研究者詳細 - 竹上　靖彦

論文 - 竹上　靖彦

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Association between stem bypass and union failure of subtrochanteric shortening osteotomy in total hip arthroplasty for high hip dislocations

Kazuya Makida, Taisuke Seki, Yasuhiko Takegami, Yusuke Osawa, Shiro Imagama

Journal of Joint Surgery and Research 2023年12月

Ulnar Nerve Neuropathy After Surgery for Intraarticular Distal Humerus Fractures: An Analysis of 116 Patients 査読有り国際誌

Oshika, Y; Takegami, Y; Tokutake, K; Yokoyama, H; Oguchi, T; Imagama, S

JOURNAL OF HAND SURGERY-AMERICAN VOLUME 48 巻 ( 11 ) 頁： 1171.e1 - 1171.e5 2023年11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 Hand Surgery

Purpose: To identify the incidence and the factors associated with a postoperative ulnar nerve neuropathy in patients who had undergone open reduction and internal fixation for intraarticular distal humerus fractures. Methods: We retrospectively reviewed 116 patients who had undergone surgery between January 2011 and December 2020. Age, sex, BMI, mechanism of injury, open or closed fracture, operation time, tourniquet time, and nerve injury at the final examination were collected from medical charts. We essentially used the paratricipital approach. In cases in which the reduction of intraarticular bone fragments was difficult, olecranon osteotomy was used. Ulnar nerve function was graded according to a modified system of McGowan. We conducted logistic regression analysis to investigate factors of neuropathy using items identified as statistically significant in univariate analysis as explanatory variables. Results: Thirty-four patients (29.3%) had persistent neuropathy at the final follow-up. In the modified McGowan classification, 28 patients had grade 1 and 6 patients had grade 2 neuropathy. Olecranon osteotomy emerged as a distinct explanatory variable for the prophylaxis of ulnar nerve neuropathy in the multivariate analysis (odds ratio, 0.30; 95% confidence interval, 0.12–0.73). Anterior transposition, however, was not a statistically significant factor (odds ratio, 1.91; 95% confidence interval, 0.81–4.56). Conclusions: Olecranon osteotomy was the only independent factor associated with preventing the occurrence of ulnar nerve neuropathy. Ulnar nerve transposition might not be associated with prevention of ulnar nerve neuropathy. Type of study/level of evidence: Prognostic IV.

DOI： 10.1016/j.jhsa.2023.02.001

Addressing osteoporosis treatment after hemiarthroplasty for a femoral neck fracture: impact on survival rates after a subsequent periprosthetic femoral fracture - a multicenter (TRON group) retrospective study 査読有り国際誌

Takegami, Y; Osawa, Y; Iida, H; Okamoto, M; Ozawa, Y; Funahashi, H; Ido, H; Asamoto, T; Imagama, S

ARCHIVES OF OSTEOPOROSIS 18 巻 ( 1 ) 頁： 122 - 122 2023年9月

担当区分：筆頭著者,　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 : This study investigated the impact of osteoporosis treatment on the prognosis of patients with periprosthetic femoral fracture (PPF) following femoral neck fracture (FNF). Our results suggested an association between osteoporosis treatment and potentially improved survival prognosis in patients who underwent surgery for PPF. These results imply that osteoporosis treatment may have a beneficial effect on patient outcomes. Purpose: This study aimed to investigate the effect of osteoporosis treatment on the prognosis of periprosthetic femoral fracture (PPF) patients after femoral neck fracture. Methods: A multicenter retrospective study named as TRON was conducted. The study population included 156 PPF patients who had undergone hemiarthroplasty for femoral neck fracture between January 2010 and December 2019. Patients were divided based on whether they had received osteoporosis treatment before PPF injury. A log-rank test was used to compare survival rates. We conducted a Cox proportional hazards analysis to identify factors associated with the survival rate after PFF injury. Results: Twenty-seven of the 156 patients had received osteoporosis treatment prior to PPF injury. The 1-year and 2-year overall survival rates after PPF were 80.9% and 75.3%, respectively. The log-rank test revealed that the 1-year survival rate with and without osteoporosis treatment was 89.5% and 78.1%, respectively (P=0.012). In the Cox proportional hazards analysis, age, BMI, presence or absence of surgery, and presence or absence of osteoporosis treatment showed independent associations with the survival rate after PFF injury. The hazard ratio for the presence of osteoporosis treatment was 0.22 (95% confidence interval 0.07–0.75, P=0.015). Conclusion: The findings of this study suggest an association between osteoporosis treatment and potentially improved survival prognosis in patients who underwent surgery for PPF. These results imply that osteoporosis treatment may have a beneficial effect on patient outcomes. It is important to consider that osteoporosis treatment could be significant not only in preventing secondary fractures but also in potentially improving prognosis in the rare event of PPF.

