Background:CAM morphology of the hip is a disorder of abnormal morphology of the femoral head-neck junction associated with loss of the osseous sphericity of the femoral head. Several radiological measurements exist to detect CAM morphology of the hip. Objectives:The aim of the study was to evaluate the precision and efficacy of a new BROH CAM offset distance as a novel magnetic resonance imaging (MRI) parameter designed to detect CAM morphology of the hip. Materials and Methods:Oblique axial MR images of 100 patients who underwent hip MRI scans were analyzed. Two readers measured the alpha angle and BROH CAM offset to detect CAM morphology. Diagnostic cutoff values for cam offset measurements were determined, and their diagnostic accuracies were evaluated. Results:The mean "alpha angle" measured on an oblique projection was 34.31 degrees (standard deviation [SD] = 14.63), and when measured on an axial projection, it was 41.98 degrees (SD = 7.44). The BROH CAM offset distance was 3.49 mm (SD = 0.90 mm). There was an excellent correlation between the new BROH CAM offset and the alpha angle with a p -value of 0.006 (Pearson's linear correlation coefficient). Based on the results, a 57-degree alpha angle correlates to a BROH CAM offset of 4.11 mm, a 60-degree alpha angle correlates to a BROH CAM offset of 4.23 mm, and a 55-degree alpha angle correlates to a BROH CAM offset of 4.03 mm. Conclusion:Our new BROH CAM offset shows an excellent correlation with the alpha angle and is the easiest metric that can be used for the detection of CAM morphology of the hip.

Pars interarticularis stress injury and spondylolysis are frequent causes of back pain among young athletes. Accurate diagnosis and grading of these conditions are essential to institute appropriate management strategies in order to achieve optimal outcomes.The aim of management strategies for acute active spondylolysis stress reactions and stress fractures is to achieve bone healing while avoiding recurrence and non-union, with the ultimate goal of returning to sports as determined by symptom resolution.Although various radiological classification systems for spondylolysis have been described, their application for prognostication and surveillance has been limited. The development of a standardised, validated classification system that guides management decisions and predicts healing outcomes would immensely benefit radiologists and clinicians.This article reviews the current imaging recommendations for diagnosing and grading pars stress injuries and spondylolysis before proposal of a novel radiological classification system. The system utilises standard MRI sagittal sequences with clear inter- and intra-observer agreement. We aim to validate the classification system through interrogation of the injury, clinical and return-to-play data in young athletes, with an aim to determine early prognostic accuracy of pars stress injuries.

PurposeHaglund’s deformity, an abnormality at the postero-superior corner of the calcaneus is a common cause of posterior heel pain. To date numerous measurements of radiological angles related to the calcaneus have been proposed to differentiate between symptomatic and asymptomatic patients with the deformity. Traditionally, these measurements have been assessed on plain radiographs. The aim of this study was to identify measurements which can be applied to Magnetic Resonance Imaging (MRI) studies of the ankle.MethodsA retrospective cohort analysis of 30 MRI ankle studies from patients with symptomatic Haglund’s deformity and 32 normal studies as controls was undertaken. The angle of BRINK, the Achilles angle, Calcaneal pitch, Achilles-plantar fascia angle and soleus calcaneal distance were measured on optimal T2 fat-saturated sagittal slices.ResultsThere was a statistically significant difference (p<0.0001) in the angle of BRINK between the Haglund’s and control group. The Area-Under-the-Curve (AUC) was 0.7783 in keeping with good discrimination between the two groups. The angle of BRINK measurement is reproducible, with an intra-observer ICC of 0.837 and an inter-observer ICC of 0.824. There was no statistically significant difference between the two groups for the other measurements. In the Haglund’s group the Achilles tendon was more likely to attach to the mid 1/3 of the posterior calcaneus as opposed to the superior 1/3 (p=0.02), calcaneal oedema was more likely to be present (p<0.001) and non-insertional tendinopathy was more likely to be present (p<0.001). The presence of a retrocalcaneal bursa is non-specific (p=0.602).ConclusionThe angle of BRINK demonstrates good discrimination between normal and Haglund’s cases on MRI studies and may improve patient management by supporting surgical decision-making. Future work should correlate the angle of BRINK to long-term outcomes.

