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Arai R.,Kyoto University | Nimura A.,Tokyo Medical and Dental University | Yamaguchi K.,Tokyo Medical and Dental University | Yoshimura H.,Kawaguchi Kogyo General Hospital | And 4 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2014

Only a few reports describe the extension of the coracohumeral ligament to the subscapularis muscle. The purposes of this study were to histo-anatomically examine the structure between the ligament and subscapularis and to discuss the function of the ligament. Methods: Nineteen intact embalmed shoulders were used. In 9 shoulders, the expansion of the ligament was anatomically observed, and in 6 of these 9, the muscular tissue of the supraspinatus and subscapularis was removed to carefully examine the attachments to the tendons of these muscles. Five shoulders were frozen and sagittally sectioned into 3-mm-thick slices. After observation, histologic analysis was performed on 3 of these shoulders. In the remaining 5 shoulders, the coracoid process was harvested to investigate the ligament origin. Results: The coracohumeral ligament originated from the horizontal limb and base of the coracoid process and enveloped the cranial part of the subscapularis muscle. The superficial layer of the ligament covered a broad area of the anterior surface of the muscle. Laterally, it protruded between the long head of the biceps tendon and subscapularis and attached to the tendinous floor, which extended from the subscapularis insertion. Histologically, the ligament consisted of irregular and sparse fibers abundant in type III collagen. Conclusion: The coracohumeral ligament envelops the whole subscapularis muscle and insertion and seems to function as a kind of holder for the subscapularis and supraspinatus muscles. The ligament is composed of irregular and sparse fibers and contains relatively rich type III collagen, which would suggest flexibility. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.

Tsukada S.,Kawaguchi Kogyo General Hospital | Okumura G.,Niigata Central Hospital | Matsueda M.,Niigata Central Hospital
Archives of Orthopaedic and Trauma Surgery | Year: 2012

Background: Fixed-angle sliding hip-screw devices are commonly used to treat pertrochanteric fractures. The controlled impaction between the head and neck fragment and the femoral shaft fragment is crucial. However, the poor quality of fracture reduction can intercept controlled impaction and lead to excessive sliding. We hypothesized that excessive sliding occurs when most of the impaction is placed on the fragile posterior cortex of the fracture site. Methods: This retrospective study included 128 AO/OTA type 31-A1 or 31-A2 fractures treated with Wxed-angle sliding hip-screw devices. Cases involving reduced continuity of the anterior cortex at fracture site were deWned as Type 1, those involving head and neck fragment anteriorly displaced relative to the femoral shaft fragment as Type 2, and those involving head and neck fragment posteriorly displaced relative to the femoral shaft fragment as Type 3. The extent of postoperative sliding distance of lag screw was measured. Results: There were 52 cases of Type 1, 30 of Type 2, and 46 of Type 3, with no diVerences in patient characteristics between types. The mean ± standard deviation extent of sliding for types 1-3 was 4.5 ± 4.9 mm, 7.8 ± 5.6 mm, and 11.1 ± 6.0 mm, respectively (p < 0.0001). Sliding was signiWcantly greater for Type 3 cases than for Type 1 or 2 (p < 0.0001 and p = 0.044, respectively). Conclusions: Excessive sliding occurs in surgical treatment for pertrochanteric fractures with posterior displacement of the head and neck fragment. In such cases, we recommend appropriate reduction prior to internal Wxation. © Springer-Verlag 2012.

Takimoto H.,Japan National Institute of Public Health | Hayashi F.,Health Science University | Kusama K.,Yamaguchi Prefectural University | Kato N.,Japan National Institute of Public Health | And 5 more authors.
Journal of Nutritional Science and Vitaminology | Year: 2011