DOI： 10.1007/s11657-023-01330-x

Intertrochanteric curved varus osteotomy for subchondral fracture of the femoral head: a case series 査読有り国際誌 Open Access

Otaka, K; Osawa, Y; Takegami, Y; Seki, T; Imagama, S

ARTHROPLASTY 5 巻 ( 1 ) 頁： 46 - 46 2023年9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：Arthroplasty

Although favorable results have been reported with total hip arthroplasty, joint-preserving treatment should be the first choice for subchondral fracture of the femoral head (SFF) in young patients. This study reviewed four young male patients with SFF who underwent intertrochanteric curved varus osteotomy (CVO). The patients had a mean age of 32.3 years (range: 18–49 years). Conservative treatment was initially attempted in all cases, but failed to alleviate the pain, leading to surgical intervention at an average time of 6 months (range: 4–10 months) after symptom onset. As the fracture sites were located medial to the lateral edge of the acetabulum in all cases, CVO was performed to achieve a postoperative intact ratio of ≥ 34% in the weight-bearing region of the femoral head. The average follow-up period after surgery lasted 4.3 years (range: 2–7 years). Clinical and radiographic assessments were performed pre- and postoperatively. At the latest follow-up, the mean Harris hip score improved from 67.3 preoperatively to 99.5 postoperatively. The average preoperative intact ratio of the weight-bearing region of the femoral head was 12.3%, which increased to 44.3% postoperatively. No progression to femoral head collapse or joint space narrowing was observed on the plain radiographs. CVO is a simple, less-invasive, and beneficial approach for treating SFF in young patients whose fractures occur medial to the lateral edge of the acetabulum.

DOI： 10.1186/s42836-023-00202-6

Pelvic morphologies of developmental dysplasia and primary osteoarthritis on range of motion after total hip arthroplasty 査読有り国際誌

Funahashi, H; Osawa, Y; Seki, T; Takegami, Y; Nishida, K; Imagama, S

JOURNAL OF ORTHOPAEDIC RESEARCH 41 巻 ( 9 ) 頁： 2007 - 2015 2023年9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 Research

Bony impingement, especially in the anterior inferior iliac spine (AIIS) after total hip arthroplasty (THA), may cause dislocation. However, the influence of AIIS characteristics on bony impingement after THA is not fully understood. Thus, we aimed to determine the morphological characteristics of AIIS with developmental dysplasia of the hip (DDH) and primary osteoarthritis (pOA) and to evaluate its effect on range of motion (ROM) after THA. Hips from 130 patients who underwent THA, including pOA were analyzed. In total, we had 27 male and 27 female participants with pOA, and 38 male and 38 female participants with DDH. The horizontal distances of AIIS from teardrop (TD) were compared. In the computed tomography simulation, flexion ROM was measured, and its relationship to the distance between TD and AIIS was investigated. DDH had a more medial (male: DDH, 36.9 ± 5.8; pOA, 45.5 ± 6.1; p < 0.001) (female: DDH, 31.5 ± 10.0; pOA, 36.2 ± 4.7; p < 0.001) position of AIIS than pOA. In the male with pOA group, flexion ROM was significantly smaller than that in the other groups, and there was a correlation between flexion ROM and horizontal distances (r = −0.543; 95% confidence interval = −0.765 to −0.206; p = 0.003). AIIS position is a factor that limits ROM during flexion after THA, particularly in males. Further studies are required to develop surgical strategies for cases of impingement at the AIIS site after THA. Level of evidence: Ш, retrospective comparative study.

