Publications by authors named "Kenichi Kazuki"

36 Publications

Open-wedge osteotomy for thumb radial angulation in Apert syndrome using a bone-graft substitute.

J Pediatr Orthop B 2022 Sep 2;31(5):500-504. Epub 2021 Dec 2.

Department of Pediatric Orthopaedic Surgery, Children's Medical Center, Osaka City General Hospital, Miyakojima-ku, Osaka.

A short thumb with radial angulation causes loss of hand function in patients with Apert syndrome. Although past reports have described various procedures for the correction of the thumb, there has been no consensus on the best procedure. This study aimed to assess the clinical and radiographic results of a surgical technique for the correction of a thumb radial angulation deformity: open-wedge osteotomy using a bone-graft substitute. Ten patients (18 thumbs) who underwent open-wedge osteotomy on the proximal phalange using a bone-graft substitute were evaluated retrospectively. The open-wedge osteotomies had been performed at the center of the proximal phalanx. Thumb radial angles and thumb lengths were measured on radiographs, and the clinical results were investigated, including bone union and complications. The median patient age at the time of surgery was 5.8 years, and the average follow-up period was 6.7 years. The average thumb radial angle was 57.3° preoperatively, 6.5° immediately postoperatively, and 19.8° at the most recent follow-up. The average thumb length was 12.1 mm preoperatively, 18.1 mm immediately postoperatively, and 22.3 mm at the most recent follow-up, indicating an extension effect of more than 50% immediately postoperatively. In all cases, the artificial bone had been absorbed and developed into autologous bone, and there were no complications such as infection and skin necrosis. These findings suggest that open-wedge osteotomy with an artificial bone substitute is simple and effective for treating radial-angulation deformities in patients with Apert syndrome. Level of evidence: Level IV - retrospective case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BPB.0000000000000938DOI Listing
September 2022

Thoracic Outlet Syndrome with Subclavian Artery Thrombosis Caused by Synostosis of the First and Second Ribs: A Case Report.

JBJS Case Connect 2022 04 6;12(2). Epub 2022 Apr 6.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Case: A 43-year-old woman presented with pain, paresthesia, and coldness of the right upper extremity suggestive of the diagnosis of thoracic outlet syndrome. Three-dimensional computed tomography angiography revealed that the right subclavian artery was constricted because it traveled over an abnormal first rib. After anticoagulation and antithrombotic therapy, the patient underwent resection of the abnormal first rib. Postoperative angiography documented improvement over time of the poststenotic dilatation and recanalization of the subclavian artery capable of delivering almost normal distal flow.

Conclusion: Arterial reconstruction is not always necessary for the treatment of arterial thoracic outlet syndrome associated with poststenotic dilatation of the subclavian artery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.21.00751DOI Listing
April 2022

Bipedicled digital artery perforator volar adiposal turned-over flap for reconstruction of transverse fingertip amputation.

JPRAS Open 2022 Jun 8;32:111-115. Epub 2022 Mar 8.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Different approaches to fingertip reconstructions are reported for cases in which microsurgical replantation is impossible. This report presents two cases of bipedicled digital artery perforator adiposal flaps for fingertip reconstruction after traumatic amputations. Adiposal flaps, including the radial and ulnar digital artery perforator vessels proximal to the distal interphalangeal joint, were elevated and turned to cover the fingertip defect. After donor-site skin closure, split-thickness skin was grafted onto the fingertip digital artery perforator adiposal flap. The technique is quick and easy to perform under loupe magnification and achieves good results in terms of healing, hand function, appearance, and patient satisfaction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpra.2022.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8956959PMC
June 2022

Divergent Dislocation of the Elbow in an Adult with Ehlers-Danlos Syndrome: A Case Report.

JBJS Case Connect 2021 08 12;11(3). Epub 2021 Aug 12.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Case: A 32-year-old man with Ehlers-Danlos syndrome (EDS) fell while snowboarding and injured his right elbow. Radiography revealed a posterior dislocation of the elbow and a proximal radioulnar joint dislocation. A diagnosis of transverse divergent dislocation of the elbow was established. Open reduction and repair of the annular ligament, anterior oblique ligament, and capsule was performed with good clinical results.

Conclusion: This is the first report of divergent dislocation of the elbow in an adult with EDS. Dislocation occurred without a fracture that required open reduction and internal fixation. The presence of soft-tissue fragility, hyperextension, and joint laxity peculiar to EDS are likely contributing factors to this phenomenon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.21.00159DOI Listing
August 2021

Clinical results of splinting versus observation for pediatric trigger thumb.

