Osteosynthesis using a plate lacking the anterior component and canulated cancellous screws to treat an avulsion fracture of the calcaneal tuberosity: A case report.

INTRODUCTION: Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal tuberosity fractures with poor heel-skin condition is yet to be established. Here, we report a case involving avulsion fracture of the calcaneal tuberosity presenting with superficial skin necrosis that was treated with a plate lacking the anterior component and screws inserted percutaneously. PRESENTATION OF CASE: A 74-year-old woman presented with progressive right heel pain following an injury to her heel sustained approximately six weeks previously. She had experienced difficulty walking due to heel pain and superficial necrosis was observed on the posterior surface of the heel. Radiography and computed tomography revealed an avulsion fracture of the calcaneal tuberosity with superior displacement. Open reduction was performed using a lateral L-shaped incision. After inserting two cancellous screws percutaneously into the calcaneal tuberosity, we fixed a plate lacking the anterior component to the lateral surface of the calcaneus. The superficial necrosis healed gradually post-operatively. Bone union was confirmed using radiography six months post-operatively. DISCUSSION: We developed a novel surgical procedure to treat avulsion fractures of the calcaneal tuberosity with poor skin condition. The combination of a plate lacking the anterior component and the percutaneous insertion of canulated cancellous screws can reduce the risk of post-operative soft tissue complications while maintaining fixation of the fractured fragment. CONCLUSION: Our findings provide a novel surgical method for the treatment of avulsion fractures of the calcaneal tuberosity with soft tissue complications.

Risk factors of poor mid-term shoulder functional outcomes of osteosynthesis using antegrade intramedullary nailing for humeral shaft fractures: a retrospective study with a minimum 5-year follow-up.

BACKGROUND: Osteosynthesis using antegrade intramedullary nailing for humeral shaft fractures yields satisfactory bone union rates; however, it may adversely affect postoperative shoulder function. To date, factors affecting mid- or long-term shoulder functional outcomes following intramedullary nail fixation have not been clarified. In this study, we aimed to identify the risk factors for poor mid-term functional outcomes over 5 years postoperatively following antegrade intramedullary nail osteosynthesis for humeral shaft fractures. METHODS: We retrospectively identified 33 patients who underwent surgery using an antegrade intramedullary nail for acute traumatic humeral shaft fractures and were followed up for at least 5 years postoperatively. We divided the patients into clinical failure and no clinical failure groups using an age- and sex-adjusted Constant score of 55 at the final follow-up as the cutoff value. We compared preoperative, perioperative, and postoperative factors between the two groups. RESULTS: Five of the 33 patients had poor shoulder functional outcomes (adjusted Constant score < 55) at a mean follow-up of 7.5 years postoperatively. Proximal protrusion of the nail at the time of bone union (P = 0.004) and older age (P = 0.009) were significantly associated with clinical failure in the univariate analyses. Multivariate analysis showed that proximal protrusion of the nail (P = 0.031) was a risk factor for poor outcomes. CONCLUSIONS: The findings of this study provide new information on predictive factors affecting mid-term outcomes following osteosynthesis using antegrade nails. Our results demonstrated that proximal protrusion of the nail was significantly associated with poor mid-term functional shoulder outcomes. Therefore, particularly in older adults, it is essential to place the proximal end of the intramedullary nail below the level of the articular cartilage.

Symptomatic Nonunion of the Coracoid Process Following Osteosynthesis Using a Suture Button for Coracoid Process and Distal Clavicle Fracture: A Case Report.

BACKGROUND Coracoid process fractures are uncommon and are often complicated by many types of shoulder girdle injuries. Previous reports have shown that osteosynthesis for isolated coracoid process fractures results in favorable outcomes and high bone union rates. However, owing to the rarity of coracoid process fractures combined with distal clavicle fractures, there are limited data to guide treatment strategies. We report a case of symptomatic nonunion despite performing osteosynthesis for fractures of the coracoid process and distal clavicle. CASE REPORT A 60-year-old man presented with left shoulder pain after falling from the back of a truck. Radiography and computed tomography (CT) findings revealed fractures of the left distal clavicle and coracoid process. We performed plate and costoclavicular fixation using a suture button for the distal clavicle fracture and cannulated cancellous screw fixation for the coracoid process fracture. However, the patient experienced severe pain around the coracoid and had limited shoulder range of motion 1 year postoperatively. CT revealed nonunion of the coracoid process, prompting a recommendation for surgery. However, despite severe persistent functional impairment, the patient refused surgery 1.5 years postoperatively. CONCLUSIONS This case suggests the potential for symptomatic nonunion of the coracoid process when using a suture-button device for a distal clavicle fracture. To prevent postoperative nonunion of the coracoid process, postoperative CT evaluation is necessary. If a symptomatic delayed bone union of coracoid process is observed, considering early removal of the suture button is recommended.

