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Background: This study aimed to investigate factors affecting discharge to an inpatient rehabilitation facility or home following total hip arthroplasty, using a clinical pathway in Japan., Methods: Five hundred hips with osteoarthritis who underwent unilateral total hip arthroplasty at our institution, with no deviation from the pathway, were included in this retrospective study. The variables were examined by univariate analysis. Multivariate logistic regression analysis was used to identify the independent factors that influenced the discharge outcome., Results: Four hundred and thirty-four hips were discharged home directly, and 66 were discharged to an inpatient rehabilitation facility. Patients discharged to an inpatient rehabilitation facility were significantly older, shorter, lighter, and more likely to live alone. Additionally, the preoperative clinical score was significantly lower in the inpatient rehabilitation facility Group for all items. Logistic regression analysis showed a significant association between being discharged to an inpatient rehabilitation facility and higher age [odds ratio 3.87, 95% confidence interval 2.03-7.38, P < 0.001], lower total score in the preoperative Japanese Orthopaedic Association hip score [odds ratio 2.42, 95% confidence interval 1.38-4.23, P = 0.002] and living alone [odds ratio 1.84, 95% confidence interval 1.01-3.35, P = 0.046]., Conclusions: In this study, age, the preoperative Japanese Orthopaedic Association hip score, and living arrangement impacted the discharge destination after THA., Competing Interests: Declaration of competing interest None. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors., (Copyright © 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Elective orthopaedic surgery has been severely curtailed because of coronavirus disease, 2019. There is scant scientific evidence to guide surgeons in assessing the protocols that must be implemented before resuming elective orthopaedic surgery safely after the second wave of the coronavirus disease, 2019., Methods: A retrospective review of elective orthopaedic surgeries performed between May 15, 2020, and November 20, 2020, was conducted. A screening questionnaire was used, and reverse transcription-polymerase chain reaction and severe acute respiratory syndrome coronavirus-2 immunoglobulin G and IgM antibodies testing were assessed in all admitted patients. Screening and testing data for coronavirus disease was reviewed for all patients., Results: Of 592 patients tested for severe acute respiratory syndrome coronavirus-2 during the study period, 21 (3.5%) tested positive. There were 2 patients (0.3%) with positive reverse transcription-polymerase chain reaction tests, 3 (0.5%) with positive IgG and IgM antibodies, 13 (2.2%) with positive IgG antibodies, and 10 (1.7%) with positive IgM antibodies. Among these 21 patients, 20 (95.2%) were asymptomatic., Conclusions: Our findings suggest that most elective orthopaedic surgery patients with severe acute respiratory syndrome coronavirus-2 are asymptomatic. In the second wave of coronavirus disease, 2019, universal testing of all patients should be strongly considered as an important measure to prevent clusters of in-hospital transmission of the disease., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Amber-the fossilized resin of trees-is rich in terpenoids and rosin acids. The physiological effects, such as antipyretic, sedative, and anti-inflammatory, were used in traditional medicine. This study aims to clarify the physiological effects of amber extract on lipid metabolism in mouse 3T3-L1 cells. Mature adipocytes are used to evaluate the effect of amber extract on lipolysis by measuring the triglyceride content, glucose uptake, glycerol release, and lipolysis-related gene expression. Our results show that the amount of triacylglycerol, which is stored in lipid droplets in mature adipocytes, decreases following 96 h of treatment with different concentrations of amber extract. Amber extract treatment also decreases glucose uptake and increases the release of glycerol from the cells. Moreover, amber extract increases the expression of lipolysis-related genes encoding perilipin and hormone-sensitive lipase (HSL) and promotes the activity of HSL (by increasing HSL phosphorylation). Amber extract treatment also regulates the expression of other adipocytokines in mature adipocytes, such as adiponectin and leptin. Overall, our results indicate that amber extract increases the expression of lipolysis-related genes to induce lipolysis in 3T3-L1 cells, highlighting its potential for treating various obesity-related diseases.

Purpose: The aim of this study was to evaluate the outcomes and early complications of obese patients who underwent total hip arthroplasty for osteoarthritis via an anterolateral approach in the supine position (ALS-THA) and compare these outcome with of a matched control group of non-obese patients., Patients and Methods: Thirty-one hips in 28 patients with obesity (BMI ≧ 30 kg/m 2 ) were included in this study. As a control group, 31 hips of 31 patients with a normal weight (BMI between 20 and 25 kg/m 2 ) were matched based on age, sex, and laterality. Clinical evaluations using the Merle d'Aubigne and Postel hip score, radiological evaluations and perioperative complications were compared in two groups., Results: There were no significant differences between the groups in the operative time, period of hospitalization, clinical hip score, or cup positioning, although the position of the cup tended to deviate from the optimal safe zone in the obese compared with non-obese group (32.3 and 16.1%, respectively). There was no infection, dislocation, nerve palsy, or life-threatening event in either group. The rate of avulsion fractures of the greater trochanter in the obese group was 3 times higher compared to that in the non-obese group., Conclusions: As the clinical outcome of ALS-THA for the obese group is not inferior to that for the non-obese group, obesity is not considered to be a contraindication for ALS-THA. However, obesity increases the risk of intraoperative greater trochanteric fracture. Thus, surgeons should be particularly careful when manipulating the femur in this class of patients, who should be informed of this risk.

Purpose: To describe the fracture lines of intra-articular distal radius fractures as evaluated by computed tomography scans., Methods: With computed tomography, we examined 95 intra-articular fractures of the distal radius from 91 patients. Multiplanar computed tomography images or 3-dimensional images, or both, were assessed. We divided the periphery of the distal articular surface of the distal radius into 6 segments (sigmoid notch, dorsoulnar, dorsoradial, volar radial, volar ulnar, radial styloid) and examined which segment had fracture lines. For fractures involving the sigmoid notch, we divided them by the location and the direction of the fracture lines entering the sigmoid notch. Next, we categorized the fractures into 3 fracture groups (extension group, neutral group, and flexion group) by the dorsal or volar angulation of the cortex of the distal radius. In all the fractures and in each of the 3 fracture groups, we described the frequency of the fracture lines in each segment and the number of the segments with fracture lines. The location and the direction of the fracture lines in the sigmoid notch were analyzed in each of the 3 fracture groups., Results: The most frequent fracture type, seen in 21% of all fractures, had fracture lines in the sigmoid notch and the dorsoulnar segment. The frequency of the fracture lines was 77% in the sigmoid notch, 71% in the dorsoulnar segment, and 57% in the dorsoradial segment. The volar ulnar segment was lowest in frequency, at 13%. The fractures in the extension group were more common in the dorsoulnar segment and less common in the dorsoradial segment and the radial styloid segment. The scaphoid facet always had a fracture in the flexion or neutral group. In the extension group, the direction of the fracture lines from the sigmoid notch was dorsoradial or parallel to the volar articular edge. In contrast, the direction was parallel or volar radial compared to the volar articular edge in the flexion group., Conclusions: We documented the location and the direction of intra-articular fracture lines of the distal radius. The location and the direction of fractures showed different tendencies related to the volar/dorsal angulation of the distal radius., Clinical Relevance: The findings might help in the evaluation, classification, and treatment of intra-articular fractures of the distal radius., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers.