Language：English   Publisher：Neuroscience  

Respiratory muscle paralysis due to trauma or neurodegenerative diseases can have devastating consequences. Only a few studies have investigated the reconstruction of motor function in denervated diaphragms caused by such conditions. Here, we studied the efficacy of transplanting E14 embryonic spinal motor neurons (SMNs) into peripheral nerve grafts for functionally reconstructing a denervated diaphragm in a rat model. The diaphragms of 8-week-old male Fischer 344 rats were first denervated by transecting the phrenic nerves. Subsequently, peripheral nerve grafts taken from the lower limb were used for neurotization of the denervated diaphragms. One week later, fetal E14 SMNs were transplanted into the peripheral nerve grafts. After 3 months, we observed functional contraction of the diaphragm following neuromuscular electrical stimulation (NMES) of the peripheral nerve graft. Additionally, we confirmed that SMN transplantation into the peripheral nerve graft had an inhibitory effect on diaphragm muscle atrophy. The SMNs transplanted into the peripheral nerve grafts formed a structure similar to the spinal cord, and the neuromuscular junction of the denervated diaphragm was reinnervated. These findings suggest the establishment of an ectopic motor neuron pool in the peripheral nerve graft. Free peripheral intra-nerve SMN transplantation in combination with NMES, which can be applied for diaphragmatic pacing, offers novel insights into the development of neuroregenerative therapies for treating life-threatening and intractable respiratory muscle paralysis caused by severe nerve damage and degenerative diseases.

DOI： 10.1016/j.neuroscience.2024.08.039

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DOI： 10.1016/j.jos.2024.09.003

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DOI： 10.1016/j.jos.2024.09.002

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Language：English   Publisher：European Journal of Trauma and Emergency Surgery  

Background: With the rise in elderly populations, the incidence of femoral trochanteric fractures has also increased. Although intramedullary nail therapy is commonly used, the incidence of peri-implant fractures (PIFs) as a complication and its associated factors are not fully understood. The purpose of this study was to determine the incidence of PIFs and treatment strategies and outcomes. Methods: A retrospective study across 11 hospitals from 2016 to 2020 examined 1855 patients with femoral trochanter fracture. After excluding 69 patients treated without intramedullary nailing, 1786 patients were analyzed. Parameters studied included age, sex, body mass index, medical history, and treatment methods. PIFs were categorized using the Chan classification. Treatment outcomes and patient mobility were assessed using the Parker Mobility Score, and postoperative complications and one-year survival data were compiled. Results: The incidence of PIFs was 8 in 1786 cases. Chan classification showed 1 case of N1A, 6 of N2A, and 1 of N2B. Only the type N1 case was a transverse fracture, whereas all cases of type N2 were oblique fractures. Among these cases, five patients had fractures extending to the upper part of the femoral condyle. The patient with N1A and one bedridden patient with N2A fracture underwent conservative treatment, one patient with N2A in which the fracture did not extend to the condyle was treated with nail replacement, and 5 patients (N2A: 4, N2B: 1) with fractures extending to the condyle were treated with additional plate fixation. All patients had survived at one year after treatment for PIF, and no reoperations were required. Conclusions: The incidence of PIF was very low (0.45%). Of the 6 PIF cases, excluding the bedridden patients, the treatment of choice for PIF was an additional plate if the fracture line extended to the femoral condyle; otherwise, the nail was replaced. All patients achieved bony fusion. Level of evidence: Therapeutic Level IV.

DOI： 10.1007/s00068-024-02567-y

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DOI： 10.1177/17585732221131923

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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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

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Language：English   Publisher：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

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Language：English   Publisher：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

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INTRODUCTION: This study aimed to investigate the survival rate, postoperative complications, and walking ability in cemented hemiarthroplasty (HA) for displaced femoral neck fractures according to the anaesthesia method. METHODS: We conducted a retrospective study of a multicentre group (the TRON group). Three hundred fifty-eight patients who underwent cemented HA between 2015 and 2019 were selected; 289 patients of ≥75 years of age with no missing data were included. Patient background factors were matched and patients were assigned to spinal anaesthesia (SA) and general anaesthesia (GA) groups. The primary outcome was death at any time during the follow-up period. Secondary outcomes included postoperative complications and walking ability assessed using the Parker mobility score (PMS). Overall survival was evaluated using the Kaplan-Meier method, and differences were compared using the log-rank test. The incidence of each complication and PMS were compared between the two groups using Fisher's exact test. RESULTS: Overall survival during follow-up was significantly higher in the SA group in comparison to the GA group (p = 0.037). In the SA and GA groups, the survival rate at 3 months postoperatively was 98.4% and 95.5%, respectively. The incidence of postoperative pneumonia was significantly higher in the GA (p = 0.012), and PMS at 3 months postoperatively was significantly higher in the SA group (p = 0.016). CONCLUSION: The survival rate of elderly patients who underwent cemented HA was better in the SA group. General anaesthesia in cemented HA may be associated with lower life expectancy, increased incidence of pneumonia, and decreased walking ability.

DOI： 10.1016/j.jos.2023.02.005

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Calcaneus fractures Sanders type II have been historically treated with various modalities. However, few studies compared these procedures directly. The multicenter (TRON group) retrospective study compared the radiographic and clinical outcomes of operative procedures using Kirschner wires (K-wires), cannulated cancellous screws (CCSs) and plates. Between 2014 and 2020, 121 patients with Sanders type II calcaneus fractures were surgically treated in our group using K-wire (Group K: n = 31), CCS (Group C: n = 60) or plate (Group p: n = 30) fixation. We assessed the American Orthopedic Foot and Ankle Society (AOFAS) score and infection after operation as clinical outcomes and Böhler's and Preiss' angles as radiographic outcomes. The AOFAS scores of the 3 groups showed a significant difference, with Group P showing significantly inferior scores to Group C at 6 months postoperatively and at the final follow-up examination (p = .015 and p < .001, respectively). The rate of infection did not differ to a statistically significant extent, but the incidence in Group P tended to be higher in comparison to the other groups. Among the three groups, Böhler's angle did not differ to a statistically significant extent immediately after the operation (p = .113) or at the final follow-up examination (p = .383). Postoperatively, Preiss' angle did not differ to a statistically significant extent (p = .251) but was significantly smaller in the Group C at the final follow-up examination (p = .0331). In Sanders type II calcaneus fracture, CCS fixation may obtain the best functional outcomes.

DOI： 10.1053/j.jfas.2023.10.002

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INTRODUCTION: Femoral neck fracture (FNF) is among the most common and devastating injuries that orthopedic surgeons encounter. However, the incidence of FNF is lower in younger adults than in elderly individuals. In elderly FNF patients, early weight bearing (EWB) is preferred to prevent loss of function and decreased activity. In younger adults, some surgeons decide on delayed-weight bearing (DWB) after surgery because EWB may cause femoral neck shortening. We aimed to compare the postoperative results (clinical outcome, radiological evaluation, and complications) of EWB and DWB after FNF surgery in younger adults. METHODS: The study included 151 younger adults (age: ≤65 years at injury; nondisplaced, n = 100; displaced, n = 51) who underwent internal fixation at 11 university-affiliated hospitals in 2016-2020, and who were followed for ≥1 year. Patients were divided into the EWB (EWB in early postoperative period) and DWB (beginning weight bearing at 4 weeks after surgery) groups. The two groups were matched for age, and nondisplaced (EWB and DWB, both n = 24) and displaced (EWB and DWB, both n = 11) FNF were analyzed. The study items were age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), presence of diabetes, days waiting for surgery, fracture type, Parker mobility score (PMS) at last follow-up examination, pain (Numerical Rating Scale: NRS), radiological evaluation (femoral neck shortening, Canulated Cancellous screws (CCS) backout, and complications (nonunion, femoral head osteonecrosis). RESULTS: The patient backgrounds of the nondisplaced and displaced types did not differ. The PMS was significantly higher in the DWB group at the last follow-up examination (nondisplaced: 8.00±2.20 vs. 6.67±2.22, p = 0.005, displaced: 8.67±0.89 vs. 6.91±2.77, p<0.001). NRS and the amount of femoral neck shortening were significantly lower in the DWB group (nondisplaced: 1.65±0.70 mm vs. 3.94±3.03 mm, p<0.001, displaced: 4.26± 2.64 mm vs. 8.91±5.69 mm, p<0.001). CCS backout did not differ between the groups. One case of each of nonunion and femoral head osteonecrosis were observed in the displaced EWB and DWB groups; these differences were not significant. CONCLUSIONS: DWB after internal fixation for FNF in younger adults was associated with better outcomes than EWB.

DOI： 10.1016/j.injury.2023.111292

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BACKGROUND: This study aimed to assess differences in implant failure and bone union rates, amount of change in alignment of lower extremities, and walking ability between early weight-bearing (EWB) and late weight-bearing (LWB) groups following retrograde intramedullary nailing (RIMN) for distal femoral fracture (AO/OTA 33) (DFF) at multiple centers using propensity score matching. METHODS: The data of 213 patients who underwent RIMN from 2012 to 2019 in multiple tertiary hospitals were extracted from our database. Cases with the following factors were excluded: age <60, open fracture, AO/OTA-type 33-C3 fracture, preoperative New Mobility Score (NMS) < 3, postoperative follow-up <3 months, and unknown weight-bearing start time. Eighty-four patients were divided into the EWB and LWB groups. EWB group patients were encouraged to perform partial weight-bearing walking at ≤4 weeks after surgery. LWB group patients were not allowed weight bearing for >4 weeks after surgery. After propensity score matching was applied, 26 cases remained in each group. RESULTS: There were no cases of nail failure in either the EWB group or LWB group (P = 1). Screw failure occurred in 0 cases in the EWB group and in 1 case (4.5%) in the LWB group (P = 1.0). Non-union occurred in 5 patients (19.2%) in the EWB group and 4 patients (15.3%) in the LWB group (P = 1). The mean amount of change in lower extremities alignment did not differ between the two groups. The median Knee Society Score was 95.5 (59-100) vs. 93 (72-100) points (P = 0.39). The median NMS was 7 (0-9) vs. 7 (4-9) points (P = 0.82). CONCLUSIONS: There were no significant intergroup differences in the rates of implant failure, bone union at one year after surgery, amount of change in lower extremities alignment, or walking ability. We suggest that early weight bearing after RIMN for DFF may not be harmful in elderly people.