Surgical Repair for Rhomboid Major Tear: A Case Report.

Rhomboid tears are a rare type of tendon injury. Although rhomboid tears can present with periscapular pain and scapular dyskinesis, their clinical presentations and diagnostic procedures remain largely unknown. In addition, few reports are available on the surgical treatment of rhomboid tears. We report a rhomboid repair case for a complete rhomboid major tear diagnosed based on physical findings and magnetic resonance imaging (MRI). A 28-year-old man presented with right medial scapular pain that appeared after carrying a heavy box. He had right medial scapular tenderness, with worsening pain during shoulder joint elevation. The inferior pole of the right scapula was lateral compared with the left scapula, and a dent was observed on the medial scapula. Magnetic resonance imaging revealed a tear in the right rhomboid major at its insertion, with muscle retraction. Two months of conservative treatment failed to improve his symptoms; therefore, we performed a surgical repair. We created the bone holes on the medial border of the scapula and repaired the torn rhomboid major muscle to its insertion using the Krackow stitch technique. He had a satisfactory functional outcome without postoperative retearing. This case report provides new information on the clinical presentation and surgical procedure of rhomboid major tears and the first MRI finding that depicts a rhomboid tear clearly. In cases of rhomboid tears, persistent medial scapular pain and winging scapula can be clinically problematic, requiring surgery. In addition to physical findings, a periscapular MRI is useful in diagnosing rhomboid tears. The results of this case study suggest that surgical repair using locking sutures is an option for treating complete rhomboid tears with muscle retraction.

Osteosynthesis using scorpion plate for nonunion of distal clavicle fracture with small distal bone fragment: A case report.

Distal clavicle nonunion is a relatively common complication of unstable, displaced distal clavicle fractures; however, its standard surgical procedure has not been fully established. We describe a case of symptomatic nonunion of a distal clavicle fracture with a very small distal bone fragment that was treated with a scorpion plate. A 63-year-old man presented with left shoulder pain after a bicycle fall 5 months earlier. Plain radiographs and computed tomography revealed atrophic nonunion of the distal clavicle with a small distal bone fragment measuring 12 mm in length. Shoulder pain interfered with his work and daily life; therefore, we scheduled surgery. After releasing the nonunion site, cancellous bone was grafted from the iliac crest. We placed a scorpion plate with two grasping arms that fixed the distal clavicular fragment without straddling the acromioclavicular joint. One year postoperatively, his pain subsided, and bone union was confirmed. Our case presents a surgical procedure for treating the nonunion of distal clavicle fractures using a scorpion plate and an autologous bone graft. This procedure is especially beneficial for cases with small distal bone fragments, because the grasping arms of the scorpion plate allow secure fixation of the distal bone fragment and bone graft without further fragmentation.

Curettage and external fixation for displaced pathological fracture through non-ossifying fibroma in the radius: A case report.

Non-ossifying fibromas are extremely rare in the upper extremity, such as those in the radius and humerus. The treatment of completely displaced fractures following non-ossifying fibromas in the radius has not been reported. We present the case of a pathological fracture caused by a non-ossifying fibroma in the radius treated using external fixation. The patient was a 10-year-old girl who presented to our hospital with right forearm pain after an accidental fall. She had no remarkable medical history. Radiographs and computed tomography showed a pathological fracture through osteolytic lesions with sclerotic rims in the diaphysis of the radius, suggesting a pathological fracture through a non-ossifying fibroma in the radius. We performed tumor curettage and external fixation due to marked fracture displacement. Histological findings were compatible with those of non-ossifying fibroma. Six months post-surgery, there were no limitations in the range of motion of supination and pronation of the forearm, and radiographs confirmed a bone union. Although non-ossifying fibromas in the radius are rare, cases with large lesions can cause pathological fractures after minor trauma. This case suggests that curettage and external fixation are beneficial, especially if early surgery is required due to unacceptable displacement and when there is no time for a biopsy to rule out malignancy.

Influence of Proximal Humeral Cortical Bone Thickness on the Radiographic Outcome After Osteosynthesis of Proximal Humeral Fractures: Propensity Matching Score Analysis.

