Preliminary results of stabilization of far distal tibia fractures with the distal tibial nail: A prospective, multicenter case series study.

INTRODUCTION: The distal tibial nail (DTN) is a novel retrograde intramedullary nail used for distal tibial fracture stabilization. We investigated the clinical results of DTN use for distal tibial fractures and compared them with those reported in the literature on locking plates and antegrade intramedullary nails. MATERIALS AND METHODS: This multicenter, prospective, observational cohort study examined distal tibial fractures with AO/OTA classification 43 types: A1, A2, A3 or C1. The primary outcomes included bone union rate, soft tissue problems, and surgical complications. Secondary outcomes were EuroQol-5 Dimension-5 Level (EQ-5D-5L), Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot clinical scores 1 year postoperatively. Incidence of varus or valgus/anterior-posterior flexion deformity with a difference of ≥5° and postoperative reduction loss rate were evaluated. RESULTS: Five men and five women were enrolled (mean age, 69 years [range, 30-77 years]), including one open-fracture-type Gustilo type IIIB case. Bone union was observed in all patients at 6 months postoperatively. Delayed union, leg edema, and guide pin breakage were observed in three, one, and one cases, respectively. No soft tissue or surgical complications were observed. During the final follow-up, the EQ-5D-5L, SAFE-Q, and AOFAS hindfoot scores were 0.876 (0.665-1.0), 83-92, and AOFAS 92.6 (76-100), respectively. Varus and retroflexion deformities were observed in one case each. DISCUSSION: DTN has been reported to have biomechanically equivalent or stronger fixation strength than locking plates or antegrade intramedullary nails. In addition, while DTN was thought to be less invasive for soft tissue and can avoid injury to the knee, it was thought that care should be taken to avoid medial malleolus fractures and posterior tibialis tendon injuries. Comparisons with literature treatment results for locking plates and antegrade intramedullary nails showed comparable to advantageous results. CONCLUSIONS: DTN treatment results for distal tibial fractures were as good as those for locking plates and antegrade intramedullary nails. DTN is useful for stabilization and does not compromise the surrounding soft tissues.

Patellofemoral Osteoarthritis Progression After Open-Wedge High Tibial Osteotomy Does Not Affect the Clinical Outcomes or Survivorship at Minimum 7 Years' Follow-Up.

PURPOSE: To evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess the effects of patellofemoral osteoarthritis (OA) progression after OWHTO on clinical outcomes at minimum 7 years' follow-up. METHODS: We retrospectively reviewed 95 knees that underwent OWHTO and at least 7 years of follow-up. Clinical parameters including anterior knee pain, Japanese Orthopedic Association score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, Hospital for Special Surgery patella score, and Knee Injury and Osteoarthritis Outcome Score-patellofemoral subscale were evaluated. Radiologic outcomes were evaluated preoperatively and at final follow-up. Patellofemoral OA progressions were evaluated using Kellgren-Lawrence grade, and we divided the patients into 2 groups (progression group and non-progression group) to evaluate the effect of patellofemoral OA progression after OWHTO on long-term clinical outcomes. RESULTS: The mean follow-up period was 10.8 ± 2.6 years (range: 7.6-17.3 years). The mean Japanese Orthopedic Association score significantly improved (from 64.4 ± 11.6 to 90.9 ± 9.3, P < .001), and the mean Oxford Knee Score at final follow-up was 40.4 ± 8.3. Due to medial OA progression, 5 cases were converted to total knee arthroplasty, and the survival rate was 94.7% at 10.8 years of follow-up. Radiologically, patellofemoral OA progression was observed at final follow-up in 48 knees (50.5%). However, there were no significant differences in all clinical outcomes at final follow-up between the progression and non-progression groups. CONCLUSIONS: Patellofemoral OA progression may progress over long-term follow-up after OWHTO. Related symptoms are minimal and this does not affect the clinical outcomes or survivorships at minimum 7 years follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Influence of lateral hinge fractures on biplanar medial closing-wedge distal femoral osteotomy for valgus knee: a new classification of lateral hinge fracture.

