Okayama University Medical SchoolActa Medica Okayama0386-300X7712023Ipsilateral Periprosthetic Fractures above and below the Knee Associated with Navigation Tracker Pin and Bone Fragility7174ENYasuakiYamakawaDepartment of Orthopedic Surgery, Kochi Health Sciences CenterYusukeKamatsukiDepartment of Orthopedic Surgery, Kochi Health Sciences CenterTomoyukiNodaDepartment of Orthopaedic Surgery, Okayama University HospitalMihoKureDepartment of Orthopaedic Surgery, Okayama University HospitalShinichiMiyazawaDepartment of Orthopaedic Surgery, Okayama University HospitalToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University HospitalCase Report10.18926/AMO/64364We report a case of ipsilateral periprosthetic fractures above and below the knee that occurred at different times due to navigation tracker pin and bone fragility. A 66-year-old Japanese woman with rheumatoid arthritis (RA) underwent a total knee arthroplasty. Four months post-surgery, a periprosthetic fracture above the knee at the navigation pin hole was detected. She underwent osteosynthesis and could walk independently, but she developed an ipsilateral tibial component fracture. Conservative treatment with a splint was followed by bone union. Patients with RA treated with oral steroids tend to develop ipsilateral periprosthetic fractures around the knee due to bone fragility.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2077-038311162022Association between Immediate Postoperative Radiographic Findings and Failed Internal Fixation for Trochanteric Fractures: Systematic Review and Meta-Analysis4879ENNorioYamamotoDepartment of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYasushiTsujimotoScientific Research Works Peer Support Group (SRWS-PSG)SuguruYokooDepartment of Orthopedic Surgery, National Hospital Organization Okayama Medical CenterKojiDemiyaDepartment of Orthopedic Surgery, Tsuyama Chuo HospitalMadokaInoueScientific Research Works Peer Support Group (SRWS-PSG)TomoyukiNodaDepartment of Orthopedic Surgery and Traumatology, Kawasaki Medical School General Medical CenterToshifumiOzakiDepartment of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakashiYorifujiDepartment of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesFailed internal fixations for trochanteric fractures have a strong negative impact owing to increased postoperative mortality and high medical costs. However, evidence on the prognostic value of postoperative radiographic findings for failed internal fixations is limited. We aimed to clarify the association between comprehensive immediate postoperative radiographic findings and failed internal fixation using relative and absolute risk measures. We followed the meta-analysis of observational studies in epidemiology guidelines and the Cochrane handbook. We searched specific databases in November 2021. The outcomes of interest were failed internal fixation and cut-out. We pooled the odds ratios and 95% confidence intervals using a random-effects model and calculated the number needed to harm for each outcome. Thirty-six studies involving 8938 patients were included. The certainty of evidence in the association between postoperative radiographic findings and failed internal fixation or cut-out was mainly low or very low except for the association between intramedullary malreduction on the anteromedial cortex and failed internal fixation. Moderate certainty of evidence supported that intramedullary malreduction on the anteromedial cortex was associated with failed internal fixation. Most postoperative radiographic findings on immediate postoperative radiographs for trochanteric fractures were uncertain as prognostic factors for failed internal fixations.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7522021Osteosynthesis for Geriatric Acetabular Fractures: An Epidemiological and Clinico-Radiological Study Related to Marginal or Roof Impaction177185ENMadokaInoueDepartment of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomoyukiNodaDepartment of Emergency Healthcare and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakenoriUeharaDepartment of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomonoriTetsunagaDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazukiYamadaDepartment of Musculoskeletal Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTaichiSaitoDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasunoriShimamuraDepartment of Orthopedic Surgery, Kochi Health Sciences CenterYasuakiYamakawaDepartment of Orthopedic Surgery, Kochi Health Sciences CenterToshifumiOzakiDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/61895This retrospective study sought to elucidate the incidence rates of roof impaction (RI) and marginal impaction (MI) and radiological and clinical outcomes of open reduction