研究者詳細 - 竹上　靖彦

論文 - 竹上　靖彦

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Does Preoperative Manual Reduction (Omoto Technique) Affect Surgical Outcomes for Calcaneal Fractures? A Multicenter (TRON Group) Retrospective Study 査読有り国際誌

Takahashi, H; Takegami, Y; Tokutake, K; Takahashi, Y; Kato, M; Mabuchi, M; Imagama, S

JOURNAL OF FOOT & ANKLE SURGERY 63 巻 ( 4 ) 頁： 450 - 455 2024年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Foot and Ankle Surgery

The Omoto technique is a well-known method that is commonly used for noninvasive manual repair of calcaneal fractures. However, there have been no detailed studies on its clinical outcomes in preoperative closed reduction for surgical cases. This multicenter retrospective study aimed to compare the clinical and radiographic outcomes of calcaneal fractures treated with and without the preoperative Omoto technique, assessing its effectiveness. We extracted 335 patients with calcaneal fracture who underwent surgery between 2015 and 2020 from our multicenter database, named TRON. We evaluated the clinical outcomes using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Böhler angle (BA) for radiographic analysis, and noted any complications. We divided the patients into those managed with the Omoto technique (group O) and those managed without the Omoto technique (group N). Patients were matched by age, sex, and fracture type, resulting in 43 patients per group. The use of the Omoto technique at the time of injury significantly improved the Böhler angle (BA). Furthermore, there were no significant differences in AOFAS, postoperative complications, or BA values at the final follow-up. In conclusion, our study demonstrates that the Omoto technique, when used preoperatively for calcaneal fractures, does not negatively impact the outcomes of subsequent surgical treatments. For patients who prefer to avoid surgery, the Omoto technique can be an effective initial intervention. Additionally, our findings suggest that the Omoto technique may facilitate less invasive surgical options in certain cases.

DOI： 10.1053/j.jfas.2024.02.003

Risk factors of periprosthetic joint infection after hemiarthroplasty for displaced femoral neck fracture in the elderly: Analysis of 1619 cases in the multicenter database 国際誌

Sumi, S; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Takatsu, T; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 55 巻 ( 7 ) 頁： 111603 - 111603 2024年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Injury

Purpose: This multicenter retrospective study focuses on understanding the incidence, causative bacteria, and risk factors for Periprosthetic Joint Infection (PJI) following hemiarthroplasty in elderly patients with displaced femoral neck fractures (FNF). Methods: From 2016 to 2020, 1,619 patients were diagnosed with displaced FNFs and treated surgically across 11 centers. After exclusions, 1,438 patients (399 men and 1,039 women) were included in the study, averaging 82.1 years in age and 20.2 kg/m² in BMI, observed over 25.7 months on average. Data on demographics, medical history, surgical details, and complications were described. Results: PJI occurred in 20 of the 1438 patients (1.4%). The causative organism was methicillin-susceptible Staphylococcus aureus in 6 patients and methicillin-resistant S. aureus in 6 patients. In patients' backgrounds, the average age was slightly higher in the non-PJI group (82.1 years) compared to the PJI group (80.4 years). There was a higher percentage of males in the PJI group (45%) than in the non-PJI group (27.5%). Drug history showed that the prevalence of anticoagulant use in the PJI group was 25%. Peripheral vascular disease and diabetes mellitus were more prevalent in the PJI group. Most patients in both groups were independent in daily activities. The blood transfusion rate was significantly higher in the PJI group (50%) than in the non-PJI group (23.8%). Notably, the incidence of hematoma was higher in the PJI group (40%). Conclusion: This multicenter retrospective study demonstrates a low incidence (1.4%) of PJI in elderly patients undergoing hemiarthroplasty for FNF, primarily due to Staphylococcus aureus. Increased usage of antiplatelets and anticoagulants, as well as comorbidities related to atherosclerosis, like peripheral vascular disease and diabetes mellitus, were observed in patients with PJI. Additionally, these patients experienced higher rates of blood transfusion and postoperative hematomas, highlighting the need for careful management. It should be noted, however, that this finding is a conclusion limited by study design issues, including the retrospective design, small PJI sample size, and variability in treatment approaches.

