Masashi Fukuta

Characteristics of Upper Extremity Injuries Sustained by Falling During Snowboarding: A Study of 1918 Cases

Background: Little epidemiological research on characteristics of upper extremity injuries resulting from snowboarding has been conducted, particularly in relation to snowboarding stance, falling direction, and the side of the body where the injury occurs. Hypothesis: Snowboarding stance and the direction of the fall may influence the frequency of the side or the location of the upper extremity injury. Study Design: Descriptive epidemiology study. Methods: This study analyzed the information obtained from 1918 patients with fractures or dislocations of the upper extremity (excluding the fingers and scapula) sustained during snowboarding/sliding between 2000 and 2008. Diagnosis, injured part and side, stance (regular or goofy), and falling directions were prospectively analyzed. Associations among these parameters were also analyzed. Results: As characterized by skill level, patients were beginners (57.9%), intermediates (38.0%), and experts (4.0%). Eighty-eight percent had not received instruction from licensed instructors. Diagnoses included wrist fractures (53.7%), upper arm fractures (16.8%), shoulder dislocations (11.5%), and elbow dislocations (9.8%). In sum, 1742 (90.8%) patients were in regular stance when they fell, whereas 176 (9.2%) were in goofy stance. There was a significant difference in the prevalence of the injured side between the 2 stances. When the injured sides were classified according to the sliding direction, wrist fractures (61.7%) occurred on the side opposite the sliding direction, whereas shoulder dislocations (65.6%), upper arm fractures (82.9%), and elbow dislocations (79.8%) occurred on the same side as the sliding direction. When the injured sides were classified according to the falling direction, wrist fractures (68.1%) and elbow dislocations (63.5%) occurred because of backward falls, and shoulder dislocations (68.9%) and upper arm fractures (60.7%) occurred because of forward falls. Conclusion: Two snowboarding stances as well as 2 falling directions had a significant influence on the frequency of the injured side in the upper extremity.

Shoulder impingement syndrome due to a ganglion cyst below the coracoacromial ligament: a case report.

Young athletes who employ overhead arm movements frequently develop shoulder pain caused by muscle tightness or scapula dysfunction1-3. Generally, they are instructed to perform a stretching and muscle-conditioning regimen1,3, but refractory pain without muscle tightness sometimes persists. In such cases, magnetic resonance imaging (MRI) should be used to look for other lesions, and occasionally a cystic lesion may be identified. Cysts located near the labrum, referred to as paralabral cysts or labral cysts, may cause shoulder pain or suprascapular nerve palsy4,5. To our knowledge, there have been no previous reports of ganglion cysts that were located below the coracoacromial ligament as being the cause of shoulder impingement syndrome in athletes. We report the presence of such a cyst in a patient who had the typical symptoms of shoulder impingement syndrome. For diagnostic imaging, we carried out radiographs, MRI, ultrasonography, and cystographic three-dimensional computed tomography (CT) examinations. Ultrasonography was particularly helpful for understanding the movement of the ganglion, while shoulder-dynamic and cystographic three-dimensional CT was very useful for identifying the location of the stalk and estimating the size of the cyst. Our patient was informed that data concerning the case would be submitted for publication, and he consented. A twenty-one-year-old male, right-hand-dominant volleyball player developed pain in the anterior aspect of the right shoulder when spiking the ball. The pain had persisted for more than a year as of the time that the patient presented to our institution, but there was no history of trauma. Physical examination revealed tenderness on compression of the area over the coracoacromial ligament. The examination findings did not suggest shoulder instability, and the patient had no limitation of motion in the shoulder. There was no evidence of local heat, a mass, muscle weakness, or …

Increased blood flow in the anterior humeral circumflex artery correlates with night pain in patients with rotator cuff tear

