Updated on 2024/03/01

写真a

 
TOKUTAKE Katsuhiro
 
Organization
Nagoya University Hospital Hand Surgery Assistant Professor
Graduate School
Graduate School of Medicine
Title
Assistant Professor
External link

Degree 1

  1. 博士(医学) ( 2019.3   名古屋大学 ) 

Research Areas 1

  1. Life Science / Orthopedics

Research History 3

  1. Nagoya University   Assistant Professor

    2023.10

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    Country:Japan

  2. Nagoya University   Designated assistant professor

    2020.11 - 2023.9

  3. Nagoya University   Assistant professor of hospital

    2019.4 - 2020.10

Education 2

  1. Nagoya University

    2015.4 - 2019.3

  2. Mie University

    2002.4 - 2008.3

Professional Memberships 10

  1. 日本整形外科学会   20150331 日本整形外科学会専門医取得

  2. 日本手外科学会   20200331 日本手外科学会専門医取得

  3. 日本肘関節学会

  4. 日本マイクロサージャリー学会

  5. 日本末梢神経学会

  6. 日本骨折治療学会

  7. 中部日本整形外科災害外科学会

  8. 中部手外科研究会

  9. 日本運動器疼痛学会

  10. 日本手関節外科ワークショップ

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Papers 53

  1. Comparative Outcomes of Anterior and Posterior Plating for Distal-Third Humerus Shaft Fractures. Reviewed International journal

    Shimamoto Y, Tokutake K, Takegami Y, Asami Y, Sato K, Ueno H, Nakano T, Fujii S, Okui N, Imagama S

    The Journal of hand surgery     2023.9

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    Authorship:Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Journal of Hand Surgery  

    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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  2. Comparison of the Outcomes of Plating, Screw Fixation, and Pinning in Sanders Type II Fractures: A Multicenter (TRON) Retrospective Study. Reviewed

    Kato M, Takegami Y, Tokutake K, Asami Y, Takahashi Y, Takahashi H, Kumagai H, Imagama S

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons   Vol. 63 ( 2 ) page: 171 - 175   2024.3

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    Language:English   Publisher:Journal of Foot and Ankle Surgery  

    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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  3. Comparing short vs. intermediate and long nails in elderly patients with unstable multifragmental femoral trochanteric fractures (AO type A2): Multicenter (TRON group) retrospective study. Reviewed

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

    Injury   Vol. 55 ( 4 ) page: 111420   2024.2

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    DOI: 10.1016/j.injury.2024.111420

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  4. Early versus delayed weight bearing after internal fixation for femoral neck fracture in younger adults: A multicenter retrospective study. Reviewed

    Hasegawa K, Takegami Y, Tokutake K, Nakashima H, Mishima K, Kobayashi K, Imagama S

    Injury   Vol. 55 ( 2 ) page: 111292   2024.2

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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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  5. Early weight bearing versus late weight bearing after intramedullary nailing for distal femoral fracture (AO/OTA 33) in elderly patients: A multicenter propensity-matched study. Reviewed

    Komaki K, Takegami Y, Tokutake K, Hanabayashi M, Kuwahara Y, Yamada Y, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   Vol. 29 ( 1 ) page: 268 - 272   2024.1

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    Language:English   Publisher:Journal of Orthopaedic Science  

    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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  6. What factors are associated with loss of alignment after open reduction and internal fixation for tibial plateau fractures? A retrospective multicenter (TRON group) study. Reviewed

    Shimizu K, Takegami Y, Tokutake K, Naruse K, Sudo Y, Matsubara Y, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   Vol. 29 ( 1 ) page: 286 - 291   2024.1

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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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  7. Home exercises after volar locking plate fixation for distal radius fracture in the elderly are as effective as supervised physiotherapy -multicenter retrospective study. Reviewed

    Saito Y, Takegami Y, Tokutake K, Shibata R, Matsubara H, Imamaga S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   Vol. 29 ( 1 ) page: 146 - 150   2024.1

