Osteoarthritis of the Fourth and Fifth Tarsometatarsal Joint After Calcaneo-Cuboid Distraction Arthrodesis in Flatfoot Correction.

Lateral column lengthening procedures are typically performed in patients with flatfoot deformity. There have been reports of complications caused by lateral column lengthening. In this study, clinical and radiographic osteoarthritis of the fourth and fifth tarsometatarsal joints were retrospectively assessed as complications after lateral column lengthening. Seventeen stage II flatfeet belonging to 15 patients were included. The mean age of the subjects was 64.2 ± 7.7 (range 52-80) years. The average lateral column lengthening length achieved was 12.7 ± 2.2 (range 8-15) mm. The average duration of follow-up postsurgically was 57.2 ± 37.7 (range 4-110) months. The pain group (n = 8), who postoperatively experienced weightbearing pain in the plantar-lateral aspect of the foot and/or tenderness at the dorsal-lateral, and the no-pain group (n = 9) were compared. All patients in the pain group underwent lateral column lengthening of 10 mm or more. However, there were no significant differences in age, body mass index, American Orthopaedic Foot and Ankle Society score, and the lateral column lengthening amounts between the groups. In the pain group, all patients had osteoarthritic changes in the fourth and fifth tarsometatarsal joints. In all subjects, 11 feet were diagnosed osteoarthritis. Patients with pain had a significantly lower postoperative first talometatarsal angle (p ≤ .05). Osteoarthritis of the fourth and fifth tarsometatarsal joints as complications after lateral column lengthening in flatfoot is first reported. Our study indicated a high possibility of osteoarthritis in patients who had pain in the lateral aspect of the foot after lateral column lengthening.

Stroke Systems of Care During the COVID-19 Epidemic in Kobe City.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) outbreak raised concerns over healthcare systems' ability to provide suitable care to stroke patients. In the present study, we examined the provision of stroke care in Kobe City during the COVID-19 epidemic, where some major stroke centers ceased to provide emergency care. METHODS: This was a cross-sectional study. The Kobe Stroke Network surveyed the number of stroke patients admitted to all primary stroke centers (PSCs) in the city between March 1 and May 23, 2020, and between March 3 and May 25, 2019. In addition, online meetings between all PSC directors were held regularly to share information. The survey items included emergency response system characteristics, number of patients with stroke hospitalized within 7 days of onset, administered treatment types (IV rt-PA, mechanical thrombectomy, surgery, and endovascular therapy), and stroke patients with confirmed COVID-19. RESULTS: During the period of interest in 2020, the number of stroke patients hospitalized across 13 PSCs was 813, which was 15.5% lower than that during the same period of 2019 (p = 0.285). The number of patients admitted with cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage decreased by 15.4% (p = 0.245), 16.1% (p = 0.659), and 14.0% (p = 0.715), respectively. However, the rates of mechanical thrombectomy and surgery for intracerebral hemorrhage were slightly increased by 12.1% (p = 0.754) and 5.0% (p = 0.538), respectively. PSCs that ceased to provide emergency care reported a decrease in the number of stroke cases of 65.7% compared with the same period in 2019, while other PSCs reported an increase of 0.8%. No case of a patient with stroke and confirmed COVID-19 was reported during the study period. CONCLUSION: Kobe City was able to maintain operation of its stroke care systems thanks to close cooperation among all city PSCs and a temporal decrease in the total number of stroke cases.

Investigation of the characteristics of headache due to unruptured intracranial vertebral artery dissection.

BACKGROUND AND PURPOSE: It is sometimes difficult to diagnose intracranial vertebral artery dissection in patients with headache as the only symptom. Knowledge of the characteristics of the headache would facilitate the diagnosis. In this study, we aimed to clarify the characteristics of intracranial vertebral artery dissection-related headache using our original self-administered questionnaire. METHODS: Via the questionnaire, we ascertained headache characteristics and investigated whether they differed between two types of unruptured intracranial vertebral artery dissection, headache type and ischemic type, based on analysis of the responses. Then, we tried to validate the consistency of commonly used criteria for intracranial artery dissection by comparing them with our results. RESULTS: Thirty-seven patients were analyzed. Our results identified the following seven headache characteristics in patients with intracranial vertebral artery dissection: (i) occurring in the occipitonuchal region (89%); (ii) unilateral (81%); (iii) pulsatile (70%); (iv) of acute onset (70%); (v) severe (73%); (vi) without nausea or vomiting (73%); and (vii) with concomitant clinical symptoms unrelated to ischemia (81%). Comparison of headache characteristics between the two types of intracranial vertebral artery dissection headache showed that the pain was significantly more severe in headache type than ischemic type intracranial vertebral artery dissection ( p = 0.01). Concomitant clinical symptoms occurred significantly more often in ischemic type than headache type intracranial vertebral artery dissection ( p = 0.03). Our results generally satisfied the established headache diagnostic criteria. CONCLUSION: The pain characteristics of headache type and ischemic type intracranial vertebral artery dissection shown in our study may facilitate its diagnosis.

Postoperative subdural hematoma with blood flow from an epidural hematoma through a tear at the suture point of an artificial dura substitute.

OBJECTIVE: We have recently seen cases of postoperative epidural and subdural hematomas after duraplasty with an artificial dura substitute. In these cases, the epidural hematoma flowed into the subdural space through a tear at the suture point of the artificial dura substitute. In this study, whether such hematomas are specific to a certain artificial dura substitute was investigated, and the cause and risk factors were examined. METHODS: In our institute, 46 patients underwent brain tumor extirpation with duraplasty with an artificial dura substitute; Gore-Tex and SEAMDURA were used as the artificial dura substitutes. Patients with postoperative hemorrhage after brain tumor extirpation with duraplasty with an artificial dura substitute were retrospectively analyzed. Moreover, suture strength was compared experimentally between Gore-Tex and SEAMDURA. RESULTS: In patients who underwent brain tumor extirpation with duraplasty with an artificial dura substitute, the rate of postoperative hemorrhage was 8.6%. Epidural and subdural hematomas were seen in four patients after tumor extirpation with duraplasty with SEAMDURA, but there were none with Gore-Tex. Exposure of the superior sagittal sinus at craniotomy, older age, and longer operative time were seen more frequently in patients with hematoma than in patients without hematoma. The strength of the suture point was significantly weaker with SEAMDURA than with Gore-Tex (P = 0.00016). CONCLUSIONS: Postoperative epidural and subdural hematomas seem to be specific for SEAMDURA and may be caused by the weak suture strength of SEAMDURA. In cases of duraplasty, a nonabsorbable artificial dura substitute may be suitable.

Clinical investigation of chronic subdural hematoma with impending brain herniation on arrival.

Chronic subdural hematoma (CSDH) with brain herniation signs is rarely seen in the emergent department. As such, there are few cumulative data to analyze such cases. In this study, we evaluated the clinical features, risk factors, and rates of completion with impending brain herniation on arrival in a cohort study. We analyzed 492 consecutive patients with CSDH between January 2010 and October 2015. First, we analyzed the clinical factors and compared them between patients with or without brain herniation signs on admission. Second, we compared clinical factors between patients with or without completion of brain herniation after operation among patients who had brain herniation signs on arrival. Eleven (2.2%) patients showed brain herniation signs on arrival, and six patients (1.2%) progressed to complete brain herniation. Patients with brain herniation signs on arrival were significantly older (P = 0.03) and more frequently hospitalized with a concomitant illness (P < 0.0001). Niveau formation (P = 0.0005) and acute-on CSDH (P = 0.0001) on computed tomography were also more frequently seen in patients with brain herniation signs. Multivariate logistic regression analysis showed that age older than 75 years (OR 2.16, P < 0.0001), niveau formation (OR 3.09, P < 0.0001), acute-on CSDH (OR 14, P < 0.0001), and admitted to another hospital (OR 52.6, P < 0.0001) were independent risk factors for having had brain herniation signs on arrival. On the other hand, having a history of head injury (P = 0.02) and disappearance of the ambient cistern (P = 0.0009) were significantly associated with completion of brain herniation. The prognosis was generally poor if the patient had presented with brain herniation signs on admission. Our results demonstrate that the diagnosis is often made late, despite hospitalization for a concomitant illness. When the elderly show mild disturbance of consciousness, physicians except neurosurgeons need to consider the possibility of CSDH regardless of a recent history of head injury.

Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study.