J Pediatr Orthop B 2021 Jul;30(4):346-350

Gakuen Minami Clinic, Gakuendaiwacho, Nara, Japan.

Patients with pediatric trigger thumb present with fixed contracture of the interphalangeal joint (IPJ) or snapping of the thumb. We applied a hand-based dynamic splint using coils at the IPJ. The aim of this study was to report the clinical outcomes of splint therapy versus observation. One hundred twenty-nine thumbs (112 patients and 57 boys) were examined retrospectively. At initial presentation, parents selected the treatment after explanation of pathology and consents were obtained. Treatment was concluded when full extension or resolution of the involved IPJ was achieved; alternatively, surgical treatment was offered for patients who failed to improve. Improvement in extension loss to 0° and hyperextension was defined as resolution of the IPJ. Surgery was not selected as a first-line treatment strategy in any of the cases in this study. The rate of resolution was 59% at 31 months of follow-up in the splint group (99 thumbs) and 43% at 30 months in observation group (30 thumbs); there was no significant difference between the groups (P = 0.15). Twenty-one thumbs showed locking of the IPJ in the extended position during splint therapy, but all recovered with a 71% rate of resolution. The splint group showed a higher rate of resolution than the observation group; however, there was no significant difference between therapies. Our study showed that 55% of patients with pediatric trigger thumb showed resolution following conservative treatment for an average of 30 months until surgery could be performed under local anesthesia. Splint therapy and observation are viable treatment options prior to surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BPB.0000000000000790DOI Listing
July 2021

Assessment of hand function using the functional dexterity test after opponensplasty in young children with Blauth type 2 hypoplastic thumb.

J Pediatr Orthop B 2020 Jul;29(4):403-408

Gakuen-Minami Clinic, Nara, Japan.

The functional dexterity test (FDT) is a timed pegboard test based on the manipulation of each peg and suitable for young children as it is both simple and quick to perform. We assessed the postoperative FDT values for children with Blauth type 2 hypoplastic thumbs after opponensplasty. We evaluated hand function using FDT for 12 hands of 11 patients with Blauth type 2 hypoplastic thumbs. Opponensplasty was performed in all hands following by Huber's procedure. All patients were evaluated from 6 to 12 months after surgery for hand function using three types of FDT scores: time in seconds to complete the test (FDT time), combined total time with penalty seconds added to the initial time (FDT total), and the number of pegs per second to complete the task as a percentage against normative values (FDT speed). We compared the postoperative FDT scores with those for Blauth type 1 or 2 hypoplastic thumb patients without surgical treatment. FDT time and FDT total for the patients postoperatively were both significantly shorter than those in the type 2 patients without surgical treatment. FDT speed was significantly higher than that for the patients without surgical treatment. There were no significant differences in the three FDT scores between the postoperative patients and the type 1 patients. There were several limitations including small sample size, large ranges of the data, and high number of variables. FDT reflected postopponensplasty improvement in hand dexterity in young children with Blauth type 2 hypoplastic thumb.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BPB.0000000000000719DOI Listing
July 2020

Computer-Assisted Three-Dimensional Corrective Osteotomy for Malunited Fractures of the Distal Radius Using Prefabricated Bone Graft Substitute.

J Hand Surg Asian Pac Vol 2018 Dec;23(4):479-486

* Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Background: Three-dimensional computed tomography (3D-CT) imaging has enabled more accurate preoperative planning. The purpose of this study was to investigate the results of a novel, computer-assisted, 3D corrective osteotomy using prefabricated bone graft substitute to treat malunited fractures of the distal radius.

Methods: We investigated 19 patients who underwent the computer-assisted 3D corrective osteotomy for a malunited fracture of the distal radius after the operation was stimulated with CT data. A prefabricated bone graft substitute corresponding to the patient's bone defect was implanted and internal fixation was performed using a plate and screws. We compared postoperative radiographic parameters of the patient's operated side with their sound side and analyzed clinical outcomes using Mayo wrist score.

Results: All patients achieved bone union on X-ray imaging at final follow-up. The mean differences of palmar tilt, radial inclination and ulnar variance between the operation side and the sound side were 4.3°, 2.3° and 1.2 mm, respectively. The Mayo wrist score was fair in 4 patients and poor in 15 patients before surgery. At the final follow-up after surgery, the scores improved to excellent in 3 patients, good in 11 patients and fair in 5 patients. There were two patients with correction loss at the final follow-up, but no patient complained of hand joint pain.

Conclusions: We believe that computer-assisted 3D corrective osteotomy using prefabricated bone graft substitute achieved good results because it worked as a guide to the accurate angle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S2424835518500467DOI Listing
December 2018

Low second to fourth digit ratio in Dupuytren disease.

