Alcohol use disorder (AUD) is a prevalent, relapsing condition. Despite well-documented links between alcohol misuse and adverse health outcomes, the role of AUD in orthopaedic surgery is underexplored, and systematic screening remains uncommon. The aim of this study was to examine the incidence of alcohol use and potential misuse among orthopaedic patients and assessed whether patients flagged for risk engaged in documented discussions about alcohol use with their care teams. We retrospectively reviewed intake data from orthopaedic trauma, spine, bone health, and general registries between May 2020 and April 2025. Alcohol use was initially assessed with a nonstandardized intake questionnaire and later with the validated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) tool. Patients meeting thresholds for possible misuse were flagged. Clinical notes were reviewed to determine whether flagged patients had alcohol use discussed by their orthopaedic team. Among 99,269 patients screened, 67.9% reported some alcohol use, and 2.5% reported a personal history of AUD. Of 1040 patients completing the AUDIT-C, 29.2% screened positive for potential misuse; 11.1% of bone health patients also met criteria for at-risk drinking. Only 80 of 718 flagged patients (11.1%) had a documented alcohol-related discussion, with higher rates in bone health registries and among older patients. Alcohol use and misuse are common among orthopaedic patients, yet systematic screening and discussion are infrequent. Integrating validated screeners such as AUDIT-C into routine intake and supporting clinicians with training and referral pathways represent critical opportunities to improve patient safety and orthopaedic outcomes.
Orthopaedic surgeons routinely consult search engines, journals, and curated websites to stay current on orthopaedic knowledge. The emergence of large language models, such as OpenAI ChatGPT and Google MedGemma, is changing the way we search for information and how residents learn. Although many orthopaedic surgeons are users of artificial intelligence (AI), most are uncertain about how these tools actually work and why they sometimes give impressively accurate explanations alongside glaring factual errors and fabricated citations. This review provides an overview of the underlying preclinical studies behind large language models at the level of detail needed to empower orthopaedic surgeons with the knowledge needed to critically evaluate AI outputs, design future research projects, and effectively incorporate AI tools into clinical practice and resident education. Through clinical examples including a Schatzker VI tibial plateau fracture and an L4 pedicle screw sizing question, we illustrate two distinct classes of AI failure-retrieval failures and reasoning failures-and demonstrate how understanding the preclinical studies behind these errors equips surgeons to evaluate any AI tool regardless of where or how it runs.
 Distal ulnar fractures (DUFs) remain under-investigated, primarily due to limited statistical power resulting from the low incidence. The present classification systems are difficult to use and are not validated for new radiological methods such as cone beam computed tomography (CBCT). We aimed to analyze the reliability and reproducibility of the 2 classification systems, Arbeitsgemeinschaft für Osteosynthesefragen foundation/Orthopaedic Trauma Association (AO/OTA) and Biyani, for fractures of the distal ulnar head and neck using CBCT images.  76 patients with DUF who underwent a CBCT scan during the years 2016-2022 were included retrospectively. The CBCT images were reviewed twice by 6 observers of different medical specialties and levels of experience. All fractures were classified according to AO/OTA and Biyani. The reliability and reproducibility of each classification system were analyzed using kappa value analysis.  The reliability was fair to moderate for AO/OTA, Light's ĸ 0.41 (95% confidence interval [CI] 0.38-0.45) and moderate for Biyani, Light's ĸ 0.45 (CI 0.42-0.49), and the reproducibility was substantial for both AO/OTA, mean ĸ 0.65 (CI 0.49-0.80), and Biyani, ĸ 0.69 (CI 0.60-0.79).  Both existing classification systems were perceived to be difficult to use and do not match existing fracture patterns. Using CBCT images, they both showed substantial reproducibility but not satisfactory reliability for clinical use.
