Associated injury complicated by pediatric lower limb shaft fractures and clinical efficacy of flexible stainless-steel intramedullary nailing in children less than 15 years old.

Although pediatric lower limb shaft fractures are common, little is known about associated injuries. The purpose of this study was to examine associated injuries complicated by pediatric lower limb shaft fractures and the efficacy of surgical treatment using a flexible stainless-steel intramedullary Ender nail in children less than 15 years old. This is a retrospective review of 29 children younger than 15 years old who were diagnosed with femoral or tibial shaft fractures and treated using Ender nails from 2005 to 2016. Baseline data, etiology, associated injuries, fracture site and patterns, operative and post-operative assessment were evaluated. The average age of the patients was 9.0 years, and mean follow-up was 18.2 months. Eleven patients (79%) had associated injury. At the final follow up, six patients (43%) sustained complications associated with the insertion area of the nail. There was no evidence of deep infection or nonunion at either fracture site. The clinical results were excellent in 10 (67%) fractures, and good in 5 (33%) fractures, based on the modified Flynn criteria. Almost all patients with a femoral fracture had an associated injury including abdominal visceral injury, cerebral contusion or other fractures. This study indicated good clinical and functional outcomes. On the other hand, the minor complications rate was high. Nevertheless, elastic stable intramedullary nailing recently has become available in Japan, and a prospective and comparative study is needed.

Short-term mortality and risk factors associated with reoperation after emergency amputation of the lower limbs.

BACKGROUND: As Japan has an aging population, elderly patients with multiple complicating comorbidities have increased in number. The purpose of the present study was to examine the 90-day mortality and reoperation rate after emergency amputation of the lower limbs and to clarify patient characteristics and preoperative comorbidities that are risk factors for reoperations. METHODS: This retrospective case study was conducted between January 2005 and December 2017. Ninety-one patients with 108 limbs who had undergone emergency amputation of the lower limbs were included in this study. Baseline data, medical comorbidities, surgical procedures and laboratory data including C-reactive protein (CRP), white blood cells (WBC) and hemoglobin A1c (HbA1c) were evaluated. Outcome measurements were mortality, reoperation rate, and factors associated with reoperation in 90 days and any complication after amputation of the lower limbs. RESULTS: The patients (male/female ratio = 64/27) had a mean age of 64.9 years, a mean WBC count of 16,747/µL, a mean CRP value of 15.6 mg/dL, and a mean HbA1c value of 7.5%. The 90-day mortality rate in the study population was 12.1%. The 90-day reoperation rate was 35.2% (32/91) patients with 32.4% (35/108) limbs. The factor significantly associated with reoperation in 90 days was peripheral arterial disease (PAD) (p = 0.022, HR = 2.75), identified with Cox proportional hazards regression analysis. A total of 41.8% (38/91) patients with 40.7% (44/108) limbs experienced postoperative wound complications. The overall rate of medical complications was 18.7% (17/91) patients with 16.7% (18/108) limbs. CONCLUSIONS: This study indicates that the 90-day mortality and reoperation rates after emergency amputation of the lower limbs were high. Furthermore, PAD influences the rate of reoperation in 90 days. However, there was no association between laboratory results or diabetes mellitus and reoperation. These findings will have important implications for the treatment of lower leg amputation and prevention of reoperation.

Stress fracture of the midshaft clavicle associated with sternocostoclavicular hyperostosis-Case report.

INTRODUCTION: Stress fracture is generally a result of cumulative and repetitive stress in athletes, which accelerates the normal remodeling process of bones, and the most frequently involved areas are the tibia and metatarsal bones. Therefore, stress fractures of the midshaft of the clavicle are very rare. PRESENTATION OF CASE: A 58-year-old female was admitted to our hospital because of pain in the middle of the right clavicle. Based on laboratory and radiographic inspection, it was concluded that the stress fracture of the midshaft of the clavicle in this case was caused by sternocostoclavicular hyperostosis (SCCH). Because the clavicular fracture had no displacement or callus formation, conservative treatment with a clavicle band was undertaken. Shoulder function at the final follow-up visit was satisfactory. DISCUSSION: SCCH is a rare chronic inflammatory disorder of the axial skeleton and ossifying diathesis associated with a predominantly osteogenic response. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and ankylosing spondylitis (AS) should be considered in the differential diagnosis of SCCH. If a patient with this type of fracture has no history of traumatic injury or sports activity, the differential diagnosis might be very difficult. CONCLUSION: We report the case of a female who had a stress fracture of the midshaft of the clavicle associated with SCCH in SAPHO or AS. Although the patient was treated conservatively, and the shoulder function was satisfactory at the final follow-up visit, re-fracture may occur in the future.

Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture.

Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment.