DOI： 10.1016/j.injury.2024.111603

Preoperative Sarcopenia Severity and Clinical Outcomes after Total Hip Arthroplasty 査読有り国際誌 Open Access

Tanaka, S; Kayamoto, A; Terai, C; Nojiri, S; Fugane, Y; Mori, T; Nagaya, M; Kako, M; Iida, H; Osawa, Y; Takegami, Y; Nishida, Y

NUTRIENTS 16 巻 ( 13 ) 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nutrients

The outcome of total hip arthroplasty (THA) in patients with end-stage arthritis of the hip is associated with preoperative physical status. This study was performed to examine the relationship between the preoperative severity of sarcopenia and clinical outcomes after THA. This retrospective cohort study was performed among 306 consecutive patients (mean age: 63.7 ± 12.9 years, 222 women) undergoing THA at a university hospital. The severity of sarcopenia was determined based on the skeletal muscle mass index (SMI), handgrip strength, and gait speed according to the criteria of the Asian Working Group for Sarcopenia 2019. The severe sarcopenia prevalence rate was 10.6%. Severe sarcopenia was significantly associated with the risk of delayed functional recovery (adjusted odds ratio, 2.82; 95% confidence interval, 1.03–7.72; p = 0.043) compared with the non-sarcopenia group after adjusting for pre-existing risk factors, including preoperative hip function and physical activity. The addition of SMI, handgrip strength, and gait speed to the model for risk of functional recovery delay significantly increased the area under the receiver operating characteristic curve (p = 0.038). Severe sarcopenia was significantly associated with poorer hip function and patient-reported outcomes at 6 months after surgery compared with the non-sarcopenia group. Severe sarcopenia was adversely associated with postoperative clinical outcomes in patients undergoing THA.

DOI： 10.3390/nu16132085

Descriptive analysis of incidence and risk factors for short intramedullary nail breakage in femoral intertrochanteric fractures: a multicenter (TRON group) retrospective study 査読有り国際誌

Noritake, H; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Ito, T; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 34 巻 ( 5 ) 頁： 2605 - 2611 2024年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology

Background: The incidence of hip fractures is increasing. Femoral intertrochanteric fractures make up 50% of hip fractures and are treated by intramedullary nails. Implant breakage is a recognized complication that can have rare and serious implications. This study aimed to investigate implant breakage rates after surgical treatment for femoral intertrochanteric fractures. Methods: This was a retrospective multicenter analysis. All 1854 patients who underwent surgical treatment for femoral intertrochanteric fractures were selected from 12 hospitals (TRON group) between 2016 and 2020. Exclusion criteria included implants other than those specified and follow-up periods less than three months. Demographic data, surgical details, and radiographic assessments were collected from medical records and X-ray evaluations. Results: Among the 983 study patients, consisting of 245 males (24.9%) and 738 females (75.1%), the implant breakage rate was 0.31%, with three confirmed cases. The average age was 83.9 years. The mean follow-up period was 640.9 days. Two cases were linked to ASULOCK implants, and one to an OLSII implant. Statistical analysis showed a significantly higher incidence of ASULOCK implant breakage (p < 0.001). In the two cases of ASULOCK implant breakage and one case of OLSII implant breakage, breakage in all three implants occurred at the anti-rotation screws. Conclusions: There were no implant breakages of the main body of the implants; all breakages occurred in the additional anti-rotation screw. The necessity of the anti-rotation screw will require further discussion. These results can potentially inform clinical decisions and guide further research in preventing implant breakage.