Objectives: Pes planus, or “flat foot,” is a common foot condition involving talus misalignment, calcaneus eversion, medial arch collapse, and forefoot abduction. It is a well-recognized cause of foot pain and can lead to disability in patients. Clinical diagnosis is supported by plain radiography. However, in patients presenting with foot pain, traditionally dorsoplantar (DP) and oblique radiographs are undertaken. Pes planus may be difficult to analyze and classify on predominant DP and oblique radiographs and often requires weight-bearing lateral foot radiographs to direct patient management. Our study introduces a novel angle for pes planus diagnosis on DP radiographs of the foot. The purpose of this study was to describe a new radiological pes planus intermetatarsal angle (PPIMA) for assessment of flatfoot DP imaging of the foot. Materials and Methods: We performed a retrospective cohort study on 114 consecutive patients presenting with foot pain referred to our foot and ankle clinic weight-bearing DP, oblique radiographs of the foot and lateral radiographs of the foot and ankle were undertaken. Demographic details and clinical indication were recorded, and radiological parameters of hallux valgus angle, calcaneal pitch and angle between the shaft of the first and fifth metatarsal PPIMA were measured by two consultant radiologists and a radiology trainee. Data were organized using Microsoft Excel, and statistical analysis was performed STATA (StataCorp LLC, College Station, TX, USA) using analysis of variance and post hoc analysis. Results: Thirty patients were excluded due to the presence of hallux valgus deformity. In our study, the cohort with normal foot alignment (n = 30, age 14–18) had an average PPIMA of 20.7°, pes cavus (n = 3, age 14–18) average PPIMA was 24.0, while the pes planus group (n = 51, age 14–18) had an average PPIMA of 20.0°. There was no statistically significant difference in PPIMA between the groups (P = 0.229). Conclusion: Our study introduces a practical diagnostic tool for pes planus on DP foot imaging. The PPIMA is not a reliable indicator for the evaluation of foot alignment.

Background and objective Foramen magnum stenosis (FMS) is a common, serious complication of achondroplasia in infancy and associated with sudden infant death. The Achondroplasia Foramen Magnum Score (AFMS; 0–4) is used to classify the severity of stenosis to inform appropriate neurosurgical management. Infants with AFMS4 are referred for neurosurgery, while well children with AFMS3 undergo repeat MRI routinely after 12 months. As the natural history of children with AFMS3 is currently unclear, the objective was to review follow-up MRI scans of infants initially classified as AFMS3 to define more clearly the evolution of this degree of stenosis. Design This retrospective cohort study, from two tertiary centres, included infants with a confirmed diagnosis of achondroplasia and AFMS3 on initial MRI who subsequently underwent repeat MRI or proceeded straight to neurosurgery. Results Twenty-two cases satisfied the inclusion criteria. Mean age in months was 6.23 (SD±3.82) and 17.95 (SD±7.68) at baseline and follow-up scans, respectively. Follow-up MRI showed no change in 23% (N=5), improvement in 36% (N=8) to either AFMS1 (N=5) or AFMS2 (N=3). There was progression in 41% to AFMS4 (N=8). One case had neurosurgey without follow-up MRI (N=1). Conclusions These results support MRI screening for FMS in infants with achondroplasia. Furthermore, infants with AFMS3 should undergo follow-up MRI as over 40% progress prompting neurosurgical intervention. There is currently no consensus on frequency or timing of screening for AFMS3 in achondroplasia; however, we suggest that guidance for follow-up imaging is modified to 6 months to detect progression earlier in this at-risk cohort.

