鈴木 崇根

The interosseous membrane (IOM) of the forearm plays a crucial role in facilitating forearm function and mechanical load transmission between the radius and ulna. Accurate characterization of its biomechanical properties is essential for developing realistic finite element models of the forearm. This study aimed to investigate the mechanical behavior and material properties of the central fibrous regions of the IOM using fresh frozen cadavers. Ten forearms from five cadavers were dissected, preserving the IOM and identifying the distal accessory band (DAB), central band (CB), and proximal accessory band (PAB). Bone-ligament-bone specimens were prepared and subjected to uniaxial tensile testing, with the loading direction aligned with the fiber orientation. Force-displacement curves were obtained and converted to force-strain and stress-strain curves using premeasured fiber lengths and cross-sectional areas. The results demonstrated distinct mechanical responses among the IOM regions, with the PAB exhibiting significantly lower force-strain behavior compared to the DAB and CB. The derived force-strain and stress-strain relationships provide valuable insights into the regional variations in stiffness and strength of the IOM, highlighting the importance of considering these differences when modeling the IOM in finite element analysis. In conclusion, this study establishes a foundation for the development of advanced finite element models of the forearm that accurately capture the biomechanical behavior of the IOM.

PURPOSE: This study aimed to introduce a novel technique using the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Furthermore, the efficacy of this novel method and the traditional Camitz technique was compared. METHODS: Patients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7 and 9 surgeries) or the Camitz technique (n = 8 and 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score were assessed. The repeated measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. RESULTS: The novel technique was associated with a significant postoperative improvement in palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score. In particular, the thumb-ring finger opposition angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. CONCLUSION: The novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic 4; Surgical technique.

PURPOSE: To investigate longitudinal changes in bone mineral density (BMD) in middle-aged female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS). METHODS: The study subjects were 229 female patients who were diagnosed with AIS and underwent spinal fusion between 1968 and 1988. A two-step survey study was conducted on 19 female AIS patients. BMD, Z-scores, T-scores, and the prevalence of osteoporosis and osteopenia were compared between the initial (2014-2016) and second (2022) surveys. Correlations between the annual changes in Z-scores and T-scores with radiographic parameters, body mass index (BMI), and the number of remaining mobile discs were analyzed. RESULTS: BMD decreased significantly from the initial (0.802 ± 0.120 g/cm2) to the second survey (0.631 ± 0.101 g/cm2; p < 0.001). Z-scores decreased from 0.12 ± 1.09 to - 0.14 ± 1.04, while T-scores decreased significantly from - 0.70 ± 1.07 to - 1.77 ± 1.11 (p < 0.001). The prevalence of osteopenia and osteoporosis increased significantly from 36.8% to 89.5% (p = 0.002), but the increase in osteoporosis alone was not statistically significant (5.3% to 26.3%; p = 0.180). Moderate negative correlations were found between annual changes in Z-scores and both main thoracic (MT) curve (r = - 0.539; p = 0.017) and lumbar curve (r = - 0.410; p = 0.081). The annual change in T-scores showed a moderate negative correlation with the MT curve (r = - 0.411; p = 0.081). CONCLUSION: Significant reductions in BMD and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population. Larger residual curves could pose an added osteoporosis risk. Further research is needed to understand if the onset of osteoporosis in AIS patients is attributable to the condition itself or the surgical intervention.