DOI： 10.1007/s00590-024-03957-z

Association of mid-thigh quadriceps muscle quality with postoperative outcomes in patients with hip osteoarthritis undergoing total hip arthroplasty: a retrospective cohort study 査読有り国際誌

Iida, H; Takegami, Y; Osawa, Y; Funahashi, H; Ozawa, Y; Ido, H; Asamoto, T; Otaka, K; Tanaka, S; Imagama, S

INTERNATIONAL ORTHOPAEDICS 48 巻 ( 7 ) 頁： 1715 - 1721 2024年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Orthopaedics

Purpose: Muscle quality is more important than muscle mass for assessing physical function. Computed tomography (CT) is used to evaluate intramuscular fatty infiltration. The mid-thigh quadriceps CT attenuation values (CTV) expressed in Hounsfield units (HU) negatively correlate with physical function. Patients with hip osteoarthritis (HOA) have lower extremity muscle atrophy, including decreased cross-sectional area (CSA), CTV, and muscle strength. Using preoperative CT images, we investigated the association between mid-thigh quadriceps CSA, CTV, and postoperative outcomes in patients with HOA. Methods: This study included 62 patients who had unilateral HOA (62 hips) and underwent total hip arthroplasty (THA). We investigated the association between preoperative and postoperative Japanese Orthopaedic Association (JOA) hip scores, 12-item Short Form survey (SF-12), mid-thigh quadriceps CSA, and CTV. Results: The mean age was 64.7 ± 10.1 years, with 15 men (24.2%), and the mean body mass index was 24.3 ± 4.3 kg/m2. Secondary HOA was present in 79.0% of patients. The mean CSA and CTV of the mid-thigh quadriceps on the operative side were 38.8 ± 9.8 cm2 and 40.3 ± 7.8 HU, respectively. Multiple regression analyses adjusted for age and sex showed that preoperative mid-thigh quadriceps CSA was not associated with preoperative and postoperative JOA hip scores or SF-12. The preoperative mid-thigh quadriceps CTV was associated with the postoperative JOA hip score in the gait ability domain and SF-12 in the physical component summary domain. Conclusion: Preoperative muscle quality is associated with postoperative outcomes in patients who have HOA regardless of age and sex.

DOI： 10.1007/s00264-024-06142-3

Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically A Retrospective Multicenter Study 査読有り国際誌 Open Access

Takahashi, Y; Takegami, Y; Tokutake, K; Asami, Y; Takahashi, H; Kato, M; Kanemura, T; Imagama, S

JBJS OPEN ACCESS 9 巻 ( 3 ) 2024年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：JBJS Open Access

Background:Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs.Methods:In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified.Results:The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments.Conclusions:CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.OA.23.00127

Retrospective study comparing the accuracies of handheld infrared stereo camera and augmented reality-based navigation systems for total hip arthroplasty 査読有り国際誌

Tanaka, S; Takegami, Y; Osawa, Y; Okamoto, M; Imagama, S

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 144 巻 ( 6 ) 頁： 2811 - 2821 2024年6月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Archives of Orthopaedic and Trauma Surgery

Background: The use of portable navigation systems (PNS) in total hip arthroplasty (THA) has become increasingly prevalent, with second-generation PNS (sPNS) demonstrating superior accuracy in the lateral decubitus position compared to first-generation PNS. However, few studies have compared different types of sPNS. This study retrospectively compares the accuracy and clinical outcomes of two different types of sPNS instruments in patients undergoing THA. Methods: A total of 158 eligible patients who underwent THA at a single institution between 2019 and 2022 were enrolled in the study, including 89 who used an accelerometer-based PNS with handheld infrared stereo cameras in the Naviswiss group (group N) and 69 who used an augmented reality (AR)-based PNS in the AR-Hip group (group A). Accuracy error, navigation error, clinical outcomes, and preparation time were compared between the two groups. Results: Accuracy errors for Inclination were comparable between group N (3.5° ± 3.0°) and group A (3.5° ± 3.1°) (p = 0.92). Accuracy errors for anteversion were comparable between group N (4.1° ± 3.1°) and group A (4.5° ± 4.0°) (p = 0.57). The navigation errors for inclination (group N: 2.9° ± 2.7°, group A: 3.0° ± 3.2°) and anteversion (group N: 4.3° ± 3.5°, group A: 4.3° ± 4.1°) were comparable between the groups (p = 0.86 and 0.94, respectively). The preparation time was shorter in group A than in group N (p = 0.036). There were no significant differences in operative time (p = 0.255), intraoperative blood loss (p = 0.387), or complications (p = 0.248) between the two groups. Conclusion: An Accelerometer-based PNS using handheld infrared stereo cameras and AR-based PNS provide similar accuracy during THA in the lateral decubitus position, with a mean error of 3°–4° for both inclination and anteversion, though the AR-based PNS required a shorter preparation time.