Medicine (Baltimore) 2017 Aug;96(33):e7801

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka Gakuen-minami Clinic, Nara, Japan.

The ratio of the lengths of the second and fourth digits (2D:4D) has been described as reflecting endogenous prenatal androgen exposure. In general, 2D:4D is lower in men than in women and has potential as a biomarker or predictor for various diseases, athletic ability, and academic performance. Dupuytren disease has digital flexion contractures and is known to predominate in men, but the pathogenesis of the disease remains unclear. To clarify the relationships between Dupuytren disease and endogenous androgens, we performed a retrospective analysis of hand radiographs to investigate 2D:4D in Dupuytren disease. The study included male patients with Dupuytren disease (n = 22) and a control group (n = 18) of male patients with carpal tunnel syndrome. Only unaffected hands, without contractures or osteoarthritis, were evaluated for the purpose of radiographic assessment. The lengths of the phalanx and metacarpal bones in the second and fourth digits were measured by 2 independent observers who each performed 2 sets of measurements separated by a minimum 1-week interval. The 2D:4D was calculated separately for the phalanges and metacarpals, and a combined (phalanx + metacarpal) 2D:4D was also calculated. The reliability of the observer measurements was established using the intraclass correlation coefficient, and both the intra- and interobserver reliability showed excellent agreement. We found that compared with control group, the Dupuytren disease group had significantly lower phalanx and combined 2D:4D. These findings suggest that endogenous prenatal androgens could contribute to the development of Dupuytren disease, leading to its characteristic clinical presentation predominantly in men and affecting the ulnar rays.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000007801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571709PMC
August 2017

Limited Wrist Arthrodesis for Scapholunate Advanced Collapse Wrist: Triangle Fixation for Four-Corner Fusion.

J Hand Surg Asian Pac Vol 2016 06;21(2):207-11

1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Background: Limited wrist arthrodesis with scaphoid excision is a useful treatment for scapholunate advanced collapse (SLAC) of the wrist. Multiple Kirschner wires were originally used for internal fixation of the four carpal bones, however long-term cast immobilization, pin tract infection, and hardware removal are still problematic. We introduce and evaluate the clinical outcomes of an internal fixation technique; triangle fixation for four-corner fusion, using three headless screws, as an alternative to conventional multiple Kirschner wires for the treatment of SLAC wrist.

Methods: Five male patients with SLAC wrist secondary to three scaphoid nonunions and two scapholunate dissociations were treated with four-corner fusion using triangle fixation with three Double-threaded Japan screws. The mean age was 59.5 years (35-79 years) and the mean follow-up period was 40 months. After surgery, short arm splints were applied for 3-4 weeks, and then range of motion exercises were initiated.

Results: Wrist range of motion and grip strength both improved postoperatively. At the final follow-up evaluation, bone union was completely achieved and satisfactory pain relief was observed in all patients.

Conclusions: Compared with the conventional Kirschner wire technique, the present technique shortens the period of splint immobilization due to a strong compression force in a skewed position, does not require pin removal or cause pin tract infections, and provides satisfactory results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S242483551650020XDOI Listing
June 2016

Anatomical Origins of Radial Artery Perforators Evaluated Using Color Doppler Ultrasonography.

J Reconstr Microsurg 2016 Oct 8;32(8):594-8. Epub 2016 Jun 8.

Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan.

Background The radial artery perforator (RAP) flap has been widely used for covering hand and forearm defects, and real-time accurate perforator mapping is important in planning and elevating the perforator flap. The origins of perforators, especially the superficial and ulnar perforators, arising from the radial artery are very important in the elevation of the RAP flap. Recently, color Doppler ultrasonography (US) using a higher frequency transducer has been developed for high-quality detection of lower flow in smaller vessels. This study aimed to identify the anatomical locations and origins of perforators arising from the radial artery using color Doppler US in healthy volunteers. Methods Twenty forearms of 10 volunteers were examined. Results In total, 120 perforators arising from the radial artery were identified 15 cm proximal to the distal wrist crease, with an average of six perforators per forearm. More than half the perforators (n = 72, 60%) were located within 50 mm proximal to the distal wrist crease. Regarding the perforator origins in the axial view, 40 perforators (33%) were located in the radial aspect of the radial artery, 47 (39%) in the ulnar aspect, 15 (13%) in the superficial aspect, and 18 (15%) in the deep aspect. In total, 62 (52%) perforators were located in the superficial and ulnar areas, which are important in nourishing and elevating the RAP flap. Conclusion We are the first to evaluate RAP using color Doppler US. This noninvasive, convenient, and real-time technique could be useful for preoperative planning and reliably elevating the RAP flaps.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0036-1584217DOI Listing
October 2016

Planning digital artery perforators using color Doppler ultrasonography: A preliminary report.

