Hidenori Matsubara

Treatment of benign bone tumours using external fixation

We present a retrospective study of patients suffering from a variety of benign tumours in whom external fixators were used to treat deformity and limb-length discrepancy, and for the reconstruction of bone defects. A total of 43 limbs in 31 patients (12 male and 19 female) with a mean age of 14 years (2 to 54) were treated. The diagnosis was Olliers disease in 12 limbs, fibrous dysplasia in 11, osteochondroma in eight, giant cell tumour in five, osteofibrous dysplasia in five and non-ossifying fibroma in two. The lesions were treated in the tibia in 19 limbs, in the femur in 16, and in the forearm in eight. The Ilizarov frame was used in 25 limbs, the Taylor Spatial Frame in seven, the Orthofix fixator in six, the Monotube in four and the Heidelberg fixator in one. The mean follow-up was 72 months (22 to 221). The mean external fixation period was 168 days (71 to 352). The mean external fixation index was 42 days/cm (22.2 to 102.0) in the 22 patients who required limb lengthening. The mean correction angle for those with angular deformity was 23 degrees (7 degrees to 45 degrees ). At final follow-up all patients had returned to normal activities. Four patients required a second operation for recurrent deformity of further limb lengthening. Local recurrence occurred in one patient, requiring further surgery.

A novel method to apply osteogenic potential of adipose derived stem cells in orthopaedic surgery.

Background A number of publications have reported that adipose derived stem cells (ADSCs) have the capacity to be induced to differentiate into osteoblasts both in vitro and in vivo. However, it has been difficult to use separate ADSCs for cortical bone regeneration and bone reconstruction so far. Inspired by the research around stromal stem cells and cell sheets, we developed a new method to fabricate ADSCs sheets to accelerate and enhance the bone regeneration and bone reconstruction. Purpose To fabricate ADSCs sheets and evaluate their capacity to be induced to differentiate to osteoblasts in vitro. Methods Human adipose derived stem cells (hADSCs) were employed in this research. The fabricating medium containing 50 µM ascorbate-2-phosphate was used to enhance the secretion of collagen protein by the ADSCs and thus to make the cell sheets of ADSCs. As the separate ADSCs were divided into osteo-induction group and control group, the ADSCs sheets were also divided into two groups depending on induction by osteogenesis medium or no induction. The osteogenic capacity of each group was evaluated by ALP staining, Alizarin Red staining and ALP activity. Results The ADSCs sheets were fabricated after one-week culture in the fabricating medium. The ALP staining of ADSCs sheets showed positive results after 5 days osteo-induction and the Alizarin Red staining of ADSCs sheets showed positive results after 1 week osteo-induction. The ALP activity showed significant differences between these four groups. The ALP activity of ADSCs sheets groups showed higher value than that of separate ADSCs. Conclusion The experiments demonstrated that ADSCs sheets have better capacity than separate ADSCs to be induced to differentiate into osteoblasts. This indicates that it is possible to use the ADSCs sheets as a source of mesenchymal stem cells for bone regeneration and bone reconstruction.

Tibiocalcaneal Fusion for Charcot Ankle With Severe Talar Body Loss: Case Report and a Review of the Surgical Literature

Severe bone loss resulting from talar body necrosis in the Charcot ankle can be challenging to treat. In particular, the Charcot ankle will demonstrate progressive instability and deformity, causing protrusion of the medial or lateral malleolus, which will mostly lead to skin ulcers or osteomyelitis and, in some cases, will ultimately require transtibial amputation. Problems such as bone fragility, poor compliance with load-bearing restrictions, susceptibility to infection, and circulatory disorders cause difficulties in the surgical treatment of the Charcot ankle. We believe that tibiocalcaneal fusion is a reliable method to obtain satisfactory outcomes in these difficult cases. However, no study has reported on the use of a locking plate for tibiocalcaneal fusion. Therefore, we report on tibiocalcaneal fusion using a locking plate in 3 patients with Charcot ankle and severe talar body loss. All patients achieved bony union with a plantigrade foot and without any skin complications. We have concluded that a locking plate provides rigid fixation and easier insertion of additional screws, when necessary.