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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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  8. Predictive factors for one-year mortality after surgery for periprosthetic femoral fracture: A retrospective multicenter (TRON group) study. Reviewed

    Kurokawa H, Takegami Y, Tokutake K, Takami H, Iwata M, Terasawa S, Inoue H, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   Vol. 29 ( 1 ) page: 299 - 305   2024.1

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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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  9. Predictive factors for reoperation after periprosthetic femoral fracture: A retrospective multicenter (TRON) study. Reviewed

    Iwata M, Takegami Y, Tokutake K, Kurokawa H, Takami H, Terasawa S, Takatsu T, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2023.12

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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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  10. Locked Tension Band Wiring: A Modified Technique for Olecranon Fractures-A Multicenter Study Comparing Clinical Outcomes and Complications with Conventional Methods Reviewed

    Kuwahara, Y; Takegami, Y; Mitsuya, S; Tokutake, K; Yamauchi, K; Imagama, S

    INDIAN JOURNAL OF ORTHOPAEDICS   Vol. 57 ( 12 ) page: 2024 - 2030   2023.12

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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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  11. Ulnar Nerve Neuropathy After Surgery for Intraarticular Distal Humerus Fractures: An Analysis of 116 Patients Reviewed

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

    JOURNAL OF HAND SURGERY-AMERICAN VOLUME   Vol. 48 ( 11 ) page: 1171.e1 - 1171.e5   2023.11

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    Language:English   Publisher:Journal of Hand Surgery  

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

    DOI: 10.1016/j.jhsa.2023.02.001

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  12. An age-matched comparative study on intramedullary nailing and plate fixation of both-bone diaphyseal forearm fracture in adolescents Reviewed

    Ishihara, N; Tokutake, K; Takegami, Y; Asami, Y; Kumagai, H; Ota, H; Kimura, Y; Ohshima, K; Imagama, S

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   Vol. 34 ( 1 ) page: 441 - 450   2023.8

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    Language:English   Publisher:European Journal of Orthopaedic Surgery and Traumatology  

    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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  13. Clinical comparison of double-plate fixation by the perpendicular plate method versus parallel plate method for distal humeral fracture: a multicenter (TRON group) study Reviewed

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

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   Vol. 33 ( 6 ) page: 2427 - 2433   2023.8

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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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  14. A less invasive operative method using a medial cannulated cancellous screw and single plate fixation for the treatment of transcondylar fracture of the humerus in elderly patients in multicenter (TRON group) study Reviewed

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

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   Vol. 33 ( 6 ) page: 2481 - 2487   2023.8

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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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  15. Retrospective multicenter (TRON group) study of humeral shaft fragility fractures Analysis of mortality rates and risk factors Reviewed

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

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   Vol. 54 ( 8 ) page: 110855   2023.8

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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.

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  16. Predictors of postoperative complications of tension band wiring techniques for patella fracture: A retrospective multicenter (TRON group) study Reviewed

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

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   Vol. 54 ( 8 ) page: 110896   2023.8

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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.

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  17. Comparison of functional outcome and complications of locking plate versus coracoclavicular fixation in the treatment of unstable distal clavicle fractures: the multicenter, propensity-matched TRON study Reviewed

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

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   Vol. 33 ( 5 ) page: 1789 - 1795   2023.7

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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.

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  18. What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study Reviewed

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

    INDIAN JOURNAL OF ORTHOPAEDICS   Vol. 57 ( 7 ) page: 1076 - 1082   2023.7

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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.

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  19. Incidence and Risk Factors for Fracture-Related Infection After Peri-Prosthetic Femoral Fractures: A Multicenter Retrospective Study (TRON Group Study) Reviewed

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

    SURGICAL INFECTIONS   Vol. 24 ( 5 ) page: 433 - 439   2023.6

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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.

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  20. Comparison of surgical treatments for distal ulna fracture when combined with anterior locking plate fixation of distal radius in the over 70 age group Reviewed International journal

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

    JOURNAL OF HAND SURGERY-EUROPEAN VOLUME   Vol. 48 ( 6 ) page: 516 - 523   2023.6

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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.