Treatment of Atypical Ulnar Fractures Associated with Long-Term Bisphosphonate Therapy for Osteoporosis: Autogenous Bone Graft with Internal Fixation.

Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and an increased risk of atypical fractures. Fractures of this nature commonly occur in the femur, and relatively few reports exist to show that they occur in other bones. Among eight previous reports of atypical ulnar fractures associated with bisphosphonate use, one report described nonunion in a patient who was treated with cast immobilization and another described ulna nonunion in one of three patients, all of whom were treated surgically with a locking plate. The remaining two surgical patients achieved bone union uneventfully following resection of the osteosclerotic lesion and iliac bone grafting before rigid fixation. We hypothesized that the discontinuation of bisphosphonate therapy, the use of teriparatide treatment, and low-intensity pulsed ultrasound (LIPUS) might have been associated with fracture healing.

Phenotypic changes during 100-year rice breeding programs in Hokkaido.

Plant breeding programs in local regions may have genetic and phenotypic variations that are desirable and shape adaptability during the establishment of local populations. Despite the characterization of genetic population structures in various kinds of populations, the effects of variations in phenotype on agro-economical traits currently remain unclear. In the present study, we evaluated phenotypic changes in 26 agro-economical traits among the local population during rice breeding programs in Hokkaido. Wide variations were observed in all 26 agro-economical traits with continuous distributions. In order to elucidate improvements in these agro-economic traits during rice breeding programs in Hokkaido, values were compared between genetic population structures. Traits were classified into four patterns based on the timing of significant differences. Patterns A and B showed significant differences once and twice, respectively. Pattern C gradually showed significant differences. Pattern D showed no significant differences for the desired directions. Based on the changes in phenotype observed in the present study and the genetic population structure for the local population in Hokkaido, a model of the artificial selection for phenotypes in genetic diversity among the local population during plant breeding programs has been proposed.

Anatomic cadaveric study of the extensile extensor digitorum communis splitting approach for exposing the ulnar coronoid process.

BACKGROUND: The extensile extensor digitorum communis (EDC) splitting approach can access the ulnar coronoid process (UCP), which can be used to treat terrible triad injuries. The present study anatomically examined the extensile EDC splitting approach for exposing the UCP. METHODS: Twenty fresh frozen cadaveric upper limbs were dissected. The splitting length of the EDC and detachment length of the extensor carpi radialis brevis (ECRB)-extensor carpi radialis longus (ECRL)-brachioradialis (BR) origin were measured to expose the UCP. The distance between the most distal site of the EDC splitting and the point at which the posterior interosseous nerve (PIN) crosses the anterior aspect of the radial shaft, and the distance between the most proximal site of the ECRB-ECRL-BR origin detachment and the point at which the radial nerve crosses the anterior aspect of the humeral shaft were measured. RESULTS: The splitting length of the EDC was 45.4 ± 4.8 mm, the detachment length of the ECRB-ECRL-BR origin was 30.2 ± 4.7 mm, the distance between the distal site of the EDC splitting and PIN was 10.6 ± 6.1 mm (minimum distance, 1.1 mm), and the distance between the proximal site of the ECRB-ECRL-BR origin detachment and the radial nerve was 49.5 ± 9.7 mm (minimum distance, 31.7 mm). CONCLUSIONS: The extensile EDC splitting approach can sufficiently expose the UCP. However, splitting must be performed carefully because the most distal site of the EDC splitting is close to the point at which the PIN crosses the anterior aspect of the radial shaft (average distance, 10 mm; minimum distance, 1 mm).

Quantitative trait loci for whiteness of cooked rice detected in improved rice cultivars in Hokkaido.

Improving the eating quality of cooked rice has been one of the most important objectives in rice breeding programs. Eating quality of cooked rice is a complex trait including several components, such as external appearance, taste, aroma, and texture. Therefore, dissection of these components followed by marker-assisted selection of detected QTL(s) may be a useful approach for achieving desirable eating quality in rice breeding. Whiteness of cooked rice (WCR) is an important factor related to the external appearance of cooked rice. WCR is known to be associated with the amylose and protein contents of the endosperm. However, the genetic basis of WCR remains unclear. In this study, we evaluated phenotypic variation in WCR among recently developed rice cultivars from Hokkaido, Japan. Then, we developed doubled haploid lines (DHLs) derived from a cross between two cultivars from Hokkaido, Joiku No. 462 (high WCR) and Jokei06214 (low WCR). Using the DHLs, we detected two QTLs for WCR, qWCR3 and qWCR11, on chromosomes 3 and 11, respectively. We also examined the dosage effect of the two QTLs based on both the categorized segregants in the DHLs and the relationship between the WCR phenotype and inheritance around the QTL regions in cultivars from Hokkaido.