DOI： 10.1002/jor.25544

Association between Locomotive Syndrome and Hearing Loss in Community-Dwelling Adults 査読有り国際誌 Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Ishizuka, S; Takegami, Y; Yoshida, T; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE 12 巻 ( 17 ) 2023年9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

The relationship between hearing and motor function as a function of aging is unclear. Therefore, we aimed to clarify the relationship between age-related hearing loss and locomotive syndrome. In total, 240 participants aged ≥40 years, whose hearing acuity and motor function had been measured, were included in this study. Patients with a hearing acuity of <35 dB and ≥35 dB were categorized into normal and low hearing acuity groups, respectively. Motor function was compared according to sex between the groups. Among men, those in the low hearing acuity group (51/100) were older, had a significantly slower walking speed, and had a higher prevalence of locomotive syndrome than those in the normal group. Among women, those in the low hearing group (14/140) were older and had a significantly slower gait speed than those in the normal group. The multivariate analysis showed that, in the low hearing acuity group, age and gait speed were risk factors in men, while age was the only risk factor in women. In conclusion, hearing loss was associated with walking speed. The association between hearing loss and locomotive syndrome was observed only in men. In the multivariate analysis, hearing loss was associated with walking speed only in men.

DOI： 10.3390/jcm12175626

骨粗鬆症患者の上腕骨近位端骨折においてDeltopectoral approachは術後骨頭壊死のリスクを上昇させる多施設共同研究(TRON study) 査読有り

平松泰, 竹上靖彦, 徳武克浩, 松浦唯, 牧原康一郎, 今釜史郎

日本骨粗鬆症学会雑誌 9 巻 ( Suppl.1 ) 頁： 436 - 436 2023年9月

Clinical comparison of double-plate fixation by the perpendicular plate method versus parallel plate method for distal humeral fracture: a multicenter (TRON group) study 査読有り国際誌

Yokoyama, H; Takegami, Y; Tokutake, K; Oshika, Y; Iwase, K; Tanaka, K; Kanemura, T; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 33 巻 ( 6 ) 頁： 2427 - 2433 2023年8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

Introduction: Double-plating methods are popular, with perpendicular and parallel plate methods being widely used surgical method for the rigid fixation of distal humeral fracture (DHF). However, which plate method is better for DHF remains controversial. The aim of this study was to compare patient outcomes including the incidences of complications and reoperation between the two plate methods. Methods: We extracted 383 patients with DHF undergoing surgery between 2011 and 2020 from our multicenter database, which is named TRON. We divided the subjects into two groups: perpendicular plating group (Group A) and parallel plating group (Group B). To adjust for baseline differences between the groups, patients were matched for age, sex, olecranon osteotomy, AO type, and type of injury. We assessed the Mayo Elbow Performance Score (MEPS) at 3 and 6 months and the last follow-up month as the clinical outcome. We investigated the incidences of complications and reoperations in both groups. Results: After matching, each group comprised 50 patients. There was no significant difference between Group A versus Group B in MEPS score at each time point. The incidence of implant removal in Group B was higher than that in Group A (26.5% vs 50%, p = 0.023). Discussion: Although there were no significant differences in clinical outcomes or complications between the two groups, the incidence of implant removal was higher in Group B than in Group A. In the parallel plate technique, where the plates have to be placed in areas with thin subcutaneous soft tissue, the incidence of implant removal might be high due to the discomfort caused by the implant.

DOI： 10.1007/s00590-022-03462-1

A less invasive operative method using a medial cannulated cancellous screw and single plate fixation for the treatment of transcondylar fracture of the humerus in elderly patients in multicenter (TRON group) study 査読有り国際誌

