Search

Background: Japan has now become a super-aged society. Notably, as the Japanese society ages, the prevalence of falls, which represent an aging-related problem, has increased. Locomotive syndrome (LS) is a condition of decreased mobility due to locomotive organ disorder. The loco-check is simple tool to detect early-stage LS. The loco-check comprises seven items relating to daily activities. Higher numbers of affirmative answers in the loco-check are negatively associated with physical functions. The purpose of this study was to examine the potential correlation between the number of affirmative answers given on the "loco-check" survey and the likelihood of experiencing at least one fall during the following one-year period., Methods: This prospective study included 154 cases (35 men, 119 women), all aged 65 years or older, answered the loco-check at baseline. As part of their normal treatment process, the participants made monthly visits to the out-patient department; thus, at each of these visits for the following 12 months a medical doctor interviewed each patient to determine whether they had experienced a fall during the previous month., Results: The mean age of the sample was 77.3 years, and the median number of affirmative answers given was 2.0. The number of affirmative answers significantly correlated with the cases which had a fall event within the follow-up period. Specifically, an increase in one "yes" answer on the loco-check increased the relative risk of fall (odds ratio: 1.32; 95% Confidence interval (CI): 1.03-1.70). In addition, the risk of fall was high in cases which showed the number of affirmative answers given on the loco-check ≥4 (odds ratio: 9.26; 95% CI: 1.05-81.7)., Conclusion: The number of affirmative answers given on the loco-check is positively correlated with a fall event within the following year., Competing Interests: Declaration of competing interest The authors have no relevant conflicts of interest to disclose., (Copyright © 2020. Published by Elsevier B.V.)

We present a case of post-traumatic osteonecrosis of the lunate after fracture of the distal radius. Post-traumatic osteonecrosis of the carpal lunate after a fracture of the distal radius has, to our knowledge, not been reported previously. We treated the patient with vascularised bone graft from the distal radius, with a satisfactory result.

Background: The present study was undertaken to examine whether antibiotic-impregnated calcium phosphate cement (CPC) would provide a valid means of treating osteomyelitis., Methods: The antibiotic used for the impregnation was dideoxy-kanamycin B (DKB), which is available in two forms (powder and liquid). Columnar test specimens (diameter 7 mm, height 14 mm) were prepared by adding the liquid or powdered DKB. Group A: Three types (6.25-titer, 12.5-titer, 25-titer) of test specimen were prepared by mixing the setting solution and DKB solutions into cement. Group B: Three types (25-titer, 50-titer, 100-titer) of test specimen were prepared by mixing the setting solution and DKB powder into cement. Group C: A control specimen was prepared by mixing the setting solution into the cement. The study included a consistency test, setting-time test, compressive strength test, porosity test, and elution test., Results: The value for the consistency test was >23 mm in all test groups. The results of the setting-time test showed that the setting time became significantly longer as the DKB content increased for groups A group B. Compressive strength decreased as the antibiotic content increased, although all specimens remained sufficiently strong for clinical application. In group A the porosity did not differ significantly depending on the antibiotic content, whereas in group B the porosity increased significantly as the antibiotic content increased. In the elution test using specimens with the same titer (25 titer), the elution efficiency was higher in group A than in group B, and the duration of elution was longer in group A., Conclusions: Although polymethylmethacrylate (PMMA) has been conventionally used as a drug-delivery system (DDS), the results of the present study indicate that CPC shows better elution efficiency than PMMA. It is thus a promising DDS for the treatment of osteomyelitis.

Six patients with recalcitrant post-traumatic humeral shaft non-unions were treated using vascularized bone grafts from the supracondylar region of the femur. The initial state of injury showed that four fractures were closed, while two were open fractures. At the acute stage, five fractures were fixed using intramedullary nailing, while one was fixed with a plate. In all patients, a bony flap was placed on the cortex after decortication. The size of the harvested bone flap ranged between 4 x 2.5 cm and 5 x 3 cm. After fixation of the bony flap, the inferior genicular artery and vein were anastomosed to the deep brachial artery and vein. The mean time required to obtain radiographic bone union was 3.3 months. The only graft-site complication involved transient mild paresthesia in the saphenous nerve area in one patient. This procedure was useful for atrophic nonunions without substantial bone defects of the humeral shaft.

Thirteen patients (10 males and 3 females; age range at surgery: 2 to 41 years, average: 13.5 years) with motor vehicle injuries of the foot (n = 10) and leg (n = 3) were treated using free and island flaps. Donor flaps consisted of a scapular flap in six cases, a peroneal flap in four, a latissimus dorsi musculocutaneous flap in one, gracillis muscle flap in one, and gastrocnemius muscle flap in one case. Free grafts were transferred in 10 patients and pedicle grafts in three. All flaps survived completely. Moderate scarring was noted in two patients who underwent scapular flap transfer, and growth disturbances occurred in two patients with metatarsal fracture accompanying epiphyseal plate injury. Functionally, no patients experienced any disturbance, and all reconstructed sites were cosmetically satisfactory. Early flap coverage of soft-tissue defects due to motor vehicle injury was shown to be useful from the point of view of both cosmetic and functional results.

The big toe is of great importance for good stability and gait, but few reports have documented reconstruction of big toe defects. In this study, seven male patients, aged 17 to 59 years at surgery (average: 35 years), were treated for big toe defects. The metatarsophalangeal (MTP) joints of the big toe were intact in all patients. Five patients were treated with free peroneal flaps (including one perforator flap), and two with free scapular flaps; flap sizes ranged from 9 x 4 to 24 x 6 cm. Follow-up periods ranged from 10 to 29 months, (average: 16.6 months). The iliac was used as the grafted bone in four patients and the scapula in one. Six flaps survived completely, and bone unions were achieved within 3 months. One flap became partially necrotic due to arterial thrombosis. All patients returned to their original jobs, and the cosmetic appearances of all toes were acceptable.

The purpose of this study was to demonstrate the feasibility of prefabricated vascularized periosteal grafts using fascial flap transfers. Fifty rats were divided into two (Group A, underwent periosteal wrapping, and Group B underwent fascial wrapping). Fascial flap from the medical leg, which were nourished by the saphenous artery and vein, were used for all grafts. In Group A, the fascia was transferred onto the proximal tibial periosteum. Two weeks postoperatively, the elevated fascioperiosteal flap was wrapped around a 4-mm hydroxapatite cube. In Group B, the fascial flap was immediately wrapped around the hydroxyapatite cube. In both groups, the hydroxapatite-wrapped cube was transferred to the inguinal region. Three days postoperatively, five rats from group A were sacrificed. On histologic examination, these five showed no necrosis of the fascioperiosteal flap and no bone formation. The remaining 45 rats were sacrificed 5 weeks postoperatively. Microangiography was performed on five rats in Group A, revealing neovascularization of the hydroxyapatite. On histologic examination, new bone formation was confirmed in 15 of the remaining 20 rats in Group A, and in three of the 20 rats in Group B. These experiments demonstrated that the prefabricated vascularized periosteal graft, which has good osteogenic capacity, could be carried out using a fascial flap transfer.