Association of the Number of Teeth With Physical Function and Length of Hospital Stay After Hip Fracture Surgery: A Prospective Observational Study at a Tertiary Hospital in Japan.

OBJECTIVES: Although lower-extremity muscle strength is associated with physical function, there are challenges in assessing the muscle strength of patients after hip surgery due to pain or limited cognitive function. The number of teeth is a characteristic that can be easily examined. Although the relationship between the number of teeth and physical function has been reported in recent years, there are no reports examining the relationship with prognosis in patients with hip fractures. Therefore, this study aimed to investigate the relationship between the number of teeth and physical function and length of hospital stay after hip fracture surgery and to evaluate the predictive efficacy of the number of teeth on postoperative prognosis. METHODS: This prospective cohort study was conducted in a tertiary clinical care facility. Patients aged ≥65 years who underwent hip surgery were included. A total of 101 patients (mean age: 85.1±8.0 years) were included. The factor analyzed was the number of teeth at admission. Patients were divided into two groups according to the number of teeth: those with ≥20 and those with ≤19 teeth. The outcomes were knee extension muscle strength-to-weight ratio at two weeks postoperatively and the length of hospital stay. A multiple regression analysis was performed to determine the association between the two groups. RESULTS: Of 101 patients, 79 (78.2%) had ≤19 teeth, whereas 22 (21.8%) had ≥20 teeth. The mean muscle strength-to-weight ratio and length of hospital stay were 0.26±0.11 kgf/kg and 57.5±31.4 days, respectively. Multiple regression analysis revealed that the number of teeth was significantly associated with the muscle strength-to-weight ratio (ß=-0.26, p=0.04) but not with the duration of hospitalization (ß=0.17, p=0.09). CONCLUSIONS: We suggest that assessment of the number of teeth at admission may be a useful predictor of patient physical function.

Periprosthetic Fracture Resembling Atypical Femoral Fracture After Fixation With Retrograde Intramedullary Nail in Elderly Women: A Report of Two Cases.

BACKGROUND/AIM: The number of individuals diagnosed with and requiring medical treatment for osteoporosis continues to increase due to global population aging and the high awareness of osteoporosis. Bone-modifying agents (BMAs) including bisphosphonate and denosumab are widely used for osteoporosis, and atypical femoral fracture (AFF) is also gaining attention as a severe potential side effect of long-term BMA treatment. The definition of AFF excludes periprosthetic femoral fracture; here, we describe two cases of a periprosthetic femoral fracture that resembled AFF. CASE REPORT: The fractures occurred at the proximal tip of the retrograde femoral nail after an internal fixation for a distal femoral shaft fracture in elderly Japanese women. Each woman had been treated with bisphosphonate therapy for >2 years and had continued the bisphosphonate after undergoing surgery for a distal femoral shaft fracture. Each patient had noticed thigh pain before falling down, and plain radiographs showed a short oblique or transverse fracture with medial spike and localized periosteal reaction of the lateral cortex in each case. The fractures were re-fixed with an antegrade intramedullary nail, and bone union was achieved at >1 year after the second operation. Although these two cases were classified as periprosthetic fractures, they fulfilled the characteristics of AFF. CONCLUSION: Physicians should conduct a thorough interview of patients with a history of BMA treatment in order to correctly diagnose periprosthetic fractures that resemble AFFs, and they should be aware that symptomatic fractures can be prevented by prophylactic fixation. The discontinuance of BMA therapy and the introduction of another drug such as teriparatide may lead to faster healing of surgically treated AFFs.

'Acute Masquelet technique' for reconstructing bone defects of an open lower limb fracture.

INTRODUCTION: The reconstruction of bone defects of open lower leg fractures is challenging, and there is no established treatment strategy to date, especially in the acute phase. We report herein an 'acute Masquelet technique' for reconstructing bone defects of open lower limb fractures as the primary treatment in the acute phase. PATIENTS AND METHODS: We retrospectively analyzed the outcomes of seven lower limbs of the seven Japanese patients (five males, two females, aged 24-76 years [mean 53 years]) who underwent the acute Masquelet technique for open fractures with bone defects. We evaluated postsurgical complications including deep infection, absorption of grafted bone, and the final result of the bone union. RESULTS: Deep infection occurred in one of the seven limbs (14%). There was no case with absorption of grafted bone in our series. We have treated two patients who needed additional surgery for delayed bone union. Bone union was eventually obtained in all seven limbs. All of the patients became pain-free and could walk without a cane. CONCLUSION: The 'acute Masquelet technique' was quite useful for reconstructing bone defects of open lower limb fractures as the primary treatment in the acute phase. We believe that this is one of the options that might be successful in the treatment of open lower limb fractures.