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  21. Low body mass index is a risk factor for increased post-operative mortality and poor functional improvement in distal femur fractures among patients aged over 65: A multicentre (TRON) study Reviewed International journal

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

    JOURNAL OF ORTHOPAEDIC SCIENCE   Vol. 28 ( 3 ) page: 631 - 636   2023.5

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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.

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  22. Hook plate fixation versus locking plate fixation for distal clavicle fracture: a multicenter propensity score-matched study Reviewed

    Takahashi, H; Takegami, Y; Tokutake, K; Katayama, Y; Imagama, S

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 85 ( 2 ) page: 223 - 232   2023.5

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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

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  23. Re: Shibata et al. Comparison of surgical treatments for distal ulna fracture when combined with anterior locking plate fixation of the distal radius in the over 70 age group. J Hand Surg Eur. Epub ahead of print 28 January 2023. DOI: 10.1177/17531934221150495 Reviewed

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

    JOURNAL OF HAND SURGERY-EUROPEAN VOLUME     2023.4

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  24. Locked Tension Band Wiring for Mayo IIA Olecranon Fractures: Modified Surgical Technique and Retrospective Comparative Study of Clinical Outcomes and Cost-effectiveness with Locking Plate Reviewed

    Kuwahara, Y; Takegami, Y; Mitsuya, S; Tokutake, K; Yamauchi, K; Imagama, S

    JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME   Vol. 28 ( 02 ) page: 205 - 213   2023.4

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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 II A) 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.

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  25. Longer time of implantation using the buried pin technique for intramedullary nailing would decrease refracture in the diaphyseal forearm fracture in children-retrospective multicenter (TRON) study Reviewed International journal

    Ohshima, K; Tokutake, K; Takegami, Y; Asami, Y; Matsubara, Y; Natsume, T; Kimura, Y; Ishihara, N; Imagama, S

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   Vol. 54 ( 3 ) page: 924 - 929   2023.3

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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.

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  26. Effect of anaesthesia on cemented hemiarthroplasty -A multicentre retrospective study (TRON study). Reviewed

    Yamamoto S, Takegami Y, Tokutake K, Nakashima R, Naito K, Ogura K, Kato D, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2023.2

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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.

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  27. Retrospective Comparative Study of Clinical Outcomes and Cost-Effectiveness with Bone Substitutes on Volar Locking Plate Fixation of Unstable Distal Radial Fractures in the Elderly Reviewed

    Mori, Y; Takegami, Y; Tokutake, K; Oka, Y; Imagama, S

    JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME   Vol. 28 ( 1 ) page: 61 - 68   2023.2

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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)

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  28. Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study Reviewed

    Sakurai, S; Takegami, Y; Tokutake, K; Kuwahara, Y; Shibata, R; Ota, H; Kumagai, H; Imagama, S

    INDIAN JOURNAL OF ORTHOPAEDICS   Vol. 57 ( 1 ) page: 117 - 123   2023.1

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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.

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  29. Mortality and clinical outcomes of Vancouver type B periprosthetic femoral fractures Reviewed

    Takami, H; Takegami, Y; Tokutake, K; Kurokawa, H; Iwata, M; Terasawa, S; Oguchi, T; Imagama, S

    BONE & JOINT OPEN   Vol. 4 ( 1 ) page: 38 - 45   2023.1

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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.