BACKGROUND: The purpose of this study was to examine the influence of lateral hinge fractures in medial closing-wedge distal femoral osteotomy (MCWDFO) on bone union. METHODS: Twenty-one patients were followed-up for more than 1 year after MCWDFO. The incidence and type of hinge fracture, as well as the course of bone healing, were investigated. Slow healing was defined as bone union was not obtained until 3 months after surgery. RESULTS: Hinge fractures were observed in 12 cases (57%). There were three types of hinge fractures. Type 1: the lateral cortex was completely cut through (4 cases), type 2: the osteotomy line was too proximal (6 cases), and type 3: the hinge point was significantly medial (2 cases). There was a significant difference in the mean correction angles between hinge fracture and no-fracture cases, with the mean angles being 13.8 ± 4.0° and 9.6 ± 3.1°, respectively. Sixty-seven percent (8/12) of cases with hinge fractures developed slow healing. Among the hinge fracture cases, when there was no displacement of the hinge fracture and good contact with the anterior flange, 40% (2/5) of cases developed slow healing. If there was displacement of the hinge or no contact of the anterior flange, 86% (6/7) of cases developed slow healing. In contrast, only 11% (1/9) of subjects who did not have a hinge fracture, developed slow healing. In 67% (6/9) of cases with slow healing, a correction loss of 2° or greater (average: 4.3 degrees valgus) was observed. There were no cases of non-union. Clinical outcomes at 1 year showed no significant difference between the groups with and without hinge fractures. CONCLUSIONS: There is a very high risk of hinge fracture in patients undergoing MCWDFO. Hinge fractures often lead to slow healing and a loss of correction. We recommend the endpoint of the distal lateral cortex of the femur as the ideal hinge point for the prevention of hinge fractures. Bone union is obtained slowly in even all hinge fracture cases without revision surgery. Consequently, surgical results are not affected by the occurrence of hinge fracture at 1 year.

Differences in age-related characteristics among elderly patients with hip fractures.

BACKGROUND: Incidence of hip fracture among aging patients has been increasing annually in Japan; patients aged ≤74 years may be inappropriately classified as elderly. This study aimed to identify differences in the incidence of serious perioperative complications and in-hospital, 90-day, 6-month, and 1-year mortality rates according to three age groups among patients with hip fractures. METHODS: Patients aged ≥65 years treated for hip fracture by our multidisciplinary treatment system were included in this study. They were divided into the pre-old age (65-74 years), old age (75-89 years), and super-old age (≥90 years) groups. The baseline characteristics and outcomes of the three groups were compared, and variables associated with in-hospital, 30-day, 6-month, and 1-year mortality were analyzed. RESULTS: In the older population, there was a higher proportion of female participants; those with trochanteric fractures, low bone mineral density, dementia, decreased walking ability and independence in performing activities of daily living; and those not living at home. Moreover, the proportion of patients with hypertension, diabetes mellitus, and circulatory disorders, American Society of Anesthesiologists Physical Status scores, and serum albumin levels significantly differed. Further, there was a significant difference in the incidence of serious complications among males and the 6-month and 1-year mortality rates among females. In addition, female patients in the pre-old age group had a higher mortality rate at any period compared with those in the old age group. CONCLUSIONS: Patients with hip fracture who were aged 65-74, 75-89, and ≥90 years differ in terms of baseline characteristics, incidence of complications, and mortality rates. Female patients aged<75 who had fragility hip fractures potentially had worse prognosis. Our findings may be useful in preoperative explanation, postoperative management, and prognostic prediction.

Low-intensity pulsed ultrasound does not promote bone healing and functional recovery after open wedge high tibial osteotomy.

