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We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.

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

我々は，左仙腸関節脱臼骨折の1例を経験したので報告する．症例は44歳,女性．重機と後進してきたトラックとの間に挟まれ受傷し当院へ搬送された．単純X線，CTにて左仙腸関節脱臼骨折を認めた．血管造影にて骨盤腔内の動脈性出血は認めなかった．術前に左脛骨より鋼線牽引を行い，受傷後16日目，観血的脱臼整復及び骨接合術を施行した．術後6週より荷重訓練，9週より1/2部分荷重を開始した．10週より松葉杖歩行とし，14週で退院となった．仙腸関節脱臼骨折の治療法としては(1)前方アプローチでのプレート固定，(2)後方アプローチでのプレート固定，(3)iliosacral screwによる固定の報告が認められる．前方アプローチでのプレート固定では直視下にて正確に整復固定できるという利点があり，今回，仙腸関節脱臼骨折に対し前方アプローチにて仙腸関節用プレートによる固定を行った．

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.

1) 過去7年間に足関節外側側副靱帯損傷で観血的治療を行なった67例のストレスX線評価を行なった.2) 新鮮例と陳旧例, 徒手とテロスによるストレスでは, T-T, AD共に有意な差はなかった.3) ATF単独損傷例とATF+CF複合損傷例ではT-T, T-T差にて有意な差が見られるが, ADやAD差では有意な差は見られなかった.4) TF単独損傷例とATF+CF複合損傷例のT-T, T-T差で Gray Zone に入る症例も多くストレスX線評価のみにて確定診断や手術適応を決めるのは難しく思えた.

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.

This paper reports a rare case of fracture-dislocation of the hamatometacarpal joint. A 25-year-old right-handed man was involved in a fistfight and struck a wall with his left fist. He was examined at our hospital 5 days after injury and found to have swelling and tenderness in the vicinity of the fourth and fifth CM joints. Radiographs of the hand revealed dorsal dislocations of the bases of the fourth and fifth metacarpal accompanied by a dorsal oblique intra-articular fracture of the distal hamate and an avulsion fracture of the base of the fourth metacarpal. Treatment consisted of closed reduction and percutaneous fixation with Kirschner wires. Three years after his injury, the patient is asymptomatic, working at his previous job, with a full ROM of all joints of his left hand wrist and normal grip strength.

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.

We reported the development of epiphyseal vessels in the femoral head of white rabbits. We prepared specimens for microangiography by modified Spalteholz technique and H. E. or Safranin-O staining for microscopic observation. The characteristic structure of epiphyseal vessels was found to be formed on the 4th week after birth and completed by 2 months after birth. With maturing of epiphyseal vessels, the thickness of the epiphyseal growth plate decreased. Tuft formations are characteristic for the ends of epiphyseal vessels and they have been connected one another for 1.5 months from birth. With maturing of epiphyseal vessels, however, the connections of tuft formation disappeared.

Rugby football is a very hard body contact sport, so players are injured very frequently. To comprehend the fact of injuries and disorders of rugby football players, we sent out questionnaire to players in high school. Results showed that 115 of 144 players suffered injuries and that 54 had disorders in playing rugby football. They injured more frequently on tackling or on being tackled. The shoulder lesions in upper limb and the ankle lesion in lower limb were seen frequently. We emphasize that warming up, cooling down and a day-off of practice are very important to prevent ruggers from disorders in rugby football.