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  30. A case of Intraneural Perineurioma which Needed Differentiation with the Cubital Tunnel Syndrome Reviewed

    Yamaga Takashi, Kurimoto Shigeru, Hara Tatsuya, Yamamoto Michiro, Iwatsuki Katsuyuki, Yoneda Hidemasa, Saeki Masaomi, Tokutake Katsuhiro, Murayama Atsuhiko, Sugiura Hirotaka, Hirata Hitoshi

    Journal of Japan Elbow Society   Vol. 30 ( 2 ) page: 402 - 404   2023

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  31. The CeCORD-J study on collagenase injection versus aponeurectomy for Dupuytren's contracture compared by hand function and cost effectiveness Reviewed

    Yamamoto M., Yasunaga H., Kakinoki R., Tsubokawa N., Morita A., Tanaka K., Sakai A., Kurahashi T., Hirata H., Hirata H., Tatebe M., Yamamoto M., Onishi T., Iwatsuki K., Tokutake K., Yasunaga H., Otani K., Morita A., Tanaka K., Sakai A., Menuki K., Yamanaka Y., Urata S., Oguchi T., Iwasaki N., Matsui Y., Ikegami H., Sakano H., Katsumura T., Nishiwaki M., Tanaka T., Hirase Y., Kanno Y., Kato H., Hayashi M., Omokawa S., Hasegawa H., Gotani H., Tanaka Y., Sunagawa T., Shinomiya R., Kajiwara R., Nakao E., Nishizuka T., Hattori Y., Shinohara T., Watanabe K., Okui N., Koshima H., Tajika T., Ohi H., Kaji Y., Nagayoshi E., Igarashi A.

    Scientific Reports   Vol. 12 ( 1 )   2022.12

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    This study compared hand function and the cost-effectiveness of treatment between collagenase Clostridium histolyticum (CCH) injection and limited fasciectomy for patients with Dupuytren’s contracture (DC). The CeCORD-J study is a prospective, multicenter, non-randomized controlled, observational study of two parallel groups. Participants were DC patients with multiple affected fingers, including flexion contracture of the proximal interphalangeal (PIP) joint. The primary outcome was the Hand10 score, as a patient-reported outcome measure (PROM). We set secondary outcomes of EQ-5D-5L (QOL) score, degree of extension deficit, and direct cost. Propensity score adjustment was used to balance differences in patient characteristics between groups. Participants comprised 52 patients in the Collagenase group and 26 patients in the Surgery group. There were no significant differences in the Hand10 and QOL scores between the two groups at 26 weeks. Mean direct cost was 248,000 yen higher in the Surgery group than in the Collagenase group. Extension deficit angle of the PIP joint was significantly larger in the Collagenase group at 26 weeks. Although the Collagenase group showed dominance in cost-effectiveness, there was no significant difference between the two groups in hand function at 26 weeks.

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  32. Do heel-unloading orthoses improve clinical outcomes in patients after surgical treatment of calcaneal fracture? A propensity-matched, multicenter analysis of the TRON database Reviewed International journal

    Kagami, Y; Tokutake, K; Takegami, Y; Okui, N; Sakai, T; Inoue, H; Kanemura, T; Hanabayashi, M; Ito, O; Kanayama, Y; Maruyama, K; Yoshida, H; Ando, T; Sugimoto, R; Sugimoto, T; Imagama, S

    PROSTHETICS AND ORTHOTICS INTERNATIONAL   Vol. 46 ( 6 ) page: 569 - 575   2022.12

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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.

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  33. Does surgical treatment for unstable fragility fracture of the pelvis promote early mobilization and improve survival rate and postoperative clinical function? Reviewed International journal

    Saito, Y; Tokutake, K; Takegami, Y; Yoshida, M; Omichi, T; Imagama, S

    EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY   Vol. 48 ( 5 ) page: 3747 - 3756   2022.10

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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.

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  34. Plate fixation through the lateral extensile approach versus cannulated screw fixation through the sinus tarsi approach for calcaneal fracture: a multicenter, propensity score-matched TRON study Reviewed International journal

    Sugimoto, T; Tokutake, K; Takegami, Y; Okui, N; Kanayama, Y; Inoue, H; Sugimoto, R; Kagami, Y; Imagama, S

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   Vol. 32 ( 7 ) page: 1333 - 1340   2022.10

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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.

