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Background: Eccentric rotational acetabular osteotomy for the operative treatment of acetabular dysplasia consists of a spherical but eccentric osteotomy and rotation of the acetabulum that moves the center of rotation of the head of the femur medially and distally. No bone graft is needed. The reorientation of the acetabular fragment not only improves acetabular coverage but also restores the center of rotation of the subluxated hip. The purpose of this paper was to describe eccentric rotational acetabular osteotomy for the treatment of acetabular dysplasia and to evaluate its clinical and radiographic outcomes.Methods: We performed this procedure consecutively in 132 hips in 126 patients with dysplasia of the hip. Eighteen hips had no osteoarthritis, fifty-three had early osteoarthritis, and sixty-one had advanced osteoarthritis. Seven patients were male, and 119 were female. The average age was 36.5 years at the time of the index operation, and the average duration of follow-up was 7.5 years. Twenty-three hips in twenty-two patients were also treated with intertrochanteric valgus osteotomy to further improve joint congruency at the time of the acetabular osteotomy.Results: The average preoperative Harris hip score of 71 points improved to an average score of 89 points at the time of the latest follow-up. The average center-edge angle improved from 0 to 36 . An apparent change in the stage of the arthritis was observed in seven hips (5%), one of which had had early-stage disease and six of which had had advanced disease preoperatively.Conclusions: Eccentric rotational acetabular osteotomy appears to be a good treatment option for young patients with either early or advanced hip osteoarthritis secondary to dysplasia. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a significant impact on healthcare systems and the general population. However, it remains unclear to what extent these major societal changes have had an impact on the management of hip fractures in older people in Japan. Therefore, we investigated the effect of the COVID-19 pandemic on the number of patients with hip fractures, their characteristics, and their perioperative management as a retrospective multicentre study., Methods: We included 1894 patients aged ≥ 65 years who underwent surgery for hip fracture at three hospitals between January 2019-December 2021. Patients were classified according to the time of injury; patients treated between January-December 2019, January-December 2020, and January-December 2021 were divided into the pre-COVID-19 group, early COVID-19 group, and late COVID-19 group, respectively. We compared age, sex, body mass index, preadmission residence, surgical procedure, length of hospital stay, waiting time for surgery, in-hospital complications, and in-hospital death., Results: Our findings suggested that the early COVID-19 and late COVID-19 groups showed a 6.8% and 7.5% reduction in the number of HF patients, respectively, compared to the pre-COVID-19 group. Waiting days for surgery, length of hospital stay, and in-hospital mortality or complication rates did not significantly change before and after the pandemic. However, infection was increased in the early COVID-19 group regarding the subgroup of complications., Conclusions: The COVID-19 pandemic altered the characteristics of hip fractures in older individuals., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the institutional review board, and it conforms to the provisions of the Declaration of Helsinki. Consent for publication: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background and Objectives : Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods : We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results : We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions : Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection that needs acute surgical intervention and other types of supportive care. The upper extremities are a less frequent site for this infection than the lower extremities. Axillary necrotizing fasciitis is quite rare and bears a high risk of iatrogenic neurovascular injuries. We report a severe case of a 39-year-old man with a right axillary necrotizing fasciitis caused by Streptococcus pyogenes . While dealing with important nerves and blood vessels at the initial emergency surgery, we marked and preserved them with vascular tapes. The patient underwent several surgical interventions for infection control in addition to supportive care to avoid limb loss and to survive. Intraoperatively, the locations of nerves and vessels could be easily found by checking the vessel tapes. Twelve months after the initial admission, the patient had no symptoms of nerve injuries and resumed work. With necrotizing fasciitis, the risk of an iatrogenic nerve injury exists even if limb amputation is avoided due to repeated debridement. We report that marking and preserving nerves and blood vessels with vascular tapes at the initial surgery may make the subsequent ones easier and may reduce iatrogenic neurovascular injury., Competing Interests: None reported.

Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and ≥13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance ≥13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve-to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance ≥13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was ≥13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders., Competing Interests: None.