AIMS: To evaluate whether low-intensity pulsed ultrasound (LIPUS) accelerates bone healing at osteotomy sites and promotes functional recovery after open-wedge high tibial osteotomy (OWHTO). METHODS: Overall, 90 patients who underwent OWHTO without bone grafting were enrolled in this nonrandomized retrospective study, and 45 patients treated with LIPUS were compared with 45 patients without LIPUS treatment in terms of bone healing and functional recovery postoperatively. Clinical evaluations, including the pain visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score, were performed preoperatively as well as six weeks and three, six, and 12 months postoperatively. The progression rate of gap filling was evaluated using anteroposterior radiographs at six weeks and three, six, and 12 months postoperatively. RESULTS: The pain VAS and JOA scores significantly improved after OWHTO in both groups. Although the LIPUS group had better pain scores at six weeks and three months postoperatively, there were no significant differences in JOA score between the groups. The lateral hinge united at six weeks postoperatively in 34 (75.6%) knees in the control group and in 33 (73.3%) knees in the LIPUS group. The progression rates of gap filling in the LIPUS group were 8.0%, 15.0%, 27.2%, and 46.0% at six weeks and three, six, and 12 months postoperatively, respectively, whereas in the control group at the same time points they were 7.7%, 15.2%, 26.3%, and 44.0%, respectively. There were no significant differences in the progression rate of gap filling between the groups. CONCLUSION: The present study demonstrated that LIPUS did not promote bone healing and functional recovery after OWHTO with a locking plate. The routine use of LIPUS after OWHTO was not recommended from the results of our study. Cite this article: Bone Jt Open 2022;3(11):885-893.

Orthogeriatric co-management at a regional core hospital as a new multidisciplinary approach in Japanese hip fracture operation.

BACKGROUND: This study aimed to evaluate the effects of orthogeriatric co-management of hip fractures at a regional core hospital. METHODS: This study included patients with proximal hip fracture. Patients were divided into two groups, conventional multidisciplinary group I including patients attending the hospital between April 2015 and March 2016 and orthogeriatric group II including patients attending the hospital between April 2016 and March 2017, which were compared etrospectively. In the control group, the conventional multidisciplinary team treated patients as whole-body controls. In the intervention group, the newly recruited geriatricians performed physical examinations, laboratory tests, radioactive imaging, and physiological tests. Furthermore, they consulted ward pharmacists, rigorously conducted positive polypharmacy interventions , and evaluated the type and number of mediated drugs on admission. RESULTS: The number of medicated drugs significantly decreased from 6.03 ± 4.3 on admission to 5.50 ± 3.59 on discharge in group II, whereas group I did not show a significant decrease. Despite the more number of hospitalized patients in group II (166 patients) than in group I (126 patients), the recovery rate from postoperative urinary retention increased significantly from 57.8% (19/30) in group I to 84.3% (32/59) in group II (p = 0.049), while the incidence of aspiration pneumonia decreased from 7.1% (9/126) in group I to 2.49% (4/166) in group II (p = 0.08). The patients received six or more prescribed drugs on admission, and the number remained constant. However, the number of medicated drugs on discharge showed a marginally significant decrease from 6.03 ± 4.3 in group I to 5.50 ± 3.59 in group II (p < 0.05). CONCLUSIONS: Compared to the conventional multidisciplinary group, the orthogeriatric team contributed to reducing the number of multi-effect drugs and perioperative complications without negatively affecting mortality despite the increased number of patients. The in-hospital mortality rate did not change between the groups. The orthogeriatric program succeeded in preventing and treating perioperative complications.

Postoperative Urinary Retention in Japanese Elderly Males with a Femoral Neck or Trochanteric Fracture.

