Remission of hypersensitivity by simple weight load stimuli in a complex regional pain syndrome mouse model

Painful sensitivity of the hand or foot are the most common and debilitating symptoms of complex regional pain syndrome (CRPS). Physical therapy is standard treatment for CRPS, but evidence supporting its efficacy is minimal and it can be essentially impossible for CRPS patients to actively exercise the painful limb. Using the well-characterized distal tibial fracture CRPS mouse model, we compared the therapeutic effects of several weeks of daily hindlimb loading versus rotarod walking exercise. The effects of loading and exercise were evaluated by weekly testing of hind-paw withdrawal thresholds to von Frey fibers and radiant heat, as well as measurements of paw and ankle edema. At 6 weeks after fracture, the mice were killed and the ipsilateral femur, spinal cord and L4/5 dorsal root ganglia, and hind-paw skin collected for PCR assays and paw skin Immunohistochemistry evaluation. Hindlimb loading reduced hind-paw von Frey allodynia and heat hyperalgesia and edema within a week and these effects persisted for at least a week after discontinuing treatment. These therapeutic effects of loading exceeded the beneficial effects observed with rotarod walking exercise in fracture mice. Levels of nerve growth factor and transient receptor potential vanilloid 1 (TRPV1) immunostaining in the hind-paw skin were increased at 6 weeks after fracture, and both loading and exercise treatment reduced increases. Collectively, these results suggest that loading may be an effective and possibly curative treatment in CRPS patients with sensitivity in the affected limb.

Thumb pronation efficacy of Camitz tendon transfer with insertion on the ulnar capsule of the metacarpophalangeal joint: a cadaver study

Several studies have indicated that Camitz transfer for severe carpal tunnel does not adequately restore thumb opposition. The aim of this study was to determine whether modification of the distal insertion of the transferred palmaris longus tendon could provide more effective opposition. We used 12 fresh-frozen upper extremity specimens. For spatial analysis, we used a three-dimensional motion-tracking device. At 0 N and 5 N of traction force, the pronation angle was significantly larger for the modified procedure than for the conventional procedure. There was no significant difference in the palmar abduction angle between the two groups. The modified palmaris longus tendon insertion on the ulnar side of the thumb metacarpophalangeal joint provides more effective thumb pronation than conventional Camitz opponensplasty in a cadaver model.    .

Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH.

Static stretching of the ankle prevents cold hypersensitivity associated with limb immobilization in model mice

BACKGROUND

Limb immobilization is considered to contribute to limb pain including hyperalgesia. Approximately 50% of patients with such chronic limb pain complain that their abnormal pain worsens after exposure to cold. However, there have been few studies on the relationship between limb immobilization and cold hypersensitivity. The aim of this study was to examine whether limb immobilization induces cold hypersensitivity, and whether physical exercise such as ankle stretching prevents its induction in model mice.

METHOD

We used forty-four 8-week-old male C57Bl/6J mice, consisting of 32 immobilized mice and 12 control mice. The bilateral hind limbs of the mice were immobilized by a thermoplastic cast. After limb-immobilization for 1 week, changes in mechanical, thermal and cold hypersensitivity, and the expression levels of TRPV1, TRPA1, TRPM8, IL-1β, IL-6, and TNFα in the spinal cord, dorsal root ganglia and the affected hind paw were evaluated in comparison with those in the control mice. In addition, we examined the effect of ankle stretching on the hypersensitivity and expression levels in the limb-immobilized mice.

RESULTS

Mechanical, thermal and cold hypersensitivity were significantly increased in the limb-immobilized mice. In addition, ankle stretching during the immobilization period significantly prevented the increases in those hypersensitivities. There were no significant differences in the expression levels of TRPV1, TRPA1 and TRPM8 among the control, and limb-immobilized mice with and without ankle stretching. The expression levels of IL-1 and IL-6 were significantly increased in the immobilized hind limb paw. Furthermore, ankle stretching significantly prevented the increases in their expression levels.

CONCLUSION

Limb-immobilization induced cold hypersensitivity as well as mechanical and thermal hypersensitivity, and ankle stretching significantly prevented the hypersensitivity induction in the model mice. It would be of great interest to clarify whether a patient with limb-immobilization experiences cold hypersensitivity and whether ankle stretching might prevent hypersensitivity induction in the future.

Two-stage surgical treatment for medially angulated great toes in Apert feet by wedged corrective osteotomy with distraction of the inter-metatarsal space: A case report

BACKGROUND

One of most severe clinical problems related to Apert foot anomalies is medial angulation deformities of the great toe as the foot grows.

CASE PRESENTATION

The patient was a 22-month-old Japanese child with Apert syndrome, who had broad bilateral great toe showing medially angulated deformity. We performed two-stage surgical treatment including distraction of the remarkable narrowing the first inter-metatarsal space using an external distractor device, and the corrective wedge-osteotomy of the first metatarsal with a graft of wedged bone in the reverse direction and inter-positioning of the resected local bone between the first and second metatarsal to preserve the space. At 3 years after surgery, the patient did not have any disturbance of gait and could wear normal shoes without weight-bearing pain, and was satisfied with the appearance of the great toes.

CONCLUSION

The two-stage surgical method could be an option for surgical treatment of Apert feet.

Measurement of the median nerve strain within the carpal tunnel using a capacitance-type strain sensor: A cadaver study

BACKGROUND

Direct and quantitative measurement of median nerve strain within the carpal tunnel has been difficult because of the technical limitations associated with conventional devices. We used capacitive sensors (C-stretch), which are thin and flexible, to measure the median nerve strain within the carpal tunnel.

METHODS

We used 12 fresh frozen upper extremity specimens. The transverse carpal ligament was left in situ, and we attached the sensor to the palmar surface of the median nerve to measure the nerve strain at 60 degrees of wrist extension. The sensor measured the median nerve strain at both the carpal tunnel site and the proximal to the carpal tunnel site before and after the carpal tunnel release. The amount of nerve excursion during wrist extension was also measured with the length change of the attached suture by a digital caliper.

FINDINGS

The mean median nerve strain within the carpal tunnel [8.07% (95 %CI:7.17-8.97)] was significantly higher than that proximal to the carpal tunnel [5.21% (95 %CI:4.46-5.97)] at the wrist extension. There was no significant difference of the mean nerve excursion within and proximal to the carpal tunnel. The mean nerve strain and excursion were unaffected by carpal tunnel release.

INTERPRETATION

These results indicated that wrist extension position might lead to increased strain on the median nerve within the carpal tunnel compared with at the proximal to the carpal tunnel. We believe that the current study might provide new information and help us understand the pathogenesis of carpal tunnel syndrome.