J Plast Reconstr Aesthet Surg 2016 May 8;69(5):634-9. Epub 2016 Feb 8.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8585, Japan.

Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2016.01.003DOI Listing
May 2016

The Classification of Swanson for Congenital Anomalies of Upper Limb Modified by the Japanese Society for Surgery of the Hand (JSSH).

Hand Surg 2015 ;20(2):237-50

§ Department of Plastic, Aesthetic and Reconstructive Surgery, Iwate Medical University School of Medicine, Iwate, Japan.

The aim of this study is to introduce the classification of Swanson for congenital anomalies of upper limb modified by the Japanese Society for Surgery of the Hand (the JSSH modification) in English. The Swanson classification has been widely accepted by most hand surgeons. However, several authors have suggested that complex cases, particularly those involving the complex spectrum of cleft hand and symbrachydactyly, are difficult to classify into the classification schemes. In the JSSH modification, brachysyndactyly, so-called atypical cleft hand and transverse deficiency are included under the same concept of transverse deficiency. Cleft hand, central polydactyly, and syndactyly are included in the same category of abnormal induction of digital rays. We believe that the JSSH modification system is effective in providing hand surgeons with the clinical features and conditions for congenital anomalies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S0218810415300041DOI Listing
July 2016

Bisphosphonate-related atypical femoral fracture with bone metastasis of breast cancer: case report and review.

Anticancer Res 2014 Mar;34(3):1245-9

2-13-22 Miyakojimahondori Miyakojima-ku, Osaka, 534-0021 Japan.

Background: Intravenous bisphosphonates (BPs) have been used to reduce the frequency of skeletal-related events due to bone metastases of several kinds of cancers. Although many studies on BP-related atypical fractures (BRAFs) due to the use of BP for osteoporosis treatment have been reported, few reports on BRAFs arising as a complication of long-term BP use for bone metastasis of cancer are available.

Case Report: A 62-year-old woman with a history of breast cancer presented with right thigh pain after she had a fall. Radiographs indicated a transverse fracture in the shaft of the right femur. She had been on zoledronate treatment for six years. Based on radiographic and histopathological findings, we concluded that the fracture was not a pathological fracture associated with metastasis but was a complication of long-term BP treatment.

Conclusion: Clinical oncologists should consider the possibility of BRAFs in patients on long-term zoledronate treatment for bone metastases.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2014

Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers.

Microsurgery 2014 Sep 16;34(6):454-8. Epub 2014 Jan 16.

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Soft tissue defects of adjacent multiple fingers covered by a single large flap require secondary separation of the flap into each finger. Such covering obstructs independent motion of injured fingers until the single large flap is separated. This report describes the technique of combined medialis pedis and medial plantar fasciocutaneous flaps for reconstructing soft tissue defects of multiple adjacent fingers. Three male patients (age range, 18-33 years) underwent soft tissue reconstructions of multiple adjacent fingers with combined flaps. Injuries involved three adjacent palmar fingers, two adjacent palmar fingers, and two adjacent dorsal fingers. Average sizes of the combined flaps were 4.2 × 4.0 cm for the medialis pedis flap and 3.0 × 1.8 cm for the medial plantar fasciocutaneous flap. All flaps survived without vascular complications, and donor sites healed uneventfully. All patients experienced excellent recovery of range of motion for the reconstructed fingers. In conclusion, combined flaps may offer an alternative for coverage of soft tissue defects that involve multiple adjacent fingers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/micr.22222DOI Listing
September 2014

Identifying key indicators for the clinical diagnosis of Bacille Calmette-Guérin Tokyo-172 strain osteomyelitis: two case reports.

J Orthop Sci 2015 Jan 13;20(1):232-6. Epub 2013 Jul 13.

Osaka City General Hospital, 13-22 Miyakojimahondori2-chome Miyakojimaku, Osakasi, Osaka, 534-0021, Japan,

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00776-013-0438-6DOI Listing
January 2015

Acceleration of peripheral nerve regeneration using nerve conduits in combination with induced pluripotent stem cell technology and a basic fibroblast growth factor drug delivery system.

