[Vitamin K2].

Vitamin K2 has been approved for the treatment of osteoporosis in Japan since 1995. Vitamin K2 treatment in osteoporosis has been shown to inhibit the occurrence of new bone fractures and to maintain BMD. The uniqueness of the prevention of bone fractures by vitamin K2 is that there has been no direct evidence of the relationship between increase of BMD and a decrease in the occurrence of bone fractures. A recent systematic review of seven Japanese randomized controlled trials by Cockayne has also shown that supplementation with phytonadione (Vitamin K1) and menaquinone (Vitamin K2) , particularly menaquinone-4, is associated with increased BMD and reduced fracture incidence. To confirm these results, a larger well design RCT using fractures as the primary endpoint is clearly needed.

Resection arthroplasty combined with a muscle graft to treat refractory post-total knee arthroplasty infections.

For refractory post-total knee arthroplasty infections, resection arthroplasty combined with muscle grafting has been conducted to control the infection while preserving the infected limb. Resection arthroplasty was conducted on 9 patients (10 knees) with post-total knee arthroplasty refractory infection. All infections were brought under control. Seven patients were pain free, and mild pain persisted in 2 after walking and during locomotion. The average range of knee motion was 67 degrees. The mean discrepancy in leg length was 5.2 cm. There was no recurrence of infection in any patient. The function of each knee was accepted. Resection arthroplasty combined with muscle transfer is an effective method if the individuals desire to preserve the affected limbs for religious or cosmetic reasons and wish to regain the ability to move their knees.

Effect of progestins with different glucocorticoid activity on bone metabolism.

OBJECTIVE: Progestins are commonly prescribed for hormone replacement therapy (HRT) and contraception. However, the effects of progestins on bone metabolism remain unclear and are often controversial. DESIGN AND PATIENTS: This study was conducted to test the hypothesis that progestins with no significant glucocorticoid activity may be a better choice for HRT to achieve increased beneficial effects on bone metabolism than progestins with strong glucocorticoid activity. A total of 104 postmenopausal women aged 50-75 years with osteoporosis were allocated randomly to three groups: (1) conjugated oestrogen plus medroxyprogesterone acetate (HRT-MPA, with significant glucocorticoid activity); (2) conjugated oestrogen plus norethisterone (HRT-NET, with no significant glucocorticoid activity); and (3) control (no treatment). MEASUREMENTS: Vertebral X-rays and bone mineral density (BMD) at distal 1/3 radius were assessed at baseline and every 6 months during the 2-year study period, along with markers of bone turnover. The occurrence of new nonvertebral fractures was identified by X-ray. RESULTS: After the 2-year treatment, mean BMD changes relative to baseline in the HRT-MPA, HRT-NET and control groups were 1.6%, 2.3% and -1.9%, respectively. In addition, the rate of increase in HRT-NET was significantly greater than that in HRT-MPA (P = 0.019). The incidence of new fractures during the 2-year treatment in the control group was 26% (9/34). HRT-NET treatment significantly inhibited the occurrence of new fractures (RR 0.14, 95% CI 0.02-0.93, P = 0.04), while HRT-MPA treatment failed to show a statistically significant reduction (RR 0.41, 95% CI 0.14-1.24, P = 0.11). Both HRT-MPA and HRT-NET treatments significantly decreased serum osteocalcin levels by 29.4% and 23.5%, respectively, after 6 months of treatment, with the decrease in HRT-MPA being significantly greater than that in HRT-NET (P = 0.042). CONCLUSIONS: These findings suggest that progestins with no significant glucocorticoid activity may be a better choice for HRT, resulting in increased beneficial effects on bone metabolism compared with progestins with strong glucocorticoid activity.

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee.

An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement from 5 degrees to 130 degrees , and did not show any indications of ADL disorder. Using this method of frame fixation between the patella and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury.

Juvenile rheumatoid arthritis manifesting in only limping due to flexion contraction of the knee.

Juvenile rheumatoid arthritis (JRA) is a relatively uncommon condition. The damage to the cartilaginous tissue is often irreversible and responsible for much of the morbidity. Timely diagnosis and appropriate aggressive treatment of patients improve quality of life and outcome. A reported case of JRA is presented in which limping associated with flexion contraction of the knee developed without any systemic symptoms. Magnetic resonance imaging and arthroscopic examination were helpful with early diagnosis. Aspirin was effective. There have been no recurrence to date.

Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures.

UNLABELLED: This study was done to assess the long-term functional outcome of very elderly patients with hip fractures, to determine whether bone mineral density and prevalent vertebral fractures could affect mortality and ambulatory status, and to examine which patient characteristics reported in the literature are predictive of patient mortality and ambulatory status. Seventy-four patients 90 years and older with hip fractures were analyzed and followed up for at least 4 years or until death. The mean age of the patients was 92.8 years and all were treated surgically. Walking ability before injury was better than at discharge; walking ability decreased during the first year after discharge, but thereafter reached a plateau. The predictors of survival were the preoperative American Society of Anesthesiologists score, walking ability, fracture type, type of surgery, and the number of prevalent vertebral fractures on admission. Dementia and the number of prevalent vertebral fractures were predictors of the recovery of walking ability. Type of surgery and fracture type are collinear variables, and because it is difficult to separate the effects of one versus the other, additional well-designed, randomized studies on the effect of the type of surgery and fracture type on outcome are needed. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

[Mortality and functional outcome of hip fractures in the elderly].