DOI： 10.1007/s00402-024-05330-5

Is spinopelvic compensation associated with unstable gait?: Analysis using whole spine X-rays and a two-point accelerometer during gait in healthy adults 査読有り国際誌

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Kayamoto, A; Oishi, R; Yamauchi, I; Takegami, Y; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

GAIT & POSTURE 111 巻頁： 22 - 29 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Gait and Posture

Background: Pelvic incidence (PI)–lumbar lordosis (LL) mismatch has a significant destabilizing effect on the center of gravity sway in the static standing position. However, the association between spinopelvic alignment and balance during gait in healthy volunteers is poorly understood. Research question: The degree of PI–LL mismatch and trunk anterior tilt in the static standing posture influences dynamic balance during gait. Methods: In this study, 131 healthy volunteers were divided into two groups: harmonious group (PI − LL ≤ 10°; n = 91) and unharmonious group (PI − LL > 10°; n = 40). A two-point accelerometer system was used for gait analysis; accelerometers were attached to the pelvis and upper trunk to measure acceleration in the forward–backward, right–left, and vertical directions so that sagittal (front–back) deviation width, coronal (right–left) width, and vertical width and their ratios were calculated. Measurements were compared between the two groups, and correlations between alignment and accelerometer data were examined. Results: The harmonious group showed a negative correlation between pelvic sagittal width and PI – LL, pelvic tilt (PT), and sagittal vertical axis (SVA) (correlation coefficient ρ = −0.42, −0.38, and −0.4, respectively), and a positive correlation between sagittal ratio and PI − LL (ρ = 0.35). The unharmonious group showed a positive correlation between pelvic sagittal width and PI and PT (ρ = 0.43 and 0.33, respectively) and between sagittal ratio and SVA (ρ = 0.32). The unharmonious group showed a positive correlation between upper trunk sagittal width and PI − LL and PT (ρ = 0.38 and 0.36, respectively). Significance: The association between spinal alignment and gait parameters differs depending on the presence or absence of PI–LL mismatch. The degree of pelvic compensation and trunk anterior tilt during static standing were associated with unstable gait balance.

DOI： 10.1016/j.gaitpost.2024.04.013

Association between advanced glycation end-products and fall risk in older adults: The Yakumo Study 査読有り

Iida, H; Takegami, Y; Osawa, Y; Funahashi, H; Ozawa, Y; Ido, H; Asamoto, T; Otaka, K; Tanaka, S; Nakashima, H; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

GERIATRICS & GERONTOLOGY INTERNATIONAL 24 巻 ( 6 ) 頁： 517 - 522 2024年6月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Geriatrics and Gerontology International

Aim: Advanced glycation end-products (AGEs) are irreversibly and heterogeneously formed compounds during the non-enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high-fat and high-protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community-dwelling older adults. Methods: This cross-sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5-items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5-items version ≥6 or not), and investigated the factors associated with fall risk. Results: The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53–0.733; sensitivity 0.415; specificity 0.814; P < 0.05). Conclusion: The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517–522.

DOI： 10.1111/ggi.14871

Comparison of conjoined tendon-preserving posterior approach and conventional posterolateral approach in hemiarthroplasty for femoral neck fracture in the elderly: A multicenter (TRON group) retrospective study. 査読有り

Ogura K, Takegami Y, Kuwahara Y, Tokutake K, Nakashima R, Yamamoto S, Naito K, Kasai T, Makida K, Imagama S

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024年5月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Orthopaedic Science

Background: Femoral neck fractures (FNF) are one of the most common traumatic injuries in the elderly. The conjoined tendon-preserving posterior (CPP) approach was developed as a modification of the conventional posterolateral (PL) approach in hemiarthroplasty (HA) for displaced femoral neck fractures (FNF) to reduce postoperative dislocation. We hypothesized that the CPP approach would result in fewer dislocations and similar functional and radiographic outcomes compared to the PL approach. Patients and methods: This was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio. Results: We identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker's mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81). Conclusion: The CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.