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  35. A Wirelessly Powered 4-Channel Neurostimulator for Reconstructing Walking Trajectory Reviewed

    Takeuchi, M; Tokutake, K; Watanabe, K; Ito, N; Aoyama, T; Saeki, S; Kurimoto, S; Hirata, H; Hasegawa, Y

    SENSORS   Vol. 22 ( 19 )   2022.10

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    A wirelessly powered four-channel neurostimulator was developed for applying selective Functional Electrical Stimulation (FES) to four peripheral nerves to control the ankle and knee joints of a rat. The power of the neurostimulator was wirelessly supplied from a transmitter device, and the four nerves were connected to the receiver device, which controlled the ankle and knee joints in the rat. The receiver device had functions to detect the frequency of the transmitter signal from the transmitter coil. The stimulation site of the nerves was selected according to the frequency of the transmitter signal. The rat toe position was controlled by changing the angles of the ankle and knee joints. The joint angles were controlled by the stimulation current applied to each nerve independently. The stimulation currents were adjusted by the Proportional Integral Differential (PID) and feed-forward control method through a visual feedback control system, and the walking trajectory of a rat’s hind leg was reconstructed. This study contributes to controlling the multiple joints of a leg and reconstructing functional motions such as walking using the robotic control technology.

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  36. Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study Reviewed International journal

    Omichi, T; Takegami, Y; Tokutake, K; Saito, Y; Ito, O; Ando, T; Imagama, S

    EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY   Vol. 48 ( 4 ) page: 2897 - 2904   2022.8

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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.

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  37. A Therapeutic Strategy for Lower Motor Neuron Disease and Injury Integrating Neural Stem Cell Transplantation and Functional Electrical Stimulation in a Rat Model Reviewed International journal

    Tokutake, K; Takeuchi, M; Kurimoto, S; Saeki, S; Asami, Y; Onaka, K; Saeki, M; Aoyama, T; Hasegawa, Y; Hirata, H

    INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES   Vol. 23 ( 15 )   2022.8

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    Promising treatments for upper motor neuron disease are emerging in which motor function is restored by brain–computer interfaces and functional electrical stimulation. At present, such technologies and procedures are not applicable to lower motor neuron disease. We propose a novel therapeutic strategy for lower motor neuron disease and injury integrating neural stem cell transplantation with our new functional electrical stimulation control system. In a rat sciatic nerve transection model, we transplanted embryonic spinal neural stem cells into the distal stump of the peripheral nerve to reinnervate denervated muscle, and subsequently demonstrated that highly responsive limb movement similar to that of a healthy limb could be attained with a wirelessly powered two-channel neurostimulator that we developed. This unique technology, which can reinnervate and precisely move previously denervated muscles that were unresponsive to electrical stimulation, contributes to improving the condition of patients suffering from intractable diseases of paralysis and traumatic injury.

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  38. Functional Reconstruction of Denervated Muscle by Xenotransplantation of Neural Cells from Porcine to Rat Reviewed International journal

    Saeki, S; Tokutake, K; Takasu, M; Kurimoto, S; Asami, Y; Onaka, K; Saeki, M; Hirata, H

    INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES   Vol. 23 ( 15 )   2022.8

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    Neural cell transplantation targeting peripheral nerves is a potential treatment regime for denervated muscle atrophy. This study aimed to develop a new therapeutic technique for intractable muscle atrophy by the xenotransplantation of neural stem cells derived from pig fetuses into peripheral nerves. In this study, we created a denervation model using neurotomy in nude rats and transplanted pig-fetus-derived neural stem cells into the cut nerve stump. Three months after transplantation, the survival of neural cells, the number and area of regenerated axons, and the degree of functional recovery by electrical stimulation of peripheral nerves were compared among the gestational ages (E 22, E 27, E 45) of the pigs. Transplanted neural cells were engrafted at all ages. Functional recovery by electric stimulation was observed at age E 22 and E 27. This study shows that the xenotransplantation of fetal porcine neural stem cells can restore denervated muscle function. When combined with medical engineering, this technology can help in developing a new therapy for paralysis.