Background Magnetic resonance imaging (MRI) is key in evaluating central cartilage tumors. The BACTIP (Birmingham Atypical Cartilaginous Tumour Imaging Protocol) protocol assesses central cartilage tumor risk based on the tumor size and degree of endosteal scalloping on MRI. It provides a management protocol for assessment, follow-up, or referral of central cartilage tumors. Objective Our study compared four MRI sequences: T1-weighted (T1-w), fluid sensitive (Short Tau Inversion Recovery (STIR)- weighted, STIR-w), and grayscale inversions (T1-w GSI and short tau inversion recovery [STIR] GSI) to see how reliably endosteal scalloping was detected. Materials and Methods Two senior consultant musculoskeletal radiologists with experience reviewed randomly selected 60 representative central cartilage tumor cases with varying degree of endosteal scalloping to reflect a spectrum of BACTIP pathologies. The endosteal scalloping was graded as per the definition of BACTIP A, B, and C. They agreed on a consensus BACTIP grade for each of the 240 key images (60 cases x 4 sequences), which was considered the final "consensus" BACTIP grade. These 240 images were then randomized into a test set and given to two fellowship-trained consultant musculoskeletal radiologists for analysis. They assigned a BACTIP grade to each of the 240 selected images while being blinded to the final "consensus" BACTIP grade. The training set was further subdivided into three groups based on the MR image quality (good quality, average quality, and poor quality) to ascertain if the quality of the acquired images influenced intraobserver and interobserver agreements on the BACTIP grading. The two observers were blinded to the grade assigned to the image quality. Results Linearly weighted kappa analysis was performed to measure the agreement between the BACTIP grading answers by two observers and the "consensus" BACTIP grading answers, as well as the BACTIP grading agreement between the two observers themselves. The analysis revealed that T1-w and STIR-w sequences demonstrated more consistent and higher agreement across different image qualities. However, the T1-w GSI and STIR-w GSI sequences exhibited lower agreement, particularly for poor-quality images. T1-w imaging demonstrated substantial agreement between BACTIP gradings for poor-quality images, suggesting potential resilience of T1-w sequence in challenging imaging conditions. Conclusion T1-w imaging is the best sequence for BACTIP grading of endosteal scalloping, followed by fluid-sensitive STIR sequences.

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Isolated lesions of the spinous process, although less common, are some of the lesions that may be encountered and can present a diagnostic dilemma. These can range from congenital abnormalities, traumatic lesions, neoplasms and lesions of inflammatory, infective and metabolic aetiology. The literature specifically reviewing these lesions is sparse. The article reviews a range of pathologies affecting the spinous process, along with their pertinent imaging features, based on isolated pathologies of spinous process lesions identified on imaging by the authors at a tertiary orthopaedic centre over a 10-year period. A search on the hospital Picture Archive and Communication System (PACS) and Radiology Information System (RIS) was performed using the keyword “spinous process” and a list of the isolated pathologies of the spinous process based on the imaging reports was compiled for the purpose of this narrative review. It is important that radiologists consider these lesions when they are identified on routine imaging of the spine.

RATIONALE AND OBJECTIVES:Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI) tool which utilises machine learning to generate original text resembling human language. AI models have recently demonstrated remarkable ability at analysing and solving problems, including passing professional examinations. We investigate the performance of ChatGPT on some of the UK radiology fellowship equivalent examination questions.METHODS:ChatGPT was asked to answer questions from question banks resembling the Fellowship of the Royal College of Radiologists (FRCR) examination. The entire physics part 1 question bank (203 5-part true/false questions) was answered by the GPT-4 model and answers recorded. 240 single best answer questions (SBAs) (representing the true length of the FRCR 2A examination) were answered by both GPT-3.5 and GPT-4 models.RESULTS:ChatGPT 4 answered 74.8% of part 1 true/false statements correctly. The spring 2023 passing mark of the part 1 examination was 75.5% and ChatGPT thus narrowly failed. In the 2A examination, ChatGPT 3.5 answered 50.8% SBAs correctly, while GPT-4 answered 74.2% correctly. The winter 2022 2A pass mark was 63.3% and thus GPT-4 clearly passed.CONCLUSION:AI models such as ChatGPT are able to answer the majority of questions in an FRCR style examination. It is reasonable to assume that further developments in AI will be more likely to succeed in comprehending and solving questions related to medicine, specifically clinical radiology.ADVANCES IN KNOWLEDGE:Our findings outline the unprecedented capabilities of AI, adding to the current relatively small body of literature on the subject, which in turn can play a role medical training, evaluation and practice. This can undoubtedly have implications for radiology.