Introduction: Osteoporosis can affect the surgical outcomes of proximal humeral fractures in older people. Recently, the cortical bone thickness of the proximal humerus on plain radiograph has been proposed to reflect local osteoporosis of the proximal humerus; however, its effect on the surgical outcome of proximal humeral fractures remains unclear. The purpose of this study is to investigate the influence of cortical bone thickness on postoperative radiographic outcomes after osteosynthesis for proximal humeral fractures. Materials and Methods: We retrospectively identified 190 patients (≥50 years) who underwent osteosynthesis with an intramedullary nail or plate for proximal humeral fractures. The patients were categorized into 2 groups according to the cut-off value of an average proximal humerus cortical bone thickness of 6 mm on plain radiographs: patients with and without local osteoporosis. After propensity score matching, we compared the incidence of postoperative radiographic complications between the 2 groups. We also performed subgroup analyses of outcomes in a subgroup of patients who underwent intramedullary nailing and those who underwent plate fixation. Results: Propensity score matching yielded 60 patients in each group. No significant difference in complication rates was observed between the 2 groups. However, in the intramedullary nailing subgroup, the incidence of reduction loss was significantly higher in patients with local osteoporosis than in those without local osteoporosis (51.7% vs 14.3%, P = .002). Discussion: The proximal humeral cortical bone thickness had no significant effect on the overall radiographic outcome; however, reduction loss after intramedullary nailing was susceptible to local osteoporosis of the proximal humerus. Conclusion: Our study suggests that plate fixation is advantageous in preventing postoperative reduction loss in patients with lower cortical bone thickness.

Factors Associated with Change in Diagnosis of Carpal Tunnel Syndrome after Electrodiagnostic Studies.

Background: Hand surgeons sometimes place more weight on clinical findings and may not always consider the results of electrodiagnostic studies (EDX) in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to determine factors associated with a change in diagnosis of CTS after EDX. Methods: This is a retrospective study of all patients with an initial clinical diagnosis of CTS who underwent EDX at our hospital. We identified patients whose diagnosis changed from CTS to non-CTS after EDX and used univariate and multivariate analysis to determine if age, sex, hand dominance, unilateral symptoms, history of diabetes mellitus, rheumatoid arthritis, haemodialysis, cerebral lesion, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items in CTS-6 and a CTS-negative EDX result were associated with a change in diagnosis after EDX. Results: A total of 479 hands with a clinical diagnosis of CTS underwent EDX. The diagnosis was changed to non-CTS in 61 hands (13%) after EDX. Univariate analysis demonstrated that unilateral symptoms, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items and a CTS-negative EDX result were significantly associated with a change in diagnosis. In the multivariate analysis, only the number of examined items was significantly associated with a change in diagnosis. Conclusions: EDX results were particularly valued in hands where the initial diagnosis was uncertain for CTS. In hands with an initial diagnosis of CTS, the performance of sufficient history-taking and physical examination was more valued at the final diagnosis than EDX results or other aspects of the patient's background. The process of confirming a clear initial clinical diagnosis of CTS using EDX may be of little value for decision-making at the final diagnosis. Level of Evidence: Level III (Therapeutic).

Plate fixation using parallelogram prism iliac bone grafts for clavicle oblique nonunion with shortening deformity: a case report.

BACKGROUND: Plate fixation using a tricortical iliac bone graft can provide a high ratio of bone union and restore clavicle length in cases of atrophic nonunion. However, the surgical treatment of clavicle oblique nonunions with marked shortening deformity remains challenging and unresolved. Here, we describe a case of clavicle oblique nonunion with shortening that was treated using plate fixation with parallelogram prism iliac bone grafts. CASE PRESENTATION: A 46-year-old man presented to our hospital with severe medial scapular pain. He had been diagnosed with a right clavicle mid-shaft fracture in a motorcycle accident 9 months earlier. He underwent conservative treatment, but radiographs and computed tomography showed clavicle oblique nonunion with marked shortening. Physical examination revealed no pain at the nonunion site; however, tenderness was noted on the medial side of the right scapula and protrusion of the inferior scapular angle was prominent. His symptoms interfered with daily life and required surgery. After release of the nonunion, we harvested the parallelogram prism bone grafts from the iliac crest. We inserted these bone grafts into the fracture ends and fixed them with lag screws, after which we performed plate fixation. Immediately after surgery, right medial scapular pain and scapula winging subsided. Bone union was achieved, and the length of the clavicle was restored at 9 months postoperatively. CONCLUSIONS: This case report provides new information on the surgical treatment of clavicle oblique nonunion with shortening deformity. The presence of medial scapular pain and winging scapula can be clinically problematic in cases of clavicle nonunion with marked shortening. Our case revealed that reliable bone union and clavicle length recovery can be achieved with plate fixation and iliac bone grafts.