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  39. The Association of Bohler's Angle With Postoperative Pain and Gender for Displaced Intra-Articular Calcaneal Fracture, Multicenter Retrospective Study-TRON Study Reviewed International journal

    Sugimoto, R; Tokutake, K; Takegami, Y; Kanayama, Y; Okui, N; Sakai, T; Kagami, Y; Sugimoto, T; Imagama, S

    JOURNAL OF FOOT & ANKLE SURGERY   Vol. 61 ( 4 ) page: 766 - 770   2022.7

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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.

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  40. Risk factors for fracture-related infection after open reduction and internal fixation of proximal humerus fractures: A multicenter retrospective study of 496 fractures (TRON group study) Reviewed

    Makihara, K; Takegami, Y; Tokutake, K; Yamauchi, K; Hiramatsu, Y; Matsuura, Y; Imagama, S

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   Vol. 53 ( 7 ) page: 2573 - 2578   2022.7

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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.

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  41. Displaced humeral head after intramedullary nailing for proximal humeral fracture is associated with worse short-term outcomes-a multicenter TRON study. Reviewed

    Hiramatsu Y, Takegami Y, Katsuhiro T, Matsuura Y, Makihara K, Kanemura T, Imagama S

    JSES international   Vol. 6 ( 3 ) page: 374 - 379   2022.5

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  42. Predictive factors for mortality after distal femoral fractures in the elderly: A retrospective multicenter (TRON group) study Reviewed International journal

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

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   Vol. 53 ( 3 ) page: 1225 - 1230   2022.3

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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.

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  43. How does intraoperative fracture malalignment affect postoperative function and bone healing following distal femoral fracture? A RETROSPECTIVE MULTICENTRE STUDY Reviewed International journal

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

    BONE & JOINT OPEN   Vol. 3 ( 2 ) page: 165 - 172   2022.2

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    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 ac-cording 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 character-istics 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°.

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  44. Low and high body mass index and lower numbers of screws in the articular segment are risk factors for non-union of distal humeral fractures in the elderly: A multi-center retrospective study (TRON study) Reviewed

    Iwase K., Takegami Y., Tokutake K., Oshika Y., Yokoyama H., Tanaka K., Sakai T., Imagama S.

    Shoulder and Elbow     2022

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    Background: Distal humerus fracture in the elderly is a challenging fracture for orthopedic surgeons. Non-union is one of the serious complications of distal humerus fracture after surgery. This retrospective multicenter study aimed to estimate the incidence of distal humeral non-union after open reduction and internal fixation, determine factors related to non-union, and compare the postoperative results of cases with non-union to cases with the union. Methods: Among 423 patients diagnosed with distal humeral fracture and who were treated by surgical therapy in 2010–2020 from our database called TRON. Only 190 subjects met the inclusion criteria. We performed a logistic regression analysis with the presence of non-union as the response variable to examine risk factors. We compare the Mayo Elbow Performance Scores of cases with non-union to cases with the union. Results: Non-union occurred after surgery in 15 patients (7.9%). The logistic regression analysis showed that body mass index<20 kg/m2 and ≥25 kg/m2, and ≤3 screws in the articular segment were significant explanatory factors for non-union (odds ratio 10.4 and 47.8, respectively). The Mayo Elbow Performance Scores were significantly worse in patients with non-union. Discussion: Low and high body mass index and three or fewer screws in the articular segment might be risk factors for non-union of distal humerus fracture in the elderly. Non-union is associated with poor clinical outcomes.

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  45. Peripheral Nerve Block and Stimulation for Controlling Rat Ankle Joint Angle using Visual Feedback System Reviewed

    Takeuchi, M; Tokutake, K; Miyamoto, T; Ito, N; Aoyama, T; Kurimoto, S; Hirata, H; Hasegawa, Y

    2022 IEEE INTERNATIONAL CONFERENCE ON CYBORG AND BIONIC SYSTEMS, CBS     page: 139 - 144   2022

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    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.