Surgical treatment options for septic non-union of the tibia: two staged operation, Flow-through anastomosis of FVFG, and continuous local intraarterial infusion of heparin.

BACKGROUND: The treatment of septic non-union of the tibia is a challenging area.　The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin. PATIENTS & METHOD: Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled.　The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm.　A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later.　Vascular anastomosis was performed with the flow-through technique in all patients.　Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week. RESULT: Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus. CONCLUSION: Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia.

SURGICAL TREATMENT FOR INFECTED LONG BONE DEFECTS AFTER LIMB-THREATENING TRAUMA: APPLICATION OF LOCKED PLATE AND AUTOGENOUS CANCELLOUS BONE GRAFT.

BACKGROUND: Treatment strategies for bone defects include free bone grafting, distraction osteogenesis, and vascularized bone grafting. Because bone defect morphology is often irregular, selecting treatment strategies may be difficult. With the Masquelet technique, a fracture site is bridged and fixed with a locking plate after treating deep infection with antibiotic-containing cement, and a free cancellous bone-graft is concomitantly placed into the defects. This procedure avoids excessive bone resection. METHODS: We studied 6 patients who underwent surgical treatment for deep infection occurring after extremity trauma (2004 through 2009). Ages at surgery ranged from 29 to 59 years (largest age group: 30 s). Mean follow-up was 50.7 months (minimum/maximum: 36/72 months). One patient had complete amputation of the upper extremity, 3 open forearm fractures, 1 closed supracondylar femur fracture, and 1 open tibia fracture. In all patients, bone defects were filled with antibiotic-containing cement beads after infected site debridement. If bacterial culture of infected sites during curettage was positive, surgery was repeated to refill bone defects with antibiotic-containing cement beads. After confirmation of negative bacterial culture, osteosynthesis was performed, in which bone defects were bridged and fixed with locking plates. Concomitantly, crushed cancellous bone grafts harvested from the autogenous ilium was placed in the bone defects. RESULTS: Time from bone grafting and plate fixation to bone union was at least 3 and at most 6 months, 4 months on average. Infection relapsed in one patient with methicillin-resistant Staphylococcus aureus, necessitating vascularized fibular grafting which achieved bone union. No patients showed implant loosening or breakage or infection relapse after the last surgery during follow-up. CONCLUSION: The advantage of cancellous bone grafting include applicability to relatively large bone defects, simple surgical procedure, bone graft adjustability to bone defect morphology, rapid bone graft revascularization resulting in high resistance to infection, and excellent osteogenesis.

Contralateral neuropathic pain and neuropathology in dorsal root ganglion and spinal cord following hemilateral nerve injury in rats.

STUDY DESIGN: The contralateral pain-related behavioral and immunohistochemical changes after hemilateral spinal nerve injury in rats were investigated. OBJECTIVES: We evaluated the longitudinal changes in contralateral mechanical allodynia, expression of tumor necrosis factor (TNF)-alpha and glial fibrillary acidic protein (GFAP)-positive satellite cells in the contralateral dorsal root ganglion (DRG), and expression of astrocytes and microglia in the contralateral spinal dorsal horn after hemilateral spinal nerve injury in rats. SUMMARY OF BACKGROUND DATA: In previous studies, hemilateral nerve injury has sometimes induced contralateral neuropathic pain. TNF-alpha expression and glial cell reactions in the DRG and spinal cord play an important role in the neuropathic pain state, and TNF-alpha is released from glial cells in the nervous system. METHODS: Adult male Sprague-Dawley rats were used. The spinal L5 nerve distal to the DRG was crushed once for 3 seconds. At days 2, 7, 14, and 21 after surgery, mechanical allodynia was determined in bilateral hind paws by the von Frey test. Expression of TNF-alpha and GFAP in bilateral L5 DRGs and expression of GFAP and ionized calcium-binding adaptor molecule-1 (Iba-1) in bilateral L5 spinal dorsal horns were studied using immunohistochemistry and immunoblotting. RESULTS: Mechanical withdrawal threshold of the ipsilateral hind paw was significantly decreased for 21 days. Conversely, mechanical withdrawal threshold of the contralateral hind paw was significantly decreased from 5 to 10 g for 7 days, and was <5 g at days 14 and 21. TNF-alpha expression and GFAP-positive satellite cells in the contralateral DRG significantly increased from day 7 to day 21. In the contralateral spinal dorsal horn, GFAP-positive astrocytes significantly increased for 21 days, but Iba-1 was not significant. CONCLUSION: These results suggest that contralateral mechanical allodynia induced by hemilateral spinal nerve injury is associated with upregulation of satellite cells and TNF-alpha in the contralateral DRG. In addition, our results suggest that spinal astrocytes play an important role in these contralateral changes.