DOI： 10.1016/j.jos.2022.10.023

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BACKGROUND: Tibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. METHODS: This multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. RESULTS: LA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02-1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00-1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). CONCLUSIONS: Preoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF.

DOI： 10.1016/j.jos.2022.12.008

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BACKGROUND: Although home exercises are used for postoperative rehabilitation of distal radius fractures (DRF), the superiority of home exercise over supervised physiotherapy rehabilitation is controversial. This study aimed to compare the function of home exercise and supervised physiotherapy rehabilitation during postoperative rehabilitation for DRF. METHODS: We conducted a multicenter, retrospective study in which we included 1949 patients over 65 years old who underwent volar locking plate fixation for DRF. After propensity score matching, 308 patients were assigned to each of an independent home exercise group (IHG) and supervised physiotherapy group (SPG). Wrist function was assessed after 3, 6, and 12 months postoperatively. RESULTS: The results showed that the Mayo Wrist Score did not differ significantly within the observation period. Range of motion of the wrist was better in the SPG up to 3 months postoperatively but was almost the same as that in the IHG at 6 months. However, the Numerical Rating Scale score was lower in the IHG during all observation periods. CONCLUSIONS: Home exercise may be as effective as supervised physiotherapy in the medium term, but supervised physiotherapy rehabilitation should be considered if early recovery and good wrist function are desired.

DOI： 10.1016/j.jos.2022.11.017

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BACKGROUND: Periprosthetic femoral fracture (PFF) after total hip arthroplasty (THA) or bipolar hip arthroplasty (BHA) represents a challenging situation and the treatment is associated with high rates of complications and mortality. The aims of this multicenter retrospective study were to determine 1-year mortality and to identify predictors associated with mortality, including patient characteristics and surgical factors, in patients undergoing surgery for PFF after THA or BHA. METHODS: We collected 249 cases of PPF after THA or BHA that were treated in our 11 hospitals (named the TRON group) between January 2010 and December 2019. We excluded patients who were conservatively treated, cases in which the 1-year postoperative outcome was unknown, and Vancouver type A cases. Finally, we analyzed 161 patients. Univariate and multivariate Cox regression analyses were performed to identify factors affecting 1-year mortality. Patient-side factors such as age, BMI, fracture type, and preoperative mobility, and surgical factors such as surgical procedure, time to surgery, and operation time were analyzed respectively. RESULTS: Eighteen of 161 patients (11.2%) died one year after surgery. The multivariate Cox regression analysis identified older age, wheelchair status before injury, and operation time as independent predictors of 1-year mortality (older age: hazard ratio [HR] 1.07, 95% CI 1.01-1.15, P = 0.048; wheelchair status: HR 5.82, 95% CI 1.01-33.47, P = 0.049; operation time: [HR] 1.01, 95% CI 1.00-1.01, P = 0.00929). Meanwhile, fracture type according to the Vancouver classification, body mass index, presence of previous fragility fractures, type of fixation, blood loss during operation, and time to surgery were not independent predictors of 1-year mortality in this analysis. ConclusionThe 1-year mortality rate after surgery for PPFs patients was 11.2%. Factors associated with older and poor activity of daily living (ADL) performance (e.g., wheelchair status before injury), and longer operative time were associated with 1-year mortality after surgery for PPF. Surgeons should carefully plan treatment according to each patient's condition.

DOI： 10.1016/j.jos.2022.12.015

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OBJECTIVE: This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis. METHODS: Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared. RESULTS: The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so. CONCLUSIONS: Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs. LEVEL OF EVIDENCE IV: Multicenter retrospective study.

DOI： 10.1007/s00590-023-03679-8

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BACKGROUND: The surgical treatment of periprosthetic femoral fracture (PFF) can be technically demanding and it is associated with high rates of complications and repeat surgery. However, repeat surgery is uncommon and few studies have examined survival and the functional prognosis following reoperation after the surgical treatment of PFF. We aimed to estimate the rate of reoperation for any reason, to determine the survival rate after reoperation for PFF, and to identify predictors associated with reoperation after PFF surgery in a multicenter (TRON group) study. METHODS: Two hundred forty-six patients were admitted for treatment of PFF. After excluding patients managed conservatively and those with Vancouver type A fracture, we analyzed 184 patients. Unadjusted risk ratios (RRs) were calculated, and multiple logistic regression was used to calculate adjusted RRs. We used the Kaplan-Meier method to create survival curves and a log-rank test to determine survival from the date of repeat surgery. RESULTS: Fifteen of the 184 patients (8.2 %) underwent reoperation after PFF surgery. The 1-year survival rate after reoperation for PFF was 66.7 % (11 of 15). Vancouver B3 and Vancouver C were identified as independent risk factors for reoperation after PFF surgery (Vancouver B3: Risk ratio [RR] 19.0, 95 % CI 1.10-329 P < 0.001; Vancouver C: RR 13.3, 95 % CI 1.4-123.0, P = 0.023). CONCLUSION: The reoperation rate after PFF surgery and the mortality after reoperation PFF surgery were relatively high. The fracture type is associated with reoperation after PFF surgery.

DOI： 10.1016/j.jos.2023.11.016

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PURPOSE: Tension band wiring is the standard treatment for olecranon fractures, but it is associated with high rate of implant-related complication. To reduce this high complication rate, we developed a modified technique, locked tension band wiring (LTBW). The aim of this study was to investigate whether LTBW reduces complication and reoperation rates compared to conventional methods (CTBW). METHODS: We identified 213 olecranon fractures treated with tension band wiring: 183 were treated with CTBW, and 30 were treated with LTBW, and patients in each group were selected using propensity score matching. We evaluated operation time, intraoperative bleeding, complication and reoperation rates, the amount of Kirschner's wire (K-wire) back-out, and Mayo Elbow Performance Index (MEPI). Complications included nonunion, loss of fracture reduction, implant failure, infection, neurological impairment, heterotopic ossification, and implant irritation. Implant removal included at the patient's request with no symptoms. RESULTS: We finally investigated 29 patients in both groups. The mean operation time was significantly longer in the LTBW (106.7 ± 17.5 vs. 79.7 ± 21.1 min; p < 0.01). Complication rates were significantly lower in the LTBW than the CTBW group (10.3 vs. 37.9%; p = 0.03). The rate of implant irritation was more frequent in the CTBW, but there was no significant difference (3.4 vs. 20.7%; p = 0.10). Removal rate was significantly lower in the LTBW (41.4 vs. 72.4%; p = 0.03). The mean amount of K-wire backout at last follow-up was significantly less in the LTBW (3.79 ± 0.65 mm vs. 8.97 ± 3.54 mm; p < 0.01). There were no significant differences in mean MEPI at all follow-up periods (77.4 ± 9.0 vs. 71.5 ± 14.0; p = 0.07, 87.4 ± 7.2 vs. 85.2 ± 10.3; p = 0.40, 94.6 ± 5.8 vs. 90.4 ± 9.0; p = 0.06, respectively). CONCLUSION: Our modified TBW significantly increased operation time compared to conventional method, but reduced the complication and removal rate and had equivalent functional outcomes in this retrospective study.

DOI： 10.1007/s43465-023-01017-y

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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

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PURPOSE: When treating distal-third humerus shaft fractures (HSFs) surgically, the optimal approach for plating is controversial. We conducted a retrospective multicenter study to investigate and compare the clinical outcomes of anterior and posterior plating in distal-third HSFs and the incidence of complications including iatrogenic radial nerve palsy. METHODS: We identified 116 patients from our multicenter trauma database who were diagnosed as having distal-third HSFs and who underwent surgical treatment, including intramedullary nailing between 2011 and 2020. We analyzed 50 cases treated in one of two ways: open reduction internal fixation with anterior plating (group A: 20 cases) and open reduction internal fixation with posterior plating (group P: 30 cases). RESULTS: The findings were similar in terms of operation time, estimated bleeding, and clinical and radiographic outcomes between the groups. Postoperative radial nerve palsy occurred only in group P (4 cases) and never in group A. CONCLUSIONS: The results of this study suggest that the anterior approach is a safe and effective method for treating distal-third HSFs with satisfactory outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

DOI： 10.1016/j.jhsa.2023.07.014

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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

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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

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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

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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

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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

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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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-023-00888-5.

DOI： 10.1007/s43465-023-00888-5

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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

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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

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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

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Hook plate fixation and locking plate fixation are two standard internal fixation implants for treating distal clavicle fractures. We aimed to clarify the following: 1) Does the locking plate offer better clinical outcomes than the hook plate? 2) Is bone union better with a locking plate than hook plate? and 3) Are complications different between the locking plate and hook plate? We conducted a retrospective multicenter study of 338 patients who underwent surgery from 2014 to 2018 in our 10 hospitals, which comprise the TRON group. Of them, 208 patients treated using any plates were eligible. After 30 patients were excluded for various reasons, 178 patients were included. We classified them into two groups, locking plate group (Group L) and hook plate group (Group H), using propensity score matching. We confirmed bone union with an X-ray, evaluated the UCLA shoulder score, and compared the frequency of complications. After matching, Group L and Group H included 49 patients each. The UCLA score was higher in Group L than in Group H at each follow-up point. We confirmed bone union in all patients in Group L, but it was not confirmed in three patients (6.1%) in Group H. No statistically significant differences were observed except for plate migration, which was observed in nine patients (18.4%) in Group H but in no patients in Group L. The postoperative UCLA score was significantly better in Group L. We recommend the locking plate as a surgical treatment for distal clavicle fractures.