MRIのCT-like bone contrastであるPhilips社のFRACTUREは,骨のみならず腱の描出にも優れる.さらにこれを元にVR画像を作成すると患者そのものの解剖図を得られる.これらの画像が手指腱損傷の診断に有用であるか検証した.対象は当院でMRI検査を行った腱損傷患者12名で,撮影条件はFRACTURE(VR像も作成),T2WI,3D PDWI,STIR等とし,手術に関与しなかった整形外科医3名が,FRACTURE MPR像,FRACTURE VR像,FRACTURE以外のシークエンスの3種類の方法で読影した.1.読影の正確性,2.読影に要した時間,3.読影しやすさに関して検討すると,FRACTUREは他のシークエンスと比較し全ての評価項目で優れていた.また手術症例ではFRACTURE VR像と術野の断裂部は概ね一致した.母指・小指の腱についてはmagic angle effectによるアーチファクトを考慮する必要があるが,撮像肢位を工夫することで回避できる.FRACTUREは手指腱の描出能が高く,手外科領域の臨床において有用と考える.(著者抄録)

MRIのCT-like bone contrastであるPhilips社のFRACTUREは,骨のみならず腱の描出にも優れる.さらにこれを元にVR画像を作成すると患者そのものの解剖図を得られる.これらの画像が手指腱損傷の診断に有用であるか検証した.対象は当院でMRI検査を行った腱損傷患者12名で,撮影条件はFRACTURE(VR像も作成),T2WI,3D PDWI,STIR等とし,手術に関与しなかった整形外科医3名が,FRACTURE MPR像,FRACTURE VR像,FRACTURE以外のシークエンスの3種類の方法で読影した.1.読影の正確性,2.読影に要した時間,3.読影しやすさに関して検討すると,FRACTUREは他のシークエンスと比較し全ての評価項目で優れていた.また手術症例ではFRACTURE VR像と術野の断裂部は概ね一致した.母指・小指の腱についてはmagic angle effectによるアーチファクトを考慮する必要があるが,撮像肢位を工夫することで回避できる.FRACTUREは手指腱の描出能が高く,手外科領域の臨床において有用と考える.(著者抄録)

Platelet-rich plasma (PRP) promotes bone union through osteoinduction. We investigated whether adding demineralized bone matrix (DBM), derived naturally from biomaterial and with various growth factors, for osteoconductivity and bone marrow fluid for osteogenesis results in different bone unions. Eight-week-old male Sprague-Dawley rats were divided into four groups of five based on transplantation material: sham control (C group); DBM alone (D group); DBM + PRP (DP group); and DBM + PRP + bone marrow fluid (DPB group). After posterolateral fusion at L3-5, postoperative weekly CT imaging determined average number of bone union in facet joints (4 joints × 5 animals = 20 joints) and bone formation. Pathological evaluation and bone strength were assessed using 3-point bending two weeks postoperatively. Facet joint bone union at four weeks postoperatively was 4/20 (20%, DP group) and 8/20 (40%, DPB group) joints. Six weeks postoperatively, it was 7/20 (35%, D group), 12/20 (60%, DP group), and 16/20 (80%, DPB group). Eight weeks postoperatively, it was 13/20 (65%, D group), 17/20 (85%, DP group), and 20/20 (100%, DPB group), suggesting that DPB > DP > D > C. Bone formation and bone strength showed a similar DPB > DP > D > C group trend. Adding PRP and bone marrow fluid to DBM promotes bone union and strength.

Precisely detecting puncture times has long posed a challenge in medical education. This challenge is attributable not only to the subjective nature of human evaluation but also to the insufficiency of effective detection techniques, resulting in many medical students lacking full proficiency in injection skills upon entering clinical practice. To address this issue, we propose a novel detection method that enables automatic detection of puncture times during injection without needing wearable devices. In this study, we utilized a hardware system and the YOLOv7 algorithm to detect critical features of injection motion, including puncture time and injection depth parameters. We constructed a sample of 126 medical injection training videos of medical students, and skilled observers were employed to determine accurate puncture times. Our experimental results demonstrated that the mean puncture time of medical students was 2.264 s and the mean identification error was 0.330 s. Moreover, we confirmed that there was no significant difference (p = 0.25 with a significance level of α = 0.05) between the predicted value of the system and the ground truth, which provides a basis for the validity and reliability of the system. These results show our system’s ability to automatically detect puncture times and provide a novel approach for training healthcare professionals. At the same time, it provides a key technology for the future development of injection skill assessment systems.