Reliability and accuracy of the critical shoulder angle measured by anteroposterior radiographs: using digitally reconstructed radiograph from 3-dimensional computed tomography images

BACKGROUND

Accuracy of current standard radiographic measurement of the critical shoulder angle (CSA) is not well established. This study analyzed the reliability and accuracy of the CSA measurements obtained via anteroposterior (AP) radiographs, using a digitally reconstructed radiograph (true AP view) generated from a computed tomography image as the gold standard.

METHODS

The CSA was measured on the radiographs and true AP views of 88 consecutive patients who had undergone shoulder arthroscopy for rotator cuff tears. Intraobserver and interobserver reliabilities of the CSA, measured by 2 orthopedic surgeons, were evaluated, and the average deviation of the CSA between radiographs and true AP views was calculated. Moreover, we compared the deviation of CSA between standard AP films (types A1 and C1) and nonstandard AP films (other types) against the Suter-Henninger criteria.

RESULTS

Intraobserver and interobserver reliabilities were almost perfect on radiographs (0.96, 0.86) and true AP views (0.93, 0.85). The average deviation of CSA was 2.1° ± 1.6° for observer 1 and 2.2° ± 1.9° for observer 2. The percentage of cases with deviations of 2° or more when compared with the true AP view was 42% (37 of 88) for observer 1 and 53% (47 of 88) for observer 2. Only 22% (19 of 88) of films were standard AP films. The average deviation of CSA was not significantly different between standard and nonstandard AP films for observer 1 (standard 1.9° ± 1.3°; nonstandard 2.1° ± 1.7°; P = .76) and observer 2 (standard 1.6° ± 1.5°; nonstandard 2.4° ± 1.9°; P = .09).

CONCLUSION

The CSA measurements using radiography were highly congruent, but a large measurement deviation occurred between radiographs and true AP views. The clinical usefulness and role of CSA in diagnosis require careful consideration.

Associations between visceral fat chronic low back pain and central sensitization in patients with lumbar spinal stenosis

BACKGROUND

Pain sensitization may be one of the mechanisms contributing to chronic low back pain (CLBP).

OBJECTIVE

To evaluate the association between visceral fat, CLBP, and central sensitization (CS); describe the relationship between low back pain (LBP) intensity and CS; and identify possible correlation between visceral fat and LBP intensity.

METHODS

Patients with CLBP were divided using their CS inventory (CSI) scores into low- (CSI < 40) and high-CSI (CSI ⩾ 40) subgroups. We compared computed tomography (CT) measurements and scores for association with pain according to the visual analogue scale (VAS) between the two groups.

RESULTS

The low-CSI and the high-CSI groups had 47 patients (67.1%; 21 men, 26 women) and 23 patients (32.9%; 11 men and 12 women), respectively. The high-CSI group had a significantly higher mean VAS score (p< 0.01) and estimated mean visceral fat area (p< 0.05) than the low-CSI group. There was a moderate positive correlation between VAS score and visceral fat (standardised partial regression coefficient: 0.659, p< 0.01) in the high-CSI group according to multiple linear regression analysis adjusted for age and sex.

CONCLUSIONS

Visceral fat is associated with CLBP, regardless of sex or age, and may be a potential therapeutic target for CLBP with CS.

Effect of Anterior Horn Tears of the Lateral Meniscus on Knee Stability

Background

Investigations on the biomechanical characteristics of the anterior horn of the lateral meniscus (AHLM) related to anterior cruciate ligament (ACL) tibial tunnel reaming have revealed increased contact pressure between the femur and tibia, decreased attachment area, and decreased ultimate failure strength.

Purpose/Hypothesis

The purpose of this study was to investigate the influence of a complete radial tear of the AHLM on force distribution in response to applied anterior and posterior drawer forces and internal and external rotation torques. We hypothesized that the AHLM plays an important role in knee stability, primarily at lower knee flexion angles.

Study Design

Controlled laboratory study.

Methods

A total of 9 fresh-frozen cadaveric knee specimens and a robotic testing system were used. Anterior and posterior drawer forces up to 89 N and internal and external rotation torques up to 4 N·m were applied at 0°, 30°, 60°, and 90° of knee flexion. A complete AHLM tear was then made 10 mm from the lateral border of the tibial attachment of the ACL, and the same tests performed in the intact state were repeated. Next, the recorded intact knee motion was reproduced in the AHLM-torn knee, and the change in the resultant force after an AHLM tear was determined by calculating the difference between the 2 states.

Results

In the torn AHLM, the reduction in the resultant force at 0° for external rotation torque (34.8 N) was larger than that at 60° (5.2 N; P < .01) and 90° (6.7 N; P < .01).

Conclusion

The AHLM played a role in facilitating knee stability against an applied posterior drawer force of 89 N and external rotation torque of 4 N·m, especially at lower knee flexion angles.

Clinical Relevance

This study provides information about the effects of AHLM injuries that may occur during single-bundle ACL reconstruction using a round tunnel.

Factors associated with low back pain in patients with lumbar spinal stenosis: a cross-sectional study

BACKGROUND

Low back pain (LBP) is a major symptom of symptomatic lumbar spinal stenosis (SLSS). It is important to assess LBP in patients with SLSS to develop better treatment. This study aimed to analyse the factors associated with LBP in patients with SLSS.

METHODS

This cross-sectional study included consecutive patients with SLSS aged between 51 and 79 years who had symptoms in one or both the legs, with and without LBP. The participants were classified into two groups: the high group (LBP visual analogue scale [VAS] score ≥ 30 mm) and the low group (LBP VAS score < 30 mm). We performed multiple logistic regression analysis with the high and low groups as dependent variables, and a receiver operating characteristic (ROC) analysis.

RESULTS

A total of 80 patients with LSS were included (35 men and 45 women; mean age 64.5 years), with 47 and 30 patients in the high and low groups, respectively. Multivariate logistic regression analysis revealed that the sagittal vertical axis (SVA; + 10 mm; odds ratio, 1.331; 95% confidence interval, 1.051 - 1.660) and pelvic incidence-lumbar lordosis (PI-LL; + 1°; odds ratio, 1.065; 95% confidence interval, 1.019-1.168) were significantly associated with LBP. A receiver operating characteristic analysis revealed cut-off values of 47.0 mm of SVA and 30.5° of PI-LL, respectively.

CONCLUSION

Our results indicated that SVA and PI-LL were significant predictors for LBP in SLSS. It is suggested that these parameters should be taken into consideration when assessing LBP in patients with SLSS.

Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication

BACKGROUND

The guidelines presented herein provide recommendations for the management of patients with lateral epicondylitis of the humerus. These recommendations are endorsed by the Japanese Orthopaedic Association (JOA) and Japan Elbow Society.