ABSTRACT Background: A healthy lower back is essential for optimal spinal function and overall wellness. Magnetic resonance imaging (MRI) has become the gold standard in assessing lumbar spine disease. This article aims to evaluate the precision and efficacy of the lumbar offset distance (LOD) as a novel MRI parameter designed to determine the lumbar spine alignment. normally measured as we compared it to a new parameter based on length. Materials and Methods: Supine sagittal magnetic resonance images of 101 patients who underwent lumbar spine MRI scans were analyzed. We focused on L1–L5 lumbar lordosis angle (LLA) and LOD to assess lumbar spine alignment. Diagnostic cutoff values for LOD measurements were determined, and their diagnostic accuracies were evaluated. Results: The normal LLA in our dataset was 23°–45°, and the normal LOD was 5–15 mm. Using linear regression, the range of 6–14 mm correlates to the LLA range of 20°–45°, which would define the standard lumbar offset as normal between 6 and 14 mm. Hence, lumbar hypolordosis was defined as <6 mm, and lumbar hyperlordosis was defined as more than 14 mm. Our study showed a good correlation between the LOD and LLA and is particularly useful in identifying cases of normal lumbar lordosis, hypolordosis, and hyperlordosis. Conclusion: Linear measurements show good diagnostic accuracy of LOD in evaluating lumbar spinal alignment, including normal alignment, hypolordosis, and hyperlordosis.

Objective In the evolving landscape of medical research and radiology, effective communication of intricate ideas is imperative, with visualizations playing a crucial role. This study explores the transformative potential of ChatGPT4, a powerful Large Language Model (LLM), in automating the creation of schematics and figures for radiology research papers, specifically focusing on its implications for musculoskeletal studies. Materials and methods Deploying ChatGPT4, the study aimed to assess the model’s ability to generate anatomical images of six large joints—shoulder, elbow, wrist, hip, knee, and ankle. Four variations of a text prompt were utilized, to generate a coronal illustration with annotations for each joint. Evaluation parameters included anatomical correctness, correctness of annotations, aesthetic nature of illustrations, usability of figures in research papers, and cost-effectiveness. Four panellists performed the assessment using a 5-point Likert Scale. Results Overall analysis of the 24 illustrations encompassing the six joints of interest (4 of each) revealed significant limitations in ChatGPT4’s performance. The anatomical design ranged from poor to good, all of the illustrations received a below-average rating for annotation, with the majority assessed as poor. All of them ranked below average for usability in research papers. There was good agreement between raters across all domains (ICC = 0.61). Conclusion While LLMs like ChatGPT4 present promising prospects for rapid figure generation, their current capabilities fall short of meeting the rigorous standards demanded by musculoskeletal radiology research. Future developments should focus on iterative refinement processes to enhance the realism of LLM-generated musculoskeletal schematics.

Background:Chemical shift Magnetic Resonance Imaging (MRI) is often routinely acquired to assess a spectrum of spinal lesions due to its ability versatility to obtain rapid sequences at the expense of spatial resolution images. It is one of the quickest sequences to acquire at the expense of spatial resolution. Objective:In this study we assess the diagnostic efficacy of Chemical shift Magnetic Resonance Imaging (MRI) in the evaluation of Neural Foraminal stenosis. Materials and methods:Conventional T2, T1 and STIR sagittal and axial images as well as 'in' and 'out' phase chemical shift sagittal MRI sequences of 25 consecutive patients presenting with back pain and radiculopathy were reviewed. The degree of neural stenosis in the lumbar spine foramina on both sides was graded using the Lee classification on T2 and 'in' and 'out' phase MRI sequences by two independent MSK radiologists. Statistical analysis was performed using paired T-Test and Cohen's weighted kappa test was applied as a measure of agreement between the two observed raters. Results:A total of 250 lumbar neural foramina were assessed. There was substantial agreement (Cohen's weighted kappa) for both raters between 'in' and 'out' phase chemical shift sagittal MRI sequences (rater 1 = 0.699, rater 2 = 0.718), as well as good agreement between raters for both 'in' and 'out' phase chemical shift sagittal MRI sequences (in phase = 0.656, 'out' phase = 0.576). However, when compared to the gold standard rating on a T2 based sequence, ratings on in' and 'out' phase MRI sequences overestimated the degree of stenosis. When comparing 'in' and 'out' ratings to the T2 ratings, agreement was poor with kappa ranging from 0.132 to 0.202. Conclusion:Though both 'in' and 'out' phase chemical shift sagittal MRI sequences can be used to analyse neural foraminal stenosis, given its propensity to over-estimate the degree of stenosis in comparison to the T2 based images, assessment of the condition on these complementary limited sequences technique should be avoided/should be undertaken with caution.