Tanaka, K; Takegami, Y; Tokutake, K; Oshika, Y; Iwase, K; Yokoyama, H; Taguchi, K; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 33 巻 ( 6 ) 頁： 2481 - 2487 2023年8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: Double plate fixation for transcondylar fracture (TCF) tends to be more invasive to the soft tissue, and often carries a higher risk of postoperative complications, including ulnar nerve neuropathy. This study presents the outcomes of TCF of the distal humerus between patients treated with a single plate and cannulated cancellous screw fixation and patients treated with double plate fixation. Methods: Between 2011 and 2021, 371 cases involving treatment of distal humeral fracture were recorded in our multicenter (named TRON group) database. Patients of ≥ 65 years of age with TCF treated with opeb n reduction and internal fixation were included. Clinical outcomes were assessed by the Mayo elbow performance score, range of motion, and total elbow arc joint. Complications included fracture-related infection (FRI) and ulnar neuropathy. Results: There were significant differences in the average operative time (CCS group vs. Plate group: 119.0 min vs. 186.5 min; p < 0.001) and average tourniquet time (CCS group vs. Plate group: 91.5 min vs. 121.0 min; p < 0.001). FRI occurred as a complication in the Plate group (n = 6). The rates of FRI did not differ to a statistically significant extent (CCS group vs. Plate group: 0% vs. 9.2%; p = 0.477). No patients underwent reoperation. The rate of sensory symptoms in the Plate group was higher than that in the CCS group (CCS group: none [n = 25], numbness [n = 1] vs. Plate group: none [n = 57], numbness [n = 15], sensory depression [n = 2]; p = 0.039). Discussion: Among patients of ≥ 65 years of age with TCF, the clinical outcomes of patients treated with medial CCS and lateral/posterolateral plate did not differ from those of patients who received double plate fixation, and the former treatment was associated with significantly fewer complications, including ulnar nerve palsy. In addition to double plate fixation, this less invasive method of medial CCS and single plate fixation should be considered as a treatment option for TCF in elderly patients.

DOI： 10.1007/s00590-022-03464-z

Retrospective multicenter (TRON group) study of humeral shaft fragility fractures Analysis of mortality rates and risk factors 査読有り国際誌 Open Access

Sato, K; Takegami, Y; Tokutake, K; Shimamoto, Y; Ueno, H; Ando, T; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 54 巻 ( 8 ) 頁： 110855 - 110855 2023年8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

Aims: This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF. Methods: From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality. Results: In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013). Conclusion: The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status.

DOI： 10.1016/j.injury.2023.110855

Predictors of postoperative complications of tension band wiring techniques for patella fracture: A retrospective multicenter (TRON group) study 査読有り国際誌

Oyama, H; Takegami, Y; Tokutake, K; Murase, F; Arakawa, O; Oguchi, T; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 54 巻 ( 8 ) 頁： 110896 - 110896 2023年8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

Objective: The relationship between postoperative complications and operative techniques of tension band wiring (TBW) is not well studied. We aimed to evaluate the incidence of implant breakage, implant migration, and loss of reduction in patellar fractures treated with TBW and identify radiographic factors associated with these postoperative complications. Methods: This multicenter (named, TRON group) retrospective study included 224 patients who underwent open reduction and internal fixation of patella fractures using TBW from January 2016 to December 2020. Radiographic findings were evaluated by experienced orthopedic surgeons, and radiographic outcomes were assessed for K-wire migration, implant breakage, and loss of reduction. Logistic regression analysis was performed to identify radiographic factors associated with postoperative complications. Results: Implant migration occurred in 44 cases (19.6%), with bending of a single K-wire end identified as a significant risk factor (OR: 12.90; 95% CI: 4.99–33.30; P < 0.001). Implant breakage occurred in 43 cases (19.2%), with a large patella-tension band ratio (OR: 291.0; 95% CI: 19.60–4330; P < 0.001) and a wide distance between K-wires (OR: 1.15; 95% CI: 1.060–1.250; P = 0.001) identified as significant risk factors. Loss of reduction occurred in 5 cases (2.0%), but no significant risk factors were identified. Conclusion: This study highlights the importance of bending both ends of the K-wires and proper placement of the tension band and K-wires in reducing postoperative complications in patellar fractures treated with TBW. Further research is needed to better understand the risk factors associated with loss of reduction.