We assessed risk factors for postoperative urinary retention (UR) in elderly males with femoral bone fractures: 169 Japanese males (mean age 81.95 ± 1.19 years) who had undergone hip surgery at a municipal hospital (Toyama, Japan). A multiple logistic regression analysis was used to test possible risk factors for UR: age, body mass index, serum albumin, cognitive impairment, activities of daily living (ADL), and history of diabetes mellitus (DM). UR occurred in 24 (14.2%) of the 169 patients. A multivariate logistic regression analysis with age adjustment showed that ADL (odds ratio [OR] 3.88; 95% confidence interval [CI]: 1.2-12.5, p=0.023) was significantly associated with the development of UR, and a history of DM showed marginal significance for UR occurrence (OR 0.36, 95%CI: 0.11-10, p=0.064). These results suggests that ADL is a risk factor for UR development in elderly males who have undergone surgery for femoral neck or trochanter fractures.

Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience.

INTRODUCTION: Japan is a super-aging society, the geriatric care system establishment for hip fractures is at an urgent task. This report described our concept of multidisciplinary care model for geriatric hip fractures and 5-year outcomes at the Toyama City Hospital, Japan. METHODS: In this retrospective cohort study, a multidisciplinary treatment approach was applied for elderly patients with hip fracture since 2014. These patients (n = 678, males: n = 143, mean age: 84.6 ± 7.5 years), were treated per the multidisciplinary care model. Time to surgery, length of hospital stays, complications, osteoporosis treatment, mortality, and medical costs were evaluated. RESULTS: The mean time to surgery was 1.7 days. Overall, 78.0% patients underwent surgery within 2 days. The mean duration of hospital stay was 21.0 ± 12.4 days. The most frequent complication was deep venous thrombosis (19.0%) followed by dysuria (14.5%). Severe complications were pneumonia 3.4%, heart failure 0.8% and pulmonary embolism 0.4%. The in-hospital mortality rate was 1.2%. The 90-day, 6-month, and 1-year mortality rates were 2.5%, 6.7%, and 12.6%, respectively. The pharmacotherapy rate for osteoporosis at discharge was 90.7%, and the continuation pharmacotherapy rate was 84.7% at 1-year follow-up. The total hospitalization medical cost per person was lower than about 400 other hospitals' average costs every year, totaled 14% less during the 5-year study period. CONCLUSION: We have organized a multidisciplinary team approach for geriatric hip fracture. This approach resulted in a shorter time to surgery and hospital stay than the national average. The incidence of severe complications and mortality was low. The multidisciplinary treatment has maintained a high rate of osteoporosis treatment after discharge and at follow-up. Furthermore, the total medical cost per person was less than the national average. Thus, the multidisciplinary treatment approach for geriatric hip fractures was effective and feasible to conduct in Japan.

Factors Associated With Patient Satisfaction After Opening-Wedge High Tibial Osteotomy.

BACKGROUND: Opening-wedge high tibial osteotomy (OWHTO) is expected to result in higher patient satisfaction compared with knee arthroplasty due to joint preservation. However, patient satisfaction rates as well as factors associated with satisfaction after OWHTO remain unclear. PURPOSE: To evaluate patient subjective satisfaction after OWHTO and determine factors associated with patient satisfaction after OWHTO. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This study enrolled 123 patients (123 knees) who underwent unilateral OWHTO. Clinical parameters, including range of motion (ROM), visual analog scale (VAS) score for pain, Knee injury and Osteoarthritis Outcome Score (KOOS), weightbearing line ratio (WBLR), and medial proximal tibial angle (MPTA), were assessed before surgery and at the final follow-up at a minimum of 2 years. Patient satisfaction was evaluated using a 5-point scale regarding (1) surgery, (2) pain relief, (3) knee mobility, (4) daily living function, and (5) lower extremity alignment. The mean overall satisfaction scores for the 5 questions were calculated, and the sample was divided into 2 main groups (satisfied or unsatisfied). Preoperative characteristics, physical activity level, patient expectations for surgery, ROM, and KOOS were compared between the groups. Cartilage regeneration was assessed at the time of plate removal, and WBLR and MPTA were also assessed. Factors associated with patient satisfaction were analyzed using multivariable logistic regression analysis. RESULTS: The mean ± SD follow-up was 54.6 ± 20.6 months. The mean WBLR significantly changed from 20.7% ± 11.8% preoperatively to 66.9% ± 10.2% at the final follow-up, and all KOOS subscale scores significantly improved after surgery. Of the 123 patients, 109 (88.6%) were graded as satisfied. Factors associated with patient satisfaction were expectations met (odds ratio, 17.4; P = .026), better postoperative KOOS Pain score (odds ratio, 1.30; P = .001), and better postoperative KOOS Activities of Daily Living score (odds ratio, 1.36; P = .002). CONCLUSION: OWHTO is an effective treatment in terms of subjective satisfactory outcomes. Patient expectations for surgery have a significant effect on patient satisfaction. Surgeons should consider patient expectations before OWHTO and provide patient education to improve patient satisfaction.