Clear aligner therapy relies on composite attachments for precise tooth movement; however, wear may compromise force delivery and treatment efficacy. This study quantitatively assessed morphometric changes in the attachment dimensions and volume over six months and explored patterns according to sex, jaw, and tooth position. This prospective cohort study included 12 adults (aged >18 years) with mild-to-moderate malocclusion, contributing 50 attachments bonded with G-ænial Universal Flo (GC Corporation, Tokyo, Japan) composite material. Intraoral scans were obtained post-attachment bonding (T1) and at six months (T6). Attachments were isolated and analyzed using SOLIDWORKS software (Dassault Systèmes SolidWorks Corp., Waltham, Massachusetts) for changes in width, length, height, and volume. Non-parametric tests and linear mixed models were used to evaluate the wear patterns (significance: p < 0.05). A significant reduction of attachments occurred over six months in all dimensions. The mean width, length, height, and volume decreased from 2.95 (1.90-3.18) to 2.30 (1.40-2.50) mm, 2.25 (2.10-2.50) to 1.60 (1.50-1.90) mm, 1.20 (1.10-1.03) to 1.00 (0.90-1.10) mm, and 9.50 (7.15-10.85) to 7.35 (5.70-8.50) mm³, respectively. The consistent and large Cohen's d effect size indicated a substantial magnitude of change. Posterior attachments showed greater width and volume loss than anterior attachments. Mandibular attachments had higher volume loss than maxillary attachments. No significant sex differences were observed (p > 0.05). Significant reductions in attachment dimensions and volume were observed over six months, confirming progressive wear during clear aligner therapy. Posterior and mandibular attachments demonstrated greater attrition, highlighting the influence of biomechanical loading and anatomical location. Regular monitoring of attachment integrity and the use of more wear-resistant materials may improve force delivery, treatment efficiency, and clinical predictability.
The objectives of this study were to determine the incidence, severity, temporal profile, and management outcomes of flare reactions following ultrasound (US)-guided intra-articular steroid injection (IASI) for frozen shoulder. This retrospective study included adult patients undergoing US-guided glenohumeral joint IASI for frozen shoulder over 1 year. Flare reactions were assessed using the Numeric Rating Scale at 1-, 4-, and 24-h postinjection. Analgesic strategies were evaluated based on pain severity. Among 84 patients, flare reaction occurred in 19 (22.6%). Most reactions were mild (63.2%) and self-limiting. Moderate-to-severe reactions (36.8%) required pharmacological treatment. Early-onset severe pain responded rapidly to low-dose sublingual buprenorphine, with complete relief in most patients within 4 h, while late-onset moderate pain was effectively managed with oral diclofenac. No adverse effects were observed. Flare reaction after IASI for frozen shoulder is not uncommon and, in most cases, can be effectively managed with appropriate analgesic strategies. Sublingual buprenorphine for moderate-severe early-onset pain ensures effective symptom control without major side effects.
Calcium phosphate graphene (CaPG) is a promising reinforcement for polymeric bone matrices, yet the impact of graphene oxide (GO) oxidation on CaPG chemistry and matrix performance remains unclear. Our previous work demonstrated that 5 wt% CaPG provides optimal mechanical and biological performance of poly (lactic-co-glycolic acid) (PLGA) matrix. The present study isolates GO oxidation as the sole variable while maintaining a fixed 5 wt% CaPG loading. CaPG was synthesized under three oxidation conditions: Low Phosphate-High Oxygen at 50 °C, High Phosphate-High Oxygen at 100 °C, and High Phosphate-Low Oxygen at 156 °C and incorporated into the PLGA microspheres. Our results have shown that oxidation state regulates oxygen functional group density, calcium phosphate incorporation, hydrophilicity, and hydration behavior, which collectively modulate mechanical properties and osteogenic activity of the matrix. These findings demonstrate that oxidation can serve as a key tunable factor that generates distinct physicochemical and biological profiles, establishing oxidation programming as a practical approach for creating adaptable CaPG-reinforced PLGA matrices for diverse bone regeneration needs.