Background: Fracture-related infection (FRI) sometimes occurs with peri-prosthetic femoral fracture (PPF) treatment. Fracture-related infection often leads to multiple re-operations, possible non-union, a decreased clinical function, and long-term antibiotic treatment. In this multicenter study, we aimed to clarify the incidence of FRI, the causative organisms of wound infection, and the risk factors associated with post-operative infection for PPF. Patients and Methods: Among 197 patients diagnosed with peri-prosthetic femoral fracture who received surgical treatment in 11 institutions (named the TRON group) from 2010 to 2019, 163 patients were included as subjects. Thirty-four patients were excluded because of insufficient follow-up (less than six months) or data loss. We extracted the following risk factors for FRI: gender, body mass index, smoking history, diabetes mellitus, chronic hepatitis, rheumatoid arthritis, dialysis, history of osteoporosis treatment, injury mechanism (high- or low-energy), Vancouver type, and operative information (waiting period for surgery, operation time, amount of blood loss, and surgical procedure). We conducted a logistic regression analysis to investigate the risk factors for FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Results: Fracture-related infection occurred after surgery for PPF in 12 of 163 patients (7.3%). The most common causative organism was Staphylococcus aureus (n = 7). The univariable analysis showed differences for dialysis (p = 0.001), Vancouver type (p = 0.036), blood loss during surgery (p = 0.001), and operative time (p = 0.001). The multivariable logistic-regression analysis revealed that the patient background factor of dialysis (odds ratio [OR], 22.9; p = 0.0005), and the operative factor of Vancouver type A fracture (OR, 0.039-1.18; p = 0.018-0.19) were risk factors for FRI. Conclusions: The rate of post-operative wound infection in patients with a PPF was 7.3%. Staphylococcus was the most frequent causative organism. The surgeon should pay attention to infection after surgery for patients with Vancouver type A fractures and those undergoing dialysis.

Case: A 59-year-old man presented with posterior sternoclavicular joint dislocation concomitant with fracture-dislocations of multiple thoracic costovertebral joints caused by traumatic injury. The posterior sternoclavicular joint dislocation was treated using an ultra-high molecular weight polyethylene fiber cable and the joint was stabilized. The degree of malpositioning of the thoracic costovertebral joints was difficult to reduce., Conclusion: The patient achieved an excellent shoulder range of motion at 12 months postoperatively; however, chronic shoulder stiffness and posterior neck discomfort persisted., Competing Interests: None., (© 2023 The Authors.)

An extensor tendon defect in the hand requires reconstruction to restore extension. We report a 44-year-old woman with a 24-mm extensor tendon defect of the middle finger over the dorsum of the hand that was reconstructed using a composite graft consisting of the triceps tendon and paratenon. This composite graft from the posterior aspect of the distal arm is simple, safe and may be considered in extensor tendon reconstruction. Level of Evidence: Level V (Therapeutic).

Osteoporotic acetabular fractures in elderly patients have recently been increasing, but the best treatment remains uncertain due to the difficulty in stabilizing these fractures with osteosynthesis. We performed total hip arthroplasty with an impacted bone graft on the acetabula of 3 elderly patients with comminuted acetabular fractures after confirming acetabular callus formation via radiographic imaging 2 months following the patients' initial injuries. Two of the patients presented in the subacute phase after conservative treatment, and 1 patient had no history of trauma or quadrilateral surface destruction. Two patients achieved good functional results at the 3-year follow-up. Furthermore, no loosening of the prosthesis components or subsidence of the acetabular cemented cup was evident on radiographic imaging in any of the patients., (© 2022 The Authors.)