Objectives: The study’s objective was to determine if Chat Generated Pre-Trained Transformer-3 (ChatGPT)-4V can interpret magnetic resonance imaging (MRI) knees and generate preliminary reports based on images and clinical history provided by the radiologist. Materials and Methods: This cross-sectional observational study involved selecting 10 MRI knees with representative imaging findings from the institution’s radiology reporting database. Key MRI images were then input into the ChatGPT-4V model, which was queried with four questions: (i) What does the image show?; (ii) What is the sequence?; (iii) What is the key finding?; and, (iv) Finally, the model generated a report based on the provided clinical history and key finding. Responses from ChatGPT-4 were documented and independently evaluated by two musculoskeletal radiologists through Likert scoring. Results: The mean scores for various questions in the assessment were as follows: 2 for “What does the image show?,” 2.10 for “What is the sequence?,” 1.15 for “What is the key finding?,” and the highest mean score of 4.10 for the command “Write a report of MRI of the…” Radiologists consistently gave mean scores ranging from 2.0 to 2.5 per case, with no significant differences observed between different cases ( P > 0.05). The interclass correlation coefficient between the two raters was 0.92 (95% Confidence interval: 0.85–0.96). Conclusion: ChatGPT-4V excelled in generating reports based on user-fed clinical information and key findings, with a mean score of 4.10 (good to excellent proficiency). However, its performance in interpreting medical images was subpar, scoring ≤2.10. ChatGPT-4V, as of now, cannot interpret medical images accurately and generate reports.

Introduction:Giant cell tumour of bone (GCTB) is a benign but locally aggressive bone tumour with a higher predilection for females of reproductive age. GCTB management poses a unique set of challenges during pregnancy due to risks associated with imaging and treatment options. Pregnancy has been implicated in GCTB progression and tumour recurrence, however an exact mechanism has not been established. This study aims to confirm the relationship between the diagnosis and progression of GCTB during pregnancy. Methods:A 17-year retrospective analysis of our tertiary sarcoma referral centre database was performed to identify the relevant patients. Pregnancy-associated tumours were defined by those already present or diagnosed during pregnancy, and up to 12 months postpartum. Lesion volume was determined by mathematical ellipsoidal modelling technique to simplify the estimation, with cross-sectional measurements obtained from the three standard orthogonal planes on initial and surveillance imaging. Due to logistical challenges, follow-up imaging was performed at either our tertiary sarcoma centre or under guidance at regional imaging centres convenient to the patient. Results:The diagnosis of GCTB was made in 113 female patients during this 17-year period, of which 20 were associated with pregnancy with a mean age of 28.8 years (range 19-40 years). 12 patients had their primary or recurrent GCTB diagnosed, or known tumour progress during pregnancy, whilst the remaining 8 were diagnosed shortly thereafter to within 12 months postpartum. The most common tumour sites were located around the knee (30 %) and distal radius (25 %). A statistically significant pattern of growth was observed through the surveillance period (p 0.018), within a relatively short mean follow-up period of only 89.8 days (SD 54.5; 13-192 days). Conclusion:This study demonstrates the significant association that pregnancy has with the growth and progression of both primary and recurrent GCTB. Pregnant patients should be subject to close surveillance well into the postpartum period due to possible accelerated disease progression and potential for disease recurrence.

Purpose: The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to. Methods: The AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1 -5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists. Results: The-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the -literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC 1 / 4 0.883). Conclusion: Summaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.

BACKGROUND:Peer review is the established method for evaluating the quality and validity of research manuscripts in scholarly publishing. However, scientific peer review faces challenges as the volume of submitted research has steadily increased in recent years. Time constraints and peer review quality assurance can place burdens on reviewers, potentially discouraging their participation. Some artificial intelligence (AI) tools might assist in relieving these pressures. This study explores the efficiency and effectiveness of one of the artificial intelligence (AI) chatbots, ChatGPT (Generative Pre-trained Transformer), in the peer review process.METHODS:Twenty-one peer-reviewed research articles were anonymised to ensure unbiased evaluation. Each article was reviewed by two humans and by versions 3.5 and 4.0 of ChatGPT. The AI was instructed to provide three positive and three negative comments on the articles and recommend whether they should be accepted or rejected. The human and AI results were compared using a 5-point Likert scale to determine the level of agreement. The correlation between ChatGPT responses and the acceptance or rejection of the papers was also examined.RESULTS:Subjective review similarity between human reviewers and ChatGPT showed a mean score of 3.6/5 for ChatGPT 3.5 and 3.76/5 for ChatGPT 4.0. The correlation between human and AI review scores was statistically significant for ChatGPT 3.5, but not for ChatGPT 4.0.CONCLUSION:ChatGPT can complement human scientific peer review, enhancing efficiency and promptness in the editorial process. However, a fully automated AI review process is currently not advisable, and ChatGPT's role should be regarded as highly constrained for the present and near future.