Contemporary total knee arthroplasty (TKA) practice has evolved from uniform mechanical alignment to individualized alignment planning in response to growing evidence that a single alignment strategy does not optimize outcomes for all patients. However, precise execution of patient-specific alignment strategies remains challenging with manual instrumentation. Augmented reality (AR) technology addresses this limitation by providing real-time intraoperative visualization of anatomic landmarks and planned resection parameters. In this study, individualized alignment was applied within predefined safety envelopes, including femoral valgus relative to the mechanical axis of 0° to 3°, tibial varus of 0° to 3°, and hip-knee-ankle alignment within 0° to 3° of neutral. All procedures were performed using the Pixee Knee + AR system (Pixee Medical, Besançon, France). Despite growing interest in AR-assisted surgery, clinical data regarding the accuracy, precision, and early outcomes of AR-guided individualized TKA remain limited, providing the rationale for this study. This retrospective consecutive case series evaluated 50 patients with end-stage knee osteoarthritis who underwent primary TKA using the Pixee Knee + AR system between April and August 2024. All procedures used individualized alignment strategies with patient-specific planning parameters. Radiographic accuracy was assessed using postoperative CT imaging, and validated patient-reported outcome measures were collected at minimum 6-month follow-up. The cohort comprised 45 men and 5 women with mean age 71.4 ± 7.6 years, American Society of Anesthesiologists score 3.0 ± 0.2, and body mass index 31.0 ± 4.1 kg/m2. Alignment accuracy was excellent, with 96% of coronal measurements within 3° of planned values and 53.3% within 1°. Component-specific accuracy rates within 1° were as follows: tibial component 72%, femoral implant 62%, and overall hip-knee-ankle alignment 46%. Four percent of measurements exceeded 3° deviation from planned alignment. No revision surgeries, infections, or mechanical complications occurred during follow-up. Patient-reported outcomes demonstrated notable improvements from preoperative scores: modified single assessment numeric evaluation scores improved 4.7 ± 3.1 points (P < 0.001) and KOOS Jr. normalized scores improved 21.6 ± 23.2 points (P < 0.001). AR-guided individualized TKA demonstrated high accuracy in executing patient-specific alignment plans with favorable early clinical outcomes and no complications at 6 months. These initial results suggest that AR technology may provide a viable alternative for precise implementation of individualized alignment strategies, although larger studies with longer follow-up are needed to establish long-term efficacy and safety.
暂无摘要（点击查看详情）
Superior labrum anterior to posterior (SLAP) lesions with paralabral cysts are uncommon. Although various procedures have been suggested, there is no consensus on the optimal choice. The purpose of this study was to compare clinical and radiological results between 2 procedures: SLAP repair with cyst decompression (RD group) and subpectoral biceps tenodesis with cyst decompression (TD group). Arthroscopic surgery for management of a paralabral cyst with a SLAP lesion was performed from January 2009 to January 2023 in 42 patients (RD group: 17, TD group: 25), who were available for a minimum 12-month follow-up. The visual analog scale (VAS) pain score, University of California, Los Angeles (UCLA) score, activities of daily living (ADL) score, and Subjective Shoulder Value (SSV) were evaluated. Postoperative magnetic resonance imaging (MRI) and manual muscle testing (MMT) were performed 6 months after surgery. The mean age of patients in the RD group was 40.0 years and that of the TD group was 46.4 years (p = 0.014). Both groups showed significant improvement in the VAS pain score, UCLA score, ADL score, SSV score, and MMT after surgery. However, no significant difference was observed between the 2 groups. All but 1 patient in the RD group were able to return to work and sports at preoperative levels. This patient was diagnosed with brachial plexopathy after surgery and showed spontaneous improvement. Twenty-five of 42 patients (59.5%) underwent follow-up MRI 6 months after surgery, and there was no recurrence of the ganglion cyst with complete resorption. Compared with cyst decompression and SLAP repair, cyst decompression combined with subpectoral biceps tenodesis demonstrated no statistically significant differences in clinical and radiographic outcomes in this retrospective cohort of patients with SLAP lesions and concomitant paralabral cysts. The findings of our study suggest that biceps tenodesis may be an effective surgical alternative for patients with compromised biceps integrity.