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  46. Association between C8 brachial plexus injury and rib fracture following median sternotomy Reviewed

    TOKUTAKE Katsuhiro

    The Central Japan Journal of Orthopaedic Surgery & Traumatology   Vol. 64 ( 5 ) page: 677 - 678   2021.9

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  47. Optimal conditions for graft survival and reinnervation of denervated muscles after embryonic motoneuron transplantation into peripheral nerves undergoing Wallerian degeneration Reviewed International journal

    Sawada, H; Kurimoto, S; Tokutake, K; Saeki, S; Hirata, H

    JOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE   Vol. 15 ( 9 ) page: 763 - 775   2021.9

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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.

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  48. Innervation of Meissner's corpuscles and Merkel -cells by transplantation of embryonic dorsal root ganglion cells after peripheral nerve section in rats International journal

    Asano, K; Nakano, T; Tokutake, K; Ishii, H; Nishizuka, T; Iwatsuki, K; Onishi, T; Kurimoto, S; Yamamoto, M; Tatebe, M; Hirata, H

    JOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE   Vol. 15 ( 6 ) page: 586 - 595   2021.6

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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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  49. Primary Radial Nerve Exploration Determined by Ultrasound in Pediatric Supracondylar Humerus Fracture: A Report of Two Cases Reviewed International journal

    Tokutake, K; Okui, N; Hirata, H

    JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME   Vol. 26 ( 02 ) page: 284 - 289   2021.6

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:The journal of hand surgery Asian-Pacific volume  

    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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  50. Visual Feedback Control of a Rat Ankle Angle Using a Wirelessly Powered Two-Channel Neurostimulator Reviewed International journal

    Takeuchi, M; Watanabe, K; Ishihara, K; Miyamoto, T; Tokutake, K; Saeki, S; Aoyama, T; Hasegawa, Y; Kurimoto, S; Hirata, H

    SENSORS   Vol. 20 ( 8 )   2020.4

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Sensors (Switzerland)  

    Peripheral nerve disconnections cause severe muscle atrophy and consequently, paralysis of limbs. Reinnervation of denervated muscle by transplanting motor neurons and applying Functional Electrical Stimulation (FES) onto peripheral nerves is an important procedure for preventing irreversible degeneration of muscle tissues. After the reinnervation of denervated muscles, multiple peripheral nerves should be stimulated independently to control joint motion and reconstruct functional movements of limbs by the FES. In this study, a wirelessly powered two-channel neurostimulator was developed with the purpose of applying selective FES to two peripheral nerves—the peroneal nerve and the tibial nerve in a rat. The neurostimulator was designed in such a way that power could be supplied wirelessly, from a transmitter coil to a receiver coil. The receiver coil was connected, in turn, to the peroneal and tibial nerves in the rat. The receiver circuit had a low pass filter to allow detection of the frequency of the transmitter signal. The stimulation of the nerves was switched according to the frequency of the transmitter signal. Dorsal/plantar flexion of the rat ankle joint was selectively induced by the developed neurostimulator. The rat ankle joint angle was controlled by changing the stimulation electrode and the stimulation current, based on the Proportional Integral (PI) control method using a visual feedback control system. This study was aimed at controlling the leg motion by stimulating the peripheral nerves using the neurostimulator.

    DOI: 10.3390/s20082210

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  51. Muscle spindle reinnervation using transplanted embryonic dorsal root ganglion cells after peripheral nerve transection in rats International journal

    Asano, K; Nakano, T; Tokutake, K; Ishii, H; Nishizuka, T; Iwatsuki, K; Onishi, T; Kurimoto, S; Yamamoto, M; Tatebe, M; Hirata, H

    CELL PROLIFERATION   Vol. 52 ( 5 ) page: e12660   2019.9

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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.