METHODS

The JOA lateral epicondylitis guideline committee revised the previous guidelines on the basis of the "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which emphasized the importance of the balance between benefit and harm, and proposed a desirable method for preparing clinical guidelines in Japan. These guidelines consist of 11 clinical questions (CQs), 9 background questions (BQs), and 3 future research questions (FRQs). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design.

RESULTS

The committee proposed recommendations for each CQ by determining the level of evidence and assessing the consensus rate. Physical therapy was the best recommendation with the best evidence. The BQs and FRQs were answered by collecting evidence based on the literature.

CONCLUSIONS

The guidelines presented herein were reviewed systematically, and recommendations were proposed for each CQ. These guidelines are expected to be widely used not only by surgeons or physicians but also by other healthcare providers, such as nurses, therapists, and athletic trainers.

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body.

Diagnostic accuracy of magnetic resonance imaging for partial tears of the long head of the biceps tendon in patients with rotator cuff tears

Background

Magnetic resonance imaging (MRI) is useful for diagnosing shoulder diseases preoperatively. However, detection of partial tears of the long head of the biceps tendon (LHBT) using current clinical tests and imaging modalities is difficult. We aimed to evaluate the accuracy of radial-slice MRI for diagnosing partial tears of the LHBT. We hypothesized that radial-slice MRI may be a valuable diagnostic tool for assessing diagnosing tears of the LHBT.

Methods

We retrospectively investigated 118 patients who underwent shoulder arthroscopy for rotator cuff tears. Intraoperative LHBT findings were compared with the identification of partial tears of the LHBT on conventional-slice MRI and radial-slice MRI, using a 3.0-T system. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of LHBT tears. Inter- and intraobserver reliability for radial-slice MRI was calculated using kappa statistics.

Results

We diagnosed 69 patients (58%) without any LHBT tears and 49 with partial tears (42%), arthroscopically. Sensitivity, specificity, accuracy, and positive and negative predictive values of conventional-slice MRI for detection of partial tears of the LHBT were 52%, 94%, 78%, 92%, and 58%, respectively. Radial-slice MRI had 84% sensitivity, 90% specificity, 86% accuracy, and 92% positive and 80% negative predictive values for partial tears of the LHBT. Inter- and intraobserver reliability for radial-slice MRI was 0.69 and 0.74, respectively, corresponding to high reproducibility and defined as good.

Conclusion

Radial-slice MRI demonstrated significantly higher sensitivity than conventional-slice MRI. These results indicate that radial-slice MRI is useful for diagnosing LHBT partial tears.

The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: a retrospective study

Background

Transverse ligament and posterior inferior tibiofibular ligament injuries have not been investigated till date because these are difficult to evaluate using standard magnetic resonance imaging. This study aimed to investigate the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles using oblique axial magnetic resonance imaging.

Methods

The patients who were diagnosed with syndesmosis injury using magnetic resonance imaging (MRI) within 7 days of the trauma were included. Patients with concomitant fractures were excluded. A total of 34 patients (1 woman and 33 men) with an average age of 22 years (range, 14–64 years) were included. The anterior inferior tibiofibular, interosseous, transverse, and posterior inferior tibiofibular ligaments were classified as intact, partial tear, or complete tear using usual axial and oblique axial MRIs.

Results

There were 8 (23.5%) ankles with an intact, 21 (61.8%) ankles with a partially torn, and 5 (14.7%) ankles with a complete tear of transverse ligament. There were 20 (58.8%) ankles with an intact, 12 (35.3%) ankles with a partially torn, and 2 (5.9%) ankles with a complete tear of posterior inferior tibiofibular ligament. Overall, 50% of the transverse ligament injuries occurred without posterior inferior tibiofibular ligament involvement.

Conclusions

The oblique axial magnetic resonance imaging scan revealed that the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 and 41.2%, respectively.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05220-0.

Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis

STUDY DESIGN

Retrospective analysis of prospectively collected observational data.

OBJECTIVE

This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS).

SUMMARY OF BACKGROUND DATA

Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis.

MATERIALS AND METHODS

This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were examined before and ≥2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed.

RESULTS

DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group.

CONCLUSIONS

SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS.

LEVEL OF EVIDENCE

Level IV.

Surgically treated reactive arthritis of the ankle after COVID-19 infection: A case report

A 37-year-old man developed right ankle pain and swelling six days after being diagnosed with coronavirus disease (COVID-19). Despite conservative treatment, his ankle symptoms persisted. Magnetic resonance imaging and computed tomography showed synovial hypertrophy and bone erosion in the ankle. Following arthroscopic synovectomy, performed 69 days after the COVID-19 diagnosis, the pain improved significantly. The clinical course was consistent with that of reactive arthritis following severe acute respiratory syndrome coronavirus 2 infection. The pathological findings resembled rheumatoid nodules. The bone erosion may have originated from the inflammatory pathway, which resembles the mechanism of rheumatoid arthritis.

Extraforaminal Stenosis at L2-L3 Treated with Microendoscopic Surgery: Report of Two Cases

Introduction

The many cases of far-out syndrome that have been reported have involved extraforaminal stenosis at L5-S1. We report two cases of extremely rare extraforaminal stenosis at L2-L3.

Case Report 1

A 59-year-old man presented with a 1/2-year history of the right leg pain. Radiological examination revealed stenosis of the right L2 spinal nerve between the osteophyte of the vertebral body and the L3 right transverse process. The right L2 spinal nerve was decompressed with microendoscopic surgery. Postoperatively, the pain in the right lower extremity was relieved.

Case Report 2

An 80-year-old man presented with a ½-year history of the right leg pain. He had undergone posterior lumbar fusion (L4-L5 and L5-S1) approximately 30 years earlier. Radiological examination revealed stenosis of the right L2 spinal nerve between the osteophyte of the vertebral body and the L3 right transverse process. The right L2 spinal nerve was decompressed with microendoscopic surgery. Postoperatively, the patient had no symptoms and his course over the next 6 months was good.

Conclusions

In both cases, we performed microendoscopic decompression of the L2 spinal nerve with good post-operative results. In both our patients, extraforaminal stenosis was caused by osteophytes that formed as a result of degenerative spondylosis.

Delayed tendon healing after injury in tetranectin-deficient mice

BACKGROUND

Tetranectin, a plasminogen-binding protein, is present in human serum and has a role in tissue remodeling. The wound healing process is established and follows a similar cascade in tendon tissue as in other tissues. In this study, we investigated whether tetranectin has a role in regulating tissue formation of injured tendon.

METHODS

Using the patella tendon injury model in the tetranectin-null mice, healing processes of the injured tendon were evaluated by histological and immunohistochemical analyses, and measurement of the expression of tetranectin, type 1 collagen (Col 1), tenomodulin, scleraxis, TGFβ, IL-1β, IL-6 and TNF-α.