Physeal fractures account for a significant percentage of pediatric fractures and carry a unique risk of resultant limb deformity due to their potential to disrupt normal bone growth. While most of these fractures heal without consequence, up to 10% result in growth disturbances that can cause limb length discrepancy or angular deformity. Surgical strategies for managing these deformities include physeal bar excision, epiphysiodesis, and corrective osteotomies. These interventions aim to restore limb alignment and preserve function. In this review, we provide an overview of the growth plate physiology, classification systems for physeal fractures, and the spectrum of complications that may arise following growth plate injury. We also present an overview of surgical strategies and demonstrate their applications through several case examples.
Currently, the elimination of postsurgical osteosarcoma (OS) and defect repair are still separately explored, which is unlike real-world clinical scenarios. Inadequate bone marrow stromal cells (BMSCs) compromise their repair and antitumor efficiencies. Here, PFSSTKT (PFS)-functionalized KLD-12 peptide hydrogels (KLD-PFS) have been engineered and integrated with 2D BiOIO3 nanosheets to obtain the injectable sono-piezoelectric/pyroelectric peptide hydrogels (KLD-PFS@BiOIO3) featuring a supramolecular peptide nanofiber (SMPNF) structure. Differing from the dominant BaTiO3 in sono-piezoelectric dynamic therapy (SPDT) of cancer, BiOIO3 nanosheets can produce ROS through sono-piezoelectric and pyroelectric catalytic processes under ultrasound irradiation, thus enabling the combination of SPDT with pyroelectric dynamic therapy against residual OS. More significantly, PFS as a bone marrow homing peptide enables KLD-PFS to capture and recruit more BMSCs, and the inherent SMPNF structure, direct ultrasound-induced current stimuli, sono-piezoelectricity/pyroelectricity-induced current stimuli and ROS birth expedite BMSCs differentiation and bone regeneration. These multifaceted actions follow the signaling pathways associated with calcium flux and cancer-neuron communication disruptions and metabolic dysfunction rectification. They have been successfully validated to repress residual OS and favor bone regeneration in a clinical scenarios-matched postsurgical osteosarcoma and bone defect model. This study offers a promising strategy for comprehensive osteosarcoma management.
Achilles tendinitis (AT) has posed as an intractable clinical problem, for which there is currently a lack of satisfactory treatment approaches. Local drug delivery has proven to be effective for AT therapy, but suitable drugs and local/sustained drug delivery technique for superior therapeutic effects are still in urgent need. In this work, screw-thread needle acupuncture-mediated in situ delivery of tangeretin@β-cyclodextrin sulfated sodium salt (TAN@CDs) complexes was developed for AT therapy. Briefly, TAN was firstly encapsulated into the cavity of CDs with a TAN loading rate of 4.6%. Then, a trimethyl[3-(trimethoxysilyl)propyl]ammonium chloride-modified screw-thread needle (TMSTN) was immersed into the TAN@CDs solution to fasten the TAN@CDs complexes to the grooves of the TMSTN through electrostatic interaction. The biosafe concentration of TAN@CDs solution was controlled at 30 mg/mL through hemolysis assay, H&E staining, and blood biochemical analyses. TAN@CDs could release TAN in a sustained manner for over 8 h in a simulated Achilles tendon microenvironment. TAN delivery amount of single acupuncture (sequential clockwise/anticlockwise rotation) of the TAN@CDs/TMSTN was determined to be 1.28 μg, and an Achilles tendon defect model of rat was applied to evaluate its therapeutic effects against AT. Gross appearance observation of the Achilles tendon, H&E staining, Masson staining, and biomechanical testing proved that through periodic acupuncture of the TAN@CDs/TMSTN, AT could nearly be cured. The superior therapeutic outcomes of TAN@CDs/TMSTN‑mediated acupuncture against AT are likely attributable to the synergistic interplay between the acupuncture intervention and the in situ release of TAN. Immunohistochemical staining demonstrated that the released TAN molecules treat AT through downregulating inflammatory cytokines and upregulating tendon repair-related factors, therefore promoting collagen synthesis and tenogenic differentiation throughout healing. In sum, this work reported an efficient strategy for AT therapy.