J Biomed Mater Res A 2014 May 11;102(5):1370-8. Epub 2013 Jun 11.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Various modifications including addition of Schwann cells or incorporation of growth factors with bioabsorbable nerve conduits have been explored as options for peripheral nerve repair. However, no reports of nerve conduits containing both supportive cells and growth factors have been published as a regenerative therapy for peripheral nerves. In the present study, sciatic nerve gaps in mice were reconstructed in the following groups: nerve conduit alone (control group), nerve conduit coated with induced pluripotent stem cell (iPSc)-derived neurospheres (iPSc group), nerve conduit coated with iPSc-derived neurospheres and basic fibroblast growth factor (bFGF)-incorporated gelatin microspheres (iPSc + bFGF group), and autograft. The fastest functional recovery and the greatest axon regeneration occurred in the autograft group, followed in order by the iPSc + bFGF group, iPSc group, and control group until 12 weeks after reconstruction. Thus, peripheral nerve regeneration using nerve conduits and functional recovery in mice was accelerated by a combination of iPSc-derived neurospheres and a bFGF drug delivery system. The combination of all three fundamental methodologies, iPSc technology for supportive cells, bioabsorbable nerve conduits for scaffolds, and a bFGF drug delivery system for growth factors, was essential for peripheral nerve regenerative therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jbm.a.34816DOI Listing
May 2014

Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease.

Eur Spine J 2013 Aug 1;22(8):1750-7. Epub 2013 Apr 1.

Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Japan.

Purpose: Primary intraspinal facet cysts in the lumbar spine are uncommon, but it is unclear whether cyst incidence increases following decompression surgery and if these cysts negatively impact clinical outcome. We examined the prevalence, clinical characteristics, and the risk factors associated with intraspinal facet cysts after microsurgical bilateral decompression via a unilateral approach (MBDU).

Methods: We studied 230 patients treated using MBDU for lumbar degenerative disease (133 men and 97 women; mean age 70.3 years). Clinical status, as assessed by the Japanese Orthopedic Association (JOA) score and findings on X-ray and magnetic resonance images, was evaluated prior to surgery and at both 3 months and 1 year after surgery. The prevalence of intraspinal facet cysts was determined and preoperative risk factors were defined by comparing presurgical findings with clinical outcomes.

Results: Thirty-eight patients (16.5%) developed intraspinal facet cysts within 1 year postoperatively, and 24 exhibited cysts within 3 months. In 10 patients, the cysts resolved spontaneously 1 year postoperatively. In total, 28 patients (12.2%) had facet cysts 1 year postoperatively. The mean JOA score of patients with cysts 1 year postoperatively was significantly lower than that of patients without cysts. This poor clinical outcome resulted from low back pain that was not improved by conservative treatment. Most cases with spontaneous cyst disappearance were symptom-free 1 year later. The preoperative risk factors for postoperative intraspinal facet cyst formation were instability (OR 2.47, P = 0.26), scoliotic disc wedging (OR 2.23, P = 0.048), and sagittal imbalance (OR 2.22, P = 0.045).

Conclusions: Postoperative intraspinal facet cyst formation is a common cause of poor clinical outcome in patients treated using MBDU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00586-013-2763-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731472PMC
August 2013

Transplantation of induced pluripotent stem cell-derived neurospheres for peripheral nerve repair.

Biochem Biophys Res Commun 2012 Mar 7;419(1):130-5. Epub 2012 Feb 7.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

In spite of the extensive research using induced pluripotent stem (iPS) cells, the therapeutic potential of iPS cells in the treatment of peripheral nerve injury is largely unknown. In this study, we repaired peripheral nerve gaps in mice using tissue-engineered bioabsorbable nerve conduits coated with iPS cell-derived neurospheres. The secondary neurospheres derived from mouse iPS cells were suspended in each conduit (4000,000 cells per conduit) and cultured in the conduit in three-dimensional (3D) culture for 14 days. We then implanted them in the mouse sciatic nerve gaps (5 mm) (iPS group; n=10). The nerve conduit alone was implanted in the control group (n=10). After 4, 8 and 12 weeks, motor and sensory functional recovery in mice were significantly better in the iPS group. At 12 weeks, all the nerve conduits remained structurally stable without any collapse and histological analysis indicated axonal regeneration in the nerve conduits of both groups. However, the iPS group showed significantly more vigorous axonal regeneration. The bioabsorbable nerve conduits created by 3D-culture of iPS cell-derived neurospheres promoted regeneration of peripheral nerves and functional recovery in vivo. The combination of iPS cell technology and bioabsorbable nerve conduits shows potential as a future tool for the treatment of peripheral nerve defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bbrc.2012.01.154DOI Listing
March 2012

Intraneural nodular fasciitis of the median nerve: case report and literature review.

J Hand Surg Am 2011 Aug 13;36(8):1347-51. Epub 2011 Jul 13.