BACKGROUND Peripherally inserted central catheters (PICCs) are commonly used by clinicians in daily practice as a safe and reliable alternative to central venous catheters. While there are advantages to the use of PICCs, such as a low insertion-related complication rate and cost-effectiveness, using PICCs may expose patients to life-threatening severe complications such as a central line-associated bloodstream infection and deep venous thrombosis (DVT). There have been no reports of infectious myositis associated with PICC insertion. CASE REPORT We report a case of infectious myositis related to PICC insertion complicated by brachial DVT in a 43-year-old immunocompromised patient with myelodysplastic syndrome. Despite the administration of broad-spectrum antibiotics, the patient's condition did not improve. He developed septic shock and required emergency excision of the infected and necrotic muscles. Although the pathogen responsible for the infection was unknown, infectious myositis and myonecrosis were observed intraoperatively. Furthermore, histopathological examination revealed evidence of infectious myositis in the biceps brachii and brachial muscles. The septic shock resolved with treatment and the patient survived with residual elbow joint dysfunction. CONCLUSIONS We present a case of infectious myositis related to PICC insertion. We believe that urgent resection of infected and necrotic tissues, rather than broad-spectrum antimicrobial therapy alone, was essential to save the patient's life.

Competing Interests: None.

Introduction: The coronoid process of the ulna is the primary stabilizer of the elbow joint. There has not yet been an accurate off-the-shelf dedicated implant because fragments of coronoid process fractures are often small and diverse. The variable angle locking compression mesh plate 2.4/2.7 (Depuy Synthes, West Chester, PA, USA) acts as a versatile, low-profile implant that can be cut to suit the specific fracture pattern and fits anatomically., Case Presentations: We report two cases of Regan-Morrey type II ulnar coronoid process fractures in terrible triad elbow injuries. In both cases, persistent instability was fluoroscopically diagnosed after repair of the lateral structures. We performed osteosynthesis for the ulnar coronoid process fractures using a mesh plate, which we cut into a rhombus-like shape and used as a buttress plate. Here we report the good results obtained thereof., Conclusion: Considering our positive experience with using mesh plates, the mesh plate may be a good method of fixation for ulnar coronoid process fractures., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 The Authors.)

BACKGROUND Chromobacterium violaceum (C. violaceum) is a gram-negative and facultative anaerobic oxidase-positive bacillus generally seen in tropical or subtropical areas (latitudes between 35°N and 35°S). C. violaceum infection is a rare but serious infection with high morbidity and mortality rates. Most clinicians practicing in non-tropical counties, such as Japan, are unfamiliar with it. CASE REPORT We report the first fatal case of a 49-year-old man infected with C. violaceum after a traffic accident in Japan (latitude 34.8°N). The patient reported brief submergence in a marshy muddy rice field after the accident. There was some evidence of soil and water contamination of the patient's skin and clothing, but he denied swallowing water or soil. There were no findings of pneumonitis or severe open wounds on admission. Until the night of the 7th day of hospitalization, his general conditions remained stable despite a persistent fever. However, he suddenly collapsed on the 8th day of hospitalization and died. C. violaceum bacteremia led to fatal sepsis on dissemination to the iliopsoas abscess, which is a rare combination for this infection. CONCLUSIONS Episodes of exposure to contaminated water or soil, especially in summer, are important predisposing factors for C. violaceum infection. Thus, it is vital to include C. violaceum infections as a differential diagnosis, since the mortality rate of C. violaceum infections is high and the cases of this infection have increased in non-tropical counties.

This report describes technical tools for the treatment of pediatric displaced and unstable diaphyseal forearm fractures, which are difficult to treat by manual closed reduction. During intramedullary fixation with Kirchner wires, we propose our original small distractor as an intraoperative distraction apparatus without open reduction. This apparatus is made using parts of the Ilizarov external fixator. Apart from general external fixation devices, our apparatus is adequate for the effective shortening and lateral dislocation of the fracture site. This adequacy is not only because of the three-dimensional control by ball joints but also owing to the gradual adjustment structure of the Quick adjust strut (Orthofix, Verona, Italy), which allows tight and fine stretching, thus making the distractor an effective reduction tool. Our findings show the feasibility and usefulness of our reduction technique and small distractor. Our small distractor is a useful intraoperative distraction apparatus without open reduction for pediatric displaced and unstable diaphyseal forearm fractures that cannot be treated by manual closed reduction. In this report, we describe the distractor, the closed reduction technique, and the clinical results of four representative cases., Competing Interests: None.