DOI： 10.18999/nagjms.85.2.223

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Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy. Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type ⅡA) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups. Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p < 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p < 0.001). Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort. Level of Evidence: Level III (Therapeutic).

DOI： 10.1142/S2424835523500224

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BACKGROUND: Intramedullary nailing using Kirschner wires in pediatric diaphyseal forearm fractures is often performed as a less invasive treatment than plate fixation, but it remains controversial whether the tips of Kirschner wires are buried or exposed. The purpose of this study was to investigate the relationship between whether the tips are buried or exposed and complications, especially of refracture. METHODS: Data of 405 patients under 16 years who underwent surgical treatment for diaphyseal forearm fractures in our 11 hospitals between 2010 and 2020 were collected. Finally, 143 patients who underwent intramedullary nailing with at least 6-month follow-up were analyzed. We investigated difference in complication rates depending on whether the Kirschner wire tips were buried (Group B: n = 79) or exposed (Group E: n = 64). Regarding refractures, we also examined time of onset and status of bone union before the refracture occurred. RESULTS: The duration before implant removal in Group B was more than 4 times longer than that in Group E (mean 187.9 vs. 41.4 days, p<0.001), although there was no significant difference in the progression of bone union between the two groups. Regarding postoperative complications, Group B had a significantly lower rate of refractures than Group E (7.9% vs. 32.8%, p<0.001), although the rate of irritation pain was significantly higher (15.2% vs. 1.6%, p = 0.006). The infection rate was also lower in Group B than Group E, but not significantly so (3.8% vs. 10.9%, p = 0.112). Refractures between 3 and 9 months after surgery accounted for 66.7% of all refractures, and those within 3 months accounted for 14.5% of all fractures. There was no significant difference in the status of bone union before the refracture occurred between patients with and without refracture. CONCLUSIONS: The present study showed that longer time of implantation using the buried pin technique for intramedullary nailing reduces refracture of pediatric diaphyseal forearm fractures. Because of the risk of refracture during remodeling, we recommend the implantation of intramedullary nailing for 6-9 months and the instruction for the patients and the parents to pay more attention to refracture at least within 9 months postoperatively. LEVEL OF EVIDENCE: Level Ⅲ, Multicenter retrospective study.

DOI： 10.1016/j.injury.2023.01.025

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Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015-2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic).

DOI： 10.1142/S2424835523500091

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INTRODUCTION: With the aging of the population, the proportion of distal radius fracture patients who are > 80 years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80 years) and middle-elderly (age: 65-79 years) who were treated with volar locking plate (VLP) fixation for distal radius fractures. PATIENTS AND METHODS: Patients of > 65 years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6 months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes. RESULTS: We identified 589 patients in this study; 452 were 65-79 years of age (Group A) and 137 were ≥ 80 years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6 months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6 months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively). CONCLUSION: Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.

DOI： 10.1007/s43465-022-00788-0

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AIMS: The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures. METHODS: A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype. RESULTS: The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype. CONCLUSION: Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible.Cite this article: Bone Jt Open 2023;4(1):38-46.

DOI： 10.1302/2633-1462.41.BJO-2022-0145.R1

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Language：Japanese   Publisher：Japan Elbow Society  

DOI： 10.24810/jelbow.30.2_402

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BACKGROUND: Postoperative protocols after surgical treatment of calcaneal fracture have not been standardized to date. There are only a few reports on the efficacy of heel-unloading orthoses (HUOs; Mars shoe, Graffin orthosis), and thier efficacy is uncertain. OBJECTIVES: The purpose of this study was to compare postoperative radiologic and clinical outcomes in patients with calcaneal fractures who used Graffin orthosis. STUDY DESIGN: Multicenter retrospective study. METHODS: We finally extracted 182 patients from a database of the Trauma Research Group of Nagoya and divided them into two groups: group C (underwent casting or splinting only) and group O (Graffin orthosis was used). A propensity score algorithm was used to match group C to group O in a 1:1 ratio. We evaluated American Orthopaedic Foot and Ankle Society (AOFAS) score at three and six months after surgery and at final follow-up. Differences in reduction of the Böhler angle between the two groups were evaluated radiographically. All data were analyzed with a t-test or Fisher's exact test. P < .05 was considered statistically significant. RESULTS: The AOFAS score 3 months after surgery in group O was significantly higher than that in group C (69.57 vs. 77.22; P = .004). However, there were no statistically significant differences between group C vs. group O in AOFAS scores at 6 months after surgery and at final follow-up (81.92 vs. 85.67 and 89.18 vs. 88.13; P = .087 and 0.597, respectively). There was no significant statistical difference in the reduction of the Böhler angle (5.07 vs. 5.89; P = .529). CONCLUSIONS: At 3 months postoperatively, the orthosis group showed predominantly better functional results. We believe that heel-unloading orthoses are useful for patients who require an early return to work and to daily life.

DOI： 10.1097/PXR.0000000000000168

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PURPOSE: This retrospective multicenter study aimed to compare rates of early mobilization and survival and functional outcome of surgical treatment (S) with that of conservative treatment (C) according to each unstable fragility fracture of the pelvis (FFP) classification type with displacement of the posterior component ≥ 5 mm. METHODS: We analyzed 64 patients with unstable type III and IV FFP who could move and transfer themselves before injury and had ≥ 5 mm displacement of the posterior component. We compared survival rate, early mobilization, walking ability at final follow-up, and complications at admission for each type of surgical and conservative treatment. RESULTS: Most of the unstable FFP were type IIIa and IVb in the study population. Type III comprised 40 cases (group S:13/group C:27) and type IV comprised 24 cases (group S:7/group C:17). There were no significant differences in 3 month and 1 year survival rates, although group C (III) had the tendency of higher mortality rate (p = 0.08). Mobilization (transferring to a wheelchair) was enabled significantly earlier in group S (III) than in group C (III) (p = 0.02), but in type IV, most patients enabled early mobilization even without surgical intervention. There were no significant differences in hospital complications and walking ability at final follow-up. CONCLUSION: In this study, the superiority of surgical treatment for unstable FFP was not proven. However, the results suggest that type IVb may be a relatively stable type compared to type III and that type IVb should be considered separately from bilaterally complete unstable sacral fractures due to high-energy trauma.

DOI： 10.1007/s00068-021-01729-6

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PURPOSE: For calcaneal fracture, plate fixation through lateral extensive approach (LEP) is the most common procedure performed to achieve anatomic reduction. However, wound complications sometimes occur after LEP. To reduce complications, minimally invasive operative methods with cannulated screw fixation through sinus tarsi approach (STS) were developed. The aim of this multicenter propensity-matched study was to compare the clinical and radiographic outcomes of LEP to those of STS for calcaneal fracture and to evaluate the incidence of postoperative complications including surgical site infection (SSI). METHODS: We extracted 271 patients with calcaneal fracture undergoing surgery between January 2014 and March 2019 from our multicenter TRON database. We assessed the American Orthopedic Foot and Ankle Society (AOFAS) score at the final follow-up as the clinical outcome. We obtained the Bohler and Preis angles as radiographic parameters and also recorded the complications. We divided the subjects into two groups: LEP group and STS group. To adjust for baseline differences between the groups, a propensity score matching algorithm was used in a 1:1 ratio. RESULTS: After matching, there were 32 fractures in each group. There was no significant difference between the LEP versus STS group in AOFAS score at final follow-up (90 vs 90 points, p = 0.98) and in the Bohler and Pries angles (19.2 vs. 18.0 degrees, p = 0.74 and 16.0 vs. 17.5 degrees, p = 0.47). The rate of SSI in the LEP group was higher than that in the STS group (21.9% vs. 0.0%, p = 0.01). CONCLUSION: For calcaneal fracture, STS provides similar fixation effectiveness and functional outcomes as LEP while reducing the likelihood of infection.

DOI： 10.1007/s00590-021-03115-9

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PURPOSE: Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively. METHODS: This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types. RESULTS: We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture. CONCLUSIONS: The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

DOI： 10.1007/s00068-021-01839-1

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A relationship between Böhler angle (BA) before or after surgery and clinical outcomes remains unclear. This retrospective multicenter cohort study aimed to compare pain and functional outcomes between a group in which the reduction angle was preserved and a group in which the reduction angle was lost during follow-up, and to clarify the risk factors leading to loss of last follow-up BA. From 2014 to 2018, 271 cases of calcaneal fractures were surgically treated at ten facilities. We divided patients into Group L (lost reduction of fracture) and Group P (preserved reduction of fracture). We matched subjects between the 2 groups according to age, sex and BA before surgery and compared American Orthopedic Foot and Ankle Society (AOFAS) score between the groups. We investigated the correlation between the amount of BA loss and postoperative pain. The factors leading to loss of last follow-up BA were examined by logistic regression analysis. Ultimately, 112 patients were eligible. After matching, each group included 38 patients. There was no difference between the 2 groups in total AOFAS score. However, the pain component of AOFAS score at 6 months and 12 months were worse in group L than in group P (p = .011, p = .031, respectively). We also showed a weak correlation between the amount of BA loss and postoperative pain. Logistic regression analysis revealed that female and BA before surgery independently predicted loss of reduction (odds ratios: 4.66, 95% CI: 1.15-18.9 and odds ratios: 0.90, 95% CI: 0.82-0.99, respectively). We clarified that reduction and preservation of BA within its normal range should lead to decrease postoperative pain. Female and lower pre-BA were risk factors leading to loss of reduction of BA in operative treatment of calcaneal fractures.