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures.

BACKGROUND: The main purpose of this study is to exhaustively explore risk factors, including age, gender, and several clinical indices, for mortality in elderly patients with femoral neck fracture and to evaluate some of them using survival analyses. METHODS: This was a retrospective study tracking 1 year for vital prognosis. Data were collected at post-operation from medical records of the cases. Survival analysis was conducted to investigate the risk factors for death, including albumin, urinary retention, activity of daily living (ADL), and cognitive disorder. RESULTS: We recruited 318 patients with a history of hip surgery carried out at Toyama Municipal Hospital, in which 39 patients died for 1 year after discharge. The results showed a significant decrease in survival rate in low albumin, positive urinary retention, and low ADL (P < 0.01, by log-rank test). The hazard ratios (95% confidence interval) of albumin, urinary retention, ADL, and cognitive disorder were 0.36 (0.19 - 0.69), 0.4 (0.2 - 0.8), 0.29 (0.15 - 0.58) and 0.65 (0.32 - 1.29), respectively. CONCLUSIONS: This study demonstrated that albumin, urinary retention and ADL were the important risk factors for mortality, and suggested that the postoperative management of albumin, urinary retention and ADL is important, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

Open-wedge high tibial osteotomy for spontaneous osteonecrosis of the medial tibial plateau shows excellent clinical outcomes.

PurposeThere have been few reports on medial tibial plateau osteonecrosis, and treatment options remain controversial. This study aimed to evaluate the clinical outcomes of open-wedge high tibial osteotomy (OWHTO) for osteonecrosis of the medal tibial plateau.MethodsPatients who underwent OWHTO for spontaneous osteonecrosis of the medial tibial plateau from November 2013 to September 2017 at our institution and followed up for at least 2 years after surgery were included in this study. Patients with history of alcohol abuse and corticosteroid therapy were excluded. Clinical evaluations, including the Japanese Orthopedic Association (JOA) score and the Oxford Knee Score (OKS), were measured preoperatively and at the final followup. Radiological evaluations included the weight-bearing line ratio (WBLR) and the lesion stage of the osteonecrosis according to Carpintero, Lotke, and the modified Ficat and Arlet classification. The area and size of the necrosis and the type of meniscus tear were also evaluated using preoperative magnetic resonance imaging (MRI). Additionally, cartilage regeneration was evaluated at plate removal.ResultsTwelve cases that underwent OWHTO for spontaneous osteonecrosis of the medial tibial plateau were enrolled. Eleven cases had isolated medial tibial osteonecrosis, and one case had both femoral and tibial osteonecrosis. The mean age was 59.6 ± 9.0 years, and the mean follow-up period was 41.8 ± 17.6 months.The WBLR significantly changed after OWHTO (24.0% ± 10.7% to 66.3% ± 6.7%, P < 0.001), and all clinical scores significantly improved after surgery: JOA score 63.3 ±12.3 to 95.0 ± 4.8, OKS 27.4 ± 7.8 to 42.6 ± 4.1, both 0.001. There were no adverse complications requiring additional surgery. The MRI findings revealed that all cases had meniscal lesions in addition to a necrotic lesion. Second-look arthroscopy was performed at plate removal in 11 cases, and cartilage regeneration was observed in 9/11 cases (81.8%).ConclusionsThis study's results demonstrated that OWHTO is an effective procedure for spontaneous osteonecrosis of the medial tibial plateau with respect to subjective and objective clinical outcomes.