DOI： 10.1016/j.jos.2024.05.003

Relationship between locomotive syndrome and advanced glycation end products measured by skin autofluorescence in community-dwelling patients: the Yakumo Study. 査読有り

Ozawa Y, Takegami Y, Seki T, Osawa Y, Iida H, Okamoto M, Nakashima H, Ishizuka S, Hasegawa Y, Imagama S

Nagoya journal of medical science 86 巻 ( 2 ) 頁： 314 - 325 2024年5月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Advanced glycation end products (AGEs) have been reported to be associated with osteoporosis, aging, sarcopenia, and frailty. This study aimed to investigate the association AGEs with locomotive syndrome (LS). Participants were Japanese individuals aged 39 years or older who participated in the Yakumo Study (n=230). AGEs were measured by skin autofluorescence (SAF) using an AGE reader. We investigated SAF values for each locomotive stage. Multivariate logistic regression models were used to calculate the odds ratios of LS-associated factors. The relationships between SAF and physical performance and bone mineral density (BMD) were investigated. A receiver operating characteristic (ROC) curves were generated to determine the optimal cut-off value of SAF for predicting LS. SAF values tended to increase correspondingly with LS severity. SAF was an independently explanatory factor for LS (odds ratio 2.70; 95% confidence interval [CI] 1.040–6.990). SAF was positively correlated with the 10-m walking speed, The Timed Up and Go test results, and was negatively correlated with BMD. ROC curve represented by SAF for the presence or absence of LS risk had an area under the curve of 0.648 (95% CI: 0.571–0.726). High SAF values were identified as an independent risk factor for LS. AGEs could be a potential screening tool for people for LS.

DOI： 10.18999/nagjms.86.2.314

Diaphyseal forearm fracture management in adolescent patients from 2011 to 2020: A multicenter study of surgery and regional anesthesia trends. 査読有り

Kimura Y, Asami Y, Tokutake K, Takegami Y, Oshima K, Ishihara N, Imagama S

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Orthopaedic Science

Background: Diaphyseal forearm fractures are common traumatic injuries among children. There has been much debate on the use of intramedullary nailing (IMN) or plate fixation in the adolescent population (10–16 years of age). Furthermore, as ultrasound technology has advanced, the safety and efficacy of ultrasound-guided axillary brachial plexus block for children has dramatically improved. Therefore, anesthesia options for adolescent patients have increased in recent years. This study aimed to investigate recent surgical and regional anesthesia trends of diaphyseal forearm fractures in patients 10 to 16 years of age in Japan through a multicenter epidemiological survey from 2011 to 2020. Methods: This retrospective, multicenter study included 226 pediatric patients with diaphyseal forearm fracture aged 10–16 years treated from January 2011 to December 2020. We divided the patients into four groups according to the period in which they were treated: early (2011–2013), middle (2014–2016), late (2017–2019), and COVID-19 (2020). Information from medical records was used to investigate the number of surgeries, types of anesthesia administered, and internal fixation methods used for diaphyseal forearm fracture in adolescent patients during each period. Results: The number of surgeries was generally constant in each period but decreased during the COVID-19 period. In the early, middle, late, and COVID-19 periods, the percentages of surgeries performed under regional anesthesia were 67.7, 85.5, 87.0, and 100% respectively (p = 0.003). During the same periods, the percentages of patients receiving IMN were 41.5, 49.3, 58.0, and 66.7%, respectively (p = 0.033). Conclusion: The use of IMN and regional anesthesia to treat diaphyseal forearm fracture in patients 10 to 16 years of age steadily increased during the study period from 2011 to 2020. These results indicate that regional anesthesia is safe, effective, and well-tolerated by adolescent patients. The treatment strategy for diaphyseal forearm fractures in adolescents using regional anesthesia in combination with IMN worked well and was effective during COVID-19. Our evidence suggests this trend will continue. We anticipate that our findings can be extrapolated for upper extremity fractures in adolescent patients beyond the Tokai region of Japan where the study was based.