BACKGROUND: Salvage procedures for distal radioulnar joint (DRUJ) arthritis, like the Darrach or Sauvé-Kapandji (S-K) procedures, often result in extensor tendon ruptures at the ulnar stump. Radioulnar instability is considered the underlying cause and stump stabilization techniques are employed. This study investigated radioulnar instability, extensor tendon irritation, and the effectiveness of stump stabilization techniques following salvage procedures. METHODS: Six upper limbs from three cadavers were used. Forearm rotation was measured using magnetic position sensors to assess radial movement. The Darrach procedure was performed on two limbs, comparing radial motion ranges for different ulnar osteotomy positions. The risk of tendon rupture was assessed with applied weight. The S-K procedure was performed on four limbs, evaluating stump stabilization techniques and radial movement distance underweight. RESULTS: Proximal osteotomy positions increased radial motion range. Extensor tendon irritation occurred when the load was applied to the volar and ulnar sides, particularly with a pronated forearm. Stump stabilization techniques did not significantly contribute to ulnar stump stabilization. CONCLUSIONS: Proximal ulnar osteotomy positions in DRUJ salvage procedures led to increased radioulnar instability and potential complications. Load application on the volar and ulnar sides, especially in a pronated forearm, increased the risk of tendon rupture. Stump stabilization techniques showed limited utility in stabilizing the ulnar stump or reducing complications. These findings can inform strategies for minimizing complications in DRUJ salvage procedures.

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim was to clarify the health-related quality of life (QOL) of patients who had adolescent idiopathic scoliosis (AIS) at a minimum of 40 years after surgery. SUMMARY OF BACKGROUND DATA: The postoperative health-related QOL of middle-aged patients with AIS has been reported to be good, but that of middle-aged and older patients with AIS has yet to be completely explored. MATERIALS AND METHODS: We included 179 patients with AIS who underwent spinal fusion(s) between 1968 and 1982. We conducted three surveys in 2009, 2014, and 2022. Patients self-administered both the Scoliosis Research Society-22 and the Roland-Morris Disability questionnaires three times (in 2009, 2014, and 2022) and the Oswestry Disability Index (ODI) questionnaire was self-administered in 2014 and 2022. We considered patients who responded to all three surveys in 2009, 2014, and 2022. RESULTS: For the Scoliosis Research Society-22 questionnaires, no significant differences were detected among the three time points (2009, 2014, and 2022) for total scores, function domain, pain domain, self-image domain, mental domain, or satisfaction domain. The results of the Roland-Morris Disability Questionnaire were also not significantly different among the surveys over time. The ODI questionnaires revealed a significant worsening of the 2022 results compared with the 2014 results. Eight patients (29.6%) who had an ODI deterioration of 10% or more had numerically fewer mobile lumbar disks than those with <10% deterioration of the ODI, although the difference did not reach statistical significance. CONCLUSION: Among patients with AIS who underwent spinal fusion(s) between 1968 and 1982, we found health-related QOL to be maintained over the last 13 years. Relatively good QOL was appreciated in this population of patients who are now middle-aged and older.

BACKGROUND: Diclofenac etalhyaluronate (DF-HA) is a recently developed analgesic conjugate of diclofenac and hyaluronic acid that has analgesic and anti-inflammatory effects on acute arthritis. In this study, we investigated its analgesic effect on osteoarthritis, using a rat model of monoiodoacetate (MIA). METHODS: We injected MIA into the right knees of eight 6-weeks-old male Sprague-Dawley rats. Four weeks later, rats were randomly injected with DF-HA or vehicle into the right knee. Seven weeks after the MIA injection, fluorogold (FG) and sterile saline were injected into the right knees of all the rats. We assessed hyperalgesia with weekly von Frey tests for 8 weeks after MIA administration. We took the right knee computed tomography (CT) as radiographical evaluation every 2 weeks. All rats were sacrificed 8 weeks after administration of MIA for histological evaluation of the right knee and immunohistochemical evaluation of the DRG and spinal cord. We also evaluated the number of FG-labeled calcitonin gene-related peptide (CGRP)-immunoreactive(ir) neurons in the dorsal root ganglion (DRG) and ionized calcium-binding adapter molecule 1 (Iba1)-ir microglia in the spinal cord. RESULTS: Administration of DF-HA significantly improved pain sensitivity and reduced CGRP and Iba1 expression in the DRG and spinal cord, respectively. However, computed tomography and histological evaluation of the right knee showed similar levels of joint deformity, despite DF-HA administration. CONCLUSION: DF-HA exerted analgesic effects on osteoarthritic pain, but did not affect joint deformity.