DOI： 10.1053/j.jfas.2021.11.011

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INTRODUCTION: One of the complications of the surgical therapy for proximal humerus fractures is fracture-related infection (FRI). This multicenter study aimed to investigate the incidence of FRI and clarify the risk factors associated with FRI in patients receiving open reduction and internal fixation for proximal humerus fracture. MATERIAL AND METHODS: Among 684 patients diagnosed as having proximal humerus fracture and who were treated by surgical therapy in 13 institutions (named TRON group) from 2015 through 2020, 496 patients (men, n = 134, women, n = 362; mean [SD] age, 68.5 [14.5] years; mean [SD] body mass index [BMI], 23.0 [4.4] kg/m2) were included as subjects. Excluded were 188 patients due to less than 12 month's follow-up, patients who underwent osteosynthesis using neither plate nor nail and those with open fracture. We extracted the following as risk factors of FRI: sex, BMI, smoking status, diabetes, glenohumeral fracture dislocation, fracture classification, approach, implant, waiting period, type of anesthesia, operative time and blood loss during surgery. We conducted logistic regression analysis to investigate the risk factors of FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. RESULT: FRI occurred after surgery for proximal humerus fracture in 9 of the 496 patients (1.8%). The causative organism was methicillin-susceptible Staphylococcus aureus in 4 patients, Pseudomonas aeruginosa in one patient and Enterococcus faecalis in one patient. In the other 3 patients, causative organisms were not detected. The univariate analysis showed significant differences for present of glenohumeral fracture dislocation (p = 0.004). Logistic regression analysis showed glenohumeral fracture dislocation to be the significant explanatory factor for FRI (odds ratio 12.3, p = 0.0375). CONCLUSION: This study revealed an infection rate following open reduction and internal fixation of proximal humerus fracture of 1.8% (9 patients) and that Staphylococcus was the most frequent causative organism. Glenohumeral fracture dislocation is a significant risk for postoperative FRI.

DOI： 10.1016/j.injury.2022.05.022

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BACKGROUND: In recent years, complex and unstable proximal humeral fractures (PHFs) are treated with intramedullary nails (IMNs) in the elderly; however, the postoperative radiographic findings related to the clinical outcome are not clear. This study evaluated the association of clinical outcomes with the radiographic findings of PHFs treated with IMNs. METHODS: We collected data of patients aged >60 years with PHFs treated with IMNs from 2015 to 2019 in 13 associated centers' database (named TRON). We excluded patients lost to follow-up of <6 months postoperatively (PO6M). We evaluated clinical outcomes with the University of California at Los Angeles (UCLA) score at PO6M and defined a score of <27 as poor. We assessed the radiographic findings on the anteroposterior view of the humeral head postoperatively, and each radiographic finding such as humeral head height (HHH), head shaft angle, and cranialization of the greater tuberosity was divided into two groups: poor and good. Factors associated with poor UCLA at PO6M were extracted by logistic regression analysis, and the factors were divided into two groups (poor and good) and matched for age, sex, and fracture type. The UCLA score at PO6M between the groups was examined by the Mann-Whitney U test, and the significance level was set at 0.05. The minimal clinical important difference in the UCLA score was set 2 points. RESULTS: The study included 243 patients (mean age, 76 years; range, 60-95 years). The mean follow-up period was 12 months (range, 6-56 months). The correlation coefficients indicated that there was either no or only a weak correlation between HHH, head shaft angle, and cranialization of the greater tuberosity. A poor HHH (HHH <0 or >10 mm) was extracted as a factor associated with a poor UCLA score at PO6M by logistic regression analysis (odds ratio: 5.78, 95% confidence interval = 1.2-27.7, P = .0287). In matched pair analysis, the UCLA score at PO6M was significantly lower in the poor HHH group (26 [range: 9-33] vs. 24 [range: 10-35], P = .0458). CONCLUSION: We revealed that the HHH was an independent risk factor for poor short-term outcomes. There was a significant difference in the UCLA score between groups divided by the HHH in cases treated with IMNs. The HHH can be used intraoperatively or postoperatively as a reliable parameter to predict clinical outcomes in PHFs treated with IMNs.

DOI： 10.1016/j.jseint.2021.12.009

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PURPOSE: This retrospective multicenter study aimed to assess the 1-year mortality rate in elderly patients with distal femoral fractures (DFFs) and identify potential risk factors for mortality. METHODS: We analyzed 321 patients aged 65 years and older with DFFs treated surgically between 2012 and 2019 in 13 hospitals. Patient demographics and surgical characteristics were extracted from medical records and radiographs. We used univariable and multivariable Cox regression analyses to identify the factors affecting mortality. RESULTS: The mortality rate for DFFs in elderly patients at 1 year was 9.0%. Multivariable Cox regression analysis revealed older age, male sex, underweight (body mass index [BMI] <18.5 kg/m2), bedridden status, and nursing home residency to be independent predictors for mortality (older age: hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.11, P<0.001; male sex: HR 3.08, 95% CI 1.23-7.71, P=0.015; underweight: HR 1.93, 95% CI 1.01-3.68, P=0.045; bedridden status: HR 4.59, 95% CI 1.61-13.07, P=0.0042; and nursing home residency: HR 2.63, 95% CI 1.18-5.83, P=0.017). None of the factors associated with surgery including types of fixation, time from initial visit to surgery, blood loss during operation, and operation time was an independent predictor for mortality. CONCLUSION: The 1-year mortality rate in elderly patients with DFFs was relatively low at 9.0%. Older age, lower BMI, and nursing home residency were associated with mortality after surgery for DFFs. Factors associated with the surgical procedure were not significant predictors.

DOI： 10.1016/j.injury.2022.01.002

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AIMS: Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes. METHODS: In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups according to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient characteristics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes. RESULTS: The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U. CONCLUSION: To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°. Cite this article: Bone Jt Open 2022;3(2):165-172.

DOI： 10.1302/2633-1462.32.BJO-2021-0191.R1

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DOI： 10.1038/s41598-022-12966-z

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Publisher：2022 IEEE International Conference on Cyborg and Bionic Systems, CBS 2022  

Spasticity is a condition in which the muscles of the limbs continuously contract. High-frequency alternating current (HFAC) is a method of blocking nerve signals, which can be applied to prevent spasticity. Functional motions can be reconstructed by controlling limb muscles using functional electrical stimulation (FES) during HFAC treatment for spastic paralysis. In this study, we conducted signal blocking and stimulation of rat peripheral nerve as a potential method for reconstructing the functional motion of limbs in spastic paralysis patients and investigated the effect of HFAC at different stimulation frequencies on the prevention of muscle contraction. FES with visual feedback was also performed to control the angle of the rat ankle joint. The HFAC experiments showed that nerve block was achieved with nerve stimulation frequencies at 1 Hz and 60 Hz when a l-kHz block signal was used. Visual feedback control of the ankle joint angle was achieved using the proportional-integral (PI) control method. The findings of this study will contribute to the establishment of new methods for reconstructing functional motion in spastic paralysis patients.

DOI： 10.1109/CBS55922.2023.10115376

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Language：Japanese   Publisher：THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY  

DOI： 10.11359/chubu.2021.677

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Motoneuron transplantation into peripheral nerves undergoing Wallerian degeneration may have applications in treating diseases causing muscle paralysis. We investigated whether functional reinnervation of denervated muscle could be achieved by early or delayed transplantation after denervation. Adult rats were assigned to six groups with increasing denervation periods (0, 1, 4, 8, 12, and 24 weeks) before inoculation with culture medium containing (transplantation group) or lacking (surgical control group) dissociated embryonic motoneurons into the peroneal nerve. Electrophysiological and tissue analyses were performed 3 months after transplantation. Reinnervation of denervated muscles significantly increased relative muscle weight in the transplantation group compared with the surgical control group for denervation periods of 1 week (0.042% ± 0.0031% vs. 0.032% ± 0.0020%, respectively; p = 0.009), 4 weeks (0.044% ± 0.0069% vs. 0.026% ± 0.0045%, respectively; p = 0.0023), and 8 weeks (0.044% ± 0.0029% vs. 0.026% ± 0.0008%, respectively; p = 0.0023). The ratios of reinnervated muscle contractile forces to naïve muscle in the 0, 1, 4, 8, and 12 weeks transplantation groups were 3.79%, 18.99%, 8.05%, 6.30%, and 5.80%, respectively, indicating that these forces were sufficient for walking. The optimal implantation time for transplantation of motoneurons into the peripheral nerve was 1 week after nerve transection. However, the neurons transplanted 24 weeks after denervation survived and regenerated axons. These results indicated that there is time for preparing cells for transplantation in regenerative medicine and suggested that our method may be useful for paralysed muscles that are not expected to recover with current treatment.

DOI： 10.1002/term.3223

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Transplantation of embryonic motor neurons has been shown to improve motor neuron survival and innervation of neuromuscular junctions in peripheral nerves. However, there have been no reports regarding transplantation of sensory neurons and innervation of sensory receptors. Therefore, we hypothesized that the transplantation of embryonic sensory neurons may improve sensory neurons in the skin and innervate Merkel cells and Meissner's corpuscles. We obtained sensory neurons from dorsal root ganglia of 14-day rat embryos. We generated a rat model of Wallerian-degeneration by performing sciatic nerve transection and waiting for one week after. Six months after cell transplantation, we performed histological and electrophysiological examinations in naïve control, surgical control, and cell transplantation groups. The number of nerve fibers in the papillary dermis and epidermal-dermal interface was significantly greater in the cell transplantation than in the surgical control group. The percent of Merkel cells with nerve terminals, as well as the average number of Meissner corpuscles with nerve terminals, were higher in the cell transplantation than in the surgical control group, but differences were not significant between the two groups. Moreover, the amplitude and latency of sensory conduction velocity were evoked in rats of the cell transplantation group. We demonstrated that the transplantation of embryonic dorsal root ganglion cells improved sensory nerve fiber number and innervation of Merkel cells and Meissner's corpuscles in peripheral nerves.

