Moto Kobayashi

A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study

This preliminary prospective study was conducted to determine whether immobilization with the arm in external rotation would decrease the rate of recurrence after initial traumatic anterior dislocation of the shoulder. Forty patients with initial shoulder dislocations were assigned to (1) conventional immobilization in internal rotation (IR group, n = 20) or (2) a new method of immobilization in external rotation (ER group, n = 20). The recurrence rate was 30% in the IR group and 0% in the ER group at a mean 15.5 months. The difference in recurrence rate was even greater among those who were aged less than 30 years (45% in the IR group and 0% in the ER group). Immobilization with the arm in external rotation is effective in reducing the rate of recurrence after initial dislocation of the shoulder.

Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis

The objective of the study was to evaluate the impact of postural deformities and spinal mobility on quality of life (QOL) in patients with spinal osteoporosis. A total of 157 postmenopausal women aged over 60 years with osteoporosis were divided into five groups according to their postural deformities: round back (RB, n=41), hollow round back (HRB, n=33), whole kyphosis (WK, n=40), lower acute kyphosis (LAK, n=18), and normal posture (NP, n=25). QOL was evaluated using the Japanese Osteoporosis QOL Questionnaire (JOQOL) proposed by the Japanese Society for Bone and Mineral Research. This questionnaire contains six domains, with higher scores indicating higher levels of QOL. The number of vertebral fractures, thoracic kyphosis and lumbar lordosis angles, and spinal range of motion (ROM) during maximum flexion and extension were also measured with radiographs. Total QOL scores in RB, HRB, WK, and LAK groups were significantly lower than those in the NP group, and those in WK group were even lower compared with the other groups (P<0.05). All the groups with postural deformities, but not the NP group, showed significant positive correlations between total QOL score and spinal ROM (0.521≤r≤0.747, P<0.05). Total QOL score showed a significant correlation with age, number of vertebral fractures, lumbar lordosis angle, and spinal ROM in a total of 157 patients. However, multiple regression analysis revealed that spinal ROM best correlated with total QOL score. We concluded that QOL in patients with osteoporosis was impaired by postural deformities, especially by whole kyphosis, and that spinal mobility has a strong effect on QOL in these patients.

Mechanical environment of the supraspinatus tendon: A two-dimensional finite element model analysis

We performed 2-dimensional finite element model analysis to estimate the mechanical environment of the supraspinatus tendon. The geometric shape of the finite element model was determined by magnetic resonance imaging of a normal human shoulder obtained at 0 degrees, 30 degrees, and 60 degrees of abduction, whereas the histologic location of noncalcified and calcified fibrocartilage was determined from a cadaveric specimen. The supraspinatus tendon was pulled proximally with the force of 10 N at 0 degrees, 53 N at 30 degrees, and 115 N at 60 degrees of abduction. The area of high principal stress maximum was observed on the articular side of the supraspinatus tendon, which shifted toward the insertion as the arm was abducted. High stress concentration on the articular side of the supraspinatus tendon near its insertion during arm elevation may explain the frequent occurrence of rotator cuff tears at this site.

Reconstruction of a chronically ruptured Achilles tendon using an internal brace: a case report

BackgroundWe reconstructed a chronically ruptured Achilles tendon and the associated scar tissue using braided polyblend polyethylene sutures (FiberWire; Arthrex Inc.; Naples, FL, USA) and anchors.Case presentationA 68-year-old Japanese man, who was being treated for right Achilles tendinosis, felt pain in his Achilles tendon when walking and started to find plantar flexion of his ankle joint difficult. As his symptoms persisted, he visited us after 4 weeks. Surgery and orthotic therapy were recommended, but he did not want to undergo these treatments. However, he began to find walking difficult and so underwent surgery 6 months after suffering the injury. The interior of the tendon was curetted, and the ruptured region was subjected to plication using the surrounding scar tissue. Using the percutaneous Achilles repair system (Arthrex Inc.), FiberWire sutures were inserted, and two skin incisions were made on the medial and lateral sides of his calcaneus in the region surrounding the Achilles tendon attachment. SutureLasso (Arthrex Inc.) was passed through, and the proximal FiberWire suture was relayed and fixed with 4.75-mm SwiveLock (Arthrex Inc.). After surgery, his foot was fixed in plaster at 20° plantar flexion of his ankle joint. The plaster was removed 1 week after surgery, and after-treatment was initiated with active dorsiflexion training. No orthosis was used after surgery. As of 16 postoperative months, no re-rupture had occurred.ConclusionsThis method might allow post-treatment rehabilitation, and so on, to occur earlier, and, hence, could become an option for the reconstruction of chronically ruptured Achilles tendons.

Non-traumatic femoral head fracture forming bone fragments

Femoral head fracture generally occurs due to high-energy injury such as dislocation of the hip joint. However, femoral head fracture forming bone fragments without apparent trauma has not previously been reported. We describe herein a unique case of non-traumatic femoral head fracture leading to rapid destruction of the femoral head and osteoarthritic changes in the hip joint, along with a review of the literature. The patients and their families were informed that data from the case would be submitted for publication, and gave their consent.