AbstractBackground Night pain is a particularly vexing symptom in patients with rotator cuff tear. It disturbs sleep and decreases quality of life, and there is no consensus regarding its etiology. Based on arthroscopic surgical observations of synovitis around the rotator interval or capsule surface in rotator cuff tear, we hypothesized that blood flow from the artery feeding the capsule increases blood supply to the synovium. This study aimed to investigate the relationship between blood flow and night pain using pulse Doppler ultrasonography.MethodsA series of 47 consecutive patients with rotator cuff tear was evaluated. The peak systolic velocity and resistance index of blood flow in the ascending branch of the anterior humeral circumflex artery were evaluated using pulse Doppler ultrasonography. We also investigated 20 normal shoulders in healthy volunteers. The peak systolic velocity and resistance index were compared between affected and unaffected sides in patients and between dominant and nondominant sides in controls.ResultsAnterior humeral circumflex artery peak systolic velocity and resistance index did not differ between sides in control subjects or in patients with rotator cuff tear without night pain. However, anterior humeral circumflex artery peak systolic velocity and resistance index did differ significantly between sides in patients with rotator cuff tear with night pain.ConclusionsThis study revealed anterior humeral circumflex artery hemodynamics in patients with rotator cuff tear and normal subjects using Doppler ultrasonography. Night pain, particularly involving aching, appears to be related to the hemodynamics. These findings suggest that investigating the hemodynamics of patients with rotator cuff tear with night pain may lead to greater understanding of the etiology of this symptom.

Comparison of Functional Recovery in the Very Early Period After Surgery Between Plate and Nail Fixation for Correction of Stable Femoral Intertrochanteric Fractures A Controlled Clinical Trial of 18 Patients

Purpose: This study aimed to compare the differences in functional recovery between patients undergoing plate and nail fixation in the very early period after surgery. Method: This study was designed as a controlled clinical trial that included 18 patients who were surgically treated with either dynamic hip screw as plate fixation or proximal femoral nail as nail fixation for stable intertrochanteric fractures. In particular, all patients selected for the study reported walking completely independently without the use of walking aids prior to sustaining their initial fracture. In all, 8 patients (mean age, 73.8 years; range, 65-89 years) were treated with plate fixation (group plate) and 10 patients (mean age, 79.7 years; range, 70-90 years) were treated with nail fixation (group nail). Functional evaluations were assessed every week after surgery using the Japanese Orthopaedic Association (JOA) hip functional scores and active range of motion (ROM) of the hip joint. Results: The recovery of activities of daily living (ADLs) according to JOA hip functional scores at week 4 after surgery was significantly better in group nail than in group plate (P = .03), whereas active ROM of hip flexion improved significantly in group plate than in group nail at weeks 3 and 4 after surgery (P = .04 and P = .02, respectively). Conclusions: The results suggested that nail fixation may provide a more rapid recovery of ADLs than that of plate fixation in the very early period after surgery. However, plate fixation may provide better ROM of hip flexion than that of nail fixation.

Functional bracing for delayed union of a femur fracture associated with Paget's disease of the bone in an Asian patient: a case report.

Pagets disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Pagets disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Pagets disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Pagets disease, which was treated successfully by functional bracing.

Comparative Study for Alignment of Extramedullary Guides versus Portable, Accelerometer-Based Navigation in Total Knee Arthroplasty

Abstract The use of portable, accelerometer‐based navigation (PN) devices for positioning of the components of total knee arthroplasty (TKA) is emerging as an alternative to standard extramedullary (EM) systems, which was needed to the image intensifier. The aim of our study was to compare the accuracy of component positioning in TKA using an EM and PN systems. Data from 100 consecutive primary TKAs, performed by multiple surgeons in 87 patients between October 2010 and June 2015, were analyzed. Coronal and sagittal plane alignments of the TKA components, relative to the mechanical axis of the limb, were evaluated by radiography. The mean postoperative coronal alignment angle of the femoral (&agr;) and tibial (&bgr;) components was comparable between the groups (&agr;: PN, 89.9 ± 2.2 degrees; EM, 89.9 ± 1.6 degrees and &bgr;: PN, 90.1 ± 1.4 degrees; EM, 89.6 ± 1.3 degrees). Groups were also comparable with regard to mean postoperative sagittal alignment angle of the femoral and tibial components (&ggr;: PN, 2.3 ± 3.3 degrees; EM, 1.8 ± 1.7 degrees and &sgr;: PN, 89.7 ± 2.5 degrees; EM, 90.1 ± 1.3 degrees). The incidence rate of a component malalignment > 3 degrees in the coronal and sagittal planes of the mechanical axis of the knee was comparable between the groups. In conclusion, the coronal and sagittal alignments for the femoral components was less accurate compared with tibial component alignment, especially in the PN group, and the sagittal alignment of the femoral component was less accurate than coronal alignment for both groups. Both the PN and EM systems provide satisfactory coronal and sagittal component alignments in TKA. Further technical improvement of the PN system could further improve its application for accurate component implantation in TKAs.