Hiroyuki Tsuchie

Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs.

In surgical treatment for atypical femoral fractures (AFFs), reconstruction nail fixation is recommended for both complete and incomplete fractures. Although it has been reported that AFF is affected by many factors, The ASBMR Task Force 2013 Revised Case Definition of AFFs states that a curved femur is often seen in Asian patients. It is sometimes difficult to insert a nail into a femur in incomplete AFF patients with severely curved femurs. We report two incomplete bisphosphonate-related AFF patients with marked femoral curvatures treated by locking plates and teriparatide, showing early bone unions and favorable long-term outcomes.

Langerhans cell histiocytosis of the sternum

We report a rare case of Langerhans cell histiocytosis involving the sternum. The patient was a 12-year-old girl presenting with anterior chest pain and swelling. Radiographs and computed tomography showed an osteolytic lesion in the sternum. Technetium bone scintigraphy revealed increased uptakes in the sternum, the greater trochanter of the right femur, and the right distal tibia. Incisional biopsy for the sternum lesion was performed, and the histopathologic diagnosis was Langerhans cell histiocytosis. She was treated with chemotherapy and the symptoms disappeared.

Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt

Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT) revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis.

Amelioration of pregnancy-associated osteoporosis after treatment with vitamin K2: a report of four patients

Abstract We demonstrate for the first time therapeutic effects of vitamin K2 (menatetrenone) on pregnancy-associated osteoporosis with multiple vertebral fractures in four cases. Due to its safety, vitamin K2 presents itself as a treatment option for women with pregnancy-associated osteoporosis. Desirably, future controlled studies should verify these findings.

Insufficiency fractures of bilateral distal tibias associated with chronic liver disease

Insuffi ciency fractures occur during normal activity as a result of repetitive accumulation of mild stresses on abnormal bones with decreased mineralization. These fractures often occur in patients with severe osteoporosis or those having diseases predisposing to osteoporosis. Insuffi ciency fractures are frequently identifi ed in the pelvis and lower extremities, but cases involving the bilateral and distal tibia are rare. We describe herein a unique case showing multiple insuffi ciency fractures involving the bilateral distal tibias associated with chronic liver disease and then review the literature. The patients and their families were informed that data from the case would be submitted for publication and gave their consent.

Combined treatment with minodronate and vitamin C increases bone mineral density and strength in vitamin C-deficient rats

Objectives Reduced bone quality caused by vitamin C deficiency in older persons may lead to incidental fragility fractures during bisphosphonate treatment, although bisphosphonate increases bone mineral density (BMD). This study aimed to evaluate the effects of minodronate and ascorbic acid (Aa) on BMD, bone quality, and bone strength in Aa-deficient osteogenic disorder Shionogi (ODS) rats. Methods Six-month-old ODS rats were divided into four groups (n = 20 per group): (1) Aa supplementation (Aa+); (2) Aa-deficient (Aa−); (3) Aa supplementation and minodronate administration (Aa+ + Mino); and (4) Aa-deficient and minodronate administration (Aa− + Mino). BMD, bone strength, bone histomorphometry, and bone quality determined using Fourier transform infrared spectroscopy imaging (FTIRI) were evaluated after 4 and 8 weeks. Results BMD was significantly higher in the Aa+ + Mino group than in the Aa− group (p < 0.05). Bone strength was significantly higher in the Aa+ and Aa+ + Mino groups than in the Aa− group (p < 0.05). Furthermore, bone strength was significantly higher in the Aa+ + Mino group than in the Aa− + Mino group (p < 0.05). Minodronate treatment irrespective of Aa supplementation significantly decreased bone resorption compared with the Aa+ and Aa− groups (p < 0.05). No significant differences in the parameters evaluated by FTIRI were observed between the groups. Conclusions Aa supplementation improved bone strength in ODS rats. Combined treatment with minodronate and Aa, but not minodronate alone, improved bone strength and increased BMD. Aa is required for bone health because it is essential for osteoblast differentiation.