RESULTS

At the inflammatory phase within 7 days after the injury, involvement of inflammatory cells and the expressions of IL-1β, IL-6 and TNF-α were significantly decreased in tetranectin-null mice. Tetranectin expression increased at 1 day and peaked at 3 days, and finally disappeared at 7 days after the injury in wild-type mice. The tendon healing period and maturity were significantly delayed in the tetranectin-null mice. Expression levels of type 1 collagen and tenomodulin in tetranectin-null mice were significantly lower than those in the wild-type mice until 70 days after injury. With regard to the long-term processes, the healing and maturation of the injured tendon in tetranectin-null mice were eventually completed.

CONCLUSION

We believe that tetranectin might have a potential role in enhancing tissue formation of healing tendon at the inflammatory phase after injuries. The characteristics of tetranectin as a purified protein from human serum could be interested in an attractive candidate as a potential agent to enhance tendon healing after injury.

Relationship between preoperative size of rotator cuff tears measured using radial-slice magnetic resonance images and postoperative rotator cuff integrity: a prospective case-control study

Background

Magnetic resonance imaging (MRI) is useful for diagnosing shoulder diseases preoperatively. However, preoperative risk factors for retears have not been previously reported using a radial-slice MRI. Here, we investigated the relationship between the preoperative tear area of the rotator cuff evaluated using radial-slice MRI and the postoperative rotator cuff integrity. Our hypothesis is that larger tear area of the rotator cuff measured using radial-slice MRI would be associated with increased retear rates.

Methods

From June 2010 to October 2015, we treated 102 consecutive patients who underwent shoulder arthroscopy for reparable rotator cuff tears. The patient demographics, medical comorbidities, radiologic factors, tear size, fatty infiltration, muscle atrophy measured using oblique coronal and oblique sagittal MRI, and the tear area calculated using radial-slice MRI were assessed to compare the intact and retear groups in univariate and multivariate logistic regression analyses. The cutoff values of the independent factors were obtained using the receiver operating characteristic curve.

Results

Retears occurred in 15 of 102 (14.7%) patients. In the univariate analysis, significant differences were found between the two groups for tear size, fatty infiltration of the supraspinatus and infraspinatus, muscle atrophy, and tear area. In the multivariate analysis, the tear area was the independent factor that significantly affected the rate of retear. A tear area of 6.3 cm² was the strongest predictor of retear with an area under the curve of 0.965, sensitivity of 86.7%, and specificity of 96.6%.

Conclusion

The tear area was the independent factor that most significantly affected the rate of retear and showed excellent accuracy with a cutoff value of 6.3 cm². Radial-slice MRI may be a valuable diagnostic tool for assessing the postoperative rotator cuff integrity.

Differential diagnosis of fibroma of tendon sheath and giant cell tumor of tendon sheath in the finger using signal intensity on T2 magnetic resonance imaging

BACKGROUND

The differential diagnosis of fibroma of tendon sheath (FTS) and giant cell tumor of tendon sheath (GCTTS) on the basis of clinical and radiographic characteristics remains difficult.

PURPOSE

To evaluate the quantitative measurement of signal intensity (SI) obtained by magnetic resonance imaging (MRI) for the differential diagnosis of FTS and GCTTS in just the finger.

MATERIAL AND METHODS

We retrospectively identified patients with FTS (n = 6) and GCTTS (n = 22) of the finger who were treated at our hospitals between April 2011 and August 2019. Two researchers independently reviewed the MRIs and measured the regions of interest (ROIs) in the tumor and flexor tendon from the same image. The SI ratio obtained for the tumor and tendon ROIs was measured and compared using receiver-operating characteristic curve analyses. Sensitivity and specificity analyses were performed.

RESULTS

The SI ratios (mean ± SD) of FTS and GCTTS were 1.83 ± 0.64 and 6.34 ± 3.16 for researcher 1 and 1.82 ± 0.60 and 6.10 ± 3.22 for researcher 2, respectively. The areas under the curve were 0.970 and 0.970 for researchers 1 and 2, respectively. The cut-off values of the SI ratio as determined by researchers 1 and 2 for differentiating FTS from GCTTS were 3.00 and 3.00, respectively (sensitivity = 95.5%, specificity = 100%).

CONCLUSIONS

The SI ratio is useful for differentiating FTS from GCTTS independent of a combination of tumor signal and shape.

Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weightbearing Computed Tomography

Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.

Comparing in vivo three-dimensional shoulder elevation kinematics between standing and supine postures

Background

It is often assumed that body posture, standing vs. supine, changes shoulder muscle activation and range of motion, but these altered shoulder mechanics have not been objectively assessed. We expected the supine posture might facilitate scapular rotation and change subacromial pressure. The purpose of this study is to evaluate the influence of body posture on shoulder kinematics during arm elevation.

Methods

Ten males and eight females with a mean age of 33 years participated in this study. Shoulder kinematics were assessed during scapular plane elevation in the standing and supine postures by using single-plane fluoroscopic images. Kinematics were measured using 3-dimensional to 2-dimensional model-image registration techniques: matching the 3-dimensional bone model derived from computed tomography onto each fluoroscopic image. Glenohumeral superior/inferior translation, acromiohumeral distance, and scapular rotations were compared between the postures. The effect of sex also was evaluated.

Results

With the arm at the side position, the humeral head in the supine posture was located 0.5 mm superior compared to the standing posture (P < .001). During humeral elevation, the humeral head significantly shifted more inferiorly in the supine posture than in standing; the biggest mean difference was 0.6 mm, P = .003. But acromiohumeral distance during elevation was not significantly affected by the body posture (P = .05). Scapular upward rotation and posterior tilt were significantly different between the postures (P < .001). Sex had statistically significant, but quantitatively small, effects on shoulder kinematics.

Conclusions

Body postures affect shoulder kinematics during humeral elevation. This knowledge will be useful to optimize rehabilitation exercises and for diagnostic insight.

Symptomatic ossicle lesion at the anterior tip of the medial malleolus in soccer players

BACKGROUND

Unfused accessory ossification centers in the medial ankle are sometimes misdiagnosed and should be distinguished from other bone lesions such as fracture, stress fracture, os subtibiale, or pseudoarthrosis of the medial malleolus. The purpose of this study was to report our experience in treating soccer players with bony elements in the subtibial region.

METHODS

We surgically treated seven soccer players who experienced medial ankle pain with bony fragments at the tip of the medial malleolus. Their ages were between 13 and 27 years. The mean duration from symptom onset to hospital visit was 4.7 years (range: 2 months to 14 years). The bony lesion located at the anterior tip of the medial malleolus in all patients and we diagnosed the lesion as an unfused accessory ossification center.