Inferior subluxation of humeral head after osteosynthesis for greater tuberosity fracture.

BACKGROUND: Inferior subluxation of the humeral head is frequently observed immediately after surgery for proximal humerus fractures; however, the incidence and risk factors of inferior subluxation after osteosynthesis for isolated greater tuberosity fractures remain unsolved. Additionally, the postoperative course of inferior subluxation has not been elucidated. The purpose of the present study is to identify the predictors for the occurrence of postoperative inferior subluxation by multivariate analysis and investigate the postoperative shift of inferior subluxation and its effect on surgical outcomes. METHODS: We retrospectively identified 68 patients who underwent surgery for isolated greater tuberosity fractures. The dependent variable was the inferior subluxation at 1 week postoperatively. The explanatory variables were age, sex, affected side of the shoulder, body mass index, history of smoking, local osteoporosis, time period to surgery, axillary nerve injury, inferior subluxation before surgery, fracture dislocation, surgical approach, surgical method, operative time, amount of blood loss, and postoperative drainage. Baseline variables that were statistically significant in the univariate analyses were included in the logistic regression analysis. The patients were further categorized into two groups according to the presence of inferior shoulder subluxation exhibited 1 week postoperatively: patients with inferior subluxation (+ IS group) and patients without inferior subluxation (- IS group). We compared the incidence of postoperative complications between the two groups. RESULTS: Of 68 patients, 17 (25.0%) had inferior shoulder subluxation observed 1 week postoperatively. Multivariate analysis showed that long operative time was a risk factor for postoperative subluxation (odds ratio = 1.03; P = 0.030). In all cases, inferior subluxation disappeared within 3 months of surgery. No significant difference in complication rate was observed between the + IS and - IS groups. CONCLUSIONS: The present study provides novel information regarding postoperative inferior subluxation of fractures of the greater tuberosity. Inferior subluxation occurred in 25% of patients immediately after surgery. Long operative time contributes to the onset of postoperative inferior subluxation; however, this was temporary in all cases and had no significant effect on the surgical outcomes. LEVEL OF EVIDENCE: Level III.

Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair.

Background: Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown. Purpose: To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models. Results: Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P = .037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P = .047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P = .038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P = .001) were risk factors for greater tuberosity resorption. Conclusion: Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.

Arthroscopic Distal Clavicle Resection for an Acromioclavicular Ganglion Cyst with Cuff Tear Arthropathy: A Case Report.

CASE: A 77-year-old man with an acromioclavicular joint ganglion cyst with cuff tear arthropathy had a large mass in the left shoulder. Arthroscopic distal clavicle resection successfully relieved his symptoms without loss of shoulder function by enlargement of the bypass between the cyst and subacromial space through the acromioclavicular joint. CONCLUSION: Arthroscopic distal clavicle resection can remove a 1-way check valve in a minimally invasive manner. This case indicated that arthroscopic distal clavicle resection could be a useful treatment option for patients with acromioclavicular joint ganglion cysts with functional but irreparable rotator cuff tears.

Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears.

BACKGROUND: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. PURPOSE: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. RESULTS: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. CONCLUSION: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.

Blocking screw augmentation in intramedullary nailing for displaced surgical neck fractures of the proximal humerus.

A displaced surgical neck fracture can be a good indication for antegrade intramedullary nailing. However, nail insertion may result in malreduction and translational displacement of the humeral head fragment because of muscle traction and size discrepancies between the diameters of the medullary canal and the intramedullary nail. We used blocking screw augmentation in 20 fractures with residual medial displacement of the distal fragment after nail insertion to anatomically reduce displacement of the fracture and to maintain the reduced position before bone union. A blocking screw was placed percutaneously at the lateral side of the canal. Next, a straight intramedullary nail was reinserted medial to the blocking screw. Finally, the nail was locked both proximally and distally. All cases showed bone union without fixation failure at the time of the final follow-up. Blocking screw augmentation with intramedullary nailing is feasible for the treatment of humeral surgical neck fractures and is thought to be helpful for fracture reduction during surgery and stable fixation after surgery.

Risk factors and prognosis of humeral head inferior subluxation in proximal humeral fractures after osteosynthesis.