DOI： 10.1016/j.injury.2023.110896

Comparison of functional outcome and complications of locking plate versus coracoclavicular fixation in the treatment of unstable distal clavicle fractures: the multicenter, propensity-matched TRON study 査読有り国際誌

Katayama, Y; Takegami, Y; Tokutake, K; Okui, N; Sakai, T; Takahashi, H; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 33 巻 ( 5 ) 頁： 1789 - 1795 2023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

Purpose: This multicenter, retrospective study aimed to compare clinical outcomes and complications between locking plate fixation and new coracoclavicular (CC) fixation for patients with unstable distal clavicle fracture. Methods: We included 142 patients in this TRON study. The mean follow-up was 15.5 (6–31) months. The patients were divided into two groups: the locking plate group (Group L) and CC fixation group (Group C). To adjust for baseline differences between the groups, a propensity score algorithm was used to match two groups in a 1:1 ratio. After matching, we compared operation time and the University of California Los Angeles (UCLA) shoulder score at 3 and 6 months postoperatively and at last follow-up as clinical outcomes and the rate of complications. Results: After matching, 20 cases from each group remained. Operation time was shorter in Group C (75 [22, 111] vs. 100 [38, 120] min; P = 0.023). At 3 months postoperatively, UCLA score in Group C was better, but no significant differences between the groups were found at 6 months and last follow-up after surgery. The rate of complications was not significantly different between the groups. Conclusion: CC fixation might be equivalent to locking plate fixation in clinical outcome, and the operation time is shorter than that required for locking plate fixation.

DOI： 10.1007/s00590-022-03358-0

Spinopelvic Imbalance Is Associated With Increased Sway in the Center of Gravity: Validation of the "Cone of Economy" Concept in Healthy Subjects 査読有り国際誌 Open Access

Segi, N; Nakashima, H; Ando, K; Kobayashi, K; Seki, T; Ishizuka, S; Takegami, Y; Machino, M; Ito, S; Koshimizu, H; Tomita, H; Hasegawa, Y; Imagama, S

GLOBAL SPINE JOURNAL 13 巻 ( 6 ) 頁： 1502 - 1508 2023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：Global Spine Journal

Study Design: Cross-sectional study. Objectives: To investigate the effects of pelvic compensation on standing balance in healthy volunteers. Methods: The 180 healthy volunteers were recruited at a basic health checkup. The inclusion criteria were: 1) age ≥ 65 years, 2) underwent a whole spine radiograph and stabilometry, 3) well-balanced standing posture with a sagittal vertical axis <50 mm, and 4) a visual analog scale of lower back pain of <20 mm. Based on the pelvic incidence (PI) and lumbar lordosis (LL) mismatch, subjects were divided into harmonious (PI–LL ≤ 10°) or unharmonious (PI–LL > 10°) groups. Results: Participants in the unharmonious group were significantly older compared with the harmonious group (70.2 ± 4.4 vs. 72.0 ± 4.6 years, P <.01). The PI minus LL values were −2.2° ± 7.5° and 16.6° ± 7.0° in the harmonious and unharmonious groups, respectively (P <.001). Anteroposterior LNG/TIME (average center of pressure sway speed) was significantly greater in the unharmonious group with both open and closed eyes (1.04 ± 0.38 cm/s vs. 1.25 ± 0.47 cm/s, P <.001 and 1.22 ± 0.54 cm/s vs. 1.58 ± 0.77 cm/s, P <.001, respectively). Lateral LNG/TIME was significantly greater in the unharmonious group only with closed eyes (1.24 ± 0.54 cm/s vs. 1.47 ± 0.79 cm/s, P =.03). Conclusions: Healthy elderly subjects with poor spinopelvic harmony had relatively unstable standing balance. The “cone of economy” was demonstrated, showing that unharmonious spinopelvic balance had a non-economic effect on standing.

DOI： 10.1177/21925682211038897

What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study 査読有り国際誌 Open Access

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

INDIAN JOURNAL OF ORTHOPAEDICS 57 巻 ( 7 ) 頁： 1076 - 1082 2023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：Indian Journal of Orthopaedics

Purpose: Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. Methods: We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. Results: We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10 mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5 mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Conclusion: Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery.