Case Presentation: A 14-year-old boy presented to the emergency department complaining of severe groin pain on the right side following a minor fall. Computed tomography and magnetic resonance imaging revealed a hematoma in his right iliacus muscle. He was diagnosed with a traumatic iliacus hematoma, and he recovered spontaneously with short-term oral analgesics., Discussion: Traumatic iliacus hematomas are rare entities and subside with conservative management in most cases. However, this condition may be associated with femoral nerve palsy, and surgery is indicated in severe cases. Traumatic iliacus hematoma should be considered in the differential diagnosis of severe groin pain.

Case Presentation: A five-year-old boy presented to our emergency department with severe posterior neck pain that was exacerbated upon neck movement. Cervical spine radiography revealed calcification in the cervical intervertebral disk 3-4., Discussion: Pediatric idiopathic intervertebral disk calcification is a benign, rare condition that might be complicated by associated severe neurological symptoms. In this case, the symptoms gradually subsided with conservative management alone.

In several cases of treatment of acromion fractures of the scapula, plate fixation provides more rigidity to the fractured area. However, no specific plates are available for the acromion because of high interindividual variation in the shape of the acromion. We report two cases of acromion fractures operated using a mesh plate (Depuy Synthes, West Chester, PA, USA), which acts as a versatile, low-profile implant, being cut according to the specific fracture pattern and anatomical fitting. Our positive experiences with using a mesh plate may help to establish it as the operative procedure of choice in cases of acromion fracture., Competing Interests: The authors declare that there are no conflicts of interest., (© 2021 The Author(s).)

Plate osteosynthesis for oblique fracture of the manubrium sterni is quite rare. We present a case of a 37-year-old man with oblique fracture of the manubrium sterni caused by a traumatic injury. He was operated on using a variable-angle locking compression plate Mesh Plate 2.4/2.7 and had a good postoperative result. We also discuss intraoperative safe techniques such as use of a cement spatula for reduction support tools and depth-limited drilling to prevent excess drilling of the opposite cortex., Competing Interests: The authors declare that there are no conflicts of interest., (© 2021 The Author(s).)

Periprosthetic osteolysis is a serious problem that limits long-term survival of total hip arthroplasty. Ceramics have been introduced as a joint surface material to reduce osteolysis due to wear particles. The aim of this study is to investigate the biological reaction of ceramic particles on murine calvarial bone, in comparison with polyethylene and titanium particles. Sixty CL/BL6 mice were divided into five groups according to the materials implanted onto the murine calvariae: control, Al(2)O(3), ZrO(2), high-density polyethylene (HDP) and Ti6Al4V. One week after the implantation, each calvarial tissue was dissected and the release of proinflammatory mediators (IL-1beta, IL-6, TNF-alpha) and bone resorption were assessed. The particles of HDP and Ti6Al4V induced three and two times larger osteolytic lesions than the control, respectively. The levels of IL-1beta and IL-6 were significantly elevated in the medium subcultured with the calvariae of HDP and Ti6Al4V groups. Any particle type did not increase the levels of TNF-alpha. There were no significant differences observed in the levels of proinflammatory mediators or osteolytic area among Al(2)O(3), ZrO(2) and control groups. The inflammatory response and bone resorption induced by ceramic particles were much smaller than those induced by HDP and Ti6Al4V. These biological features suggest the biocompatibility of ceramics as a joint surface material for artificial joints.

The relationship between change in the shape of the femoral head and the clinical results after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head was investigated. Fifty-six hips in 50 patients, followed for at least 2 years, showed no progressive collapse and no osteoarthrotic change during that time. The growth of a superolateral osteophyte of the femoral head was observed postoperatively at a higher rate with progression of the preoperative stage. Excessive restoration of the rotated necrotic lesion of the femoral head was observed at a higher rate in hips with the growth of the superolateral osteophyte. The total Japanese Orthopaedic Association score at final follow-up in hips with these shape changes of the femoral head was significantly inferior to the score in hips without these changes. There was a tendency for hips with a low ratio of intact articular surface of the femoral head in the weight-bearing area to the acetabulum just after surgery to manifest these shape changes. Although such changes of the femoral head were considered to represent remodeling to stabilize the hip joint, excessive remodeling could worsen the clinical results.