DOI： 10.1016/j.jos.2024.03.009

Comparing short vs. intermediate and long nails in elderly patients with unstable multifragmental femoral trochanteric fractures (AO type A2): Multicenter (TRON group) retrospective study 査読有り国際誌

Tsugeno, H; Takegami, Y; Tokutake, K; Mishima, K; Nakashima, H; Kobayashi, K; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 55 巻 ( 4 ) 頁： 111420 - 111420 2024年4月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Injury

Background: Unstable femoral trochanteric fractures (FTFs), especially Arbeitsgemeinschaft für Osteosynthesefragen/ the Orthopedic Trauma Association (AO/OTA) 31-A2 fractures, which are multifragment fractures, occur in elderly individuals with osteoporosis and are associated with high mortality and complication rates due to prolonged immobilization. Longer nails (LNs) were developed to obtain superior fracture site stabilization in unstable FTFs. We hypothesized that the postoperative outcomes of elderly patients with unstable FTFs treated with LNs would be superior to those of patients treated with short nails (SNs), with fewer complications. Methods: This multicenter retrospective study aimed to compare the outcomes of SNs versus LNs in elderly patients with unstable FTFs. From the Trauma Research Group of our university (TRON) database, 1854 trochanteric fractures treated between January 2016 and December 2020 were extracted. A total of 174 patients>65 years of age with AO/OTA 31-A2 fractures were included in the present study. They were divided into the SN group and the LN group and matched for age and sex. Parameters such as operative time, blood loss, survival rate, Parker Mobility Score (PMS), and numerical rating scale (NRS) for pain, complications, and radiographic findings were analyzed. Results: Both groups included 67 patients with an average age of 87.32 years. The LN group had a longer operative time (76.52 min vs. 51.61 min, P < 0.001) and more blood loss (106.79 mL vs. 49.98 mL, P = 0.014) in comparison to the SN group. However, the 1-year survival rate, PMS, and NRS for pain did not differ to a statistically significant extent between the groups. The rates of complications, including screw cutout, nonunion, implant breakage, osteonecrosis of the femoral head, and surgical site infections, were comparable. The radiographic findings, including the nail/canal ratio, progression of varus, and sliding distance, were also similar. Conclusion: Although LNs are associated with longer operative times and increased blood loss, the overall outcomes and complication rates are comparable to those of SNs in elderly patients with AO/OTA 31-A2 type unstable FTFs. The use of LNs did not confer any distinct advantages for this specific type of fracture.

DOI： 10.1016/j.injury.2024.111420

Anti-sclerostin antibody therapy prevents post-ischemic osteonecrosis bone collapse via interleukin-6 association 査読有り国際誌

Ozawa, Y; Takegami, Y; Osawa, Y; Asamoto, T; Tanaka, S; Imagama, S

BONE 181 巻頁： 117030 - 117030 2024年4月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Bone

Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by subchondral bone necrosis, which frequently culminates in joint destruction. Although total hip arthroplasty is conventionally practiced to remediate ONFH, for patients under the age of 60, the outcomes can be suboptimal. Chronic inflammation, particularly that mediated by interleukin-6 (IL-6), has been conjectured to be a potential mechanism underlying the etiology of ONFH. This study aimed at exploring the interplay between IL-6, the canonical Wnt signaling pathway, and ONFH to provide insights for potential therapeutic interventions. Human ONFH specimens depicted an elevation in β-catenin expression in the transitional layer, while IL-6 levels were pronounced in the same region. Subsequently, mouse models of ischemic osteonecrosis were treated with an anti-sclerostin antibody to assess its effects on bone metabolism and cellular processes. Histological analysis revealed that the administration of anti-sclerostin antibodies effectuated early recovery from bone necrosis, reduced empty lacunae, and suppressed IL-6 expression. The treatment evidently initiated the activation of the Wnt/β-catenin signaling pathway, presenting a potential mechanism associated with IL-6-mediated inflammation. Furthermore, the antibody upregulated osteoblast formation, downregulated osteoclast formation, and increased bone volume. Micro-CT imaging demonstrated increased bone volume, prevented epiphyseal deformity, and improved compression strength. Therefore, this study yields significant findings, indicating the potency of anti-sclerostin antibodies in effectively modulating the Wnt/β-catenin pathway, associating with IL-6 expression, and preventing post-ONFH bone collapse. Additionally, this preclinical investigation in mouse models offers an avenue for prospective research on potential therapeutic interventions against human ONFH.