BACKGROUND: Humeral head inferior subluxation often occurs immediately after osteosynthesis for proximal humeral fracture; however, the underlying cause remains largely unknown. In addition, the prognosis of postoperative inferior subluxation has not been fully investigated. This study aimed to clarify the predictive factors that affected the onset of postoperative inferior subluxation using multivariate analysis and examine the postoperative course of inferior subluxation and its influence on postoperative outcomes. METHODS: We retrospectively reviewed 212 patients who underwent osteosynthesis for Neer 2- or 3-part proximal humeral fractures. In the multivariate analysis, the dependent variable was set as the inferior subluxation observed 1 week after the surgery. The explanatory variables included age, sex, affected side, body mass index, smoking, local osteoporosis, preoperative axillary nerve injury, time from injury to surgery, fracture dislocation, fracture pattern, preoperative inferior subluxation, surgical procedure, surgical approaches, blood loss, operative time, and postoperative drainage. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models. Furthermore, based on the presence of inferior subluxation at 1 week after the surgery, we divided the patients into two groups: with inferior subluxation (+IS group) and without inferior subluxation (-IS group). We compared the postoperative outcomes (incidence of postoperative complications and range of motion) between these two groups. RESULTS: Of 212 patients, 64 (30.7%) experienced inferior subluxation at 1 week after the surgery. On multivariate analyses, preoperative inferior subluxation (odds ratio = 4.69; 95% confidence interval = 2.45-9.76; P < .001) and longer operative time (odds ratio = 1.01; 95% confidence interval = 1.00-1.02; P = .049) were the risk factors for postoperative inferior subluxation. In the +IS group, inferior subluxation resolved at 1 year after the surgery in 89.5% of patients. There was no significant difference in the postoperative outcome between the +IS and -IS groups. However, four of six patients with persistent inferior subluxation, more than 6 months after the surgery, experienced complications, such as varus angulation of the humeral head or screw joint perforation. CONCLUSIONS: This study provides new information on the risk factors for and prognosis of postosteosynthesis inferior subluxation in patients with proximal humeral fracture. Longer operative time and presence of preoperative inferior subluxation was associated with an increased risk of postoperative inferior subluxation, although it was temporary in most cases, and had no significant influence on the postoperative outcomes. However, in patients with persistent inferior subluxation of more than 6 months duration, inferior subluxation may be related to postoperative complications.

Glycyrrhizin Derivatives Suppress Cancer Chemoresistance by Inhibiting Progesterone Receptor Membrane Component 1.

Progesterone receptor membrane component 1 (PGRMC1) is highly expressed in various cancer cells and contributes to tumor progression. We have previously shown that PGRMC1 forms a unique heme-stacking functional dimer to enhance EGF receptor (EGFR) activity required for cancer proliferation and chemoresistance, and the dimer dissociates by carbon monoxide to attenuate its biological actions. Here, we determined that glycyrrhizin (GL), which is conventionally used to ameliorate inflammation, specifically binds to heme-dimerized PGRMC1. Binding analyses using isothermal titration calorimetry revealed that some GL derivatives, including its glucoside-derivative (GlucoGL), bind to PGRMC1 potently, whereas its aglycone, glycyrrhetinic acid (GA), does not bind. GL and GlucoGL inhibit the interaction between PGRMC1 and EGFR, thereby suppressing EGFR-mediated signaling required for cancer progression. GL and GlucoGL significantly enhanced EGFR inhibitor erlotinib- or cisplatin (CDDP)-induced cell death in human colon cancer HCT116 cells. In addition, GL derivatives suppressed the intracellular uptake of low-density lipoprotein (LDL) by inhibiting the interaction between PGRMC1 and the LDL receptor (LDLR). Effects on other pathways cannot be excluded. Treatment with GlucoGL and CDDP significantly suppressed tumor growth following xenograft transplantation in mice. Collectively, this study indicates that GL derivatives are novel inhibitors of PGRMC1 that suppress cancer progression, and our findings provide new insights for cancer treatment.

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures.