DOI： 10.1002/term.3196

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We report two pediatric cases of radial nerve palsy caused by supracondylar fracture of the humerus requiring nerve exploration. The children had comparable conditions, palsy types (complete motor and partial sensory) and radiographic findings. The fracture in the first case was managed conservatively with closed reduction and percutaneous pinning but, while the patient eventually recovered from the partial sensory palsy, her motor palsy remained unchanged. In the second case, ultrasound assessment of the nerve prior to fixation indicated that surgical exploration was needed as it revealed tethering on the edge of the proximal fracture fragment. The nerve was released during an open reduction and the patient subsequently recovered from both sensory and motor palsies. Ultrasonography proved essential in the initial clinical assessment by determining how to proceed. We recommend primary nerve exploration when ultrasound findings show entrapment or tethering of the radial nerve.

DOI： 10.1142/S2424835521720097

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OBJECTIVES: Muscle spindles are proprioceptive receptors in the skeletal muscle. Peripheral nerve injury results in a decreased number of muscle spindles and their morphologic deterioration. However, the muscle spindles recover when skeletal muscles are reinnervated with surgical procedures, such as nerve suture or nerve transfer. Morphological changes in muscle spindles by cell transplantation procedure have not been reported so far. Therefore, we hypothesized that transplantation of embryonic sensory neurons may improve sensory neurons in the skeletal muscle and reinnervate the muscle spindles. MATERIALS AND METHODS: We collected sensory neurons from dorsal root ganglions of 14-day-old rat embryos and prepared a rat model of peripheral nerve injury by performing sciatic nerve transection and allowing for a period of one week before which we performed the cell transplantations. Six months later, the morphological changes of muscle spindles in the cell transplantation group were compared with the naïve control and surgical control groups. RESULTS: Our results demonstrated that transplantation of embryonic dorsal root ganglion cells induced regeneration of sensory nerve fibre and reinnervation of muscle spindles in the skeletal muscle. Moreover, calbindin D-28k immunoreactivity in intrafusal muscle fibres was maintained for six months after denervation in the cell transplantation group, whereas it disappeared in the surgical control group. CONCLUSIONS: Cell transplantation therapies could serve as selective targets to modulate mechanosensory function in the skeletal muscle.

DOI： 10.1111/cpr.12660

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BACKGROUND: Although some radiographic evaluations of the risk of flexor tendon injury following fixation of a distal radius fracture are useful, these radiographic measurements are limited because of their inability to obtain three-dimensional measurements. We hypothesized that CT-based measurements would be more sensitive indicators for risk estimation than radiography. METHODS: We retrospectively evaluated the relationship between plate positioning and the incidence of flexor tendon symptoms based on postoperative radiographic and CT-based measurements in 99 hands that were followed up for more than 12 months. We also compared the reproducibility, diagnostic accuracy, and ability to detect the plate-bone gap between radiographic and CT-based measurements. We also assessed the correlation between the volar prominence and plate-bone gap using CT. Multivariable analysis using stepwise logistic regression was performed to identify factors independently associated with tendon rupture or irritation. RESULTS: In single variable analysis, we found that the volar tilt was significantly smaller and the radiographic plate-to-critical line distance (PCL), CT-PCL, and CT-gap were significantly greater in the group with tendon irritation or rupture. Multivariable logistic regression analysis indicated that the CT-based measurement of the volar prominence is a significantly positive independent predictor of tendon rupture or irritation. CONCLUSION: CT-based measurement of the volar prominence may be one of the best radiographic predictors of the risk of flexor tendon injury following fixation of a distal radius fracture regardless of the plate type and distal prominence and the extent of rotation. This measurement may assist surgeons when deciding on the need for removal of hardware to decrease the long-term risk of flexor tendon rupture.

DOI： 10.1016/j.jos.2018.08.021

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Language：Japanese   Publisher：THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY  

DOI： 10.11359/chubu.2018.1017

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

高齢者における橈骨遠位端骨折(DRF)に伴う尺骨遠位端骨折(DUF)は,骨質の低下により粉砕を伴い最適な治療方法の選択が難しい骨折の一つである.今回,多施設共同研究により,高齢女性のVolar locking plate固定を受けたDRFに伴うDUFに対する保存治療(C群:69例),Plate固定(P群:43例),Darrach法(D群:32例)の3群143例の臨床成績,放射線学的評価および合併症を後ろ向きに比較検討した.Modified Mayo Wrist Score,Pain NRS,握力比に有意差を認めなかった.術後外固定期間はD群がC群,P群に比べて有意に短かった.背屈可動域においてC群がP群よりも有意に優れていた.P群に比べC群,D群は合併症が少なかった.高齢女性のDRFに伴うDUFの治療法としては,橈骨が強固に固定されている場合,尺骨のPlate固定は必ずしも有益ではない.(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：日本末梢神経学会  

われわれは、ラット脱神経筋モデルの遠位末梢神経断端内に胎子脊髄前角細胞由来の神経幹細胞を移植することで、脳神経筋を再支配し機能的電気刺激で筋収縮が得られることを報告している。今回、工学研究科との共同研究により、カフ型電極を用いて末梢神経に接続し足関節角度情報を入力信号としてアクチュエーターとしての各筋肉の収縮程度を微調整する、というフィードバック制御システムを構築した。この技術を用いることで、脱神経筋の迅速かつ高精度な追随・制御が可能であることを示すことができた。この再生医療と工学制御技術の融合による治療戦略は、難治性である下位運動ニューロン疾患や損傷に対し、新たな治療法創発のきっかけとなりうる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

【背景】掌側ロッキングプレートを用いた橈骨遠位marginal fractureの内固定では,強固に固定すべきvolar rim(VR)骨片のため遠位設置が要求されるが,遠位設置はスクリューの関節内穿破や屈筋腱障害のリスクとなる.またVR骨片の骨形態の個体差も固定方法の選択を複雑にしている.【目的】VR骨片の形態の異なる骨でのmarginal fractureを見据えた固定方法の選択について3D-CADを用いて検討する.【方法】骨折のないVRの矢状面での突出量(volar offset;VO)が異なる複数の骨モデルを作成した.Acu-loc2,Medartis ADAPTIVE2のモデルを作成し,3D-CAD上でそれぞれ骨モデルの上に設置し手術のシミュレーションを行った.設置は矢状面でwatershed lineの直下で,冠状面で橈骨骨軸とプレート長軸を一致させた.この条件下でスクリュー関節内穿破の有無を確認し,穿破があった場合は近位にプレートを移動させた.プレートの掌側突出と矢状面断面での関節面からスクリュー刺入部の距離を測定し,固定可能な最低の骨片の大きさ(fragment length;FL)として測定した.【結果】VO 10mm以下のモデルではスクリューの関節内穿破が生じなかったが,10mm以上のvolar rimを有する骨の場合はwatershed lineの直下にプレートを置いた場合スクリューが関節内に突出した.いずれのプレートもVOの大きさに比例して支えられる骨片の大きさは異なり,VOの大きさに比例してFLは大きくなった.【考察】marginal fractureの固定ではVOの大きさに合わせてFLの大きさが変化した.Volar rimの掌側突出が大きい場合には関節内にスクリューが穿破しやすく,プレートを近位に移動させる必要があり関節近傍の骨片が小さいと固定することができない.またFLが7mm以下の小骨片の固定にはvolar rimの形態にかかわらず,watershed lineを乗り越えて設置可能なプレートか創外固定が必要である.【意義】橈骨marginal fractureでは,volar rimの大きさと骨折線の位置を術前に調べたうえで内固定法を選択する必要がある.(著者抄録)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

【背景】舟状骨中央1/3の骨折の内固定においてスクリューの挿入には遠位結節部からの挿入か,近位橈骨舟状関節面からの挿入の2つの選択肢があるが,どちらが望ましいか結論はでていない.【目的】本研究では転位の少ない舟状骨骨折のCT画像を再構成して三次元モデルを作成し,骨片の大きさや骨折線の特徴を明らかにし,スクリュー挿入との関連を明らかにすることを目的とした.【対象】当院を過去5年間に受診した2 partの骨折のうち,粉砕のない骨折に対し解析を行った.CT画像から3D骨折モデルを作成し,骨折部の3点を通る面を骨折面として規定した.舟状骨全長をもとに体積重心と慣性軸を算出し,慣性軸のうち最も長軸に該当する軸をL軸として規定した.骨折面に垂直な軸とL軸のなす角をF角として計測した.舟状骨は骨折面にて分断し近位骨片と遠位骨片の体積および比率を計測した.また,慣性軸全長における近位骨片の通過距離の比率をI率として算出した.【結果】再構成CT画像が利用可能であった12例を対象として調査を行った.近位骨片の体積はHerbert分類A2骨折で遠位骨片の65.7%,B1骨折で同92.3%であった.体積重心はB1の2例のみ近位骨片に存在し,残りは遠位骨片内に存在した.I率はA2骨折で38.3%,B1骨折で62.4%であった.【考察】Herbert分類A2骨折,B1骨折ともに遠位骨片のほうが近位骨片よりも体積が大きく,ほとんど全例において体積重心は遠位骨片に位置した.一般にスクリューの挿入は小骨片から大骨片へ行うことが有効であることと,慣性軸に沿った挿入は近位からのほうが容易であることを考慮すれば,近位骨片からのスクリュー固定のほうが骨折把持の面で優位なケースが多い.【意義】舟状骨中央1/3の2part骨折において一般には遠位からスクリューが挿入されることが多い.骨片体積や骨折線の入り方を解析し遠位よりに骨折線が入る骨折型がHerbert分類でB1に該当する場合を除いて形態学的には近位挿入のほうが望ましいことが多いことを示した.(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