This study aimed to examine the association of fetal growth and elevated third trimester maternal serum folate due to folic acid (FA) supplement intake. Dietary intake, use of FA supplements, weight, and blood biomarkers of B-vitamins (serum folate, pyridoxal, vitamin B 12, and plasma total homocysteine) were observed in 33 healthy pregnant women at the third trimester (average gestational age 35 wk). Birth outcomes were assessed through hospital birth records. Infant anthropometry and maternal blood biomarkers were followed up at 1 mo postpartum. Fourteen women were taking FA supplements at the third trimester. Dietary intake was similar among FA users and non-users, but serum folate and pyridoxal were significantly higher in users (11.6±6.7 vs. 6.1 ±3.2 ng/mL, and 13.8±21.7 vs. 3.2 ± 1.4 ng/mL, respectively). Plasma total homocystein (tHcy) was higher in non-users compared to users, but not significantly. Nine FA users and eight non-users had low serum vitamin B12 values (<203 pg/mL). Nine FA users and all non-users had low serum pyridoxal values (< 7.0 ng/mL). Infant birthweight was significantly lower in users compared to non-users (2,894±318 vs. 3,154±230 g). At 1 mo postpartum, infant weight and length were similar between FA users and non-users, but infant weight gain was larger in users. Higher serum folate values due to FA use in the third trimester was related to reduced fetal size. Excess FA under low vitamin B 6 and B 12 status may affect fetal growth.

Tsukada S.,Nekoyama Miyao Hospital | Wakui M.,Nekoyama Miyao Hospital | Hoshino A.,Kawaguchi Kogyo General Hospital
Bone and Joint Journal | Year: 2016

There is conflicting evidence about the benefit of using corticosteroid in periarticular injections for pain relief after total knee arthroplasty (TKA). We carried out a double-blinded, randomised controlled trial to assess the efficacy of using corticosteroid in a periarticular injection to control pain after TKA. A total of 77 patients, 67 women and ten men, with a mean age of 74 years (47 to 88) who were about to undergo unilateral TKA were randomly assigned to have a periarticular injection with or without corticosteroid. The primary outcome was post-operative pain at rest during the first 24 hours after surgery, measured every two hours using a visual analogue pain scale score. The cumulative pain score was quantified using the area under the curve. The corticosteroid group had a significantly lower cumulative pain score than the nocorticosteroid group during the first 24 hours after surgery (mean area under the curve 139, 0 to 560, and 264, 0 to 1460; p = 0.024). The rate of complications, including surgical site infection, was not significantly different between the two groups up to one year postoperatively. The addition of corticosteroid to the periarticular injection significantly decreased early post-operative pain. Further studies are needed to confirm the safety of corticosteroid in periarticular injection. © 2016 The British Editorial Society of Bone & Joint Surgery.

Tsukada S.,Nekoyama Miyao Hospital | Wakui M.,Nekoyama Miyao Hospital | Hoshino A.,Kawaguchi Kogyo General Hospital
Journal of Bone and Joint Surgery - American Volume | Year: 2014

Background: Although epidural analgesia has been used for postoperative pain control after total knee arthroplasty, its usefulness is being reevaluated because of possible adverse effects. Recent studies have proven the efficacy of periarticular analgesic injection and its low prevalence of adverse effects. The present study compares the clinical efficacies of epidural analgesia and periarticular injection after total knee arthroplasty. Methods: This is a prospective, single-center, randomized controlled trial involving patients scheduled for unilateral total knee arthroplasty. One hundred and eleven patients were randomly assigned to periarticular injection or epidural analgesia groups. All patients were managed with spinal anesthesia. The surgical technique and postoperative medication protocol were identical in both groups. The primary outcome was postoperative pain at rest, quantified as the area under the curve of the scores on a visual analog pain scale to seventy-two hours postoperatively. The Student t test and chi-square test were used to compare the data between groups. Results: In the intention-to-treat analysis, the periarticular injection group had a significantly lower area under the curve for pain score at rest (788.0 versus 1065.9; p = 0.0059). In the periarticular injection group, the mean knee flexion angle was small but significantly better at postoperative day 1 (64.2° versus 54.6°; p = 0.0072) and postoperative day 2 (70.3° versus 64.6°; p = 0.021) than in the epidural analgesia group. The incidence of nausea at postoperative day 1 was significantly lower in the periarticular injection group (4.0% versus 44.3%; p < 0.0001). Transient peroneal nerve palsy was frequently seen in the periarticular injection group (12.0% versus 1.6%; p = 0.026). Conclusions: Compared with epidural analgesia, periarticular injection offers better postoperative pain relief, earlier recovery of knee flexion angle, and lower incidence of nausea. Care should be taken to avoid transient peroneal nerve palsy when using periarticular injection. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

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