Risk factors for the development of aspiration pneumonia in elderly patients with femoral neck and trochanteric fractures: A retrospective study of a patient cohort.

Aspiration pneumonia (AP) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of AP in elderly patients with femoral neck fractures.We recruited 426 patients (age 84.9 ±â€Š7.4 years) with a history of hip surgery carried out at Toyama Municipal Hospital. AP occurred in 18 out of 426 cases (4.23%). Statistical test has found significant differences in age, gender, serum albumin level, and cognitive impairment, between AP and non-AP groups. Subsequently multiple logistic regression analysis was conducted to investigate the risk factors for AP, including age, gender, serum albumin, cognitive impairment, and activities of daily living (ADL). Adjusted odds ratio showed significant differences in age, gender, and serum albumin, whereas no significant differences were found in cognitive impairment and ADL.This study suggested that serum albumin seemed to be a risk factor for AP but were necessary to assess under adjustment of confounding factors, including age and gender. Monitoring serum albumin level seemed to be important for the postoperative management of AP, especially in elderly patients receiving surgery of femoral neck and trochanteric fractures.

Hip fracture care and national systems: Australia and Asia.

The Asia-Pacific region includes countries with diverse cultural, demographic, and socio-political backgrounds. Countries such as Japan have very high life expectancy and an aged population. China and India, with a combined population over 2.7 billion, will experience a huge wave of ageing population with subsequent osteoporotic injuries. Australia will experience a similar increase in the osteoporotic fracture burden, and is leading the region by establishing a national hip fracture registry with governmental guidelines and outcome monitoring. While it is impossible to compare fragility hip fracture care in every Asia-Pacific country, this review of 4 major nations gives insight into the challenges facing diverse systems. They are united by the pursuit of internationally accepted standards of timely surgery, combined orthogeriatric care, and secondary fracture prevention strategies.

Plate removal without loss of correction after open-wedge high tibial osteotomy is possible when posterior cortex bone union reaches osteotomy gap center even in incompletely filled gaps.

PURPOSE: The study aimed to evaluate the optimal timing for plate removal after open-wedge high tibial osteotomy (OWHTO) without loss of correction and to investigate risk factors for loss of correction after plate removal. The study presents the hypothesis that plate removal without loss of correction was possible when gap filling reached zone 2 (25-50%) on anteroposterior radiographs. METHODS: Ninety-one patients (101 knees) who underwent OWHTO using the TomoFix® plate were enrolled. Plate removal was performed at an average 16.4 ± 5.4 months after OWHTO. Clinical evaluation included plate-related symptoms, the Japanese Orthopedic Association Knee Score (JOA score), and Oxford Knee Score (OKS). Radiological outcomes, including the hip-knee-ankle angle (HKA), weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS), were evaluated preoperatively, at plate removal and at 1 year after plate removal. Computed tomography (CT) was performed at plate removal to evaluate the flange bone union, progression rates of gap filling, and posterior cortex bone union. In addition, the risk factors for loss of correction after plate removal were evaluated. RESULTS: At plate removal, 63 (62.4%) knees had plate-related symptoms (mild, 56 knees; moderate, 7 knees; severe, 0). After plate removal, the JOA score did not change, whereas OKS further improved; six knees developed loss of correction. On CT evaluation at plate removal, the flange bone union was achieved in all cases; the progression rates of gap filling and posterior cortex bone union were 47.0% ± 16.6% and 62.8% ± 16.5%, respectively. A posterior cortex union rate of < 43.3% was the only predictor for loss of correction after plate removal (odds ratio: 1.38, P < 0.01). CONCLUSIONS: Plate removal without loss of correction after OWHTO was possible when bone union of the posterior cortex reached the center of the osteotomy gap even in incompletely filled gaps. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

Comparison of Clinical and Radiologic Outcomes Between Normal and Overcorrected Medial Proximal Tibial Angle Groups After Open-Wedge High Tibial Osteotomy.

