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Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.

Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures ( p = 0.003), Barthel index (BI) at discharge ( p = 0.011), and place-to-discharge ( p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking ( p = 0.007), length of hospital stay (LOS; p = 0.009), and BI ( p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI 2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS Conclusions: Previous vertebral fractures and BI 2, TCCI ≥5, smoking history, LOS

From 1990 to 1998, 11 Miller-Galante Unicompartmental Knee Arthroplasties were evaluated clinically and radiographically on cases followed up for more than one year. The mean age was 71.6 years, and mean follow-up period was 2.9 years. All patients had underwent medial compartmental replacements, with 7 osteoarthritis and 4 osteonecrosis. The mean JOA score improved from 56.8 preoperatively to 87.3 at the final follow-up period. The mean range of motion improved from 125.1° to 127.5°. Partial radiolucent lines were noted in about 7 femoral components and 5 tibial components. No components were thought to be clinically loose in the latest follow-up evaluation. Unicompartmental knee arthroplasty allows good-excellent early results with appropriate patient selection and requires careful longer term follow-up evaluation.

Ten torn anterior talofibular ligaments repaired with fibular periosteal flap reinforcement were studied.The operative results were evaluated by measurements of stress X-ray photos and using Seligson's scale as a clinical score.In most of these cases, roentgenographic instability of the ankles was reduced.The average talar tilt angle improved from 14.7° to 4.7°, and the average distance of the anterior drawer test (Landeros method) was 8.0mm to 6.5mm.Clinical scores were rated from 8 to 10 points by the Seligson scale.Repair of the anterior talofibular ligament reinforced with a fibular periosteal flap is a useful method in cases of insufficient repair with a simple suture.The possibility of ossification and the tensile weakness of the perioteal flap have already been reported. No disadvantages were found in this series.

Nine patients with ACL tear (acute 6, choronic 3) were treated with Marshall's procedure augmented by Kennedy's LAD, and followed-up for between eight and 30 months. As postoperative treatment, ROM exercises were started on the eighteenth day after the operation, and full weight bearing in the eight week on the average. All the patients returned to work or school within three months. Five patients could resume their preoperative sports' activities within one year.

Isolated fracture-dislocation of the medial cuneiform bone is very rare. We report on a case that we recently experienced with this injury and review the relevant literature. We treated this patient by manual reduction and fixation of the fragments with two Kirschner wires and a satisfactory result was achieved

The etiology of spontaneous osteonecrosis of the knee is still unknown. Severa authors have reported that medial meniscal tears are related to osteonecrosis. We report a case in which osteonecrosis occurred after sustaining a medial meniscal tear. A factor in the etiology of this disease is the stress concentration over the edge of the meniscal fragment.

Twenty deformed hands of 19 Japanese patients with cerebral palsy were treated with release of the flexor digitorum profundus, the flexor digitorum sublimis, and the extensor digitorum communis. The results were satisfactory and included enhanced daily activities, voluntary grasp, and release of the fingers. Simultaneous cocontraction of the multiarticular muscles inhibits voluntary movement of the fingers and causes rigidity and involuntary movements. Use of the intrinsic muscles is facilitated by reducing hypertonicity of the multiarticular muscles and by activation of voluntary movements of the fingers. Many such patients can then become functionally independent.