and internal fixation (ORIF) for RI and MI in geriatric acetabular fractures. The cases of 68 patients aged ≥ 65 years (mean 71 years) treated with ORIF were analyzed. MI was present in 12 fractures (67%) and an RI of the weight-bearing surface was present in 24 (46%) of the potential fracture types. Regarding the reduction quality, 54% of the reductions were graded as anatomical, 37% as imperfect, and 9% as poor. In the clinical evaluations of the 45 patients who had > 1-year follow-up (follow-up rate: 66.2%), 18% were graded as excellent, 53% as good, 16% as fair, and 13% as poor. An anatomic reduction was strongly associated with good or excellent clinical and radiological outcomes. CT was superior to radiographs for detecting the residual displacement postoperatively. Postoperative deep infection occurred in four patients. Three patients (6.7%) underwent a total hip arthroplasty conversion due to secondary
osteoarthritis of the hip. We recommend ORIF as the preferred surgical treatment option for displaced acetabular fractures in elderly patients.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2218-273X10112020Deep Learning for Osteoporosis Classification Using Hip Radiographs and Patient Clinical Covariates1534ENNorioYamamotoDepartment of Orthopaedic Surgery, Kagawa Prefectural Central HospitalShintaro SukegawaDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityAkiraKitamuraSearch Space Inc.RyosukeGotoSearch Space Inc.TomoyukiNodaDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeisukeNakanoDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKiyofumiTakabatakeDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHotakaKawaiDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHitoshiNagatsukaDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKeisukeKawasakiDepartment of Orthopaedic Surgery, Kagawa Prefectural Central HospitalYoshihikoFurukiDepartment of Oral and Maxillofacial Surgery, Kagawa Prefectural Central HospitalToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesThis study considers the use of deep learning to diagnose osteoporosis from hip radiographs, and whether adding clinical data improves diagnostic performance over the image mode alone. For objective labeling, we collected a dataset containing 1131 images from patients who underwent both skeletal bone mineral density measurement and hip radiography at a single general hospital between 2014 and 2019. Osteoporosis was assessed from the hip radiographs using five convolutional neural network (CNN) models. We also investigated ensemble models with clinical covariates added to each CNN. The accuracy, precision, recall, specificity, negative predictive value (npv), F1 score, and area under the curve (AUC) score were calculated for each network. In the evaluation of the five CNN models using only hip radiographs, GoogleNet and EfficientNet b3 exhibited the best accuracy, precision, and specificity. Among the five ensemble models, EfficientNet b3 exhibited the best accuracy, recall, npv, F1 score, and AUC score when patient variables were included. The CNN models diagnosed osteoporosis from hip radiographs with high accuracy, and their performance improved further with the addition of clinical covariates from patient records.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7422020Non-traumatic Atypical Peri-implant Femoral Fracture at the Distal Screw after Short Femoral Nail Fixation for a Pertrochanteric Fracture151157ENNorioYamamotoDepartment of Orthopedic Surgery, Unnan City HospitalTomoyukiDanfuraDepartment of Orthopedic Surgery, Unnan City HospitalTomoyukiNodaDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/58274 This is the second report of an atypical peri-implant femoral fracture occurring at the distal screw after intramedullary nail fixation of a pertrochanteric fracture. A 94-year-old Japanese female with a 5-year history of alendronate intake presented with prodromal pain in her right thigh after intramedullary nail fixation. Plain radiographs showed an incomplete noncomminuted transverse fracture at the distal screw, suggesting an atypical peri-implant femoral fracture. The pathogenesis of an atypical peri-implant femoral fracture could be a combined systemic bone metabolism disorder and repetitive overloading at the screw, similar to the pathogenesis of an atypical periprosthetic femoral fracture around stem implantation.