PURPOSE: To evaluate whether the overcorrected medial proximal tibial angle (MPTA) affects the clinical outcomes after open-wedge high tibial osteotomy (OWHTO) and to assess the correlation between knee joint line obliquity (KJLO) changes and the compensatory changes in the hip and ankle joints. METHODS: Consecutive patients who underwent OWHTO from July 2006 to August 2015 were included. Exclusion criteria were bilateral OWHTO and follow-up of <2 years. The patients were retrospectively divided into 2 groups according to postoperative MPTA; a normal group (MPTA <95°) and an overcorrected MPTA group (MPTA ≥95°). The groups were compared with respect to the clinical and radiologic outcomes after OWHTO. Clinical parameters, including Japanese Orthopedic Association (JOA) score, Oxford Knee Score (OKS), and Knee Injury and Osteoarthritis Outcome Score (KOOS), were evaluated. Radiologic outcomes, including the hip-knee-ankle angle (HKA), joint line convergence angle (JLCA), MPTA, KJLO, ankle joint line obliquity (AJLO), and hip abduction angle (HAA), were evaluated preoperatively and at the final follow-up. RESULTS: Ninety-four patients (normal group; n = 52, overcorrected group; n = 42) were included in this study. After OWTHO, the mean increases in HKA and MPTA were 11.0° ± 3.2° and 10.4° ± 2.7°, respectively, whereas the change in KJLO was only 3.7° ± 2.9°. The mean AJLO (4.3 ± 3.9 to -1.3 ± 3.3, P < .001) and HAA (3.7 ± 2.5 to -1.1 ± 2.3, P < .001) significantly decreased after OWHTO. The mean postoperative MPTA in the overcorrected group was 96.9° ± 1.5°, whereas the mean postoperative KJLO was only 3.1° ± 2.0°. No significant differences were noted in all clinical scores between the groups at the final follow-up. CONCLUSIONS: A certain degree of overcorrected MPTA (≥95°) did not affect the clinical outcomes after OWHTO because of compensatory changes in the hip and ankle joints. LEVEL OF EVIDENCE: Level Ⅲ, retrospective comparative study.

Treatment of a sacral fracture associated with an intrasacral meningocele: A case report.

We report a case of sacral fracture complicated by an intrasacral meningocele in a 37-year-old male. The patient had a left sacral fracture with bilateral fractures of the superior and inferior pubic rami. The sacrum was fixed with a posterior plate and both superior pubic rami were fixed with an intramedullary screw. However, computed tomography myelogram and magnetic resonance imaging showed the intrasacral meningocele with the leakage of the cerebrospinal fluid into the buttocks and developed delayed union. Reoperation utilizing a strong anterior and posterior internal fixation combined with posterior bone grafting was undertaken and bone union was obtained.

Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures: A retrospective study of a patient cohort.

Urinary retention (UR) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of UR in elderly female patients with femoral neck fractures.We recruited 221 female patients (age 85.3 ±â€Š7.0 years) with a history of hip surgery carried out at Toyama Municipal Hospital. UR occurred in 34 out of 221 cases (15.4%). Multiple logistic regression analysis was conducted to investigate the risk factors for UR, including age, body mass index (BMI), serum albumin, cognitive impairment, and activities of daily living (ADL).The results showed significant association of UR with cognitive impairment (P = .005, odds ratio [OR] 4.11, 95% confidence interval [CI] 1.53-11.03), and ADL (P = .029, OR 2.61, 95% CI 1.11-6.18), under adjustment with age and BMI.This study demonstrated that cognitive function and ADL were the important risk factors for UR, suggested that the postoperative management of UR is important with taking account of neurofunctional assistance and nursing care in daily living, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

Long-term clinical results of the crosse de hockey procedure for recurrent patellar dislocation.

BACKGROUND: A gold standard procedure has not been established for recurrent patellar dislocation because of multifactorial etiologies. We have been performing crosse de hockey procedure, which is a combination of medial and anterior transfer of the tibial tuberosity, in our institution since 1993. This study aimed to investigate the long-term clinical results of this procedure. MATERIALS AND METHODS: A total of 19 patients (21 knees) underwent the crosse de hockey procedure for recurrent patellar dislocation. Of these patients, four were lost to follow-up. The remaining 17 knees in 15 patients (5 male and 10 female) were included in this study. The mean follow-up period was 13.2 years (range: 5-22.6 years). Clinical evaluation was performed using the Kujala score. Radiographic indicators, such as modified Insall-Salvati ratio, sulcus angle, congruence angle, tilting angle, lateral shift ratio, and the progression of patellofemoral osteoarthritis (OA), were measured. RESULTS: Positive apprehension sign and redislocation were not observed in any of the patients. The mean Kujala score was significantly improved from 36.5 ± 18.0 preoperatively to 92.6 ± 9.9 at the final follow-up. Definite OA (a grade 2 or more using the Iwano grading system) was not observed in the patellofemoral joint at the final follow-up. CONCLUSIONS: The crosse de hockey procedure showed satisfactory long-term clinical results for recurrent patellar dislocation. This procedure could prevent the progression of patellofemoral OA because of the unloading effect of the patellofemoral joint by anteromedial transfer of the tibial tuberosity.

The influence of pre-operative antiplatelet and anticoagulant agents on the outcomes in elderly patients undergoing early surgery for hip fracture.

BACKGROUND: Early surgery improves the prognosis of elderly patients with hip fractures. However, many patients take antiplatelet and anticoagulant therapies for comorbidities. This study compared perioperative outcomes and 1-year mortality rates with early surgery in elderly patients with hip fractures taking or not taking these agents preoperatively. METHODS: Among 418 patients undergoing surgery for hip fractures at our institution from 2014 to 2016, 266 patients over 65 years who had surgery within 48 hours of admission were enrolled. We excluded patients with high-energy injuries, multiple or pathological fractures, and patients undergoing osteosynthesis for femoral neck fractures. The study population was divided into those who underwent hemiarthroplasty for neck fractures and those who underwent osteosynthesis for trochanteric fractures. We also divided the population into patients receiving chronic anticoagulation therapy (medicated group: 19 hemiarthroplasty, 70 osteosynthesis) and patients not receiving anticoagulation therapy (non-medicated group: 47 hemiarthroplasty, 130 osteosynthesis). Comorbidities, intraoperative blood loss, estimated blood loss from admission to the first and seventh day after surgery, transfusions, length of stay, complications, and 1-year mortality rates were evaluated. RESULTS: Diabetes mellitus and cerebrovascular disorders were significantly more common in the medicated group for both surgery types. In the osteosynthesis group, estimated blood loss on the first day was 710 ml in the medicated group and 572 ml in the non-medicated group (P = 0.015). In the hemiarthroplasty group, corresponding values were 668 and 480 ml, respectively (P = 0.016). Estimated blood loss on the seventh day, complications, length of stay and 1-year mortality rate were not increased significantly. CONCLUSIONS: The medicated group had an increase in estimated blood loss on the first day. However, there was no significant increase in transfusions, complications and 1-year mortality rates. Early surgery for elderly patients with hip fractures is recommended, even for those taking antiplatelet and anticoagulant agents.