稀な外傷である幼児期の上腕骨顆部T型骨折の3例を経験し5年以上経過観察した.全ての症例で手術的加療が行われ,1例に経皮的鋼線刺入術,2例に観血的骨接合術が行われた.観血的治療が行われた症例では,内外側よりアプローチし,そのうち1例では前方より関節面を直視下に整復し内固定した.内外側からのアプローチは選択肢の1つとなりうると考えられた.術後成績は比較的良好であったが,一部の症例で軽度の内反変形やfish tail変形を認めた.手術時の整復が重要であり,長期間の経過観察を行う必要がある.(著者抄録)

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

手部挫滅損傷に対して有茎腹部皮弁を施行する際の骨盤上肢創外固定の有用性を調査した.対象は8例で,皮弁の種類は有茎鼡径皮弁が6例,有茎腹壁皮弁が1例,田島皮弁が1例であった.ハーフピン刺入部位は,上肢には第2中手骨が1例,橈骨が7例で,骨盤には同側の腸骨稜に刺入する同側骨盤上肢創外固定法(同側法)が4例,対側の腸骨稜に刺入する対側骨盤上肢創外固定法(対側法)が4例であった.ハーフピンの径は第2中手骨には径3mmが1例,橈骨には径4mmが4例,径5mmが3例,腸骨には径3mmが1例,径5mmが5例,径6mmが2例であった.ハーフピンの本数は全例2本ずつ刺入した.創外固定期間は平均19.8日であった.歩行は創外固定のまま全例可能であり,皮弁は全例生着した.骨盤上肢創外固定は,固定性に優れ,何度でも微調整が可能で,低侵襲,軽量,コンパクトで,創傷管理も容易である.同側法の方がコンパクトであるが,対側法は皮弁と患肢の位置の自由度が高く,ピン刺入部から皮弁採取部への感染の危険がない.固定方法は皮弁の種類と肢位などを考慮して選択することができる.(著者抄録)

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

2016年1月～12月の胸骨正中切開手術症例で術後1ヵ月以内に第1肋骨をCT撮影した73例78肋骨を対象に、第1肋骨骨折の有無と部位、術後神経障害について後ろ向きに検討した。開胸後に第1肋骨骨折が生じていたのは39例44肋骨であった。Axial像での肋骨頭から骨折部までの距離で分けると、肋骨頭周辺が6肋骨、肋横突関節周囲までが31肋骨、肋横突関節より外側～前方が7肋骨であった。胸骨正中切開術後に小指環指の感覚障害が術後新たに出現した3例はいずれも患側肋骨骨折が存在し、2例は肋骨頭周辺、1例は肋横突関節周囲であった。骨折の有無が直接神経症状と関連しないが、有症状3例はいずれも骨折を有し肋骨関節に近い部位で症状を有する症例が多かった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00831&link_issn=&doc_id=20211201120036&doc_link_id=10.11359%2Fchubu.2021.677&url=https%3A%2F%2Fdoi.org%2F10.11359%2Fchubu.2021.677&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞月状三角骨障害は手関節尺側部痛の原因の一つであり単純X線でのVISI変形が有名だが,多くの症例では正常であり見過ごされやすい。病歴の確認や丁寧な身体診察の後,月状三角骨障害を含めた手関節尺側部痛の鑑別として画像診断を進めていく。単純X線,MRIともに適切な撮像方法やパラメータを設定し,鑑別可能な疾患をしっかりと読影していくことが重要である。近年MRIの性能の向上や専用のコイルによって,様々な手関節尺側部痛の病態を捉えることが可能となってきているが,月状三角骨靱帯損傷に関しては未だ感度は高くないのが現状である。造影剤の使用や撮像方法の工夫,牽引の併用など,診断率を向上させるための様々な工夫が報告されている。身体診察と画像診断を照らし合わせながら,必要であれば関節鏡を併用して最終診断および治療を行う。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00767&link_issn=&doc_id=20210712070008&doc_link_id=10.18888%2Fse.0000001808&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fse.0000001808&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

橈骨遠位端骨折による変形により手関節の障害が生じうるが,その中でも尺側部痛が残存することが多い.橈骨遠位端骨折後に尺側部痛を訴え,保存療法が奏効せず,尺骨短縮術を行い,1年以上経過観察を行った28例(男性12例・女性16例,平均年齢47歳)を後ろ向きに調査した.橈骨遠位端骨折の初期治療はギプス20例,手術7例,無処置1例で,受傷から尺骨短縮までは平均56ヵ月であった.全例関節鏡視の後,骨幹端部での尺骨短縮骨切りを行いプレートにて内固定を行った.これらの症例についてX線所見と臨床成績について検討した.最終経過観察時Mayo wrist scoreでexcellent 7/good 13/fair 6/poor 2例となっていた.女性患者で年齢が高めであり握力が低くなっていた.術後,遠位橈尺関節周囲の骨棘形成を13例に認めていたが,性別などの患者背景は骨棘形成の発生に有意差は認めておらず,術後の手関節可動域/握力/治療成績にも影響を生じていなかった.術後の可動域はulnar variance,握力は年齢と受傷からの期間とradial inclination,Mayo wrist scoreは年齢とradial inclinationと相関していた.回帰分析の結果では治療成績はradial inclinationと関連していた.今回の結果より,橈骨遠位端骨折変形癒合に対する尺骨短縮術は総じて良好な成績が得られていたが,可動域/握力/治療成績には年齢とulnar variance,radial inclinationが関与していた.患者の術後における状況を熟慮し,解剖学的なparameterを考慮したうえでの施行が望ましいと考えられた.(著者抄録)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

橈骨遠位端骨折治療における掌側ロッキングプレート固定法は、若年者の高エネルギー外傷から高齢者の脆弱性骨折に至るまで今やなくてはならない治療法として確立されている。ただしそれに伴う合併症が徐々に明らかとなり、原因・対策についても様々な知見が得られてきている。なかでも重篤な合併症とされる屈筋腱断裂に対してはSoongらが提唱した単純X線側面像によるgradingが有名で認知されており、またKitayらが提唱したプレートの掌側突出距離(PCL:plate-to-critical line distance)は鋭敏で客観的な評価方法としてエビデンスが得られている。筆者も掌側突出距離に注目し検討したため、本稿では、その有用性と注意すべき点・対策などについて、重篤な合併症である腱障害と神経障害を中心に詳述する。(著者抄録)

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本末梢神経学会  

神経内ガングリオンは、末梢神経の外側上膜内に嚢胞性腫瘤を形成し、末梢神経障害の原因となる。尺骨神経内ガングリオンを伴った肘部管症候群の2例について治療成績を報告する。2症例とも右尺骨神経麻痺で当院を紹介受診した。術前エコーとMRI検査にて尺骨神経内に嚢胞性腫瘤を伴っていた。神経内ガングリオンを伴った肘部管症候群と診断し、尺骨神経の皮下前方移動術をおこなった。神経内剥離やガングリオン摘出術をおこなっていないが、術後それぞれ6年6ヵ月と3年1ヵ月の時点で、エコーやMRI検査において神経内ガングリオンの再発を認めていない。(著者抄録)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：日本末梢神経学会  

筋組織は神経細胞とのinteractionを失うと、脱神経筋内でアセチルコリン受容体の脱凝集といった神経筋接合部の形態変化が起こる。末梢神経を損傷して長期間たった脱神経筋は神経再生に対してnon-permissiveな状態となり、神経修復術をおこなっても十分に運動機能が回復しない。脱神経筋の神経筋接合部を治療ターゲットとした末梢神経損傷治療の研究について文献的考察を交え報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J03411&link_issn=&doc_id=20190117120015&doc_link_id=%2Fet2perip%2F2018%2F002902%2F016%2F0166-0168%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fet2perip%2F2018%2F002902%2F016%2F0166-0168%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

症例1は70歳女性で、左母趾背側の腫瘤と疼痛を主訴とした。MRIでIP関節直上にガングリオンを疑う嚢胞像を認め、発生を関節由来と判断した。局所麻酔下にガングリオンシストからIP関節に繋がるstalkを切除した。術後10ヵ月に再発を認め、再手術を行ったが、再手術後1ヵ月に再々発を認めた。MRIの再検で嚢胞像と長母趾屈筋腱(FHL)の腱鞘にそった液体貯留を認め、腱由来のガングリオンと判断した。腰椎麻酔下にFHLを切開すると粘調な液体が流出し、腱滑膜や腱鞘を含めて全て切除した。その後2年が経過するが、再発を認めていない。症例2は64歳女性で、左母趾内側のガングリオンに対し前医で穿刺を受けていたが、再発を繰り返した。MRIで嚢胞像とFHLにそった液体貯留を認め、腰椎麻酔下に手術を施行した。ガングリオンシストがFHLの腱鞘と連続していたため、腱鞘を取り巻くように切除した。術後1年の現在、再発を認めていない。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J00831&link_issn=&doc_id=20190116170040&doc_link_id=10.11359%2Fchubu.2018.1017&url=https%3A%2F%2Fdoi.org%2F10.11359%2Fchubu.2018.1017&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(一社)日本骨折治療学会  