DOI： 10.1007/s43465-023-00888-5

Incidence and Risk Factors for Fracture-Related Infection After Peri-Prosthetic Femoral Fractures: A Multicenter Retrospective Study (TRON Group Study) 査読有り国際誌

Matsuno, Y; Takegami, Y; Tokutake, K; Takami, H; Kurokawa, H; Iwata, M; Terasawa, S; Yamauchi, KI; Imagama, S

SURGICAL INFECTIONS 24 巻 ( 5 ) 頁： 433 - 439 2023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：Surgical Infections

Background: Fracture-related infection (FRI) sometimes occurs with peri-prosthetic femoral fracture (PPF) treatment. Fracture-related infection often leads to multiple re-operations, possible non-union, a decreased clinical function, and long-term antibiotic treatment. In this multicenter study, we aimed to clarify the incidence of FRI, the causative organisms of wound infection, and the risk factors associated with post-operative infection for PPF. Patients and Methods: Among 197 patients diagnosed with peri-prosthetic femoral fracture who received surgical treatment in 11 institutions (named the TRON group) from 2010 to 2019, 163 patients were included as subjects. Thirty-four patients were excluded because of insufficient follow-up (less than six months) or data loss. We extracted the following risk factors for FRI: gender, body mass index, smoking history, diabetes mellitus, chronic hepatitis, rheumatoid arthritis, dialysis, history of osteoporosis treatment, injury mechanism (high- or low-energy), Vancouver type, and operative information (waiting period for surgery, operation time, amount of blood loss, and surgical procedure). We conducted a logistic regression analysis to investigate the risk factors for FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Results: Fracture-related infection occurred after surgery for PPF in 12 of 163 patients (7.3%). The most common causative organism was Staphylococcus aureus (n = 7). The univariable analysis showed differences for dialysis (p = 0.001), Vancouver type (p = 0.036), blood loss during surgery (p = 0.001), and operative time (p = 0.001). The multivariable logistic-regression analysis revealed that the patient background factor of dialysis (odds ratio [OR], 22.9; p = 0.0005), and the operative factor of Vancouver type A fracture (OR, 0.039-1.18; p = 0.018-0.19) were risk factors for FRI. Conclusions: The rate of post-operative wound infection in patients with a PPF was 7.3%. Staphylococcus was the most frequent causative organism. The surgeon should pay attention to infection after surgery for patients with Vancouver type A fractures and those undergoing dialysis.

DOI： 10.1089/sur.2022.347

Comparison of surgical treatments for distal ulna fracture when combined with anterior locking plate fixation of distal radius in the over 70 age group 査読有り国際誌

Shibata, R; Tokutake, K; Takegami, Y; Natsume, T; Matsubara, Y; Imagama, S

JOURNAL OF HAND SURGERY-EUROPEAN VOLUME 48 巻 ( 6 ) 頁： 516 - 523 2023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：Journal of Hand Surgery: European Volume

We conducted a retrospective multicentre study to compare the clinical and radiographic outcomes, and complications of three surgical treatments of distal ulna fracture (DUF) when combined with anterior locking plate fixation for distal radial fracture (DRF) in patients over 70 years of age. We identified 1521 patients over 70 years of age who were diagnosed as having DRF and who underwent anterior locking plate fixation between 2015 and 2020, among which 122 cases of DUF were analysed. Three surgical treatment options for DUF were identified in this cohort: K-wire fixation (Group K), locking plate fixation (Group L) and Darrach procedure (Group D). The results of the analysis showed the total immobilization period in Group D to be the shortest among the three treatments. Functional outcomes were superior, and the rate of complications were smaller in Group D than in Group L. In addition, rotational range of motion was larger in Group D and Group L compared with Group K. In patients who are 70 years of age or older with combined unstable DRF and highly comminuted or displaced DUF, the Darrach procedure for DUF seems to be the most useful and reasonable treatment option once the fracture of the distal radius has been rigidly fixed. Level of evidence: IV.

DOI： 10.1177/17531934221150495

Factors affecting return to sports after eccentric rotational acetabular osteotomy 査読有り国際誌 Open Access

Osawa, Y; Seki, T; Takegami, Y; Makida, K; Ochiai, S; Hasegawa, Y; Imagama, S

ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH 109 巻 ( 4 ) 頁： 103442 - 103442 2023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：Orthopaedics and Traumatology: Surgery and Research