Department of Orthopaedic Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan.

Nodular fasciitis, a benign soft tissue tumor, occurs most frequently in the forearm and is generally divided into subcutaneous, intramuscular, and fascial types. Intraneural nodular fasciitis has been reported in only 5 patients previously. We present the case of a 79-year-old woman with nodular fasciitis within the median nerve at the proximal forearm. Carpal tunnel syndrome was suspected at the initial visit, but high median nerve palsy and a mass at the proximal forearm were found a few months later. Subtotal resection of the tumor within the median nerve was performed and histological diagnosis indicated nodular fasciitis. There was no evidence of recurrence at follow-up 1 year and 3 months after surgery. Motor weakness had resolved but sensation was compromised.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2011.05.034DOI Listing
August 2011

Clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture: use of one-stage skin closure.

J Plast Surg Hand Surg 2010 Dec;44(6):306-10

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.

Y-V or Z-plasties are a useful one-stage technique for skin closure after aponeurotomy. However, we know no details about postoperative improvement, particularly at each joint. The purpose of this study was to evaluate the clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture. We retrospectively reviewed the postoperative results of 23 patients (25 hands, 29 fingers). The preoperative severity of the contracture evaluated by the Meyerding classification was grade I in 11 fingers, II in two fingers, and III in 16 fingers. In total, 26 metacarpophalangeal (MP) joints and 27 proximal interphalangeal (PIP) joints were treated. In each finger we assessed clinical outcomes according to the percentage improvement in extension and a modified version of Tubiana's classification. Primary wound closure was possible in all cases. The mean contracture values were improved from 46.5° preoperatively to 4.2° postoperatively for the MP joint and from 43.9° to 22.4° for the PIP joint. The mean percentage improvement in extension for the MP joint was 92% and for the PIP joint 56%. The rate for the PIP joint of the little finger was 40% and for the other fingers 78%. In total, 83% of the fingers had satisfactory results. For Dupuytren's contracture, primary skin closure with Y-V and Z-plasties gives satisfactory results, more so with involvement of the MP than the PIP joint and less so with involvement of the little finger.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/2000656X.2010.534340DOI Listing
December 2010

Bone morphogenetic protein-2 retained in synthetic polymer/β-tricalcium phosphate composite promotes hypertrophy of a vascularized long bone graft in rabbits.

Plast Reconstr Surg 2011 Jan;127(1):98-106

Osaka, Tochigi, and Nara, Japan From the Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine; the Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine; the Spine Center, Shiraniwa Hospital; and the Department of Orthopedic Surgery, Osaka City General Hospital.

Background: Vascularized bone grafting is a useful method for repairing critical bone defects. The repaired bone often presents compromised mechanical strength because of insufficient thickness of the graft. To promote the hypertrophic response, bone morphogenetic protein (BMP) with osteoinductive capacity may be effective. This study was designed to evaluate the efficacy of BMP in rabbits.

Methods: The first metatarsal bones with or without feeding vessels were transferred to critical-sized bone defects in the femurs of rabbits. Recombinant human (rh) BMP-2 (0, 30, or 60 μg) with a carrier material composed of 30 mg of β-tricalcium phosphate powder, 30 mg of a polymer gel (p-dioxanone/polyethylene glycol block copolymer) was placed in contact with the cortical surface and the elevated periosteum of the vascularized bone graft. After surgery, hypertrophic changes were evaluated radiographically. Twelve weeks after surgery, the reconstructed femurs were harvested for investigation by biomechanical and histologic methods.

Results: Rapid hypertrophy was observed on radiographs in the vascularized bone grafts with rhBMP-2-retaining implants. The increase of bone volume and the biomechanical strength were dependent on the dose of rhBMP-2 (p < 0.01). Histologic sections in the vascularized bone grafts with rhBMP-2-retaining implants revealed a large amount of newly formed bone.

Conclusion: The potential use of BMP may improve clinical outcome by promoting hypertrophy of the vascularized bone graft and shortening the treatment time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0b013e3181f95a73DOI Listing
January 2011

A tissue-engineered bioabsorbable nerve conduit created by three-dimensional culture of induced pluripotent stem cell-derived neurospheres.

Biomed Mater Eng 2011 ;21(5-6):333-9

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Japan.