RESULTS

Three types of surgical treatments were performed in patients according to age, ossicle size, status of the epiphyseal plate, and degenerative changes around the lesion. Bony fusion was achieved in patients who underwent open reduction and fusion with bone graft. Patients who underwent focal drilling or removal of the bony fragment experienced improvement in symptoms, and all patients were allowed to resume their sports or full preinjury activities.

CONCLUSION

We believe that surgery is the first-line treatment for the patients with unfused accessory ossification centers with their prolonged symptom and favorable outcomes can be expected. Bony fusion should be attempted in the patients with the large ossicle especially in their growth period.

Surgical Procedures Based on the Arthrographic Findings of the Fifth MTP Joint With Proximal Phalanx Duplication in Postaxial Polydactyly of the Foot

Radiographic findings in several atypical cases of postaxial polydactyly of the foot do not provide sufficient information to assess the cartilaginous structures or duplicated digit connections at the MTP joint. The purpose of this study was to demonstrate the surgical procedures using arthrography for the cartilaginous structures of the MTP joint in postaxial polydactyly of the foot. We performed arthrography in 7 feet of 7 patients with postaxial polydactyly of the foot in which duplication of the proximal phalanx was observed at the fifth MTP joint on the basis of radiographic evaluation. The average age at surgery was 13.5 months and average duration of postsurgical follow-up was 36 months. Individual surgical procedures were confirmed or modified during the operation by reference to the arthrographic findings. Radiographic and arthrographic findings were assessed in relation to the findings from direct observation of the cartilaginous structures at surgery. Postoperative malalignment, functional disturbance and pain in the reconstructed toe were evaluated. The arthrographic findings provided different forms of cartilaginous structures that could be categorized in 4 types, and reflected the cartilaginous connection visualized at surgery that could not be detected on radiographs in each case. No cases revealed any deformities, functional disturbance, or pain in the reconstructed toe after surgery. The parents' evaluation in each case was "very satisfied" or "satisfied." The arthrographic findings provided additional information regarding variations in the cartilaginous structures of the fifth MTP joint and for determining individual surgical procedure for postaxial polydactyly of the foot.

Early adverse events after the first administration of zoledronic acid in Japanese patients with osteoporosis

INTRODUCTION

The occurrence of early adverse events and the factors associated with these events in zoledronic acid-treated Japanese patients with osteoporosis were investigated.

MATERIALS AND METHODS

All patients treated with zoledronic acid for the first time for primary osteoporosis were analyzed. Based on the history of bisphosphonate (BP) administration, the patients were divided into three groups: BP-switch, BP-washout, and naïve groups. The BP-washout and naive groups were combined into a non-BP group.

RESULTS

A total of 184 patients with a mean age of 77.4 years were included. Acute phase reactions (APRs) occurred in 32 patients (17.4%). The significant risk factors were hospitalization (vs. outpatients), BP-switch (vs. non-BP), and age > 80 years (vs. ≤ 69 years), and the odds ratios were 5.63, 0.12, and 0.23, respectively. The serum calcium levels were significantly reduced in the non-BP group, regardless of the co-administration of active vitamin D₃. However, the patients who were co-administered active vitamin D₃ had significantly higher values than those who were not. In the BP-switch group, no significant reduction in serum calcium levels was observed; however, the reductions tended to be smaller in the patients who were co-administered active vitamin D₃.

CONCLUSION

Occurrence of APRs might be lesser in clinical practice than in phase 3 clinical trials. Although serum calcium levels decreased in many cases, the decrease could be suppressed by the co-administration of active vitamin D₃.

Prevalence of Multiple-Level Spondylolysis and the Bone Union Rates among Growth-Stage Children with Lower Back Pain

Introduction

Lumbar spondylolysis is usually single level, and only a few multiple-level cases have been reported. We investigated the frequency of multiple-level spondylolysis and the bone union rates among growth-stage children with lower back pain (LBP).

Methods

The subjects were growth-stage children examined for LBP between April 2013 and December 2018. All patients with LBP persisting for at least 2 weeks and severe enough to make playing sports difficult underwent lumbar plain radiogram, computed tomography, and magnetic resonance imaging. The cases diagnosed as multiple-level spondylolysis and classified as early or progressive stage received conservative treatment to achieve bone union.

Results

A total of 782 growth-stage children were examined for LBP. Of them, 243 children (31.1%) were diagnosed with lumbar spondylolysis. Of these 243 children, 23 (9.5%) children had multiple-level spondylolysis. Of the children diagnosed with multiple-level spondylolysis, most children (87.0%) had pars defects in the early or progressive stage in which bone union could be expected. Most children (78.3%) had pars defects in the terminal stage and combined with these defects, had pars defects in the early or progressive stage at a different spinal level.

Twenty children diagnosed with multiple-level spondylolysis who also had pars defects in the early or progressive stage received conservative treatment for bone union, which was achieved in 31 of 39 sites (79.5%). The bone union rate by stage was 92.9% (26 of 28 sites) in the early stage and 45.5% (5 of 11 sites) in the progressive stage.

Conclusions

In cases of multiple-level spondylolysis, bone union is likely to be achieved with conservative treatment when the pars defects are in the early or progressive stage. Therefore, the first choice of treatment should be conservative treatment to achieve bone union, the same for single-level spondylolysis.

Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor

BACKGROUND

Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility.

METHODS

First, 5 ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra- and interinvestigator reliability were also analyzed.Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on radiographic images were then compared.

RESULTS

The mean anterior drawer distances were 3.7 ± 1.0 mm for the intact cadavers, 6.1 ± 1.6 mm with the ATFL transected (P < .001), and 7.9 ± 1.8 mm with the ATFL and CFL transected (P < .001). The intrainvestigator intraclass correlation coefficients (ICCs) were 0.862 to 0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 ± 0.9 mm, and it was 2.7 ± 0.9 mm for the radiographic images. The correlation coefficient between the sensor and the radiographic images was 0.843.

CONCLUSION

We quantitatively evaluated anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility and strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.

Oncological and prognostic analysis of soft tissue sarcoma of the elbow: report using the bone and soft tissue tumor registry in Japan

OBJECTIVE

Soft tissue sarcomas in the elbow are extremely rare, and they have primarily been described in case series. Definitive concerning the prevalence and prognostic factors of elbow soft tissue sarcomas remain unknown. We examined the outcome of patients with elbow soft tissue sarcomas and identified the relevant prognostic factors.

METHODS

In total, 219 patients with elbow soft tissue sarcomas were identified using data from the bone and soft tissue tumor registry in Japan. Differences in demographics, disease characteristics, treatment and survival were compared among the patients. Survival analyses including local recurrence-free survival, distant metastasis-free survival, and overall survival were performed using the Kaplan-Meier method with log-rank tests and the Cox proportional hazards model.

