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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.


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 | Otsuji M.,Kawaguchi Kogyo General Hospital | Shiozaki A.,Kawaguchi Kogyo General Hospital | Yamamoto A.,Teikyo University | And 4 more authors.
International Orthopaedics | Year: 2013

Purpose: The reduction of periosteal compression through the use of a locking plate may minimize disturbances of bone blood supply and may improve the rate of bone union. A single-centre, assessor blinded randomized controlled trial was conducted to compare the clinical effectiveness of a locking plate and a non-locking plate. Methods: A total of 52 patients with AO/OTA 44B lateral malleolar fractures were included in this study. All patients underwent surgical fixation using a lag screw and neutralization plate. An identical treatment protocol was used in all patients, with exception of plate selection. The rate of radiographic bone union, defined as the complete disappearance of fracture lines confirmed through anteroposterior, lateral, and internal oblique views was compared at three, six, and 12 months following surgery. In addition, the Medical Outcomes 36-Item Short-Form Health Survey (SF-36) score, the time required for resolution of tenderness at the fracture site and the complication rate were evaluated. Results: Twenty-three patients were randomly assigned to undergo fixation using a locking plate, and 29 patients were assigned to undergo fixation using a non-locking plate. Intention-to-treat analysis showed no difference in the radiographic bone union rate of fibula, SF-36 score, the time for resolution of tenderness at the fracture site and complication rates. Conclusion: No differences were observed in patients with AO/OTA 44B lateral malleolar fractures undergoing fixation with a locking versus non-locking neutralization plate. © 2013 Springer-Verlag Berlin Heidelberg.


Tsukada S.,Kawaguchi Kogyo General Hospital | Hoshino A.,Kawaguchi Kogyo General Hospital | Cho S.,Kawaguchi Kogyo General Hospital | Ikeda H.,Kawaguchi Kogyo General Hospital
Archives of Orthopaedic and Trauma Surgery | Year: 2013

Background: Intraoperative soft tissue tension can significantly impact the range of motion following total knee arthroplasty (TKA). However, the level of impact remains unclear. The purpose of this study was to investigate the relationship between intraoperative soft tissue tension and postoperative range of motion. Methods: This retrospective study included 504 patients operated with posterior stabilized TKA. During surgery, we adjusted the soft tissue tension from 80 to 160 N for both flexion and extension with the tensor/balancer device and torque driver. Patients were grouped into three categories based on intraoperative soft tissue tension and analyzed with the 1-year postoperative range of motion using one-way analysis of variance (ANOVA). In addition, Pearson's correlation coefficients were determined to assess the association between intraoperative soft tissue tension and postoperative range of motion. Results: The absolute tension value at 90 flexion did not affect the postoperative flexion angle (p = 0.61). The absolute tension value at 0 extension did not affect the postoperative extension angle (p = 0.91). Likewise, the difference of tension between flexion and extension did not affect the postoperative flexion angle (p = 0.86). All comparisons did not have the differences in sex, height, weight, body mass index, diagnosis and preoperative range of motion between three groups. No significant correlation was found in each comparison (r = 0.078, r = 0.031, r = -0.052, respectively). Conclusions: We did not observe a correlation between intraoperative soft tissue tension adjusted from 80 to 160 N and 1-year postoperative range of motion in posterior stabilized TKA. © 2012 Springer-Verlag Berlin Heidelberg.


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: 2015

Background: Periarticular injection is becoming more commonly utilized for pain relief following total knee arthroplasty. However, we are aware of no randomized controlled trial that has investigated the efficacy of periarticular injection for pain relief after simultaneous bilateral total knee arthroplasty. Methods: We performed a randomized controlled trial of patients scheduled for simultaneous bilateral total knee arthroplasty. Seventy-one patients with 142 involved knees were randomly assigned to receive periarticular injection or epidural analgesia. Other perioperative interventions, including spinal anesthesia, surgical techniques, and postoperative medication protocols, were identical for all patients. The primary outcome was postoperative pain at rest, measured with the use of a 100-mm visual analog scale (VAS) during the initial twenty-four-hour postoperative period. The cumulative VAS score was calculated with use of the area under the curve and compared between the groups. Results: Postoperative pain at rest, quantified as the area under the curve of serial assessments during the initial twentyfour-hour postoperative period, was significantly less in the periarticular injection group than in the epidural analgesia group (174.9 ± 181.5mm• day compared with 360.4 ± 360.6mm× day; p = 0.0073). The prevalences of nausea on the night of surgery and postoperative day 1 and of pruritus were significantly lower in the periarticular injection group than in the epidural analgesia group (14% and 45%, p = 0.0031; 14% and 55%, p = 0.0003; and 0% and 15%, p = 0.014, respectively). Conclusions: Periarticular injection was associated with better pain relief during the first twenty-four hours following simultaneous bilateral total knee arthroplasty and decreased opioid-related side effects compared with epidural analgesia. Periarticular injection may be preferable to epidural analgesia for pain relief after simultaneous bilateral total knee arthroplasty. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. © 2015 By The Journal of Bone and Joint Surgery, Incorporated.


Tsukada S.,Kawaguchi Kogyo General Hospital | Ikeda H.,Kawaguchi Kogyo General Hospital | Seki Y.,Urawa Red Diamonds | Shimaya M.,Kawaguchi Kogyo General Hospital | And 2 more authors.
Sports Medicine, Arthroscopy, Rehabilitation, Therapy and Technology | Year: 2012

Background: Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure.Methods: The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity.Results: All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient.Conclusions: There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level. © 2012 Tsukada et al.; licensee BioMed Central Ltd.


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.


PubMed | Kawaguchi Kogyo General Hospital and Nekoyama Miyao Hospital
Type: Journal Article | Journal: The bone & 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 no-corticosteroid 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 post-operatively. 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.The use of corticosteroid in periarticular injection offered better pain relief during the initial 24 hours after TKA.


PubMed | Tokyo Medical and Dental University, Shiga Medical Center for Adults, Hokkaido University and Kawaguchi Kogyo General Hospital
Type: | Journal: Journal of the neurological sciences | Year: 2017

Spinocerebellar ataxia type 6 (SCA6) is an autosomal dominant neurodegenerative disorder. However, it remains unclear whether SCA6 shows a gene dosage effect, defined by earlier age-of-onset in homozygotes than heterozygotes. Herein, we retrospectively analyzed four homozygous SCA6 subjects from our single institution cohort of 120 SCA6 subjects. We also performed a neuropathological investigation into an SCA6 individual with compound heterozygous expansions. In the 116 heterozygotes, there was an inverse correlation of age-of-onset with the number of CAG repeats in the expanded allele, and with the total number of CAG repeats, in both normal and expanded alleles. The age-of-onset in the four homozygotes was within the 95% confidence interval of the age-of-onset versus the repeat-lengths correlations determined in the 116 heterozygotes. Nevertheless, all homozygotes had earlier onset than their parents, and showed rapid disease progression. Neuropathology revealed neuronal loss, as well as 1A-calcium channel protein aggregates in Purkinje cells, a few 1A-calcium channel protein aggregates in the neocortex and basal ganglia, and neuronal loss in Clarkes column and the globus pallidus not seen in heterozygotes. These data suggest a mild clinical and neuropathological gene dosage effect in SCA6 subjects.

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