Surgical treatment for humeral shaft fractures has been reported to yield satisfactory results; however, there may be complications, such as delayed bone union, nonunion, iatrogenic radial nerve injury, and infection. The risk factors for postoperative complications remain largely unknown. This study aimed to investigate the influence of timing of surgery on the incidence of postoperative complications of acute humeral shaft fractures. We retrospectively reviewed 43 patients who underwent osteosynthesis for acute humeral shaft fractures between 2006 and 2020. The patients were divided into early (21 patients) and delayed (22 patients) treatment groups based on the timing of the surgical intervention (within or after four days). Outcomes were the incidences of complications (delayed union, nonunion, iatrogenic radial nerve injury, and infection) and postoperative fracture gaps. We evaluated the outcomes using plain radiographs and clinical notes. In addition, we performed subgroup analyses on outcomes in a subgroup of patients who underwent intramedullary nailing and one who underwent plate fixation. The frequency of delayed union was significantly higher in the delayed group (P=0.046), and the postoperative fracture gap size was also significantly greater in the delayed group (P=0.007). The subgroup analyses demonstrated a significant association between the increased incidence of delayed union and delayed surgical interventions only in the intramedullary nailing subgroup (P=0.017). This study suggests that performing surgery within four days after acute humeral shaft fracture is recommended to reduce the occurrence of delayed union, particularly in cases requiring intramedullary nailing fixation.

Distal clavicle fracture malunion associated with scapular dyskinesis treated with 3D preoperative planning.

A 44-year-old woman with distal clavicular malunion and scapular dyskinesis, causing limited shoulder elevation, underwent clavicular osteotomy 2 years postinjury. We used three-dimensional (3D) surface data from both injured and intact sides for correction of the distal clavicular shape by closing wedge osteotomy. The plate position and screw directions were decided preoperatively. Surgery was performed with reference to a 3D-printed, reduced model. Range of shoulder motion and scapular dyskinesis improved by 1 year postoperatively. Precise corrective osteotomy for distal clavicular malunion, referencing a 3D-printed, reduced model, improved scapular dyskinesis and range of shoulder motion 2 years postinjury.

Scaphoid non-union with pre-existing screws treated by 3D preoperative planning.

Scaphoid fractures, if deemed operative, can often be treated successfully by headless compression screw fixation. Unfortunately, some patients go on to develop a scaphoid fracture non-union with screw loosening, bone resorption, bone deformity and carpal malalignment. To assist surgeons in managing these difficult cases, specifically designed scaphoid fracture plates have recently been introduced. We present a case of a scaphoid fracture non-union with retained screws and bone loss that was effectively treated by volar plate fixation using a three-dimensional (3D) printed model to assist with restoration of scaphoid morphology and implant positioning. Before surgery, 3D preoperative planning using a surface registration technique and a 3D printer was performed. Referring to the 3D-printed reduced model facilitated the prediction of gaps after reduction and helped decide the implant position and screw directions. Carpal alignment parameters gradually improved by 1 year postoperatively.

Risk factors for failure of reduction of anterior glenohumeral dislocation without sedation.

BACKGROUND: Although anterior glenohumeral dislocations are common, the reduction procedure is often difficult, requiring sedation or anesthesia. To date, the risk factors for reduction failure without sedation have not been fully investigated. This study aimed to clarify the predictive factors that render the reduction of anterior glenohumeral dislocation without sedation difficult by use of multivariate analyses. METHODS: We retrospectively reviewed 156 patients who underwent attempted reduction of anterior glenohumeral dislocation between 2006 and 2019. Patients were included based on the following criteria: traumatic dislocation, undergoing attempted reduction using the traction-countertraction method, and acute dislocation in which reduction was attempted within 2 days of the injury. The dependent variable was set as an irreducible glenohumeral dislocation without sedation, which was defined as a reduction failure in this study. Explanatory variables included age, sex, side of injury, recurrent dislocation, axillary nerve injury, time from dislocation to attempted reduction, greater tuberosity fracture, humeral neck fracture, glenoid rim fracture, and glenohumeral osteoarthritis. We evaluated these outcomes from radiographs and clinical notes. Univariate and multivariate analyses were performed. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models, which used logistic regression to identify independent predictors of reduction failure. RESULTS: Of the 156 patients, 25 (16.0%) experienced reduction failure. Multivariate analyses showed that older age (≥55 years) (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-10.4; P = .036), greater tuberosity fractures (OR, 3.6; 95% CI, 1.1-12.2; P = .033), and glenoid rim fractures (OR, 11.5; 95% CI, 1.5-87.7; P = .018) were risk factors for reduction failure. CONCLUSIONS: Our results demonstrated that multiple factors were associated with unsuccessful reduction of anterior glenohumeral dislocation without sedation. In elderly patients or patients with concurrent greater tuberosity fractures and glenoid rim fractures, reduction failure could occur in the absence of sedation; thus, the administration of sedatives or anesthesia should be considered.