RESULTS

Two hundred nineteen patients with elbow soft tissue sarcomas were identified, including 119 males (54.3%) and 100 females (45.7%). In total, 189 patients (86.3%) underwent surgery including re-excision. Of the surgically treated patients, 180 (95.2%) underwent limb salvage surgery, and nine patients (4.8%) underwent amputation. The 5-year overall survival, local recurrence-free survival, and distant metastasis-free survival rates for the entire patient cohort were 76.3, 70.1, and 69.3%, respectively. After adjusting for clinically relevant factors, overall survival was significantly worse among patients with tumors: >10 cm (hazard ratio = 4.34; 95% confidence interval = 1.03-18.2) and metastatic disease (hazard ratio = 6.94; 95% confidence interval = 1.55-31.0).

CONCLUSIONS

Tumor size was identified as an independent risk factor for poor prognosis.

Soft tissue injury in the limbs increased regional bone turnover

BACKGROUND

Pathological conditions after skeletal tissue injury such as trauma and surgical intervention are often accompanied with regional osteoporotic changes, which are recognized to be mainly caused by limb immobility after injury. However, the mechanisms for the progression of regional osteoporotic changes related to the injury remains unknown. Previous studies reported that the pathophysiological conditions related to tissue injury include the acidic micro-environment formation and increased ATP levels. In addition, we previously demonstrated that those changes in the micro-environment induced a high bone turnover state through the activation of TRPV1, ASICs and P2X expressed in bone cells. We, therefore, hypothesized that tissue injury could enhance a high bone turnover state due to those pathophysiological changes in soft tissue in the injured limb. The aim of this study was to examine whether soft tissue injury associated with cutaneous incisions in a limb affects regional bone turnover.

METHODS

Eight-week-old male C57BL/6 J mice underwent soft tissue injury associated with cutaneous incisions in the right femoral skin. During the 14 days after the incision, changes in the expression of osteoblast and osteoclast differentiation regulators and ATP were evaluated in comparison with those in uninjured mice. The pain-like behaviors and the expression of those differentiation regulators with and without treatment with bisphosphonate and Cox2 inhibitor were assessed in the injured limb.

RESULTS

Consistent with the wound healing process, the expression levels of Osterix, osteocalcin and RANKL in the femur of the incised limb were significantly increased up to 7 days, and then decreased to the same level as those in the control limbs by 14 days after the incisions. The levels of TRAP 5b and ATP were initially significantly increased, and then decreased to the same level as before injury by day 14. Bisphosphonate significantly improved the pain-like behaviors in the injured limb associated with the inhibition of osteoblast and osteoclast differentiation regulators.

CONCLUSION

We believe that the pathophysiological changes in soft tissue resulting from cutaneous incisions could be related to the induction of osteoblast and osteoclast differentiation regulators.

Long-term outcomes after corrective cartilaginous joint resection based on arthrographic findings of duplicated thumbs

We report greater than 10-year outcomes in duplicated thumbs following corrective cartilaginous resection during the growth period. We have undertaken corrective resection of cartilaginous joint connections based on intraoperative arthrographic findings to reconstruct favourable alignment in six Wassel Type II and IV thumb duplication in six patients. The age at surgery was 13 months (range 10-15), and the average post-surgical follow-up was 134 months (range 120-160). We observed five excellent and one good outcome using the Japanese Society for Surgery of the Hand scoring method. Favourable joint congruency and alignment were preserved, and no growth plate arrest or joint space narrowing was present more than 10 years after surgery. We conclude that corrective resection of the cartilaginous joint based on intraoperative arthrographic findings has long-term reliability for duplicated thumbs, especially those of Wassel Type II and IV, which have a cartilaginous joint connection.Levels of evidence: IV.

Reconstruction after Subtotal Sacrectomy for Sacral Ewing's Sarcoma Using Tibial Allograft Strut Grafting: A Case Report

We present the case of a 15-year-old girl. Two months after becoming aware of pain, she was diagnosed with a sacral tumor and referred to our department. She was diagnosed with a sacral Ewing's sarcoma; after chemotherapy, it was determined that the tumor could be resected, so surgical treatment was performed. The sacrum and ilium were partially resected at the lower end of S1, and the lumbar vertebrae and pelvis were fixed with a pedicle screw and two iliac screws on each side of L3, and the sacral resection was reconstructed with a tibial strut allograft. No tumor recurrence or metastasis has been observed 1 year postoperatively. She developed bladder and rectal dysfunction, but she remained independent in activities of daily living and her daily life was not limited. The bone fusion in the reconstructed area confirmed the lack of instrumentation looseness. Surgical treatment for sacral Ewing's sarcoma was performed to cure the patient. We believe that the tibial allograft contributed to the patient's ability to walk on her own due to its high mechanical stability. Postoperative bone healing was observed with the same material, suggesting that the tibial allograft is useful for similar procedures.

Association between lumbar segmental mobility and intervertebral disc degeneration quantified by magnetic resonance imaging T2 mapping

Background

The relation between segmental mobility and degree of lumbar degenerative change is still unknown. This cross-sectional study aimed to elucidate the association between intervertebral disc degeneration (IVDD) and segmental mobility in chronic low back pain using magnetic resonance imaging (MRI) T2 mapping.

Methods

Subjects comprised 60 patients (29 men, 31 women; mean age, 61.8 ± 1.9 years; range, 41–79 years). T2 values of the anterior annulus fibrosus (AF), the nucleus pulposus (NP) and the posterior AF were evaluated with MRI T2 mapping. Facet joint degeneration was divided into 4 grades using MRI. We analyzed the correlation between segmental mobility and T2 values of anterior AF, NP and posterior AF using multiple linear regression analysis adjusted for age and facet joint degeneration.

Results

The standardized partial regression coefficient of the anterior AF, NP and posterior AF T2 values were 0.125 (p=0.72), 0.499 (p<0.01) and –0.026 (p=0.11), respectively, for the L1-2 level; 0.102 (p=0.27), 0.395 (p<0.01) and –0.094 (p=0.20), respectively, for the L2-3 level; 0.108 (p=0.38), 0.415 (p<0.01) and –0.050 (p=0.51), respectively, for the L3-4 level; 0.124 (p=0.09), 0.396 (p<0.01) and 0.025 (p=0.73), respectively, for the L4-5 level; and 0.011 (p=0.89), 0.443 (p<0.01) and 0.030 (p=0.72), respectively, for the L5-S level. There was a significantly positive correlation between segmental mobility and the T2 values of NP at L1–L2, L2–L3, L3–L4, L4–L5, and L5–S1. No significant correlations arose between segmental mobility and the T2 values of the anterior AF and the posterior AF at L1–L2, L2–L3, L3–L4, L4–L5, and L5–S1.

Conclusion

Characterization of the relationship between NP degeneration and lumbar segmental mobility may enhance our ability to evaluate the changes seen in kinematics of functional spinal unit.