We previously reported a bioabsorbable nerve conduit coated with Schwann cells for the treatment of peripheral nerve defects. Since there have been dramatic developments in induced pluripotent stem (iPS) cells in recent years, the purpose of the present study was to create a tissue-engineered nerve conduit coated with iPS cell-derived neurospheres. Such a conduit was constructed by three-dimensional (3D)-culture of these cells using a bioabsorbable polymer conduit as a scaffold. The nerve conduit was composed of a mesh of poly L-lactide, and a porous sponge of 50% poly L-lactide and 50% poly ε-caprolactone. The primary and secondary neurospheres (PNS and SNS, respectively) induced from iPS cells were suspended in individual conduits. The conduits were incubated for 7 or 14 days in vitro and then evaluated using immunohistochemistry. All of the 7- and 14-day differentiated PNS and SNS were observed to have adhered to the inner surface of the conduits and to have migrated into the inner porous sponge. The engrafted cells were positive for anti-Tuj1, -S-100 and -GFAP antibodies, indicating that their pluripotent ability to form neural or glial cells was maintained. These findings indicate the feasibility of creating nerve conduits coated with a 3D-culture of iPS cell-derived neurospheres for the treatment of peripheral nerve defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/BME-2012-0680DOI Listing
September 2012

Temporary scaphotrapezoidal joint fixation for adolescent Kienböck's disease.

J Hand Surg Am 2009 Jan;34(1):14-9

Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.

Purpose: There are few therapeutic guidelines for adolescent Kienböck's disease. The purpose of our study was to investigate the clinical and radiographic outcomes of temporary scaphotrapezoidal (ST) joint fixation for adolescent Kienböck's disease.

Methods: This was a retrospective review of 6 adolescent patients with Kienböck's disease treated by temporary ST joint fixation. All patients had pain with rest and activity before surgery. The mean patient age at the time of surgery was 14 years, and final follow-up examination was at a mean of 23 months. Under general anesthesia, 2 or 3 K-wires were inserted from the dorsal trapezoid to the scaphoid. The wires were removed at 3 to 6 months.

Results: Mean postoperative wrist extension and flexion were increased from 46 degrees and 48 degrees to 68 degrees and 77 degrees , respectively. These improvements were statistically significant compared with preoperative wrist extension and flexion. Grip strength significantly increased from 52% to 86% of the unaffected side. None of the 6 patients had postoperative pain either at rest or with activity. On final follow-up wrist x-ray films, none of the patients had sclerotic change or fragmentation of the lunate, although decreased lunate height remained in all patients. Magnetic resonance imaging revealed improvement to nearly normal intensity of the lunate on T1- and T2-weighted images in all patients.

Conclusions: Both clinical and radiographic outcomes of temporary ST joint fixation for adolescent Kienböck's disease were excellent. We therefore recommend this procedure for the surgical treatment of adolescent Kienböck's disease.

Type Of Study/level Of Evidence: Therapeutic IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2008.09.019DOI Listing
January 2009

Skiing-induced rupture of the extensor pollicis longus tendon: a report of three cases.

Clin J Sport Med 2008 May;18(3):292-4

Osaka City University Graduate School of Medicine, Osaka City, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSM.0b013e31816a1c83DOI Listing
May 2008

Volar dislocation of the extensor carpi ulnaris tendon on magnetic resonance imaging is associated with extensor digitorum communis tendon rupture in rheumatoid wrists.

J Hand Surg Am 2006 Nov;31(9):1454-60

Department of Rheumatology, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan.

Purpose: Extensor tendon rupture in rheumatoid wrists is a common problem and causes immediate dysfunction of the digits. The best treatment for tendon rupture may be prophylactic management, although the factors associated with tendon rupture must first be identified. The purpose of this study was to evaluate structures around rheumatoid wrists using magnetic resonance imaging with forearm rotation and to identify factors associated with extensor tendon rupture as indications for prophylactic surgery.

Methods: The subjects were 34 patients (40 wrists) with active rheumatoid arthritis. The extensor digitorum communis (EDC) tendons were ruptured in 15 wrists. Magnetic resonance imaging of the wrists was performed in maximally pronated and supinated positions of the forearm. Axial images of the distal radioulnar joints (DRUJs) were selected to evaluate DRUJ synovitis, dorsal tenosynovitis, volar dislocation of the extensor carpi ulnaris (ECU) tendon, sigmoid notch angle, and the radioulnar ratio (RUR) (ie, the degree of DRUJ subluxation).

Results: No significant correlations were found between EDC tendon rupture and DRUJ synovitis, dorsal tenosynovitis, or RUR in pronation. Extensor digitorum communis tendon rupture correlated significantly with volar ECU tendon dislocation, sigmoid notch angle, and RUR in supination. Radioulnar ratio correlated significantly with volar ECU tendon dislocation only in supination and not in pronation. Thus, DRUJ subluxation was advanced even in the supinated wrist with volar ECU tendon dislocation. As a factor associated with EDC tendon rupture, volar ECU tendon dislocation had 87% sensitivity and 76% specificity.