The "Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine" drafted by the Japan Surgical Society (JSS) and the Japanese Association of Anatomists in 2012 helped dispel legal concerns over cadaver surgical training (CST) and the usage of donated human bodies for research and development (R&D) in the country. Subsequently, in the fiscal year 2018, the Ministry of Health, Labour and Welfare increased the funding for CST, prompting its wider implementation. This study analyzed data obtained in 2012-2021 through the reporting system of the JSS-CST Promotion Committee to map the usage of cadavers for clinical purposes, specifically education and R&D, in Japan. We found that the number of medical universities using cadavers for CST and R&D programs was just 5 in 2012, and it reached 38 for the decade. Thus, about half of Japan's medical universities implemented such programs over the period. Meanwhile, the total number of programs was 1,173. In the clinical field, the highest number of programs were implemented in orthopedics (27%), followed by surgery (21%), and neurosurgery (12%). Based on the purpose, the most common objective of the programs (approximately 70%) was acquiring advanced surgical techniques. Further, the highest number of programs and participants were recorded in 2019 (295 programs, 6,537 participants). Thus, the guidelines helped expand cadaver usage for clinical purposes in Japan. To further promote the clinical usage of cadavers in medical and dental universities throughout Japan, sharing know-how on operating cadaver laboratories and building understanding among the general public is recommended.

Cadaver surgical training (CST), which ensures medical safety by improving the skills of surgeons, is popular overseas. However, training involves ethical issues given the use of cadavers. In 2012, the Japan Surgical Society and the Japanese Association of Anatomists compiled and opened the "Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine (Guideline 2012)" to the public. This has allowed Japan to conduct CST or research under the regulations of Postmortem Examination and Corpse Preservation Act and the Body Donation Act. However, its dissemination has been sluggish. The Clinical Anatomy Lab (CAL), established in 2010 at Chiba University, is a facility for conducting CST and research. In the 11 years since its inception, 250 programs have been implemented. Orthopedics had the most implemented in the clinical field, with 120 (48%), followed by emergency and critical care medicine with 27 (10.8%), and neurological surgery with 27 (10. 8%). Based on the purpose of the training, the most common objective for the programs (approximately 83%) was education. Further, the highest number of programs was recorded in 2018 (34) and participants in 2017 (631). The implementation of CST requires more than just guiding surgeons to a dissection practice room. There are several methods of preserving cadavers to make them suitable for CST. For various surgical simulations, an operating table is more suitable than a dissection table. The current paper provides information on how to implement CST in universities that have so far only worked on anatomy education for medical students.

This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.

This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.

BACKGROUND: Autologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury. RESULTS: The rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. Gene expression of HO-1 was evaluated by quantitative polymerase chain reaction (qPCR). The response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group. CONCLUSIONS: FVW increased the withdrawal threshold similar to VW in a rat CCI model for short periods. Frozen vein wrapping using vein allograft without donor site morbidity may be an alternative therapeutic option.