To determine optimal drill guide positioning over the articular disc of the triangular fibrocartilage complex (TFCC) for accurately targeting the foveal insertion of the TFCC during arthroscopic one-bone tunnel transosseous repair using radiographic and magnetic resonance imaging (MRI)-based analysis. A retrospective review was conducted on 60 patients who underwent arthroscopic one-bone tunnel TFCC repair for Palmer type 1B foveal tears. Postoperative radiographs were analyzed to measure the bone tunnel's starting point, angle relative to the ulnar shaft, and tunnel length. These parameters were then used to set the expected position of the drill guide tip over the articular disc of the TFCC on preoperative MRI scans. The mean starting point of the bone tunnel was 12.0 mm proximal to the ulnar styloid tip, with an average tunnel angle of 37.0° and length of 10.0 mm. MRI analysis localized the drill guide tip approximately 4.0 mm radial to the medial aspect of the ulnar styloid over the articular disc of the TFCC. This location corresponded to the lateral one-third of a line connecting the center of the sigmoid notch to the center of the ulnar styloid process under the radiocarpal arthroscopic view. These radiologic and anatomic parameters provide a guide for positioning the TFCC drill guide during arthroscopic one-bone tunnel repair. Targeting the lateral one-third of a line between the center of the sigmoid notch and ulnar styloid under the radiocarpal arthroscopic view offers a practical landmark to optimize bone tunnel placement for targeting the foveal insertion of the TFCC.
To gain insight into higher fracture risk in individuals with type 2 diabetes, we determined the association of type 2 diabetes glycemic status and severity with longitudinal changes in peripheral bone density and microarchitecture. We conducted a longitudinal study of 769 participants from the Framingham Study who underwent high-resolution, peripheral, quantitative computed tomography (HR-pQCT) at the tibia and radius, in 2012-2016 and 2021-2023 (mean 8-year follow-up). Linear regression models estimated mean 8-year percent changes in bone measures, across indicators of diabetes severity, adjusting for age, sex, weight, and height. The mean age was 67 ± 7 years, and 59% of participants were women. More than half (57%) were normoglycemic (fasting plasma glucose [FPG] <100 mg/dL, not on any treatment), 31% had prediabetes (100 ≤ FPG ≤125 mg/dL), and 12% had type 2 diabetes (FPG >125 mg/dL or on treatment). Adjusted mean percent changes in HR-pQCT bone measures were similar across diabetes severity, including glycemic status, use of diabetes medications, duration of diabetes, and HbA1c. For example, cortical volumetric bone mineral density at the radius changed by -1.50% (95% CI -2.43, -0.56) in type 2 diabetes and -1.96% (-2.53, -1.39), in prediabetes, compared with -2.42% (-2.86, -1.97) in normoglycemia (reference group; all P > 0.05). The magnitude of peripheral bone loss over 8 years did not differ between individuals with type 2 diabetes and those with normoglycemia, suggesting that bone deterioration alone does not explain the higher fracture risk in older adults with type 2 diabetes. Future studies should address other contributors to skeletal fragility.