Conclusions: Volar ECU tendon dislocation is associated with increased RUR in supination and EDC tendon rupture. Volar ECU tendon dislocation can thus be considered a factor associated with EDC tendon rupture, and its presence may indicate the need for prophylactic surgical intervention in a subset of rheumatoid arthritis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2006.08.004DOI Listing
November 2006

Paediatric Galeazzi-equivalent fracture: two case reports.

Hand Surg 2005 ;10(2-3):249-54

Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Shibata, Osaka, Japan.

The authors present two rare cases of a paediatric Galeazzi-equivalent fracture. In contrast to Galeazzi's fracture-dislocation in adults, an epiphyseal separation of the distal ulna occurred instead of dislocation of the distal radioulnar joint (DRUJ) or both. A precise radiographic analysis of the epiphyseal separation of the distal ulna and its anatomical reduction were keys to obtaining a good result in the treatment of paediatric Galeazzi-equivalent fracture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S0218810405002735DOI Listing
June 2006

Time course of magnetic resonance images in an adolescent patient with Kienböck's disease treated by temporary scaphotrapezoidal joint fixation: a case report.

J Hand Surg Am 2006 Jan;31(1):63-7

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, and the Department of Orthopaedic Surgery, Higashisumiyoshi Morimoto Hospital, Higashisumiyoshi-ku, Osaka, Japan.

Unlabelled: Kienböck's disease in a 15-year-old girl was treated successfully by temporary scaphotrapezoidal joint fixation using longitudinal K-wires. Repeated magnetic resonance imaging begun 3 months after surgery showed progressive increases in signal intensity on T1-weighted sequences of the lunate and was almost normal 6 months after surgery. The K-wires used for the temporary joint fixation were removed 6 months after surgery. The signal intensity of the lunate on magnetic resonance images remained normal 2 years after surgery. At that time plain x-ray showed no sign of lunate sclerosis and there was no cystic shadow or sign of advanced collapse. At 2 years after surgery the patient does not complain of wrist pain, can lead a normal daily life, and plays sports without difficulty.

Type Of Study/level Of Evidence: Therapeutic, Level IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2005.08.015DOI Listing
January 2006

Palmar plating for AO/ASIF C3.2 fractures of the distal radius with arthroscopically assisted reduction.

Hand Surg 2005 Jul;10(1):71-6

Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka City, 530-0012, Osaka, Japan.

We performed a retrospective study of 15 patients with AO/ASIF C3.2 fracture of the distal radius. All patients were treated with arthroscopically assisted reduction of the radiocarpal joint followed by palmar plating with autologous bone graft, with a follow-up evaluation of 24 months. According to the demerit point system of Gartland and Werley, five patients had excellent results and 10 had good results. Grade 1 arthritic changes were found in 10 patients even though with no step-off on radiographs. In the current study, this combined treatment was challenging and useful for AO/ASIF C3.2 fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S0218810405002590DOI Listing
July 2005

Palmar plating system for Colles' fractures--a preliminary report.

J Hand Surg Am 2005 Jul;30(4):750-5

Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan.

Purpose: To present our results of the palmar plating system that we developed for the treatment of Colles' fractures.

Methods: By using the palmar plating system that we developed a consecutive series of 40 acute Colles' fractures were treated surgically. There were 12 men and 28 women with a mean age of 57 years at the time of the injury (range, 25-90 y). All patients had internal fixation using the trans-flexor carpi radialis tendon approach. The system has 3 main features. First, the plate is small in size, being 1.1 mm in thickness and 47 mm in length. Only a 3- to 4-cm skin incision is required for application of the plate. Second, the screw is cannulated and cancellous in type, with a low-profile head. Subchondral screw fixation is achieved both easily and safely by using a guidewire. Third, the plate has a window through which injectable bone cement can be placed.

Results: Union was achieved in all patients. The palmar tilt, radial inclination, radial length, and ulnar variance were maintained after surgery. According to the Gartland and Werley rating scale that was modified by Sarmiento there were 12 excellent and 28 good results. There were no extensor tendon injuries that could occur when the dorsal approach was used.

Conclusions: This palmar plating system can make fixation of the distal radius easy, safe, and effective in the treatment of unstable Colles' fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2005.02.009DOI Listing
July 2005

Bilateral recurrent dislocation of the ulnar nerve in semiprofessional swimmer: a case report.

Clin J Sport Med 2005 May;15(3):191

Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.jsm.0000164040.91787.e7DOI Listing
May 2005
-->