骨盤骨折に対して様々なケーブル固定法を施行しているので、その種類と有用性について紹介する。対象はケーブルを使用して骨接合術を施行した骨盤輪・寛骨臼骨折30例で、男性25例、女性5例、平均年齢は50歳、骨盤輪骨折6例、寛骨臼骨折21例、骨盤輪・寛骨臼複合骨折3例であった。ケーブル固定法は、恥骨上枝(SPR)cerclage cable:17例、SPR-下前腸骨棘(AIIS)figure 8 cable:1例、SPR-腸骨翼(IW)figure 8 cable:1例、SPR-大坐骨切痕(GSN)figure 8 cable:1例、SPR-GSN circular cable:1例、AIIS-GSN cerclage cable:15例であった。ケーブル固定法には(1)骨片を収束させる効果、(2)線で支持するbuttress効果、(3)プレートとの併用で固定力を増強させる効果などがあり骨盤輪・寛骨臼骨折に対しても有用である。(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

前腕切断に対して再接着術を11例に施行した.完全切断2例,不全切断9例で,切断部位はChuang分類でtype 1:6例,type 2:4例,type 4:1例であった.術前cross-limb vascular shuntingを1例,術中temporary intravascular shuntingを2例,intraosseous wiringによる簡易固定後の血管吻合を5例に行った.静脈移植は7例に行い,軟部組織再建として後骨間皮弁1例,肋間動脈穿通枝皮弁1例,肩甲皮弁1例,ALT flap 1例,DIEP flap 2例,機能的薄筋移植1例を施行した.10例で生着し救肢できたが,1例は生着したが広範な感染のため上腕切断を施行した.Chuang分類type 1では良好な機能回復が得られChen's criteriaでgrade 1, 2であったが,type 2以上ではgrade 3, 4と回復は不良であった.前腕切断では早期血行再開が望まれるため,通常の深部から修復する順序から血行再開を優先する治療戦略に切り替える必要がある.術前cross-limb vascular shunting,術中temporary intravascular shunting,intraosseous wiringによる簡易固定後の血管吻合などによる早期血行再開が有用であった.(著者抄録)

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

仙骨骨折を伴う完全不安定骨盤輪骨折に対して水平方向・垂直方向の転位を制御するように縦横にrodを設置する縦横腰椎-腸骨固定術(transverse and longitudinal lumbo-iliac fixation:TALLIF)を施行した。AO/OTA分類で61-C1.3:6例、C2.3:3例、C3.3:1例、Denis分類でzone 1:2例、zone 2:5例、zone 3:3例であった。骨癒合率は100%であり、Majeed's scoreは平均89点であった。インプラント破綻はなかったが、深部感染が1例に生じた。水平転位、垂直転位は術後有意に整復・保持されていた。TALLIFは仙骨骨折に対して両側腸骨の2本ずつのiliac screwを2本の横方向のrodで固定し、腰椎のpedicle screwと縦方向のrodで固定する方法であり、水平・垂直転位の整復、保持に優れている。(著者抄録)

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

転位型踵骨関節内骨折に対して低侵襲手術を行った11例の短期成績(男性8例、女性3例、平均年齢58歳)について検討した。平均観察期間23.8ヵ月の結果、Sanders分類はtype IIAが5例、IIBが3例、IIIABが3例であった。Maxifieldの臨床評価基準はexcellentが5例、very goodが5例、fairが1例であった。JSSF ankle/hind foot scaleは平均88.5点であった。抜釘を含めて、のべ20の手術に重大な軟部組織合併症は認められなかった。スクリューヘッドの疼痛や違和感のために9例で抜釘を必要としたが、抜釘後は全例で症状が軽快していた。また、スクリューの関節内への突出、長母趾屈筋へのirritationが原因で早期抜釘を必要とした症例が2例に認められた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J00831&link_issn=&doc_id=20170623030018&doc_link_id=10.11359%2Fchubu.2017.297&url=https%3A%2F%2Fdoi.org%2F10.11359%2Fchubu.2017.297&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(一社)日本手外科学会  

橈骨遠位端骨折術後屈筋腱障害の頻度を調査し,障害の予測因子を検討する.橈骨遠位端骨折に対し掌側ロッキングプレート固定を行った296例を対象とした.屈筋腱障害の有無で二群に分け,VT,UV,Soong分類,プレートの遠位突出距離,掌側突出距離を比較検討した.屈筋腱障害は29例(9.8%)存在し,そのうち断裂が6例(2.0%),腱刺激症状が23例(7.8%)であった.VT,UV,掌側突出距離で両群に有意差を認めた.遠位突出距離は両群に有意差はなかった.Soong分類は断裂群でGrade 0以外が有意に多かった.屈筋腱障害の予測因子として,掌側突出距離が最も有効な指標であった.掌側プレート固定を行う場合は,解剖学的な整復とプレートを骨に密着させることを意識し,腱断裂予防のための抜釘については,良好な画像かどうかを注意深く確認した上で掌側突出距離を参考にし,検討すべきである.(著者抄録)

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

Suture button fixation(SBF)法で治療し、3ヵ月以上経過観察可能であった不安定型鎖骨遠位端骨折9例の治療成績を検討した。骨折型はCraig分類type IIb:5例、V:4例であった。その結果、最終観察時の平均肩関節可動域は屈曲175度、外転172度、平均JOAスコアは98.5点と良好な結果であった。9例中8例で骨癒合を認め、1例で偽関節となったものの無症候性であった。なお、合併症は認めなかった。以上、SBF法は遠位骨片が粉砕等でプレート固定が困難な症例でも使用可能であり、低侵襲かつ抜釘が不要な有効な内固定方法であると考えられた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J00831&link_issn=&doc_id=20170424060010&doc_link_id=10.11359%2Fchubu.2017.31&url=https%3A%2F%2Fdoi.org%2F10.11359%2Fchubu.2017.31&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(株)南江堂  

脛骨骨欠損に対し金属骨補填材料を用いて人工膝関節全置換術を行った107膝(男性11膝、女性96膝、平均年齢75.3歳)の短期成績について検討した。その結果、1)脛骨骨欠損は平均14.8mm、FTAは内反膝104膝であった。手術により術前平均194°が術後は平均173.3°に改善した。また、外反膝3膝では術前平均162.2°が術後は平均172.2°に改善した。2)使用したインサートは89.7%が12mm以下で、適切な骨切りが行われていた。3)手術時間は平均89.4分であったが、初期30膝の平均113.5分と比べ、後期77膝では平均80.5分と有意に短縮されていた。4)術後1年以上追跡可能であった83膝の臨床成績については、JOAスコアは術前平均44.2点が術後平均77.7点に改善していた。一方、膝ROMも伸展および屈曲とも術後は改善がみられた。尚、放射線透過性線(RLL)あり群22膝、なし群61膝で比較すると、RLLあり群では有意に年齢が若く、Stem extensionの髄腔占拠率が有意に低かった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00764&link_issn=&doc_id=20160607270001&doc_link_id=issn%3D0030-5901%26volume%3D67%26issue%3D6%26spage%3D501&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D67%26issue%3D6%26spage%3D501&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

2010年2月～2014年3月の間に指尖損傷に対して逆行性指動脈皮弁を用いて指尖部の再建をした13例14指(男性12例、女性1例、年齢27～74歳、平均年齢43歳)を対象に、術後のPIP関節可動域を調査し、可動域制限の要因について検討した。その結果、軽度のうっ血を生じる症例はあったが、部分抜糸やケミカルリーチによって対応し、皮弁は全て生着した。術後最終診察時の平均PIP関節自動屈曲可動域は97.9°(70°～110°)、自動伸展可動域-5.0°(-20°～10°)、伸展角度が0°未満の症例(屈曲拘縮群)が14指中6指(43%) 存在した。また、屈曲拘縮群のPIP関節屈曲可動域は非屈曲拘縮群よりも有意差はないが良好な傾向があった。屈曲拘縮群で皮膚性拘縮が主であった症例はなく、全て関節性拘縮が中心であった。尚、2群間において年齢、皮弁の大きさ、指ごとの発生頻度、受傷から手術までの期間には有意差はみられなかった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J02567&link_issn=&doc_id=20160928310005&doc_link_id=10.11270%2Fjjsrm.29.29&url=https%3A%2F%2Fdoi.org%2F10.11270%2Fjjsrm.29.29&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：金原出版(株)  

2歳5ヵ月男児。特に誘因なく左足の痛みを訴え受診となった。軽度の跛行がみられたが、単純X線像と理学所見では異常所見はなく、採血でも軽度の炎症反応を認めるのみであった。鎮痛剤とシーネ固定にて経過観察としたが、その後、徐々に足部内側部に軽度の腫脹と圧痛が出現し、初診より4日後に再診となった。蜂窩織炎を疑い、セフジニルの内服で経過観察としたが、初診より2週後の外来では炎症反応の改善傾向が認められるも、跛行や理学所見とも改善はなく、精査加療目的で入院となった。足部MRIでは足底部中心にT1強調像で低信号、T2強調像で高信号のびまん性の炎症を疑う所見がみられ、楔状骨骨端核にも炎症が認められた。そこで、セファゾリン点滴とクーリングを開始し、抗菌薬のメロペネム、テイコプラニンへの変更を行なったところ、速やかに解熱し、局所所見も改善傾向となった。以後、セフトリアキソンに変更後も再燃はなく炎症反応の正常化を確認して、セフジトレン内服にて退院となった。尚、2ヵ月経過の単純X線像では内側楔状骨骨端核は消失、MRIで楔状骨の炎症を疑う所見の改善を確認して抗生剤の内服を中止した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00767&link_issn=&doc_id=20160126110020&doc_link_id=10.18888%2FJ00767.2016180770&url=https%3A%2F%2Fdoi.org%2F10.18888%2FJ00767.2016180770&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

下肢骨折内固定術後に生じた軟部組織欠損に対してsural flapを使用した6例の治療成績を報告した。全例で皮弁生着が得られたが、皮弁移植前に感染を伴っていた3例で術後に表層壊死などを認め、植皮術や軟膏使用などの追加処置を要した。代表例2例を提示した。

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Language：Japanese   Publisher：東海整形外科外傷研究会  