Introduction and Aims:Grade 1 spondylolisthesis can be challenging to detect on magnetic resonance imaging (MRI), particularly for spinal surgeons and radiologists with limited experience interpreting spinal MRIs. This study aims to describe a unique sign described as a "mustache sign," which may assist in detecting subtle Grade I spondylolisthesis on sagittal sequences on MRI of the spine. Patients and Methods:A retrospective review of 50 lumbar spine MRI scans of patients with Grade I spondylolisthesis of L5/S1 performed over 3 years was conducted at a tertiary orthopedic spinal center in the United Kingdom. The scans were assessed for the presence of the "mustache sign" and findings were independently recorded by one musculoskeletal radiology registrar and one fellowship trained musculoskeletal radiologist with over 10 years of experience. Results:There were 35 females (70%) and 15 males (30%). The patient's mean age was 54.3 years (13-82). The "mustache sign" was present in 13 (26%) of these patients. Twelve of 13 scans (92%) positive for the sign also demonstrated pars interarticularis defects (P < 0.001, Fisher's Exact test), compared to those without the sign. There was excellent interobserver reliability with a kappa of 1. Conclusion:The "mustache sign" on MRI spine correlates well with the presence of Grade I spondylolisthesis. This ancillary sign can complement other previously described radiological findings on sagittal MRI sequences to confirm Grade I spondylolisthesis.

Abstract Background: Groin pain is a complex musculoskeletal condition, causing significant difficulty in its diagnosis and management. The stability of the anterior pelvis is maintained by the formation of a complex fibrous aponeurotic plate by the rectus abdominis and adductor longus tendons. It is, therefore, vital to have a comprehensive understanding of this condition to guide appropriate management. We aimed to measure the adductor–rectus angle (ARA), which is the angle between the rectus abdominis and adductor longus tendon to establish a normal range in a diverse group of healthy individuals on magnetic resonance imaging (MRI) with the aim of investigating its possible association with the occurrence of athletic pubalgia. Materials and Methods: A retrospective cross-sectional study assessed the ARA in 100 asymptomatic normal healthy individuals who had undergone an MRI of the pelvis. The participants were categorized based on gender and divided into three age groups: under 40, between 40 and 60, and above 60 years. Descriptive statistics were calculated for each group and were followed by a one-way analysis of variance to identify any significant differences between these groups. Results: The mean ARA in the entire study cohort was 135.543° +6.4814°. The ARA did not differ significantly among different age groups or genders. Conclusion: The ARA helps to evaluate pelvic muscles’ alignment and offers valuable insights into the force applied to the fibrous aponeurotic plate. This information could potentially aid in identifying athletes at risk of sports hernias and inform the development of personalized treatment strategies.

Objective To assess the displacement of the supinator fat pad in radial head and neck fractures and to validate its significance. Material and methods One hundred two adult patients from the Royal Orthopaedic Hospital, Birmingham, United Kingdom and Sultan Qaboos University Hospital, Muscat, Oman with confirmed radial head and/or neck fractures were included. Fractures were classified using the Mason-Johnston classification. The displacement of the supinator fat pad from the radius was measured on anterior-posterior (AP) and lateral radiographs and correlated to fracture classification. Results The supinator fat pad was on average displaced by 10.6 mm and 13.8 mm from the radius on AP and lateral radiographs, respectively. The displacement of the fat pad progressively increased between non-displaced (Mason I) and severely comminuted (Mason III) fractures on both the AP (10.25 to 14.25 mm) and lateral (12.70 to 16.00 mm) projections. The progression of displacement on AP ( p = 0.016) and on lateral ( p = 0.007) projections was statistically significant. Fracture dislocation was not associated with increased fat pad displacement. Conclusion The supinator fat pad sign is a useful adjunct in the assessment of radial head and neck fractures.