AIM: Endoscopic surgery for acute subdural hematoma (ASDH) has recently been performed in elderly patients. Unlike other reported procedures, we used the endoscope's fixation device to ensure hemostasis because the surgeon can then use a surgical instrument with each hand. To date, there have no reports that prove lesser invasiveness or noninferiority of endoscopic surgery based on direct comparison with a large craniotomy. In this study, we investigated whether our endoscopic procedure was effective and safe. MATERIALS AND METHODS: We performed 6 cases of endoscopic surgical procedures in elderly patients over the past year. First, our surgical outcomes were evaluated. Second, the outcomes were compared between our endoscopic surgery and our large craniotomy procedures. Third, the outcomes were compared between our endoscopic surgery and other reported endoscopic surgeries. RESULTS: The outcomes of our endoscopic surgery were generally satisfactory without complications or rebleeding. Mean hematoma evacuation percentage was 91.6 ± 4%. Compared with a large craniotomy, operative time was significantly shorter ( P = .01), and the hospital costs were significantly less for endoscopic surgery ( P = .008). There was no inferiority of outcomes when compared with other reported endoscopic surgeries. CONCLUSION: Our surgical procedure is safe and effective when performed with strict operative indications. Endoscopic surgery for ASDH in elderly adults may be an alternative to a large craniotomy in simple-type hematomas.

Primary intraventricular oligodendroglioma: A case report of the usefulness of Olig2 immunohistochemistry for diagnosis.

Primary intraventricular oligodendroglioma (IVO) is a rare form of clear cell neoplasm and diagnosis is challenging because other clear cell neoplasms such as central neurocytoma must be ruled out. We report a case of primary IVO in which Olig2 immunohistochemistry was useful for the diagnosis. A 33-year-old man was admitted to our hospital with severe headaches due to an intraventricular mass lesion and underwent total resection of the mass lesion. The histological diagnosis was oligodendroglioma because the tumor was negative for synaptophysin and positive for Olig2. IVO is rare and differential diagnoses must be considered. The correct pathologic diagnosis is essential for anticipating the prognosis and selecting adjuvant therapy. In this case, Olig2 was useful for the diagnosis of oligodendroglioma.

The Effect of Japanese Herbal Medicines (Kampo) Goreisan and Saireito on the Prevention of Recurrent Chronic Subdural Hematoma: A Prospective Randomized Study.

BACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) sometimes recurs after surgical treatment and requires reoperation. In Japan, Japanese herbal medicines (Kampo), such as Goreisan and Saireito, have been used as adjunctive therapies to prevent the recurrence of CSDH. However, no prospective randomized study has proven the efficacy of Kampo medicine in all patients. To investigate whether Goreisan and Saireito reduce the postoperative recurrence of CSDH in a prospective randomized study. METHODS: Between April 2017 and July 2019, a total of 118 patients who underwent initial burr hole surgery for CSDH were randomly assigned to the following 3 groups: (1) Goreisan for 3 months (Group G), (2) Saireito for 3 months (Group S), and (3) no medication (Group N). The primary end point was symptomatic recurrence within 3 months postoperatively, and the secondary end point was complications associated with the administration of Kampo medicine. RESULTS: Among 118 patients, 114 (Group N, n = 39; Group G, n = 37; and Group S, n = 38) were included in our analysis. In this study, byakujutsu (containing Atractylodes rhizome ) Goreisan and Saireito were used, unlike other prospective randomized studies in which sojutsu (containing Atractylodes lancea rhizome) Goreisan was used. The overall recurrence rate was 11.4% (13/114: 10 for Group N, 2 for Group G, and 1 for Group S). The recurrence rate of Group G was significantly lower than that of Group N (5.4% vs 25.6%; P = .043). The recurrence rate of Group S was also significantly lower than that of Group N (2.6% vs 25.6%; P = .02). No patients developed complications associated with the administration of Kampo medicine. CONCLUSION: This is the first study to show that Kampo medicine reduced the recurrence rate of CSDH in an overall population. This study demonstrated that byakujutsu Goreisan and Saireito may have favorable effects, unlike other studies, because byakujutsu has stronger anti-inflammatory activity than sojutsu.

Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank.

AIM: Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined. METHODS: Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge. RESULTS: Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 - -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy. CONCLUSIONS: Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.

Cervical radiculopathy due to extracranial vertebral artery dissection treated by stent placement with a flow diversion effect: illustrative case.

