. Subscribe so you never miss one.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises "Arthroscopic meniscal surgery vs non-operative treatment for degenerative tears with mechanical symptoms: 5-year outcomes" published in the Journal of Orthopaedic Reports. The clinical question: for a degenerative meniscal tear with mechanical symptoms, does arthroscopic surgery beat non-operative care at five years? The evidence reinforces a non-operative-first approach. 📄 Citation: Zilani N, Tan J, Raj S, Maris A, Vasiliadis AV, Patel A. Arthroscopic meniscal surgery vs non-operative treatment for degenerative tears with mechanical symptoms: 5-year outcomes systematic review and meta-analysis of RCTs. J Orthop Rep. 2025;100809. DOI: https://doi.org/10.1016/j.jorep.2025.100809 Key Takeaways: * Systematic review and meta-analysis of 6 RCTs (n=1,157) reporting 5-year outcomes — a Level I evidence synthesis. * No clinically meaningful patient-reported outcome benefit from arthroscopic meniscal surgery over physiotherapy-led care. * Even the "mechanical symptoms" subgroup — the usual justification for operating — showed no durable advantage. * Risk of osteoarthritis was roughly doubled after surgery (OR 2.09, 95% CI 1.49–2.93). * Practice implication: structured exercise-based care is a sound first line, interpreting the pooled estimates alongside the usual between-trial heterogeneity. 🔗 Full paper: https://doi.org/10.1016/j.jorep.2025.100809 Keywords: degenerative meniscal tear, knee arthroscopy, mechanical symptoms, meniscectomy versus physiotherapy, evidence-based knee surgery. New episodes every Sunday. Subscribe so you never miss one.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! ## Episode 3: Early vs Delayed Weight-Bearing After Ankle Fracture Surgery (Dehghan + WAX) In this episode of Ortho Appraised, Dr Rajabifard appraises two randomised trials on weight-bearing after ankle fracture fixation — Dehghan et al. in the Journal of Orthopaedic Trauma and the large multicentre WAX trial in The Lancet. The clinical question: after fixation of an unstable ankle fracture, is it safe to bear weight early rather than staying non-weightbearing for six weeks? Both support letting selected patients walk sooner. 📄 Citation: Dehghan N, McKee MD, Jenkinson RJ, et al. Early weightbearing and range of motion versus non-weightbearing and immobilization after ORIF of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016;30(7):345–352. DOI: https://doi.org/10.1097/BOT.0000000000000572 — and Bretherton CP, Achten J, Jogarah V, et al. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet. 2024;403:2787–97. DOI: https://doi.org/10.1016/S0140-6736(24)00710-4 Key Takeaways: * Two RCTs paired: Dehghan (2016, ~100 patients) and the large multicentre WAX trial (2024). * Dehghan's return-to-work primary was null (51.2 vs 47.8 days, p=0.72), while functional recovery was faster with early motion. * WAX found early weight-bearing clinically non-inferior and highly likely to be cost-effective. * Practice implication: early protected weight-bearing is safe in appropriately stable fixed ankle fractures. * Both excluded the least stable patterns, so they offer least reassurance for those; a baseline return-to-work imbalance affected Dehghan's primary outcome. 🔗 Full papers: https://doi.org/10.1097/BOT.0000000000000572 · https://doi.org/10.1016/S0140-6736(24)00710-4 Keywords: ankle fracture rehabilitation, early weight-bearing, ORIF, WAX trial, orthopaedic trauma evidence. New episodes every Sunday. Subscribe so you never miss one.