Background: Although eccentric acetabular rotation osteotomy (ERAO) is an effective treatment for developmental dysplasia of the hip (DDH), there is little information about return to sports after ERAO. This study aimed to investigate 1) the patient factors that influence the return to sports after ERAO, 2) whether postoperative sports participation will affect future osteoarthritis progression. Hypothesis: Some factors affect the return to sports after ERAO. Patients and methods: Of 503 patients who underwent ERAO from 1990 to 2010, 124 who had been continuously participating in sports preoperatively (average 13.2 years after surgery) were included. Patient demographics of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative Kellgren-Lawrence (KL) grade, center edge angle, joint congruency, Harris hip score, complications and the survival rate were compared between the S group (patients who participated in the same sports preoperatively) and N group (patients who could not participate in sports postoperatively). Results: Seventy-two (58%) and 52 patients (42%) in the S and N groups, respectively, had an overall return to sports rate of 64% (79 patients). The most common sports that patients participated in were swimming (30 patients [24%]), jogging (12 [10%]), and golf (10 [8%]) preoperatively, and swimming (14 patients [11%]), golf (8 [6%]), and jogging (8 [6%]) postoperatively. There were no significant differences between both groups in terms of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative KL grade, and joint congruency. There was a significant difference in patient factors between the S (11 joints [14%]) and N (20 joints [38%]) groups only when the preoperative center edge angle was < 0°. There was no significant difference in the preoperative Harris hip score and the final survey between the S (73.2 ± 4.6 and 93.4 ± 7.2) and N (72.5 ± 4.8 and 92.1 ± 7.4) groups. Complications showed no significant differences between the five patients (7%) in the S group and six patients (13%) in the N group. The KL grade progressed in 10 cases (grade II to III in 2 cases and grade III to IV in 8) in the S group and 8 cases (grade II to III in 1 case and grade III to IV in 7 cases) in the N group. The 10-year and 20-year joint survival rates with THA conversion as the endpoint were 98.1% (95% CI: 87.4%–99.7%) and 83.7% (95% CI: 62.6%–93.4%) in the S group and 100% (95% CI: 70.7%–99.3%) and 95.2% (95% CI: 12.6%–92.6%) in the N group, respectively. In the evaluation of factors affecting sports return by logistic regression analysis, only one significant factor (odds ratio 3.42, 95% confidence interval: 1.58–7.42, p < 0.01) was the preoperative center edge angle < 0°. Discussion: The chief factor affecting the return to sports after surgery was a preoperative center edge angle < 0°; moreover, the continuation of sports did not affect the subsequent progression of osteoarthritis or THA conversion. Level of evidence: level III, cohort study.

DOI： 10.1016/j.otsr.2022.103442

Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study 査読有り Open Access

Bando, K; Takegami, Y; Ando, T; Sugino, T; Sato, T; Fujita, T; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE 28 巻 ( 3 ) 頁： 651 - 655 2023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: Open reduction and internal fixation (ORIF) for unstable ankle fractures (AF) are relatively predictable with excellent outcomes. Rehabilitation strategies are still being debated after surgical intervention for AF: non-weight bearing and cast immobilization for six weeks after the surgical repair of unstable AF or early functional treatment with partial weight bearing. This study aimed to compare early weight bearing and functional outcomes and complications. Methods: Between April 2014 and March 2019, 1421 patients with AF underwent ORIF at 11 institutions (TRON group). The patients were divided into two groups: Group E started weight bearing within six weeks after surgery, and group L started weightbearing for more than six weeks after. To adjust for baseline difference between groups, a propensity score-matched algorithm was used to match Group E with Group L in a 1:1 ratio of 294 cases each. We compared the American Orthopedic Foot and Ankle Society (AOFAS) score as the functional outcome, the rate of wound dehiscence, superficial and deep infections, blistering, nonunion, neurapraxia, and reoperation at 3, 6, and 12 months after surgery. Results: The mean period of non-weight bearing was significantly shorter in group E (3.68 ± 1.02 vs. 6.67 ± 1.43; P < 0.001). The mean period of cast immobilization term were shorter in group E (1.84 ± 1.35 vs. 2.65 ± 1.51; P < 0.001). There were no differences in the AOFAS score at any period. The rates of deep infection and reoperation in Group E were significantly lower than those in Group L (1.7% vs. 6.1%; P = 0.009, 2.0% vs. 7.8%; P = 0.002, respectively). There were no significant differences in superficial infection (9 vs. 15; P = 0.297), nonunion (9 vs. 15 P = 0.30), blistering (4 vs. 3; P = 1.00), neurapraxia (2 vs. 1; P = 1.00), and wound dehiscence (15 vs. 18; P = 0.72). Conclusions: Although functional outcome was similar depending on whether early weight bearing was allowed, the rates of deep infection and reoperation decreased in patients with early weight bearing. We recommend early postoperative weight bearing in patients with a surgically treated AF.