BACKGROUND: Cervical radiculopathy due to extracranial vertebral artery dissection (VAD) is extremely rare. The disease is usually treated with conservative treatment because of its favorable prognosis. However, there is a possibility that conservative treatment may bring about no improvement in radiculopathy. Although stent placement with a flow diversion effect may be effective in such cases, there are no reported cases that were treated with stent placement. OBSERVATIONS: A 40-year-old healthy man presented with severe right neck pain, right arm pain, and right arm weakness after cracking his neck. A neurological examination revealed right C5 radiculopathy. Neuroimaging studies revealed right extracranial VAD. The VAD compressed the right C5 nerve root. Although medications were administered, there was no improvement in the symptoms. He experienced severe radicular pain. The authors performed stent placement with a flow diversion effect 10 days after the onset of VAD. His radicular pain improved immediately after the procedure, and the remaining radiculopathy completely improved within 1 month. Follow-up angiography showed complete improvement of the VAD. LESSONS: Stent placement with a flow diversion effect may be considered when radiculopathy that hinders a patient's daily life exists. Stent placement may bring about rapid improvement in radiculopathy, especially radicular pain.

Incidence and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Registry-based Descriptive Trial in Kobe City.

The current study aims to evaluate the incidence and results of aneurysmal subarachnoid hemorrhage (aSAH) throughout Kobe City. Based on a multicenter retrospective registry-based descriptive trial involving all 13 primary stroke centers in Kobe City, patients with aSAH treated between October 2017 and September 2019 were studied. A total of 334 patients were included, with an estimated age-adjusted incidence of 11.12 per 100,000 person-years. Curative treatment was given to 94% of patients, with endovascular treatment (51%) preferred over surgical treatment (43%). Of the patients, 12% were treated by shunt surgery for sequential hydrocephalus with a worse outcome at 30 days or discharge (14% vs. 46%, odds ratio (OR): 0.19, 95% confidence interval (CI): 0.088-0.39, p-value <0.001). As for vasospasm and delayed cerebral ischemia, most patients were given intravenous fasudil infusion (73%), with endovascular treatment for vasospasm in 24 cases (7.2%). The fasudil group had more good outcomes (42% vs. 30%, OR: 1.64, 95% CI: 0.95-2.87, p-value = 0.075) and significantly less death (3.3% vs. 35%, OR: 0.064, 95% CI: 0.024-0.15, p-value <0.001) at 30 days or discharge. Mortality rose from 12% at 30 days or discharge to 17% at 1 year, but neurological function distribution improved over time (modified Rankin Scale 0-2 was 39% at 30 days or discharge, 53% at 60 days, and 63% at 1 year). Our retrospective registered trial presented various statistics on aSAH, summarizing the current treatment status and prognosis.

Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: two case reports.

CONTEXT: Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction. DESIGN: Case reports of SSEH with acute hemiparesis. FINDINGS: In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH. CONCLUSION: Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication.

A case of posterior cerebral artery occlusion that developed into an artery of Percheron infarction.

The thalamus is predominantly supplied by multiple small vessels originating from the posterior communicating artery and the P1 and P2 segments of the posterior cerebral artery (PCA). The artery of Percheron (AOP) is a rare anatomical variant of arterial supply to the thalamus. This single thalamic perforating branch supplies the bilateral thalamus so that occlusion results in a characteristic cerebral infarction. Herein, we report a case of posterior cerebral artery occlusion that developed into an AOP infarction. A 74-year-old man, who had undergone coronary artery bypass grafting 5 days previously presented with sudden consciousness disorder and tetraplegia, and was admitted to our hospital. Magnetic resonance imaging (MRI) revealed a hyper-intense area in the bilateral paramedian thalamus on diffusion-weighted imaging and a deficit of the left PCA on MR angiography (MRA). The patient was diagnosed with cardiogenic cerebral embolism, and immediately underwent mechanical thrombectomy (MT), thereby complete recanalization was obtained. Post-procedural MRI showed no new lesions, and the left PCA could keep patency. His consciousness disorder and tetraplegia improved; however, cognitive impairment and vertical gaze palsy persisted as sequelae. To the best of our knowledge, such cases have not been previously reported. Additionally, in this case, we were able to identify an AOP on digital subtraction angiography, which was considered to be the responsible artery.

Asymmetric posterior reversible encephalopathy syndrome secondary to epilepsy occurring in the chronic phase of subarachnoid hemorrhage.