Revision high tibial osteotomy with the Taylor spatial frame for failed opening-wedge high tibial osteotomy

High tibial osteotomy is a surgical option for individuals with osteoarthritis of the medial compartment of the knee, or varus malalignment of the knee, who are not yet candidates for joint replacement. The techniques described include conventional closing-wedge osteotomies with plate fi xation, acute opening-wedge osteotomies with plate fi xation, and callotasis with external fi xation. These procedures have a high success rate when appropriate correction has been obtained in a properly selected patient. Satisfactory results are achieved when the mechanical axis passes through the Fujisawa point (the lateral one-third of the lateral femorotibial compartment). Medial opening-wedge high tibial osteotomies have become increasingly popular over the past 2 decades because the peroneal nerve is not in jeopardy, and disruption of the proximal tibiofi bular joint and lateral ligaments is avoided. However, many problems can occur in acute opening-wedge-type osteotomies, such as propagation of the osteotomy into the joint, nonunion, inadequate fi xation, and most importantly overor under-correction. In addition, opening-wedge osteotomies simultaneously increase the tibial plateau angle in the sagittal plane, limiting full extension of the knee joint and causing anterior knee pain due to increased pressure in the patellofemoral joint. We present the case of a patient on whom we performed a revision high tibial osteotomy with the Taylor spatial frame (Smith and Nephew, Memphis, TN, USA) to treat anterior knee pain and a fi xed fl exional deformity that was associated with a previous failed medial opening-wedge high tibial osteotomy. Our patient was informed that data concerning the case would be submitted for publication. Case report

Correction of Ankle Ankylosis with Deformity Using the Taylor Spatial Frame: A Report of Three Cases

Ankle ankylosis, such as that caused by failed ankle fusion, fixed ankle from trauma, bone tumor, and stiff contracture, is associated with pain, limb-length discrepancy, and deformity. The Ilizarov external fixator has been used to treat these challenging problems.2,3,6,8,10 However, the Ilizarov external fixator requires surgeons to master special skills and is difficult to handle. Recently, a new type of external fixator called the Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN) has been increasing in popularity as an alternative to the Ilizarov external fixator.1,4,5 The TSF has two rings and six struts that are expandable. It can correct every deformity simultaneously: angulation, translation, rotation, elongation, and shortening. The TSF is supported with software available on a web site (https://www.spatialframe.com/) to analyze the deformity parameters of interest. To treat a deformity with the TSF, one must determine the frame parameters: proximal and distal ring diameters and neutral strut length or frame height. The deformity parameters should then be determined. By inputting these parameters into the software, spatial displacements and transformations are analyzed and a prescription is printed. The TSF can correct various deformities and shortening more accurately and easily than the Ilizarov external fixator. However, there have been only a few reports published regarding the application of the TSF to ankle and foot problems.11,12 We report three patients in whom ankle ankylosis with deformity was corrected using the TSF and following procedure.

Correction of a Severe Poliomyelitic Equinocavovarus Foot Using an Adjustable External Fixation Frame

One-stage surgical correction of severe equinocavovarus deformity can result in complications ranging from skin necrosis to tibial nerve palsy. Fewer complications have been reported when severe deformities were treated by gradual correction using external frames such as the Ilizarov external fixator or the Taylor Spatial Frame™. We describe a case of a 64-year-old female patient with severe poliomyelitic equinocavovarus whose deformity required her to ambulate using the dorsum of her right foot as a weightbearing surface. We treated the deformity with gradual correction using a Taylor Spatial Frame™, followed by ankle arthrodesis. At the most recent postoperative evaluation, 20 months after the initial surgery, the patient was pain free and ambulating on the sole of her right foot.