Recently, the incidence of osteoporosis and its related fracture are increasing as the aging of population has been progressing in most developed countries, becoming a serious medical and social problem. Among osteoporosis-related fractures, especially, hip fracture might have a marked influence on survival prognosis as well as a restriction of patient's daily activity and the bed-ridden status. Thus, clinical significance of hip fracture has been increasing, but particularly in the extreme elderly, it is difficult to manage patients in most cases because of the peculiarity due to their extreme old age. For example, hip fracture in the extreme elderly is characterized as follows: (1) It occurs easily with a slight external force. (2) It often associates various complications. (3) Its physical differences among individuals are considerably large. (4) Rehabilitation after surgery is difficult in many cases because of complicated dementia. and (5) It is difficult for the patients to live independently at home. This article reviews the literature on survival prognoses and functional results in the extreme elderly with hip fracture. The data from the literature indicate that in the extreme elderly, preoperative general condition, walking ability, type of fracture, and the type of surgery are likely to be the significant predictors of survival prognosis, whereas the degree of dementia seems to be the significant predictor of the recovery of walking ability.

A giant rheumatoid nodule.

Subcutaneous rheumatoid nodules occur commonly in advanced cases of rheumatoid arthritis and are the most common extra-articular lesion of this disease. We present a case of a very unusual giant rheumatoid nodule that developed on the lateral side of a knee. The case was devoid of systemic symptoms of arthritis and the lesion was limited to a rheumatoid nodule. The nodule was successfully treated by surgical excision. However, other new nodules developed in her hand. Her clinical course has not been satisfactory.

RETRACTED: Comparative efficacy of hormone replacement therapy, etidronate, calcitonin, alfacalcidol, and vitamin K in postmenopausal women with osteoporosis: The Yamaguchi Osteoporosis Prevention Study.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor in Chief because of the stated concerns listed below. This article was accepted for publication by a previous editor and editorial board, at a time when submissions and documentation were in paper form, prior to the transition of The American Journal of Medicine to a digital submission and review process. These records are no longer extant and consequently we are unable to review the comments of the reviewers and editors involved at that time. We have attempted to contact the authors regarding these concerns and received no response. We are therefore retracting this article since the evidence presented below strongly argues for scientific misconduct. The integrity of these publications is severely compromised by wide-ranging and serious concerns about governance, ethics, authorship, implausible study conduct, implausible workload, discrepant participant numbers and treatment groups, impossible data, implausible data, implausible outcome data, and discrepant methodology.

Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment.

STUDY DESIGN: A prospective study of 22 patients with the syndrome of acute central cervical spinal cord injury with motor and sensory impairment involving only upper extremities (ACCSCI-U) was done from admission to the 2-year follow-up. OBJECTIVES: To evaluate the course of neurologic function and to identify predictors of a good neurologic recovery in patients with ACCSCI-U. SUMMARY OF BACKGROUND DATA: Little is known regarding the time-course profile of neurologic and functional recovery and the prognostic factors for neurologic recovery in patients with ACCSCI-U. METHODS: Between 1997 and 1998, 22 new cases of ACCSCI-U were identified (15 men and 7 women) with a mean age of 45.9 years (range, 13-75 years). They were all treated nonsurgically. Neurologic impairment, as evaluated by the American Spinal Injury Association (ASIA) motor and sensory scores, was assessed on patient arrival at the emergency department and followed prospectively at intervals from admission to the 2-year follow-up. The magnetic resonance imaging (MRI) studies were performed acutely (1 hours to 2 days after injury), subacutely (3-21 days after injury), and chronically (3-9 months after injury). Logistic regression analysis was used to identify the variables that were associated with neurologic improvement. RESULTS: No patient sustained cervical fractures. The mean sagittal diameter of the cervical spinal canals (14.8 mm) was smaller than that of normal subjects in Japan. Of these 22 patients, seven (32%) had radiologic evidence of developmental cervical canal stenosis and two (9%) had evidence of ossification of posterior longitudinal ligament. Thirteen (59%) had cervical spondylosis: of these, four (31%) had cervical stenosis. Nonsurgical treatment resulted in nearly full neurologic recovery within approximately 6 weeks after the injury. None of the patients went on to need surgery. Their average ASIA score of motor, light touch sensation, and pin sensation was increased from 82.2, 104.5, and 104.3 at admission to 99.3, 111.2, and 111.0, respectively, at 2 years after injury. Logistic regression analysis revealed that the best predictor associated with a better neurologic recovery of motor, light touch sensation, and pin sensation was the absence of MRI findings of abnormal signal intensity in the spinal cord, with an odds ratio of 64 (P < 0.006), 13 (P < 0.04),and 15 (P < 0.03), respectively. The results also revealed that percent deficit improvement became significant at 1 week after injury to predict neurologic recovery at 2-year follow-up points. CONCLUSIONS: In patients with ACCSCI-U, a favorable neurologic prognosis can be predicted following nonsurgical treatment. Most recovery occurred by 6 weeks, and patients with severe initial neurologic damage and old age had poorer recovery. Touch and pin sensation recovered at the same rate, whereas motor recovered more quickly. The absence of abnormal MRI signal intensity in the spinal cord and a good early neurologic improvement were the significant predictors of long-term improvement in neurologic function.