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare clinical syndrome that refers to a disorder with reversible subcortical vasogenic brain edema involving the parieto-occipital lobe, temporal lobe, basal ganglia, and its surroundings. Radiologically, it is characterized by symmetrical lesions; however, atypical findings have sometimes been reported. Case Description: A 79-year-old woman experienced subarachnoid hemorrhage (SAH) a year and a half previously before this hospitalization. She presented with sudden-onset coma, dacryorrhea, and moderate right hemiparesis and was taken to our hospital. Computed tomography showed no apparent abnormal acute lesions. Electroencephalography confirmed periodic lateralized epileptiform discharges in the left hemisphere. First, based on the findings, she was diagnosed with nonconvulsive status epilepticus and started antiepileptic therapy. Six days after admission, however, multiple asymmetric lesions were confirmed on magnetic resonance imaging. Considering that findings subsequently improved, we finally diagnosed her with asymmetric PRES secondary to epilepsy occurring in the chronic phase of SAH. Aphasia and right hemispatial neglect persisted as sequelae and she was transferred to a rehabilitation hospital with a modified Rankin scale of 3. Conclusion: Excessive elevation of blood flow in the hemisphere is inferred to lead to blood-brain barrier collapse and subsequent asymmetric PRES.

Toxicological aspects of cadmium and occupational health activities to prevent workplace exposure in Japan: A narrative review.

Chemicals are an essential part of modern manufacture processes. Their use must be managed with great attention in occupational settings to avoid serious detrimental effects to the health of employees. For example, cadmium compounds are indispensable for the production of nickel-cadmium rechargeable batteries or as chemical stabilizer in plastics. It is an exceptionally toxic heavy metal and personnel exposed to cadmium in the workplace meet with potential health risks that can lead to the development of kidney, skeletal and respiratory disorders. In consequence, proactive and systematical development of occupational hygiene and health activities are necessary to reduce chemical exposure to cadmium in the workplace. This review describes the known facts of cadmium toxicity, the biological effects of cadmium exposure, possible regulation measures to prevent occupational cadmium exposure in three industrial health management systems and discusses future cooperation programs in these systems, proactive safety activities and occupational safety and health management strategies.

Atraumatic Posterior Hip Dislocation following Short Femoral Nail for Intertrochanteric Fracture Treated by Dual Mobility System in Total Hip Arthroplasty: A Case Report.

INTRODUCTION: Atraumatic hip dislocation after short femoral nail (SFN) fixation for an intertrochanteric fracture is extremely rare. CASE REPORT: An 84-year-old woman presented with an atraumatic posterior hip dislocation that occurred 8 years after SFN fixation for an intertrochanteric hip fracture. She experienced an acute-onset left hip pain when standing up from a sitting position while bathing at a day care facility. We performed total hip arthroplasty (THA) with a dual mobility system. During the post-operative THA evaluation, the combined anteversion angle was within the optimum range of 57. However, the dislocation recurred after the THA. During the revision THA, a dual mobility system was used to moderately extend the stem neck. Measures were adopted to strain the posterior soft tissues of the hip joint. We speculated that the posterior hip joint capsule ruptured because the support of the posterior hip joint was weak after the intertrochanteric hip fracture. At the final follow-up visit at 6 months after the operation, the hip joint pain had disappeared, and her activities of daily living recovered to almost the same level as her preinjury activities. CONCLUSIONS: We should consider the lack of support of posterior soft tissues as a cause of this atraumatic posterior hip dislocation following intertrochanteric fracture fixation.

Intramedullary spinal cord metastasis of gastric cancer.

The incidence of intramedullary spinal cord metastasis (ISCM) has been increasing because the overall survival of patients with cancer has improved thanks to recent advanced therapies, such as molecular targeted drugs, anticancer agents, and various irradiation techniques. ISCM from lung and breast cancer is the most common form among cases of ISCM. We report an extremely rare form of ISCM from gastric cancer. This 83-year-old man who had a past medical history of gastric adenocarcinoma presented with acute onset of paraparesis. Spinal magnetic resonance imaging revealed an intramedullary lesion at the upper thoracic level. Due to rapid worsening of his paresis, we decided to perform tumor extirpation. Gross total resection of the tumor was successfully performed. Pathological examination revealed poorly differentiated adenocarcinoma, suggesting the diagnosis of ISCM from gastric cancer. He demonstrated gradual improvement of paraparesis soon after surgery, although his overall survival was limited to about 6 months after surgery. When examining the etiology of acute paraparesis in elderly patients with a past medical history of cancer, ISCM should be considered in the differential diagnosis. The prognosis of ISCM from gastric cancer is still extremely limited. Unfortunately, there is currently no treatment with proven efficacy. Surgery for ISCM from gastric cancer, although a challenging procedure for spine surgeons, should be considered as a therapeutic option in these patients.

Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey.

BACKGROUND: This survey aims to assess the satisfaction of patients who have had treatment using external fixation (EF). MATERIALS AND METHODS: An original questionnaire and a Short Form 36 (SF-36) were distributed to 121 patients who underwent treatment using EF for deformity correction and lengthening between 2006 and 2016. A multivariate analysis was performed on the factors associated with satisfaction. RESULTS: Sixty patients returned a response. The average satisfaction score was 83.6 points. In the 5-point satisfaction survey, 43 of 60 patients (71.7%) responded "very satisfied" or "satisfied" and 27 patients (45.0%) responded "yes" to the question as to whether they would request EF treatment again if presenting with the original preoperative condition. In addition, the subjectively expressed tolerance for having an external fixator device on the limb was 92.1 days on average. A correlation was established with the ISOLS score. CONCLUSION: The top three factors that determined subjective inconvenience with EF are pain, walking, and heaviness. Although EF treatment was stressful, the satisfaction scores were high. Furthermore, the satisfaction with EF treatment was improved by (1) pain control, (2) shortening the EF period, and (3) psychological support. HOW TO CITE THIS ARTICLE: Ugaji S, Matsubara H, Kato S, et al. Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey. Strategies Trauma Limb Reconstr 2021;16(1):27-31.

Assessment of lateral hindfoot impingement with weightbearing multiplanar imaging in a flatfoot.

BACKGROUND: Estimation of the lateral hindfoot impingement in the standing position in conventional radiography can be difficult due to superimposition of different bones. Patients with flat feet frequently suffer from pain around the lateral malleolus and sinus tarsi caused by osseous impingement in the lateral hindfoot. Weightbearing multiplanar images (tomosynthesis) yield tomographic images and can be taken while full weightbearing. PURPOSE: To assess the availability of tomosynthesis to determine hindfoot lateral impingement. MATERIAL AND METHODS: A total of 14 feet (in 13 patients) with acquired flatfoot deformity and lateral hindfoot pain were included (mean age 64 years; age range 55-80 years). All patients underwent tomosynthesis, radiography, and computed tomography (CT) (non-weightbearing). Talofibular, calcaneofibular, and talocalcaneal impingement were determined. To compare the number of impingements or to determine the area between each image, statistical evaluations were analyzed using the Mann-Whitney U-test (P < 0.05). RESULTS: On tomosynthesis, we clearly found talofibular impingement in three feet, calcaneofibular impingement in seven feet, and talocalcaneal impingement in 11 feet. Therefore, we could identify most impingements as "positive" compared to those on normal radiographs and CT images. The number of impingements in the calcaneofibular and talocalcaneal regions was significantly higher using tomosynthesis than when using CT (P < 0.05). CONCLUSION: Tomosynthesis imaging makes it easier to obtain CT-like images in a short period of time, in a free position, including while standing, and provides useful information to assess lateral pain in patients with flatfoot deformity.

Comparison of treatment indices associated with the correction and lengthening of deformities along various lower limb frontal plane directions.

PURPOSE: The Taylor spatial frame (TSF) provides higher precision in the dimensional correction of some lower limb deformities. However, no study to date has compared the osteogenesis outcome of correction and lengthening among various directions in the frontal plane. We examined the relationship between the external fixation index (EFI) and the direction of correction in the frontal plane. METHODS: We classified 25 patients undergoing correction with the TSF into three groups: Group A (8 patients, varus deformity), Group B (6 patients, valgus deformity), and Group C (9 patients, non-correction in the frontal plane). We excluded patients who underwent chemotherapy, were converted to internal fixation, had infection or pseudarthrosis, and in whom the corrected gain was <2.4 cm. RESULTS: No significant differences in age, sex, etiology of deformity, complication due to deformity in another plane, osteotomy distribution, TSF use duration, and correction distance were found. The average EFI was 83.4, 60.5, and 51.2 days/cm in Groups A, B, and C, respectively, with the EFI being significantly higher in Group A than in Group C (P < 0.05). CONCLUSIONS: Osteogenesis of varus deformities was more prolonged than that of non-correction in the frontal plane. These results provide useful insights that can aid in minimizing complications due to external fixation and improving our understanding of the mechanism of osteogenesis in the tibia.