Lengthening of the normal tibia in a patient with hemihypertrophy caused by Klippel- Trenaunay-Weber syndrome: a case report

We report a case of Klippel-Trenaunay-Weber syndrome in a 31-year-old woman who presented with hypertrophy of the left leg. She had severe osteoarthritic changes in the left hip joint secondary to the lack of acetabular coverage of the femoral head as the result of lateral inclination of the pelvis owing to leg-length discrepancy of 4 cm. The centre-edge angle (coverage ratio of the acetabulum to the femoral head) was improved from 15° to 33° after a foot lift. She underwent osteotomy and lengthening of the normal contralateral tibia using a Taylor spatial frame. Hip arthroplasty could be avoided as osteoarthritic changes of the hip joint had improved.

Ilizarov Technique for Correction of the Shepherd's Crook Deformity: A Report of Two Cases

We report 2 patients with fibrous dysplasia who underwent correction, using the Ilizarov technique, of Shepherds crook deformities and pathological fractures of the left femurs. A 12-year-old boy underwent an opening wedge osteotomy and a 48° gradual correction, whereas a 43-year-old woman underwent a 34° acute correction without osteotomy at the fracture site. Both patients could initiate early weight bearing. Final leg function was excellent and alignment was maintained. No complications were encountered. Both patients had no difficulty sleeping and no major complaints about the Ilizarov technique. It is more important to achieve accurate alignment than resection of the lesion. The Ilizarov technique is effective for treating the Shepherds crook deformity in patients with fibrous dysplasia.

Intra-articular osteoid osteoma of the calcaneus: a case report and review

Osteoid osteoma of the calcaneus is rare and frequently misdiagnosed as arthritis because of similar symptoms. In addition, radiographic findings may be nonspecific, and magnetic resonance imaging (MRI) may show a bone marrow edema and changes in adjacent soft tissue. A 19-year-old man presented with a 6-month history of persistent pain and swelling in the left hind foot; diagnostic computed tomography and MRI analyses revealed lesions suggesting an intra-articular osteoid osteoma of the calcaneus. Initial MRI did not show specific findings. On operation, the tumor was removed by curettage; pathologic findings demonstrated woven bone trabeculae surrounded by connective tissue, confirming the diagnosis. To the best of our knowledge, MRI scans in all cases of calcaneal osteoid osteoma reported till 3 months after the injury exhibited a nidus. We believe that calcaneal osteoid osteoma should be considered as a differential diagnosis in patients undergoing MRI 3 months after symptom presentation; early computed tomography is critical in diagnosis.

Clinical Outcomes of Conversion Surgery from an External Fixator to anIodine-Supported Titanium Alloy Plate

Background: External fixators brought a revolution in orthopaedic surgical treatment after the invention of distraction osteogenesis, which enabled treatment of various difficult diseases. However, they had some drawbacks, such as pin-site infections, psychological pain, and refracture after removal. To overcome these problems, many efforts have been made by shortening of the period of wearing them. One of those methods is conversion to locking plate, which had high risk of infection. To reduce the risk of infection, we performed conversion surgery using iodinesupported titanium plate (We named it iPlates, developed at our department). Questions/purposes: We therefore evaluated (1) Operation time, (2) whether bone union was achieved, (3) blood biochemistry, including thyroid hormone levels, (4) post-surgical complications. Patients and Methods: We assessed 28 legs. There were 13 legs after deformity correction and limb lengthening, three legs with pseudarthrosis after bone fracture, two legs after bone transport, one leg after shortening distraction, and one leg after open fracture. The mean follow-up period was 24.5 months. Results: Average operation time was 197 minutes. Bone union was achieved in all cases. Blood examinations did not find any abnormalities due to iImplant implantation, such as with thyroid hormones. One patient had superficial soft tissue infection treated with re-operation without removal of plate. Conclusions: An iPlate can reduce complications compare to previous studies. Conversion surgery with iPlate could be a new path for the future of external fixation.