DOI： 10.1016/j.jos.2022.03.002

Low body mass index is a risk factor for increased post-operative mortality and poor functional improvement in distal femur fractures among patients aged over 65: A multicentre (TRON) study 査読有り Open Access

Kuwahara, Y; Takegami, Y; Tokutake, K; Yamada, Y; Komaki, K; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE 28 巻 ( 3 ) 頁： 631 - 636 2023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: Distal femur fractures have been reported to have a mortality rate comparable to hip fractures, but the risk is still unknown. Recent studies have reported that low body mass index (BMI) is a risk factor for mortality in the elderly. We investigated the efficacy of low BMI for predicting the risk of mortality in distal femur fractures in patients aged over 65 within 18 months after injury and its impact on postoperative clinical outcomes and mortality. Methods: Data from patients followed for more than six months were obtained from our trauma research group's database. We investigated risk factors for increased mortality using Cox proportional hazards models. We divided the analysed cases into low (<18.5 kg/m2) and high (>18.5 kg/m2) BMI groups. We adjusted the background characteristics of the groups by patient matching, and evaluated the postoperative mortality, complication rate, and knee society score (KSS). Results: We identified 216 patients, including 58 (26.9%) with low BMI values. Low BMI was an independent risk factor for mortality in all models (Hazard Ratio: 2.9, p = 0.011). The overall survival rate of the low BMI group at 18 months was significantly lower than that of the high BMI group (70.7% vs. 89.1%; p = 0.003). The complication rates of the low BMI and high BMI groups were not significantly different (33.3% vs. 22.2%; p = 0.283). The mean KSS values at 3, 6, and 12 months in the low BMI group was significantly worse than that in the high BMI group (78.7 ± 16.2 vs. 84.8 ± 13.1; p = 0.035, 82.2 ± 16.9 vs. 89.7 ± 8.9; p = 0.005, 86.4 ± 13.0 vs. 91.4 ± 8.4; p = 0.020, respectively). Conclusions: Our study indicated that low BMI was independent associated with increased mortality and impaired postoperative functional recovery in distal femur fractures of the elderly patients.

DOI： 10.1016/j.jos.2022.01.014

Factors affecting sports participation after total hip arthroplasty 査読有り国際誌

Osawa, Y; Seki, T; Takegami, Y; Kato, D; Takemoto, G; Imagama, S

INTERNATIONAL ORTHOPAEDICS 47 巻 ( 5 ) 頁： 1181 - 1187 2023年5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：International Orthopaedics

Purpose: The purpose of this study was to investigate the rate of return to sports after total hip arthroplasty (THA) in patients who regularly participate in sports and evaluate the factors that can affect the return to sports. Methods: In total, 165 patients who had been continuously participating in sports prior to surgery were included from a total of 401 patients who underwent THA from 2015 to 2018. The mean follow-up was 3.3 (range, 2–6) years. Demographics, medical history, surgical parameters, functional outcomes, and anxiety about complications at the final follow-up were compared between the patients who participated in the same sports as before surgery (S group) and those who could not (N group). Results: The overall return to sports rate was 79% for 68 (41%) and 97 (59%) patients in the S and N groups, respectively. The most common sports that patients participated in post-operatively were walking (76 patients, 46%) and swimming (37 patients, 22%), followed by muscle training (25 patients, 15%). There were significant differences between the groups in the following patient factors: sex, primary disease, post-operative Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire outcome, and anxiety about falls and dislocation. In the evaluation of factors affecting return to sports using logistic regression analysis, male sex (odds ratio 3.66, 95% confidence interval 1.13–11.19, p = 0.029) and anxiety of dislocation (odds ratio 3.42, 95% confidence interval 1.58–7.42, p < 0.01) were extracted as independent risk factors. Conclusion: Careful patient guidance and rehabilitation, in addition to accurate surgical procedures, will improve patient participation in sports.

DOI： 10.1007/s00264-023-05724-x

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