DOI： 10.1016/j.bone.2024.117030

Obesity Is Associated with Asymptomatic Vertebral Fractures: A Yakumo Study 査読有り国際誌 Open Access

Miyairi, Y; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Oishi, R; Yamauchi, I; Machino, M; Seki, T; Ishizuka, S; Takegami, Y; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE 13 巻 ( 7 ) 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Clinical Medicine

(1) Background: Patients with primary vertebral fracture (VF) are at high risk of re-fracture and mortality. However, approximately two-thirds of patients with VFs receive minimal clinical attention. (2) Methods: The current study aimed to investigate the factors associated with asymptomatic VFs in middle-aged and elderly individuals who underwent resident health examinations. (3) Results: The current study included 217 participants aged > 50 years. VFs were diagnosed based on lateral radiographic images using Genant’s semiquantitative (SQ) method. The participants were divided into non-VF (N; SQ grade 0) and asymptomatic VF (F; SQ grades 1–3) groups. Data on body composition, blood tests, quality of life measures, and radiographic parameters were assessed. A total of 195 participants were included in the N group (mean age, 64.8 ± 7.8 years), and 22 were in the F group (mean age, 66.1 ± 7.9 years). The F group had a significantly higher body mass index (BMI), body fat percentage (BF%), and proportion of patients with knee osteoarthritis (KOA) than the N group. The F group had a significantly higher knee joint pain visual analog scale (VAS) score and painDETECT score than the N group. Logistic regression analysis showed that BF% was associated with asymptomatic VFs. (4) Conclusions: Middle-aged and elderly individuals with asymptomatic VF presented with high BMIs, BF%, and incidence of KOA.

DOI： 10.3390/jcm13072063

Does Early and Late Weight Bearing Have an Effect on the Results of Elderly Tibial Plateau Fractures with Internal Fixation?: A Multicenter (TRON Group) Study 査読有り国際誌

Sudo, Y; Takegami, Y; Tokutake, K; Shimizu, K; Naruse, K; Takatsu, T; Imagama, S

INDIAN JOURNAL OF ORTHOPAEDICS 58 巻 ( 4 ) 頁： 354 - 361 2024年4月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Indian Journal of Orthopaedics

Introduction: There is still no consensus on the length of the non-bearing period required for tibial plateau fractures (TPFs) treated surgically. Several studies showed that full weight bearing immediately postoperatively does not affect fixation or cause joint collapse in patients with TPF. While there are concerns about weight bearing in the elderly due to fragile bone quality, their physical disability often makes it difficult to carry out activities of daily life when weight bearing is not allowed. The purpose of this study was to assess differences in clinical and radiographic outcomes between an early weight-bearing (EWB) group and a non-weight-bearing (NWB) group following TPF in elderly patients. Material and Methods: We extracted the data of 432 patients who suffered TPF from January 2011 to December 2020 from a database which is named TRON. We excluded patients with insufficient follow-up postoperatively, AO type A/C fracture, age < 60 years old, multiple trauma, and those lost to follow-up. Finally, 91 patients were eligible. EWB group patients were encouraged to perform partial weight-bearing walking at ≤ 4 weeks after surgery, whereas NWB group patients were not allowed weight bearing for > 4 weeks after surgery. Baseline intergroup differences were adjusted for by matching age, sex, body mass index, smoking history, and injury mechanism. We compared Knee Society Score (KSS), timing of full weight bearing, and X-ray findings including step-off, tibia plateau angle, plateau slope, and condylar widening in the X-rays between the two groups. Results: There were no significant statistical differences between the EWB group and NWB group after matching. The mean follow-up period was 28.0 (range 12–73) months. All cases did not require reoperation or additional procedures. The median KSS at 12 months or at the last follow up postoperatively was 100 (77–100) vs. 95 (75–100) points (P = 0.33). There were no differences in fracture-related infection rates or wound dehiscence. In the radiological evaluation of EWB and NWB, the correction loss of condylar widening was only significantly greater for EWB compared to NWB. Conclusions: We found that early weight bearing could contribute to increased condylar widening. While our short-term follow-up didn’t reveal any significant clinical differences, this highlights the need for long-term follow-up to comprehensively understand the implications of these radiographic changes.