Long-term outcomes after phalangeal distraction lengthening in patients with constriction band syndrome

We investigated the long-term post-operative outcomes, more than 10 years after surgery, of distraction lengthening of phalanges in patients with congenital constriction band syndrome. Five shortened digits of two patients with congenital constriction band syndrome underwent distraction lengthening of the proximal phalanges using external fixator for the reconstruction of grasp and pinch at age of 53 and 41 months. The post-operative followed-up was 126 and 124 months. Subjective evaluation of hand function was performed using the tape measure method and Functional Dexterity Test pre-operatively and at 1 year after surgery. The parameters for proximal phalangeal distraction and the changes in the length ratio of the phalanges were evaluated. Grasp and pinch function was markedly improved after phalangeal lengthening. Regarding the radiographic findings, the length of distraction was 9.7 mm, % increase of lengthening: 52%, duration of distraction: 28 days, duration of fixation: 83 days, and healing index: 90 days. At the latest follow-up, the relative length of the proximal phalanx did not change significantly (-6%) during the 10 years after distraction lengthening. Patients with constriction band syndrome obtained favorable hand function and preserved those functions for more than 10 years after distraction lengthening of short phalanges using an external fixator.

Quantitative examination of isolated finger flexion associated with function of the flexor digitorum superficialis

[Purpose] Isolated finger flexion associated with function of the flexor digitorum superficialis has been qualitatively assessed using standard and modified tests. The purpose of this study was to quantify isolated finger flexion in healthy participants. [Participants and Methods] We assessed 100 volunteers (mean age: 44.6 years) without upper limb dysfunction using the standard and modified flexor digitorum superficialis tests. The sum of the isolated active flexion angles of the metacarpophalangeal and proximal interphalangeal joints of the test finger was also calculated, with the other three fingers held in an extended position with our original jig. [Results] The mean isolated flexion angles were, respectively, 152.4° and 154.8° for the right and left index fingers, 161.1° and 160.4° for the middle fingers, 160.6° and 158.2° for the ring fingers, 129.4° and 134.6° for the independent flexor digitorum superficialis function, 85.8° and 74.7° for the common flexor digitorum superficialis function, and 75.8° and 71.2° for absent flexor digitorum superficialis function in the small finger. The functional variations of the flexor digitorum superficialis of the small fingers showed symmetry in 65.0% of the fingers but asymmetry in 35.0%. [Conclusion] The data obtained in this study provide normal reference values for the examination of independent movement disorders of the fingers.

A juvenile recurrent elbow dislocation resolved by internal fixation of the avulsed lateral chondral fragment after ossification: A case report

We report a case of juvenile recurrent posterior dislocation of the elbow with an avulsed cartilage fragment. The avulsed fragment from the lateral condyle gradually became larger since the initial dislocation, and was ossified. After three dislocations, the avulsed bone fragment was secured with screws and the anterior capsule was repaired. Elbow function recovered without any dislocation after the avulsion fracture healed. Open reduction and internal fixation of the avulsed fragment is worth trying at first for juvenile recurrent elbow dislocation, even in chronic cases.

High bone turnover state under osteoporotic changes induces pain-like behaviors in mild osteoarthritis model mice

INTRODUCTION

Our previous studies demonstrated that a high bone turnover state under osteoporotic changes decreased the threshold of skeletal pain. Recent studies reported that the incidence of joint pain due to osteoarthritis (OA) in postmenopausal women was higher than that in males even with the same radiographic OA grade. The aim of this study was to evaluate whether a high bone turnover state affects the induction of pain-like behaviors in mild OA model mice.

MATERIALS AND METHODS

We established mild OA model mice with accompanying osteoporotic changes by monosodium iodoacetate injection after ovariectomy. We assessed pain-like behaviors by von Frey test and paw-flick test; histological changes in OA joints; the expression of Runx2, Osterix, Osteocalcin, and Rankl; bone micro-architecture by μCT and measured serum tartrate-resistant acid-phosphatase 5b levels in the model mice.

RESULTS

Pain-like behaviors in mice with OA and osteoporotic changes were significantly increased in comparison with those in OA mice without osteoporotic changes. The severity of histological OA changes did not differ significantly between the OA mice with and without osteoporotic changes. Bisphosphonate significantly improved pain-like behaviors accompanied with improvement in the high bone turnover state in the OA mice with osteoporosis, while it had no significant effect on pain-like behaviors in the OA mice without osteoporosis. In addition, the improvement was maintained for more than 4 weeks even after the discontinuation of bisphosphonate treatment.

CONCLUSION

These results indicated that a high bone turnover state under osteoporotic changes could affect the induction of pain-like behaviors in mild OA model mice.

Osteofibrous dysplasia-like adamantinoma treated via intercalary segmental resection with partial cortex preservation using pedicled vascularized fibula graft: a case report

Background

Morphologically, osteofibrous dysplasia-like adamantinoma is thought to be intermediate between osteofibrous dysplasia and adamantinoma. Its treatment is not well established owing to its rarity.

Case presentation

We report about of a 10-year-old girl with osteofibrous dysplasia-like adamantinoma initially diagnosed as osteofibrous dysplasia and treated via intercalary segmental resection with partial cortex preservation using a pedicled vascularized fibula graft for reconstruction. Bone union was observed 9 weeks after surgery. Twenty-two months after the definitive surgery, no recurrence was observed.

Conclusion

This case illustrates the upgrade from osteofibrous dysplasia to osteofibrous dysplasia-like adamantinoma. The surgical method may aid the treatment of osteofibrous dysplasia-like adamantinoma with incomplete cortex involvement of the tumor.

Hypersensitivity to cold stimulation associated with regional osteoporotic changes in tail-suspended mice

INTRODUCTION

Cold intolerance is defined as abnormal pain resulting from exposure to cold stimulation after trauma. However, the pathophysiology remains unclear. We recently demonstrated that regional osteoporotic changes accompanied by high bone turnover were involved in causing pain-like behaviors in the unloaded hind limbs of tail-suspended mice. Bisphosphonate prevented pain-like behaviors and high bone turnover conditions in tail-suspended mice. The aims of this study were to examine the relationship between regional osteoporotic changes and the induction of hypersensitivity to cold stimulation.

MATERIALS AND METHODS

The hind limbs of tail-suspended mice were unloaded for 2 weeks. The von Frey test and paw-flick test assessed pain-like behaviors and cold plate test evaluated cold escape behaviors. Furthermore, we examined whether cold hypersensitivity associated with regional osteoporotic changes could be improved by bisphosphonate, TRPV1 and TRPA1 antagonists.