Chronic expanding hematoma after spinal surgery

BACKGROUND CONTEXT Chronic expanding hematoma after spinal surgery is extremely rare, with no case previously reported in the literature. PURPOSE To report a rare case of a chronic expanding hematoma of the spine that occurred 24 years after thoracic laminectomy and spinal cord tumor resection. STUDY DESIGN Case report. METHODS A 71-year-old man presented with a spinal mass located approximately at the level of the sixth thoracic vertebral body. The patient had undergone thoracic laminectomy with tumor resection 24 years previously. The mass had appeared 5 years after this and had gradually enlarged over 19 years. RESULTS The tumor was resected en bloc. The lamina and spinous processes had been partially eroded by the tumor at the fifth and sixth thoracic vertebrae, but the dura was intact. Histopathologic examination confirmed the diagnosis of chronic expanding hematoma. The hematoma had not recurred at the 1-year follow-up. CONCLUSION We report herein an extremely rare case of chronic expanding hematoma after spinal surgery. This entity may be considered a late complication after surgery regardless of the number of years that have passed since the index surgery.

Bilateral stress fracture of the fibulae and periostitis of the tibiae.

Objective: This study describes a unique case of bilateral stress fractures of the fibulae and provides a literature review. Clinical Presentation and Intervention: A 16-year-old female badminton player presented with pain around the bilateral distal lateral legs. She had mild bilateral varus deformity at the knee joint, and the bilateral ankles showed valgus deformity in standing posture. Radiographs and computed tomography showed periosteal reactions on the bilateral distal fibulae. Technetium-99m bone scintigraphy demonstrated increased uptake in the bilateral distal fibulae and the bilateral middle third of the tibiae. A diagnosis of bilateral distal fibular stress fractures was made. She was advised to stop playing badminton until the symptoms disappeared. Conclusion: Varus deformity of the knee and valgus deformity of the ankle may have influenced the mechanism underlying bilateral symmetric stress fractures.

Glomus tumor of the toe with symptoms similar to those of Morton’s disease

Glomus tumor is a rare, benign tumor that was fi rst described clinically by Wood in 1812. The most common site is the hand, especially in the subungual area; and severe pain is a characteristic symptom. Surgical excision is the only curative treatment, and dramatic pain relief after excision is characteristic. Glomus tumor is diffi cult to diagnose clinically. Some patients have endured long-standing pain due to misdiagnosis. Morton’s disease is a condition caused by compression of the common digital plantar nerves and frequently involves the third digital plantar nerve. We describe a case of glomus tumor causing atypical symptoms similar to those of Morton’s disease.

Effects of combined therapy of alendronate and low-intensity pulsed ultrasound on metaphyseal bone repair after osteotomy in the proximal tibia of glucocorticoid-induced osteopenia rats

Objectives Glucocorticoid (GC) treatment inhibits activation of runt-related transcription factor 2 (Runx2), which is essential for osteoblast differentiation from stem cells. As a result, GC treatment results in bone loss, GC-induced osteoporosis (GIO), elevated fracture risk, and delayed bone healing. Bisphosphonates such as alendronate (ALN) are recommended for treating or preventing GIO, and low-intensity pulsed ultrasound (LIPUS) facilitates fracture healing and maturation of regenerated bone. Combined therapy with ALN and LIPUS may stimulate cancellous bone healing in GIO rats. Here, we examined the effect of ALN and LIPUS on cancellous bone osteotomy repair in the proximal tibia of GIO rats. Methods Prednisolone (10 mg/kg body weight/day) was administered for 4 weeks to induce GIO in 6-month-old female Sprague-Dawley rats. Tibial osteotomy was then performed and daily subcutaneous injection of ALN (1-μg/kg body weight) was subsequently administered alone or in combination with LIPUS (20 min/day) for 2 or 4 weeks. Results ALN significantly increased bone mineral density (BMD) at 2 and 4 weeks, and ALN + LIPUS significantly increased BMD at 4 weeks. Bone union rates were significantly increased after 2 and 4 weeks ALN and ALN + LIPUS treatment. Lastly, ALN and ALN + LIPUS significantly increased the proportion of Runx2 positive cells at 4 weeks. Conclusions ALN monotherapy and combined ALN and LUPUS treatment augmented BMD and stimulated cancellous bone repair with increased Runx2 expression at the osteotomy site in GIO rats. However, the combined treatment had no additional effect on cancellous bone healing compared to ALN monotherapy.