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama23526440252020The Masquelet technique for septic arthritis of the small joint in the hands: Case reports100268ENTaichiSaitoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesTomoyukiNodaDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesHiroyaKondoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesKojiDemiyaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesSatoshiNezuDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesSuguruYokooDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesMinamiMatsuhashiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesTakenoriUeharaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesYasunoriShimamuraDepartment of Sports Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesMasayukiKodamaMizushima Central HospitalToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical SciencesSeptic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama0936-805114042019External iliac artery thrombosis following open reduction of acetabular fracture: a case report and literature review481485ENNorioYamamotoDepartment of Orthopedic Surgery, Kagawa Prefectural Central HospitalTomoyukiNodaDepartment of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTaichiSaitoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakenoriUeharaDepartment of Emergency Healthcare and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceYasunoriShimamuraDepartment of Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceBACKGROUND:<br/>
Postoperative thrombosis of the external iliac artery (EIA) following open reduction and internal fixation for acetabular fracture is extremely rare.<br/>
PURPOSE:<br/>
To report a patient with EIA thrombosis following open reduction and internal fixation using the modified ilioinguinal approach for acetabular fractures.<br/>
STUDY DESIGN:<br/>
This is a case report of a 69-year-old male with a left acetabular fracture who was treated surgically.<br/>
METHODS:<br/>
A 69-year-old male presented with left hip pain after a 1.5-m fall. Radiographs revealed left acetabular anterior wall and posterior hemitransverse fractures with dome impaction. Computed tomography (CT) showed atherosclerotic changes in many arteries. Open reduction and internal fixation were performed using the modified ilioinguinal approach. Adhesion around the external iliac vessels was severe, and the external iliac vein (EIV) ruptured during exposure. After EIV repair, anatomical reduction was achieved and the fracture was fixed using a reconstruction plate. Nine hours after surgery, the left lower limb showed acute ischemic symptoms. Contrast-enhanced CT indicated complete occlusion of the left EIA. The patient was immediately taken for a thrombectomy via EIA cut-down using a Fogarty catheter. Postoperatively, he had palpable dorsalis pedis and posterior tibial pulses; however, post-reperfusion compartment syndrome developed. Fasciotomy of the left leg was performed.<br/>
RESULTS:<br/>
At the 2-year and 4-month follow-up, he was pain-free in his hip and leg. Although he was walking with a cane, activity was limited due to a mild foot drop.<br/>
CONCLUSIONS:<br/>
It is very important for surgeons to consider EIA thrombosis as a potential complication following open reduction and internal fixation. In this case, EIA thrombosis could be explained by preoperative atherosclerotic changes and intraoperative vascular handling procedures. Preoperative screening and management, and meticulous surgical procedures are necessary for patients with a high risk of thrombosis.No potential conflict of interest relevant to this article was reported.Springer Japan KKActa Medica Okayama0949-26581832013Efficacy of low-intensity pulsed ultrasound treatment for surgically managed fresh diaphyseal fractures of the lower extremity: multi-center retrospective cohort study410418ENYoKinamiTomoyukiNodaToshifumiOzakiThere are no evidence on the effects of low-intensity pulsed ultrasound (LIPUS) on surgically managed fresh fractures. We therefore performed a multicenter retrospective cohort study to investigate the effects of LIPUS on surgically managed fresh fractures.
This study included patients surgically treated for diaphyseal fractures of the femur or tibia between August 2009 and July 2010 at 14 institutions. Outcome was the union period. We performed an overall comparison of the LIPUS group (78 cases) with the control group (63 cases), as well as subgroup analyses comparing outcomes for fracture sites, fracture types, soft tissue conditions, and fixation methods between the groups.
There was no significant difference between the groups in terms of distribution of cases by fracture site, fracture type, soft tissue condition, fixation method. Analyses comparing subgroups, however, showed significant differences between the two groups, particularly in relation to type C fractures, regardless of whether all cases or only closed-fracture cases were analyzed: there was an approximately 30 % reduction in the union period for type C fractures in the LIPUS group. There were also cases requiring reoperation due to lack of stability, even among the type C fractures.
