OBJECTIVE: To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive effect of spinal flexibility on bracing outcomes.
METHODS: A broad literature search was performed in the PubMed, Web of Science, EMBASE, CINAHL, Scopus, and Cochrane Library databases to obtain relevant information about spinal flexibility and bracing outcomes. All literature was retrieved by October 14, 2023. The inclusion and exclusion criteria were meticulously determined. The quality of each included study and the level of evidence were evaluated by the Quality in Prognosis Studies (QUIPS) method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively.
RESULTS: After screening 1863 articles retrieved from databases, a total of 14 studies with 2261 subjects were eligible for the final analysis in this review. Overall, nine methods of flexibility assessment were identified, including supine radiographs, supine lateral bending radiographs, lateral bending radiographs but without clear positions, hanging radiographs, fulcrum bending physical method, and ultrasound imaging in the positions of supine, prone, sitting with side bending and prone with side bending. In addition, five studies demonstrated that flexibility had a strong correlation with in-brace correction, and eleven studies illustrated that spinal flexibility was a predictive factor of the bracing outcomes of initial in-brace Cobb angle, initial in-brace correction rate, curve progression, and curve regression. The results of GRADE demonstrated a moderate-evidence rating for the predictive value of spinal flexibility.
CONCLUSIONS: Supine radiography was the most prevalent method for measuring spinal flexibility at the pre-brace stage. Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes.

OBJECTIVE: Psychosocial interventions can improve teenagers\' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population.
METHODS: A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis.
RESULTS: Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety.
CONCLUSIONS: Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles.
CONCLUSIONS: Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment.

Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: \"Idiopathic Clubfoot\" (All Fields) AND \"Management\" OR \"Outcomes\" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0-12 months). A full-text review of these articles was then performed looking for \"complications\" or \"errors\" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients.

OBJECTIVE: To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks.
METHODS: A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021.
METHODS: Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support.
METHODS: Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings.
RESULTS: A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient.
CONCLUSIONS: Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.

Juvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention.
This is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded.
Children were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear.
This large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.

Background and purpose: Osteoporotic hyperkyphosis is associated with adverse outcomes, such as fatigue, back pain, or reduced back extensor strength, with a negative impact on functionality and quality of life. The purpose of this review is to assess the effectiveness of spinal orthosis on these adverse effects. Methods: A systematic review following the PRISMA guidelines was performed. Inclusion criteria were (1) women with osteoporosis; (2) randomized controlled trials only; and (3) type of intervention: spinal bracing. Exclusion criteria were (1) article not written in English; (2) full-text not available; and (3) no kyphosis assessment. Quality-of-life variables such as back pain, functional variables such as back extensor strength, and osteoporotic-related variables such as lumbar spine bone mineral density were extracted and recorded before and after the intervention. The characteristics of the intervention programs were also extracted and recorded. The characteristics of studies, interventions, and participants are summarized in a table. Then, the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the quality of the studies. Results and Discussion: Four randomized controlled trials with a low risk of bias were included (n = 326 women with osteoporosis, aged 51-93 years). Interventions consisting of wearing a dynamic hyperextension orthosis for at least two hours per day for six months improved functionality, mobility, back extensor strength, respiratory function, and reduced the thoracic kyphosis angle. Conclusions: Spinal orthosis, especially dynamic hyperextension braces, seems effective in improving the adverse outcomes of osteoporotic hyperkyphosis. It does not seem necessary to wear the orthosis during all daily activities.