 We aimed to compare the effect of 2 femoral stem designs on periprosthetic bone mineral density (BMD) after total hip arthroplasty in a randomized controlled trial. We hypothesized that a short collum-fixated stem (Primoris) would better preserve proximal BMD than a conventional metaphyseal-fixated and diaphyseal engaging stem (Echo).  61 patients with primary osteoarthritis were randomized to receive either the Primoris (n = 31) or Echo (n = 30) uncemented femoral stem. DXA scans were performed preoperatively, at 6 weeks, 12 months, and 24 months. The prespecified primary outcome was periprosthetic BMD at 24 months and patient-reported outcomes (EQ-5D, Oxford Hip Score, FJS-12) were collected preoperatively, and at each follow-up were secondary.  At 24 months, model-based estimates showed significantly higher BMD in the Primoris group than in the Echo group in Gruen zones 3 (mean difference 0.40 g/cm², 95% confidence interval [CI] 0.26-0.53; P < 0.001), 5 (0.20 g/cm², CI 0.07-0.33; P = 0.003), and 7 (0.27 g/cm², CI 0.14-0.41; P < 0.001). These differences corresponded to relative differences of +19.1%, +9.1%, and +14.3%, respectively, compared with the Echo group. In addition, the increase in BMD from 6 weeks to 24 months was significantly greater in the Primoris group in Gruen zone 7 (mean difference in change 0.18 g/cm², CI 0.04-0.32; P = 0.01). PROMs improved similarly in both groups, with no statistically significant between-group differences.  At 2 years, the collum-fixated Primoris stem preserved more proximal femoral bone than the Echo stem, while PROMs were comparable between groups. The observed preservation of proximal bone stock may be advantageous for long-term bone maintenance and future revision surgery.
In cases with complex glenoid bone defects, bony increased-offset reverse shoulder arthroplasty can restore glenoid bone stock and improve stability using autografts harvested from the humeral head. However, conventional grafting methods may be insufficient when glenoid defects or deformities are complex. We present a novel bracket-shaped bone grafting technique applied in a patient with advanced rheumatoid arthritis and significant glenoid erosion. The graft was sculpted from the resected humeral head to match the glenoid defect in a Lego block-like fashion, resulting in stable fixation and favorable clinical outcomes.
Chronic ankle instability and chronic low back pain are highly prevalent in musculoskeletal conditions. Emerging evidence suggests that they are interconnected through shared biomechanical, neuromuscular, and neurophysiological mechanisms, where deficits in proprioception, postural control, and load distribution contribute to persistent dysfunction across the kinetic chain. This study employed a narrative review with a conceptual framework, incorporating evidence from biomechanical, neuromuscular, and neurophysiological studies found through targeted database searches (PubMed, Scopus, and Google Scholar 2019-2025). Findings were thematically analyzed to establish connections between distal and proximal dysfunction within the kinetic chain. A total of 23 studies were included. Overall, the evidence suggests consistent distal-to-proximal alterations in individuals with chronic ankle instability, including impaired ankle biomechanics, compensatory lumbopelvic movement patterns, and deficits in proprioception and neuromuscular control. Emerging findings also indicate neurophysiological adaptations affecting sensorimotor integration. Collectively, these findings suggest a potential association between chronic ankle instability and chronic low back pain. Chronic ankle instability and chronic low back pain may coexist within a functionally interconnected kinetic system. Recognizing their potential interdependence supports a model of multi-segmental stability and highlights the importance of combined ankle-core rehabilitation strategies.
Adductor injuries represent a notable musculoskeletal burden among athletes accounting for half of acute hip injuries in soccer and nearly one quarter in professional basketball. The pyramidalis-anterior pubic ligament-adductor longus complex represents a critical anatomic concept for understanding injury patterns with the adductor longus most injured. Clinical evaluation follows the Doha agreement classification, emphasizing adductor tenderness and pain on resisted adduction testing to differentiate adductor-related groin pain from other etiologies. Magnetic resonance imaging provides comprehensive injury characterization, with validated classification systems predicting return-to-play timelines. Prevention strategies target modifiable risk factors including adductor weakness and reduced hip rotational range of motion, with strengthening programs demonstrating potential to reduce injury incidence. Nonsurgical management remains the cornerstone of treatment for most injuries with return to play averages 2 to 3 weeks for partial tears and 8 to 12 weeks for complete tears managed nonsurgically, although recurrence rates are as high as 19%. Surgical intervention is considered for acute avulsions with greater than 2 cm retraction or chronic injuries refractory to conservative treatment, although comparative evidence versus structured nonsurgical care is limited. Surgical management options include repair, partial tenotomy, or complete tenotomy. All three surgical approaches demonstrate good outcomes in nonrandomized cohort studies with return to play averaging 10 to 14 weeks and repair being favored for traumatic complete avulsion particularly in professional athletes.