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  52. Usefulness of CT-based measurement of volar prominence for evaluation of risk of flexor tendon injury following fixation of a distal radius fracture Reviewed International journal

    Tokutake, K; Iwatsuki, K; Tatebe, M; Okui, N; Mizuno, M; Hirata, H

    JOURNAL OF ORTHOPAEDIC SCIENCE   Vol. 24 ( 2 ) page: 263 - 268   2019.3

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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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  53. Two cases of ganglion cyst of the hallux Reviewed

    HOSOKAWA Yuta

    The Central Japan Journal of Orthopaedic Surgery & Traumatology   Vol. 61 ( 5 ) page: 1017 - 1018   2018.9

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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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KAKENHI (Grants-in-Aid for Scientific Research) 6

  1. 新たな麻痺治療技術開発における再支配筋の筋肥大実証と変性疾患への適応拡大に向けて

    Grant number:23K15712  2023.4 - 2026.3

    科学研究費助成事業  若手研究

    徳武 克浩

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\4680000 ( Direct Cost: \3600000 、 Indirect Cost:\1080000 )

    末梢神経内神経幹細胞移植により脱神経筋近傍で脊髄様構造を有する神経節を誘導することで刺激可能な筋に変化させる技術は、中枢からの神経再生が望めない下位運動ニューロン障害が原因の麻痺疾患に対するユニークかつ有効な運動機能再建法となる可能性を秘めている。しかし現状では健常筋と比較し再支配筋の筋力は弱く、臨床応用に向けての課題である。また、筋萎縮性側索硬化症を含む変性疾患への適応も期待されるが、現行の末梢神経損傷モデルのみでは証明出来ていない。再支配筋に対する電気刺激による筋肥大の実証、筋萎縮性側索硬化症モデルマウスでの実験、この2つの課題に取り組むことで、本治療戦略の更なる臨床応用の推進につなげる。

  2. 視覚と上肢の運動に注目した不確実性に対応する手術技術の数値化・習熟に関する研究

    Grant number:23K08675  2023.4 - 2026.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    建部 将広, 下田 真吾, 大山 慎太郎, 徳武 克浩

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    Authorship:Coinvestigator(s) 

    外科医の減少が問題となっており、手技の獲得をどのようにするかは一つの課題で、顕微鏡を用いたマイクロサージャリーの分野についても同様となっている。手術用顕微鏡は光学技術の進歩により外視鏡としての利用が可能となり、術者の頭部が自由となって各種の解析が可能となってきた。眼と腕には協調運動(eye-hand coordination)があり、この解析行う目的で手術野映像での視線解析/運動解析等の評価する。これらの結果から熟練者と初心者のその手術手技の違いを明らかにし、評価の基準を抽出する。最終的には適切なトレーニング方法と安全な手術手技の可視化を目指す。

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  3. Sensorimotor Control System with Ectopic Ganglion Induction

    Grant number:22H03451  2022.4 - 2025.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

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    Authorship:Coinvestigator(s)  Grant type:Competitive

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  4. 肥満細胞が狭窄性腱鞘炎発症に与える影響の解明と新薬開発への応用

    Grant number:21K09275  2021.4 - 2024.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    仲野 隆彦, 栗本 秀, 平田 仁, 徳武 克浩

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    Authorship:Coinvestigator(s) 

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  5. Development of An Implantable Electrical Stimulation Device towards Reconstructing Functional Motions

    Grant number:21H01290  2021.4 - 2024.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

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  6. Reconstruction of Motor Function by Regenerative Medicine and Implantable Neurostimulator Device for Overcoming Intractable Paralysis

    Grant number:20K17997  2020.4 - 2023.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Early-Career Scientists

    Tokutake Katsuhiro

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    Authorship:Principal investigator  Grant type:Competitive

    Grant amount:\4160000 ( Direct Cost: \3200000 、 Indirect Cost:\960000 )

    A rat model of lower motor neuron injury was used as intractable paralysis. We combined nerve stem cell transplantation into peripheral nerves with an electrical stimulation control system we developed. As a result, denervated muscles that normally do not move were reinnervated. The strategy of stimulating multiple nerves to control reinnervated muscles allowed them to follow the target position of the toe as well as healthy rats. During treadmill walking, the paralyzed leg could be controlled by constructing a system of stimulation accompanying the preliminary movement.

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