LIPUS is effective for surgically managed, fresh, type C comminuted diaphyseal fractures of the lower limbs when there is appropriate stability at the fracture site.No potential conflict of interest relevant to this article was reported.ͺRγwοActa Medica Okayama0030-155812322011γrO€γθχΜfΓKChC141144ENYasunoriShimamuraMadokaInoueMasatuguOzawaTomokoKanazawaTaiichiSaitouRyuichiNakaharaTomoyukiNodaKeiichiroNishidaToshifumiOzakiNo potential conflict of interest relevant to this article was reported.ͺRγwοActa Medica Okayama0030-155812232010εΪzE]qάΜKChC253257ENTomoyukiNodaToshifumiOzakiNo potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6422010Biomechanical Evaluation of the Fixation Methods for Transcondylar Fracture of the Humerus:ONI Plate Versus Conventional Plates and Screws115120ENYasunoriShimamuraKeiichiroNishidaJunyaImataniTomoyukiNodaHiroyukiHashizumeAijiOhtsukaToshifumiOzakiOriginal Article10.18926/AMO/32855<p>We biomechanically evaluated the bone fixation rigidity of an ONI plate (Group I) during fixation of experimentally created transcondylar humerus fractures in cadaveric elbows, which are the most frequently observed humeral fractures in the elderly, and compared it with the rigidity achieved by 3 conventional fixation methods:an LCP reconstruction plate 3.5 using a locking mechanism (Group II), a conventional reconstruction plate 3.5 (CRP) with a cannulated cancellous screw (Group III), and a CRP with 2 cannulated cancellous screws (CS) in a crisscross orientation (Group IV). In the axial loading test, the mean failure loads were:Group I, 98.9+/-32.6;Group II, 108.5+/-27.2;Group III, 50.0+/-7.5;and Group IV, 34.5+/-12.2 (N). Group I fixations failed at a significantly higher load than those of Groups III and IV (p0.05). In the extension loading test, the mean failure loads were:Group I, 34.0+/-12.4;Group II, 51.0+/-14.8;Group III, 19.3+/-6.0;and Group IV, 14.7+/-3.1 (N). Group IV fixations showed a significantly lower failure load than those of Group I (p0.05). The fixation rigidities against mechanical loading by the ONI plate and LCP plate were comparable. These results suggested that an ONI system might be superior to the CRP and CS method, and comparable to the LCP method in terms of fixation rigidity for distal humerus fractures.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6422010Operative treatment for pincer type femoroacetabular impingement:a case report149154ENHirosukeEndoTomoyukiNodaShigeruMitaniRyuichiNakaharaTomonoriTetsunagaToshiyukiKunisadaToshifumiOzakiCase Report10.18926/AMO/32853<p>Femoroacetabular impingement (FAI) is a condition characterized by the impingement of the femur and acetabulum. In Japan, this disorder has become recognized gradually. Here we report a rare case of surgically treated FAI, associated with an osseous protrusion on the acetabulum of a 30-year-old female. Plain computed tomography (CT) and reconstructive 3D-CT images clearly demonstrated an anterolateral bony protrusion. Hip arthroscopy showed no degeneration of the cartilage on either the femoral or acetabular side, but degeneration at the edge of labrum was observed in the region of the bony protrusion. The complete removal of the bony protrusion under hip arthroscopy was thus considered impracticable, and a small skin incision was therefore made anteriorly to approach the acetabulum. The Short-Form 36-Item Health Survey (SF-36) revealed improvement in all scores.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6252008The Minimally Invasive Plate Osteosynthesis (MIPO) Technique with a Locking Compression Plate for Femoral Lengthening333339ENHirosukeEndoKojiAsaumiShigeruMitaniTomoyukiNodaHiroshiMinagawaTomonoriTetsunagaToshifumiOzakiOriginal Article10.18926/AMO/30972<p>A minimally invasive plate osteosynthesis technique using a locking compression plate (LCP) has been used widely in trauma cases. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing, and that the LCP has excellent angular stability. Its use in bone lengthening, however, has not been established. In such cases, it is desirable to shorten the external skeletal fixation period as much as possible. Here, the MIPO technique using an LCP was applied to femoral distraction osteogenesis in an attempt to shorten the external skeletal fixation period. For femoral lengthening, the MIPO technique was performed in 2 stages. Orthofix external fixators (Orthofix, England) were used to insert screws from the anterolateral side rather than from the lateral side of the femur for bone lengthening. When sufficient callus formation was detected postoperatively at the site of bone lengthening, and the absence of infection was ensured, limb draping was performed, including a whole external fixator, and then the MIPO technique was applied with an LCP.
In 3 cases (5 limbs), the average duration of external skeletal fixation was 134days, the average external-fixation index was 24days/cm, and the average consolidation index was 22days/cm. The MIPO technique using an LCP made it possible to shorten the external skeletal fixation-wearing period in femoral lengthening.</p>No potential conflict of interest relevant to this article was reported.Acta Medica Okayama2000Clinico-radiological study of total knee arthroplasty after high tibial osteotomyENNo potential conflict of interest relevant to this article was reported.