OBJECTIVE: The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS).
METHODS: A comprehensive search was conducted by two independent reviewers on PubMed, Embase, Medline, and Web of Science to obtain all published information on morphological predictors of AIS progression. Search items included \'adolescent idiopathic scoliosis\', \'progression\', and \'imaging\'. The inclusion and exclusion criteria were carefully defined. Risk of bias of studies was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In all, 6,286 publications were identified with 3,598 being subjected to secondary scrutiny. Ultimately, 26 publications (25 datasets) were included in this review.
RESULTS: For unbraced patients, high and moderate evidence was found for Cobb angle and curve type as predictors, respectively. Initial Cobb angle > 25° and thoracic curves were predictive of curve progression. For braced patients, flexibility < 28% and limited in-brace correction were factors predictive of progression with high and moderate evidence, respectively. Thoracic curves, high apical vertebral rotation, large rib vertebra angle difference, small rib vertebra angle on the convex side, and low pelvic tilt had weak evidence as predictors of curve progression.
CONCLUSIONS: For curve progression, strong and consistent evidence is found for Cobb angle, curve type, flexibility, and correction rate. Cobb angle > 25° and flexibility < 28% are found to be important thresholds to guide clinical prognostication. Despite the low evidence, apical vertebral rotation, rib morphology, and pelvic tilt may be promising factors. Cite this article: Bone Joint J 2022;104-B(4):424-432.

BACKGROUND: Osteoporotic vertebral fractures affect a large number of older adults OBJECTIVES: Systematically review evidence of the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with standard care (control); and evaluate the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with an alternative non-pharmacological, non-invasive intervention.
METHODS: Systematic review and meta-analysis of randomized controlled trials. Five electronic databases (CINAHL, EMBASE, MEDLINE, PUBMED, and COCHRANE) were searched. Eligible trials included participants with primary osteoporosis and at least one vertebral fracture diagnosed on radiographs, with treatment that was non-surgical and non-pharmacological involving more than one session.
RESULTS: Twenty randomized controlled trials were included with 2083 participants with osteoporotic vertebral fractures. Exercise, bracing, multimodal therapy, electrotherapy, and taping were investigated interventions. Meta-analyses provided low certainty evidence that exercise interventions compared to no exercise were effective in reducing pain in patients with osteoporotic vertebral fractures (mean difference (MD)= 1.01; 95% confidence interval (CI): 0.08, 1.93), and low certainty evidence that rigid bracing intervention compared with no bracing was effective in reducing pain in patients with osteoporotic vertebral fractures (MD= 2.61; 95%CI: 0.95, 4.27). Meta-analyses showed no differences in harms between exercise and no exercise groups. No health-related quality of life or activity improvements were demonstrated for exercise interventions, bracing, electrotherapy, or multimodal interventions.
CONCLUSIONS: Exercise and rigid bracing as management for patients with osteoporotic vertebral fractures may have a small benefit for pain without increasing risk of harm.
BACKGROUND: PROSPERO registration number CRD42012002936.

BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment.
METHODS: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords \"developmental dysplasia hip\", \"brace\", \"harness\", \"splint\", \"abduction brace\" to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.).
RESULTS: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized.
CONCLUSIONS: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4-5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures.
A systematic review of the PubMed database was performed. Two reviewers evaluated the studies found for eligibility. Randomized controlled trails (RCTs) and prospective nonrandomized, prospective single-arm, and retrospective comparative studies of the treatment of acute osteoporotic vertebral fractures with spinal orthoses were included.
A total of 16 studies were included: 5 RCTs, 6 nonrandomized prospective comparative studies, 1 retrospective case-control study, and 4 prospective single-arm studies. Of the 16 studies, 4 (3 single-arm studies and 1 nonrandomized study) provided low-quality evidence that bracing, with or without bedrest, was safe. Also, 1 nonrandomized and 1 single-arm study provided low-quality evidence that bracing improved pain and disability. In addition, 4 studies demonstrated that the use of a rigid brace was equivalent to the use of a soft brace or no brace (2 high-quality RCTs, 2 nonrandomized studies, 1 low-quality RCT). Two nonrandomized and one case-control study demonstrated a benefit of kyphoplasty compared with bracing alone (all low quality). Two RCTs had provided low-quality evidence that bracing was superior to no brace and one nonrandomized study provided low-quality evidence that a dynamic brace was superior to rigid orthosis.
Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients.