Risk Factors for Reintubation After Anterior Cervical Spine Surgery: Comparative Study of Patients With Cervical Spine Trauma and Patients With Cervical Degenerative Disease.

STUDY DESIGN: Single-center retrospective study. OBJECTIVES: The aim was to compare the postoperative outcomes of anterior cervical spine surgery (ACSS) in patients with and without cervical spine trauma. SUMMARY OF BACKGROUND: Few papers have addressed airway obstruction after anterior ACSS for patients with cervical spine trauma. This study aimed to compare airway obstruction after ACSS between patients with cervical degenerative disorders and cervical spine injuries and identify the risk factors for unplanned postoperative reintubation. MATERIALS AND METHODS: Seventy-seven patients who underwent ACSS were enrolled in this retrospective study. There were 52 men and 25 women, with a mean age of 60.3±15.5 years old. The causes of surgery were as follows: 24 cervical spine fractures or dislocations, 12 spinal cord injuries without bony fracture, 19 disc herniations, and 22 myelopathies. The patients' characteristics, operative data, and risk factors for unplanned reintubation within 5 days postoperatively were analyzed using medical records. RESULTS: Postoperative reintubation was performed in 3 patients (3.9%), all of whom suffered trauma. We further examined risk factors for reintubation in patients in the trauma group. There was no significant difference between the reintubation (R) and nonreintubation (non-R) groups in age, sex, body mass index, amount of blood loss and operation time, preoperative paralysis severity, and the number of fused segments. Patients in group R had significantly higher rates of severe anterior element injury (100% vs. 27.3%, P=0.0011). Airway obstruction due to laryngopharyngeal edema and swelling was confirmed by laryngoscopy and computed tomography images. CONCLUSIONS: Unplanned reintubation after ACSS occurred at a higher rate in trauma patients than in patients with degenerative disorders. Our results suggested that the severe damage to the anterior element of the cervical spine was associated with postoperative reintubation. EVIDENCE LEVEL: Level IV.

Preoperative Lower-Limb Muscle Predictors for Gait Speed Improvement after Total Hip Arthroplasty for Patients with Osteoarthritis.

This study aimed to identify preoperative lower-limb muscle predictors for gait speed improvement after total hip arthroplasty (THA) with hip osteoarthritis. Gait speed improvement was evaluated as the subtraction of preoperative speed from postoperative speed. The preoperative muscle composition of ipsilateral hip abductors was evaluated using computed tomography. The females (n = 45) showed smaller total cross-sectional areas of the gluteal muscles than the males (n = 13). The gluteus maximus in the females showed lower lean muscle mass area (LMM) and higher ratios of the intramuscular fat area and the intramuscular adipose tissue area to the total muscle area (TM) than the males. Regression analysis revealed that LMM/TM of the glutei medius and minimus may correlate negatively with postoperative improvement in gait speed. Receiver operating characteristic curve analysis for prediction of minimum clinically important improvement in gait speed at ≥0.32 m/s resulted in the highest area under the curve for TM in the upper portion of the gluteus maximus with negative correlation. The explanatory variables of hip abductor muscle composition predicted gait speed improvement after THA more precisely in the females compared with the total group of both sexes. Preoperative muscle composition should be evaluated separately based on sex for the achievement of clinically important improvement in gait speed after THA.

Risk Factors for the Incidence of the Volar Lunate Facet Fragments in Distal Radius Fractures.

Background The volar lip of the distal radius is the key structure for wrist joint stability. Rigid fixation of the volar lunate facet (VLF) fragment is difficult because of its unique anatomy, and a high rate of postoperative displacement was demonstrated. Purposes The aim of the study is to identify risk factors for VLF in distal radius fractures (DRFs) and to reconsider the important point for primary fixation. Patients and Methods One hundred fifty-five patients who underwent open reduction and internal fixation for an DRF were included and classified into one of the following two groups: VLF(+)or VLF(-). Demographic data, including age, sex, body mass index (BMI), laterality, trauma mechanism, and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification were recorded. Several parameters were investigated using wrist radiographs of the uninjured side and computed tomography scans of the injured side. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for VLF. Results There were 25 patients in the VLF(+) group and 130 patients in the VLF(-) group. The incidence of VLF was 16.1%. The VLF(+) group tended to have a higher BMI and higher energy trauma mechanism. The odds ratio for the sigmoid notch angle (SNA), volar tilt (VT), and lunate facet curvature radius (LFCR) were 0.84, 1.32, and 0.70, respectively, with multivariate analysis, which was significant. A smaller SNA, larger VT, and smaller LFCR are potential risk factors for VLF. Conclusion Over-reduction of the VT at primary fixation should be avoided because it could place an excess burden on the VLF and cause subsequent postoperative fixation failure and volar carpal subluxation. Level of Evidence IV.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction.

BACKGROUND: There has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF. METHODS: Forty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12-98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander's traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction. RESULTS: The fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0-2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain. CONCLUSIONS: Risk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

Down-regulating Effect of a Standardized Extract of Cultured Lentinula edodes mycelia on Cortactin in Prostate Cancer Cells Is Dependent on Malignant Potential.

BACKGROUND/AIM: The incidence and mortality rates of prostate cancer have been increasing worldwide. Although prostate cancer cells grow slowly in the local original site, once the cancer cells spread to distant organs they grow rapidly and show very aggressive features. Cortactin is a protein that regulates the actin cytoskeleton and plays crucial roles in cancer metastasis. Up-regulated cortactin is correlated with the metastatic capacity of prostate cancer cells. AHCC®, a standardized extract of cultured Lentinula edodes mycelia, has been previously reported to have cortactin-down-regulating effects on human pancreatic cancer cells. In the present study, the effects of AHCC® treatment on cortactin levels in prostate cancer cells was evaluated. MATERIALS AND METHODS: LNCaP.FGC, DU145, and PC-3 are human prostate cancer cell lines. LNCaP.FGC is well differentiated, androgen-dependent, and poorly metastatic. DU145 is less differentiated, androgen-independent, and moderate metastatic. PC-3 is less differentiated, androgen-independent, and highly metastatic. The effects of AHCC® treatment on cortactin levels in prostate cancer cells was evaluated by western blot. RESULTS: In vitro AHCC® treatment decreased cortactin levels in LNCaP.FGC and DU145 cells but did not change those in PC-3 cells. CONCLUSION: AHCC® treatment down-regulated cortactin expression in poor and moderate metastatic LNCaP.FGC and DU145 cells but showed no effect on cortactin expression in the highly metastatic PC-3 cells. Further studies are required to elucidate the mechanism of the resistance to AHCC® treatment in highly metastatic PC-3 cells.

Activation of STAT3 (signal transducer and activator of transcription 3) in synovial tissues from the hip joint in the early stage of rapidly destructive coxopathy.

Interleukin-6 signaling activates signal transducer and activator of transcription 3 (STAT3), resulting in matrix metalloproteinase-3 (MMP-3) production. The hip joints with rapidly destructive coxopathy (RDC) show rapid chondrolysis, probably by increased MMP-3. This study aimed to elucidate STAT3 activation in the synovial tissues with joint destruction in the early stage of RDC. Synovial tissues within 7 months from the disease onset were obtained from four RDC patients with femoral head destruction and high serum levels of MMP-3. RDC synovial tissues demonstrated the synovial lining hyperplasia with an increase of CD68-positive macrophages and CD3-positive T lymphocytes. STAT3 activation was found in the synovial tissues by immunohistochemistry using anti-phospho-STAT3 antibody. The majority of phospho-STAT3-positive cells were the synovial lining cells and exhibited negative expression of the macrophage or T cell marker. Treatment with CP690,550, a Janus Kinase inhibitor, resulted in a decrease in phospho-STAT3-positive cells, especially with high intensity, indicating effective suppression of STAT3 activation in RDC synovial tissues. Inhibitory effect of CP690,550 could work through the Janus Kinase/STAT3 axis in the synovial tissues in the early stage of RDC. Thus, STAT3 may be a potential therapeutic target for prevention of joint structural damage in RDC.

Association of preoperative variables of ipsilateral hip abductor muscles with gait function after total hip arthroplasty: a retrospective study.

BACKGROUND: This study aimed to identify the association of preoperative variables of ipsilateral hip abductors with gait function after total hip arthroplasty (THA). METHODS: This study enrolled 42 patients who underwent unilateral primary THA for osteoarthritis. Gait speed and Timed Up-and-Go test were conducted 6 months postoperatively. Preoperative composition of the glutei medius and minimus and the upper portion of gluteus maximus was evaluated by computed tomography. Cross-sectional area ratio of individual composition to the total muscle was calculated. Preoperative variables associated with gait speed and Timed Up-and-Go test after THA were identified by using stepwise regression analysis. RESULTS: Faster gait speed and shorter Timed Up-and-Go test correlated with smaller cross-sectional area of low-density lean tissue or intramuscular adipose tissue (low-density lean tissue plus intramuscular fat) in the glutei medius and minimus and lower cross-sectional area ratio of low-density lean tissue to the total glutei medius and minimus. Faster gait speed and shorter Timed Up-and-Go test also correlated with larger cross-sectional area of lean muscle mass in the gluteus maximus, higher cross-sectional area ratio of lean muscle mass to the total gluteus maximus, and lower cross-sectional area ratio of intramuscular fat or intramuscular adipose tissue to the total gluteus maximus. Faster gait speed additionally correlated with larger total cross-sectional area of the gluteus maximus. Regression analysis showed that the total cross-sectional area of the gluteus maximus and the low-density lean tissue cross-sectional area of the glutei medius and minimus were the explanatory variables of gait speed and Timed Up-and-Go test after THA, respectively. CONCLUSIONS: There was a potential association between preoperative composition of ipsilateral hip abductors and gait function 6 months after THA. This study indicates a predictive role of preoperative assessment of ipsilateral hip abductor composition in the recovery of gait function after THA.

Inverse association between sarcopenia and displacement in the early phase of fragility fractures of the pelvis.

Objectives: Fragility fractures of the pelvis (FFP) commonly occur in the frail elderly. Displacement in the posterior pelvic ring is recognized as the key sign of instability. This study aims to elucidate the relationship between computer tomography (CT)-based frailty markers and displacement of the posterior pelvic ring within 7 days after injury. Methods: This retrospective study included 49 patients (42 females, 7 males) with FFP (type I 10, type II 24, type III 12, type IV 3). On a CT slice at the level of the third lumbar vertebra, skeletal muscle area, skeletal muscle radiation attenuation, and skeletal muscle index (SMI) were calculated as sarcopenia markers. Osteopenia was measured with trabecular region of interest attenuation technique on the same CT slice. Results: There was no difference in the demographics between non-displaced and displaced FFP. CT-based data showed that patients with FFP had osteopenia. However, no difference was found between non-displaced and displaced FFP. SMI was higher in FFP types III/IV than non-displaced FFP when CT-based data on sarcopenia were compared among all patients. Female patients with FFP demonstrated similar results. Logistic regression analysis using the demographics and CT-based markers on sarcopenia and osteopenia revealed that SMI was a potential determinant of displacement of the posterior pelvic ring fractures. Conclusions: There was inverse association between sarcopenia and displacement of the posterior pelvic ring in the early phase of FFP. Relatively preserved muscle may develop displacement in the elderly with osteopenia.

Association between sagittal spinopelvic alignment and femoral head destruction in the early stage of rapidly destructive coxopathy.