Reverse total shoulder arthroplasty (rTSA) relies on a competent deltoid muscle to provide stability and function. This study aims to determine the importance of ultrasonically measured deltoid muscle volume on patient strength, function, and satisfaction after rTSA. We retrospectively reviewed 56 shoulders in 28 patients underwent rTSA with surveys of American Shoulder and Elbow Society questionnaire (ASES), simple shoulder test, and ultrasonography measurement of deltoid volume. Statistical analysis was done to determine the correlation between deltoid muscle volume and abduction strength, ASES score, Constant-Murley Score, Visual Analog Scale, range-of-motion testing, between surgical shoulder and nonsurgical repair groups, respectively. A strong positive correlation was observed with deltoid muscle volume and abduction strength, and a moderate positive correlation between deltoid muscle volume and the Constant-Murley Score. No notable difference was observed between the mean deltoid volume for the surgical and nonsurgical sides. No correlation existed between deltoid volume and ASES. A decrease in deltoid muscle volume was observed with patients' age, but no trend regarding length of time since surgery. These findings indicated that deltoid muscle assessment in candidate selection and postoperative care are associated with improved postoperative outcomes. Deltoid volume is a robust predictor of postoperative abduction strength and has a moderate association with shoulder function including muscle strength and range of motion but does not correlate with pain or satisfaction. The results can inform clinicians to prioritize deltoid evaluation during patient selection and follow-up, guiding additional research on optimizing rehabilitation and implant design. IV.
Serial casting can effectively treat early-onset scoliosis (EOS), thereby preventing or delaying the need for surgery. Reported complications range from pressure sores to cardiac arrest. The modified Clavien-Dindo-Sink (mCDS) system has high reliability for grading complications following EOS surgery, but has not previously been used to classify complications of casting. We aimed to assess the utility of the mCDS system for grading complications of EOS casting and hypothesized that, with modifications, it would be a valid system for assessing these complications. This was a multicenter retrospective study. Patients aged 10 years or younger who underwent ≥1 cast application for EOS treatment were included. Demographics, radiographic data, casting details, complications, and unplanned procedures were collected. Two authors (E.S. and M.H.) reviewed complications and assigned a mCDS grade to each. One thousand twenty patients (5605 casts) were included. Two hundred forty-four casting-related complications in 159 patients were analyzed. 15.6% of patients (n=159) had a complication, and 47 patients (4.6%) had >1 complication. Fifteen complications were categorized as mCDS grade I (6.1%), 192 as grade II (78.7%), 5 as grade IIIa (2.0%), 28 as grade IIIb (11.5%), 4 as grade IVa (1.6%), and 0 as grade IVb or grade V (0%). The most common reason for a grade IIIb complication, which is an unplanned procedure, was early cast removal necessitating early cast re-application (25/28 patients). Most casting complications in our cohort were grades II and IIIb. The mCDS system, in its current state, may not accurately describe the complications of casting. Although a grade IIIb complication after casting results in an additional procedure requiring anesthesia, an unplanned return to the operating room after surgery is likely associated with greater morbidity than an unplanned cast re-application. Using the mCDS system to compare casting with surgery risks overstating the severity of casting complications and may inadequately represent outcomes. We propose modifying the mCDS system for casting. Level III-therapeutic.