DOI： 10.1007/s43465-024-01113-7

視力が静的・動的体幹バランスに及ぼす影響(体幹2点歩行動揺計The Walkingを用いた検討) Yakumo Study

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 石塚真哉, 竹上靖彦, 大石遼太郎, 山内一平, 宮入祐一, 森田圭則, 松本太郎, 長谷川幸治, 今釜史郎

Journal of Spine Research 15 巻 ( 3 ) 頁： 297 - 297 2024年4月

中高年者における脊柱アライメントと歩行時体幹動揺の関係 2点加速度センサによる歩行解析結果

世木直喜, 中島宏彰, 伊藤定之, 大内田隼, 栢本あずさ, 大石遼太郎, 宮入祐一, 山内一平, 森田佳則, 関泰輔, 竹上靖彦, 石塚真哉, 長谷川幸治, 今釜史郎

Journal of Spine Research 15 巻 ( 3 ) 頁： 197 - 197 2024年4月

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study. 査読有り

Murase F, Takegami Y, Tokutake K, Oyama H, Arakawa O, Takatsu T, Nakashima H, Mishima K, Imagama S

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024年3月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Orthopaedic Science

Background: The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. Methods: We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. Results: Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042). Conclusion: In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

DOI： 10.1016/j.jos.2024.03.008

External validation of a deep learning model for predicting bone mineral density on chest radiographs 査読有り国際誌

Asamoto, T; Takegami, Y; Sato, Y; Takahara, S; Yamamoto, N; Inagaki, N; Maki, S; Saito, M; Imagama, S

ARCHIVES OF OSTEOPOROSIS 19 巻 ( 1 ) 頁： 15 - 15 2024年3月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Archives of Osteoporosis

Summary: We developed a new model for predicting bone mineral density on chest radiographs and externally validated it using images captured at facilities other than the development environment. The model performed well and showed potential for clinical use. Purpose: In this study, we performed external validation (EV) of a developed deep learning model for predicting bone mineral density (BMD) of femoral neck on chest radiographs to verify the usefulness of this model in clinical practice. Methods: This study included patients who visited any of the collaborating facilities from 2010 to 2020 and underwent chest radiography and dual-energy X-ray absorptiometry (DXA) at the femoral neck in the year before and after their visit. A total of 50,114 chest radiographs were obtained, and BMD was measured using DXA. We developed the model with 47,150 images from 17 facilities and performed EV with 2914 images from three other facilities (EV dataset). We trained the deep learning model via ensemble learning based on chest radiographs, age, and sex to predict BMD using regression. The outcomes were the correlation of the predicted BMD and measured BMD with diagnoses of osteoporosis and osteopenia using the T-score estimated from the predicted BMD. Results: The mean BMD was 0.64±0.14 g/cm2 in the EV dataset. The BMD predicted by the model averaged 0.61±0.08 g/cm2, with a correlation coefficient of 0.68 (p<0.01) when compared with the BMD measured using DXA. The accuracy, sensitivity, and specificity of the model were 79.0%, 96.6%, and 34.1% for T-score < -1 and 79.7%, 77.1%, and 80.4% for T-score ≤ -2.5, respectively. Conclusion: Our model, which was externally validated using data obtained at facilities other than the development environment, predicted BMD of femoral neck on chest radiographs. The model performed well and showed potential for clinical use.

DOI： 10.1007/s11657-024-01372-9

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