Floating knee(同側大腿骨・下腿骨骨折)に膝蓋骨骨折が合併すると術後の可動域訓練の開始が遅れ、後療法の遅れは機能予後不良につながることから、膝蓋骨骨折の合併は重大な術後成績不良因子であると考えられる。今回著者等は、膝蓋骨骨折を合併した症例と合併しなかった症例を各1例経験したので、手術成績を中心に報告した。合併しなかった症例(25歳男性)の最終観察時ROMは患健差を認めず、合併した症例(27歳男性)のROMは屈曲100度・伸展0度と屈曲制限を認めた。『Karlstroemの治療判定基準』による評価では、症例1がgood、症例2がacceptableであった。

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

平成23年4月から2年間における開放骨折・脱臼8例を含む外傷性四肢軟部組織欠損症例12例(男6例、女6例、平均年齢48歳)を対象に局所陰圧閉鎖療法(NPWT)を行い、治療成績を報告した。感染のない6例は、NPWT使用期間は平均14日であり、全例創の治癒が得られ、閉鎖方法は全層植皮4例・皮弁2例であった。感染を合併した6例では、感染の沈静化が得られず切断となった1例以外は創閉鎖を得た。NPWT使用期間は平均38日であり、閉鎖方法は全層植皮3例・皮弁2例であった。NPWTは浸出液が多い創や、骨や腱が露出し創閉鎖までに肉芽形成を促すべき創に良い適応であり、開放骨折や感染創に対しても有効であると思われた。

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Language：Japanese   Publisher：(株)医学書院  

比較的稀な特発性脛骨内顆骨壊死の3例を経験した.全例高齢の女性で,明らかな誘因はなく安静時痛があった.MRIでLotke分類type C2例,type D1例であり,保存的治療は無効であったため,金属骨補填材料を併用した人工膝関節置換術を行った.全例とも日本整形外科学会膝疾患治療成績判定基準(JOAスコア)の改善を認め,短期成績は良好であった.病理組織像では,軟骨下骨に骨壊死像や骨新生を認めた.MRIは早期診断に有用であると考えられた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01554&link_issn=&doc_id=20140808080022&doc_link_id=10.11477%2Fmf.1408103136&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408103136&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

肩関節重度開放損傷の術後MRSA感染に対し、創内持続陰圧洗浄療法と有茎広背筋皮弁を用い、患肢温存が可能であった1例を経験した。症例は25歳の男性で、自動車単独事故によりガードレールが右肩関節を打ち抜き受傷した。高度の挫滅を伴う右肩関節重度開放骨折(Gustilo type IIIB)を認めたが、主要血管や神経は温存されていた。患肢温存を目指し同日緊急手術にて広範なデブリドマン・洗浄・骨接合を行い、後日全層植皮術にて創閉鎖を行った。しかし術後2週経過時よりMRSA感染を併発し潰瘍を形成した。複数回のデブリドマン洗浄でも鎮静が得られないため抜釘を行い、創内持続陰圧洗浄療法を2週間施行し有茎広背筋皮弁にて被覆し治癒せしめた。深部MRSA感染巣に対する創内持続陰圧洗浄療法は筋皮弁の前段階として有用な手段であったと考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

プレート固定を行った脛骨遠位端骨折22例を対象に、ロッキングプレート使用11例(男5例、女6例、平均54.5歳;A群)とノンロッキングプレート使用11例(男9例、女2例、平均45.6歳;B群)で成績を比較した。関節内骨折はB群に多かったが、粉砕の強い多骨片関節内骨折はA群4例、B群5例と同等であった。プレートはA群が内側8例、前方1例、前外側2例、B群はそれぞれ10例、1例、0例であった。全例骨癒合が得られ、癒合期間はA群平均11.5週、B群11.3週で有意差はなかった。免荷期間はA群5.5週、B群8.8週と有意差を認め、A群では外傷性クモ膜下出血合併例が12週免荷、B群では脛骨プラトー骨折合併例が24週免荷であったが、これらを除いても有意差があった。術後合併症は皮膚壊死をA群1例、B群3例に認めた。Burwellの評価基準では殆どがanatomicalまたはgoodで、両群間に差はなかった。

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Language：Japanese   Publisher：東海整形外科外傷研究会  

大腿骨インプラント周囲骨折に対しLCP cable systemによる観血的骨接合術を行った5例の治療成績について検討した。男性1例、女性4例で、平均年齢は71.2歳、術後経過観察期間は平均14ヵ月であった。使用プレートはLCP curved broadプレートが2例、LCP Distal Femurプレート(LCP-DF)が3例、LCP broadプレートが1例であった。その結果、4例は良好な骨癒合が得られた。一方、LCP-DFを用いた1例は免荷が守れずワイヤーの断裂によりプレートが脱転し、偽関節となった。

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

掌側ロッキングプレートによる手術治療を行った橈骨遠位端骨折35例において、術後6週の時点でDASHスコアを調査し、スコアに影響する因子を検討した。DASHスコアの全症例の平均は14.6点であった。10点未満の17例(男4例、女13例、平均年齢58歳:A群)と10点以上の18例(男4例、女14例、平均年齢63歳:B群)で比較検討した結果、尺骨茎状突起骨折はB群が有意に多く、握力の健側比はA群が有意に高かった。ロジスティック回帰分析の結果、尺骨茎状骨折の有無、利き手の受傷、握力対健側比の3因子がDASHスコアと高い関連を示した。

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Language：Japanese   Publisher：東海整形外科外傷研究会  

大腿骨骨幹部骨折に対する髄内釘治療後の偽関節例7例8肢(全例男、平均年齢37歳)を対象として追加手術内容を調査し、偽関節発生要因と再手術時の適切な術式適応を検討した。初回手術から再手術までの待機期間は平均348日であった。再手術の内訳は、髄内釘入れ替え6肢、骨移植1肢、両者併用1肢であった。7肢で髄内釘周囲の骨透亮像を認め、髄内釘が骨内で動き、骨折部に対し前後左右方向への剪断力が働いていることが示唆された。髄内釘入れ替え例では追加リーミングと2mm以上太い径の髄内釘への変更を行い、多方向からの横止め螺子固定を行った。6肢で骨癒合が確認され、骨癒合までの期間は平均147日であった。

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：金原出版(株)  

症例1(76歳女性)。マヨネーズのチューブを搾った際に左中指MP関節が屈曲したまま伸展不能となった。症例2(76歳男性)。寝ぼけて扉に左手をぶつけてから左中指MP関節が屈曲したまま伸展不能となった。両症例とも近医にて徒手的解除を試みられるも困難で、著者らの施設へ紹介となった。理学所見および画像所見より尺背側の骨棘による伸展制限を考え、尺背側アプローチによる観血的手術を行った結果、術中所見では骨棘に側副靱帯のcord-like portionが捕捉されており、骨棘を切除するとロッキングは解除された。このことから本症例は尺背側の骨棘による中指MP関節ロッキングと診断された。尚、術後は伸展制限は改善し、それぞれ術後1年8ヵ月、術後9ヵ月の現在、再発はみられていない。

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海整形外科外傷研究会  

2001～2010年に標題の皮弁術を行った10例の成績を報告した。男性9例、女性1例、受傷時年齢は11～68歳であった。軟部組織欠損の内訳は、機械等の直達外力による欠損が5例、巻き込み等によるデグロービング損傷が3例、交通事故で地面との摩擦による欠損が2例であった。合併損傷として6例に同側上肢の開放骨折を認め、また尺骨神経損傷を2例、正中・尺骨神経損傷を1例、正中・尺骨神経損傷+上腕動脈断裂を1例、正中神経損傷+上腕動脈断裂を1例に認めた。使用した皮弁は遊離皮弁が5例、有茎皮弁が5例であり、遊離皮弁の内訳は広背筋皮弁4例、鼠径皮弁1例、有茎皮弁の内訳は胸部皮弁2例、腹部皮弁1例、広背筋皮弁2例であった。術後観察期間は24～268週で、皮弁は最終的に全例で生着した。合併症として術後感染を2例、皮弁の部分壊死を1例に認めたが、いずれも保存的治療で改善した。最終的な肘関節可動域は屈曲が平均123°、伸展が-16°、回内57°、回外64°であり、JOAスコアは平均83点(47～93点)であった。代表例2例を提示した。

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Language：Japanese   Publisher：東海整形外科外傷研究会  

上腕骨遠位端骨折で粉砕の比較的少ない症例にONI transcondylar plate(以下ONI plate)による治療を施行した症例のうち術後3ヵ月以上観察しえた18例の治療成績を報告した。男性3例、女性15例、手術時年齢21～95歳(平均79歳)、骨折型(AO分類)はA2型が14例、C1型が3例、C2型が1例であった。手術では全例、外側のONI plate固定に加えて内側の固定を行い、内側固定法の内訳は、中空螺子15例、鋼線締結1例、ONI medial plate 1例、AO1/3円プレート1例であった。治療成績は、最終観察時のJOAスコアが平均90点(73～97点)、肘関節可動域は屈曲が平均126°、伸展が-17°であった。骨癒合は15例(83%)で得られ、他の3例中2例は通院を自己中断したため最終的な癒合の確認ができず、残りの1例は最終観察時の術後9ヵ月でも癒合が得られていなかったことから偽関節と判定した。代表例として、偽関節例を含む2例を提示した。

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：東海産科婦人科学会  

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Event date： 2023.12

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：名古屋市  

Event date： 2023.12

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：名古屋市  

Event date： 2023.12

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：名古屋市  

Event date： 2023.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：つくば市  

Event date： 2023.10

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：神戸市  

Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：新潟市  

Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

Event date： 2023.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

Event date： 2023.5

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

Event date： 2023.5

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：岡山  

Event date： 2023.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京都新宿区