AIMS: This study aimed to evaluate sagittal spinopelvic alignment (SSPA) in the early stage of rapidly destructive coxopathy (RDC) compared with hip osteoarthritis (HOA), and to identify risk factors of SSPA for destruction of the femoral head within 12 months after the disease onset. METHODS: This study enrolled 34 RDC patients with joint space narrowing > 2 mm within 12 months after the onset of hip pain and 25 HOA patients showing femoral head destruction. Sharp angle was measured for acetabular coverage evaluation. Femoral head collapse ratio was calculated for assessment of the extent of femoral head collapse by RDC. The following parameters of SSPA were evaluated using the whole spinopelvic radiograph: pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), sagittal vertical axis (SVA), thoracic kyphosis angle (TK), lumbar lordosis angle (LL), and PI-LL. RESULTS: The HOA group showed higher Sharp angles compared with the RDC group. PT and PI-LL were higher in the RDC group than the HOA group. SS and LL were lower in the RDC group than the HOA group. No difference was found in PI, SVA, or TK between the groups. Femoral head collapse ratio was associated with PT, SS, SVA, LL, and PI-LL. A PI-LL > 20° and a PT > 30° correlated with greater extent of femoral head destruction by RDC. From regression analysis, SS and SVA were significantly associated with the femoral head collapse ratio within 12 months after disease onset. CONCLUSION: Compared with HOA, RDC in the early stage correlated with sagittal spinopelvic malalignment. SS and SVA may partially contribute to the extent of femoral head destruction by RDC within 12 months after the onset of hip pain. The present study indicates a potential role of SSPA assessment in identification of RDC patients at risk for subsequent bone destruction. Cite this article: Bone Jt Open 2022;3(1):77-84.

Impact of the COVID-19 pandemic on a trauma center of a university hospital in Japan.

BACKGROUND: The Coronavirus disease 2019 pandemic caused the Japanese government to declare a State of Emergency on April 7, 2020. The aim of this study is to provide an overview of the effects of the pandemic on surgical cases at a university hospital trauma center. METHODS: An observational study was performed at a trauma center in a tertiary hospital in Tokyo, Japan. The number of surgeries was compared between two periods: a historical control period (Tuesday April 9 to Monday May 27, 2019) and the period of the Japan State of Emergency due to COVID-19 (Tuesday April 7-Monday May 25, 2020). Information on patient age, gender, and surgical diagnosis, site, and procedure was collected for cases operated on in each period. The number of trauma surgeries was compared between the two periods. Data from the two periods were compared statistically. RESULTS: The total number of surgical cases was 151 in the control period and 83 in the COVID-19 period (including no cases with COVID-19), a decrease of 45.0%. There were significantly more surgeries for patients with hip fractures in the COVID-19 period (9 vs. 19, P < 0.001 by Fisher exact test). CONCLUSIONS: During the State of Emergency in Japan, the number of operations for trauma patients at the trauma center decreased, but surgeries for hip fracture increased.

Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results.

PURPOSE: Fragility fractures of the pelvis (FFPs) type IIIa in the Rommens classification include unilateral iliac fractures as well as pubic rami fractures. We devised a new, less-invasive fixation technique to achieve increased stability for FFPs type IIIa. The aim of this study was to describe this procedure and report the preliminary clinical results. METHODS: A total of 14 geriatric patients (> 60 years old) who sustained FFP type IIIa caused by low-energy trauma were surgically treated with interdigitating screw fixation including a trans-pubic screw in a retrograde manner and two trans-iliac screws from the anterior inferior iliac spine toward the posterior inferior iliac spine. All iliac fractures were displaced with external rotation, and closed reduction was performed. Percutaneous screw fixation, in which fully threaded screws were in contact with each other, provided stable fixation allowing early mobilization. RESULTS: A median decrease in pain levels by post-operative day two was 4.5 compared with pre-operatively using a numerical rating scale. While full weight-bearing was allowed from four weeks post-operatively in the initial five patients, immediate full weight-bearing was instructed as tolerated for the subsequent nine patients. No complications were encountered during the peri-operative period. At the final follow-up, all fractures were united without fixation loss, screw dislodgment, or hardware failure. CONCLUSIONS: This procedure of closed reduction and interdigitating screw fixation for FFP type IIIa appears to represent a safe, reliable technique. Our experience suggests that interdigitating fixation for FFP type IIIa is effective for relieving pain and promoting early mobilization in elderly patients.