RESULTS

Hypersensitivity to cold stimulation was induced more noticeably in the tail-suspended mice, and this effect was related to the increased expression of bone metabolism markers. In addition, the cold hypersensitivity was improved by the resumption of weight bearing and prevented by bisphosphonate or a TRPV1 antagonist, and was accompanied with a decrease in the expression of bone metabolism markers. TRPA1 antagonist significantly improved the cold escape behavior, but had no significant effects on the expression of those markers.

CONCLUSION

We demonstrated that the regional osteoporotic changes accompanying a high bone turnover state could be involved in the induction of hypersensitivity to cold stimulation in the tail-suspended mice.

Effects of treatment interruption due to patient convenience on treatment of once a week teriparatide

Objectives

Once-weekly teriparatide (W-TPTD) is an effective drug for patients with osteoporosis; however, some patients discontinue W-TPTD owing to its adverse drug reactions (ADRs). Sequential treatment with W-TPTD and antiresorptive therapy may be effective in treating such patients. In this study, we evaluate the efficacy of this sequential treatment regimen.

Methods

This retrospective study was conducted at a single institution in Japan. The target subjects were patients with osteoporosis who started W-TPTD treatment. The subjects who received W-TPTD for 6 months or more were divided into 3 groups: TTT (W-TPTD for 18 months); TBT (sequential treatment of W-TPTD/bisphosphonates/W-TPTD; each for 6 months); and TET (sequential treatment of W-TPTD/elcatonin/W-TPTD, each for 6 months) groups. The efficacy endpoints were bone mineral densities (BMD) in the lumbar spine and femur.

Results

Lumbar spine BMD in group TBT increased significantly by 1.6% (P = 0.023), 2.9% (P = 0.001), and 4.4% (P < 0.001) after 6, 12, and 18 months, respectively, compared with baseline values. In group TET, it increased by 2.1%, (P = 0.001), 1.3% (P = 0.066), and 3.0% (P = 0.015) after 6, 12, and 18 months, respectively. A significant increase was observed only after 6 and 18 months. In group TTT, it increased significantly by 3.3% (P = 0.023), 5.1% (P = 0.019), and 7.1% (P = 0.010) after 6, 12, and 18 months, respectively. However, no significant difference in total hip BMD was observed among all three groups. No serious ADRs were reported.

Conclusion

In patients who discontinue treatment with W-TPTD due to ADRs, sequential treatment with W-TPTD and antiresorptive therapy would be beneficial.

Effect of continuous long-term treatment for 10 years with bisphosphonate on Japanese osteoporosis patients

INTRODUCTION

In terms of the balance between benefits and risks of long-term treatment with bisphosphonate, uncertainties remain regarding the optimal treatment duration. We investigated effects of continuous long-term treatment for 10 years with bisphosphonate in postmenopausal osteoporosis patients.

MATERIALS AND METHODS

Fifty five patients in the outpatient clinic of our hospital have been continuously treated with alendronate or risedronate for 10 years. All data were retrospectively collected. The age, height, weight, total muscle volume, total fat volume, and BMD at the lumbar spine, total hip and distal 1/3 radius, alkaline phosphatase (ALP), urinary type I collagen cross-linked N-telopeptide (uNTX) and tartrate-resistant acid phosphatase-5b (TRAP5b), calcium (Ca) and phosphate (P) levels were measured pre- and after the start of 10-year continuous treatment.

RESULTS

BMD at the lumbar spine increased continuously over the 10-year period, while BMD at the total hip slightly but significantly decreased, and that at the 1/3 radius did not show any significant change over the 10 years. Serum Ca value was significantly decreased after the start of treatment, and became stable within the reference range from the second year. Bone resorption markers such as uNTX and TRAP5b significantly decreased from the second year after the start of treatment and no significant changes were observed thereafter. There were no serious medical adverse events including atypical femoral fractures and osteonecrosis of the jaw.

CONCLUSION

We believe that the continuous use of alendronate and risedronate for 10 years could be an option for the treatment of postmenopausal osteoporosis patients.

Comparative Study of Dorsal and Volar Plating for Ulnar Shortening Osteotomy

Background: Postoperative results of ulnar shortening osteotomy for ulnar abutment syndrome were compared between groups of patients in whom the plate was placed on the volar side and those in whom the plate was placed on the dorsal side. Methods: A total of 35 wrists of 14 males and 21 females were evaluated. The average age of patients at surgery was 44.3 years, and the average follow-up period was 66.2 months. After transverse osteotomy was performed, the ulna was fixed using a 6-hole LC-LCP or a LC-DCP on the dorsal (group D) or the volar (group V) side, respectively. Imaging and clinical results, rates and reasons for implant removal were evaluated. Results: There were 27 patients in group D and 8 in group V. A significant difference was observed only in the postoperative grip strength compared with that of the unaffected side between groups V and D (102% and 87%, respectively). Implant removal was performed in 18 (64%) patients in group D and in 7 (88%) in group V, and the main reasons for this were pain in group V and discomfort in group D. Re-fracture occurred after implant removal in one patient in group D. Conclusions: There were no differences in the imaging and clinical results depending on the plate position. It is preferable to avoid implant removal by placing the lower profile plate on the dorsal side.

Sagittal band reconstruction in the index finger using a modified Elson technique

PURPOSE

The Elson technique is a rigid reconstruction method for a hypoplastic or absent sagittal band in the treatment of chronic extensor digitorum communis (EDC) tendon dislocation. We performed a modified procedure based on the Elson technique for reconstruction of the radial sagittal band in case involving the index finger. We investigated the postoperative outcomes of chronic EDC dislocation after treatment with the original and modified Elson technique.

METHODS

We examined five fingers of five patients (2 males and 3 females) with a mean age of 41 years. The chronic EDC tendon dislocation was due to an old trauma, or a spontaneous or congenital condition involving the index in two, middle in two, and ring finger in one patient. Sagittal band reconstruction was performed using the modified Elson technique for the index finger and the original technique for the other fingers. The mean duration of postoperative follow-up was 58 months. Clinical findings such as pain and discomfort at metacarpophalangeal flexion associated with the tendon dislocation, range of motion (ROM), and disabilities of the arm, shoulder and hand were evaluated. We also examined postoperative recurrence and subjective patient evaluation.

RESULTS

All cases achieved pain-free stability of the EDC tendon with no recurrence, and full ROM was maintained at the latest examination after surgery. The postoperative subjective evaluation by the patients was "very satisfied" in four fingers and "neutral" in one finger.

CONCLUSION

We demonstrated our modified Elson technique for the treatment of chronic extensor tendon dislocation of the index finger.

Simultaneous non-union of scaphoid and capitate: a case report

A 44-year-old painter separately developed simultaneous nonunions at the middle of the capitate and distal third of the scaphoid, for which we performed a cancellous bone graft from the iliac crest and a pedicled 1,2-intercompartmental supraretinacular artery graft, respectively. Union of both bones was ultimately achieved.