BACKGROUND: Monoiodoacetate (MIA)-induced arthritis models are used widely in osteoarthritis (OA) research to develop effective conservative treatments for hip OA, as an alternative to joint replacement surgery. In joint OA models, such as the MIA-induced knee OA model, various doses of MIA are utilized, depending on the purpose of the research. So far, only 2 mg of MIA has been used for MIA-induced hip OA research. We hypothesized that the amount of MIA should be adjusted according to the osteoarthritis model under investigation. We performed radiographic and histological evaluations in rats for hip OA models induced by different doses of MIA. METHODS: One hundred and eighty right hips of six-week-old, male Sprague-Dawley rats (n = 30 rats per group) were treated with either a single intra-articular injection of various doses of MIA (0.25, 0.5, 1.0, 2.0, and 4.0 mg) dissolved in 25 μl of sterile saline (MIA group), or with 25 μl of sterile saline alone (Sham group). Radiographic and histological evaluations of the hip joint were performed at one, two, four, eight, and 12 weeks after administration (n = 6 rats per group per time point). RESULTS: OA changes progressed from 1 week after administration in the 1.0-mg, 2.0-mg, and 4.0-mg MIA groups. The degree of OA changes increased as the dose of MIA increased. The 0.25-mg and 0.5-mg MIA groups presented fewer OA changes than the 2.0-mg and 4.0-mg MIA groups during the entire study period (up to 12 weeks). The administration of 0.25 mg and 0.5 mg of MIA-induced both radiographic and histological OA changes in a time-dependent manner, whereas more than 2 mg of MIA provoked end-stage OA at 8 weeks after injection. Absolute, dose-dependent histopathological OA changes were observed 4 weeks after MIA administration. CONCLUSIONS: Intra-articular MIA injection to the hip joints of rats induced diverse OA changes dose-dependently. Research for developing novel conservative treatments for hip OA and intractable pain should consider the pathological condition when determining the dose of MIA to be employed.

BACKGROUND: Proximal femur fractures are usually categorized as either a cervical or trochanteric fracture, but the relationship between fracture type and fall direction is not clear. By cadaveric mechanical testing and finite element analysis (FEA), the aims of this research were to verify the factors that define the proximal femur fracture type and to clarify the change in stress distribution based on fall direction. METHODS: From fresh frozen cadavers, we obtained 26 proximal femora including ten pairs of 20 femora. We conducted quasi-static compression tests in two fall patterns (lateral and posterolateral), and identified the fracture type. We then examined the relationship between fracture type and the following explanatory variables: age, sex, neck shaft angle, femoral neck length, bone mineral density (cervical and trochanteric), and fall direction. In addition, for the ten pairs of femurs, the effect of fall direction on fracture type was examined by comparing the left and right sides. In addition, we generated the proximal femur finite element (FE) models from computed tomography data to simulate and verify the change of external force in different fall directions. RESULTS: In mechanical tests, only fall direction was found to have a significant relationship with fracture type (p = 0.0227). The posterolateral fall group had a significantly higher incidence of trochanteric fractures than lateral fall group (p = 0.0325). According to FEA, the equivalent stress in the lateral fall was found to be more concentrated in the cervical area than in the posterolateral fall. CONCLUSION: In proximal femur fractures, fall direction was significantly associated with fracture type; in particular, trochanteric fractures were more likely to occur following a posterolateral fall than a lateral fall.

Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment. This study aimed to investigate the relationship between intertendinous septum's presence or absence, internal pressure and wrist positon in the first compartment. Fourteen arms were obtained from seven fresh frozen cadavers. A pressure sensor was inserted into the first compartment; if a septum was present, the pressure sensor was inserted into the abductor pollicis longus (APL) side and the extensor pollicis brevis (EPB) side, respectively. Three wrist positions were also tested: neutral, 45° flexion, and 45° extension. Intertendinous septa were present in seven wrists. The average pressure change in the first compartment measured on the EPB side of a present septum was significantly greater than that measured on the APL side of a present septum or where no septum existed: no septum = 54.6 ± 48.3 kPa; septum, EPB = 81.7 ± 76.5 kPa; and septum, APL = 32.8 ± 37.4 kPa. The average pressure change was also significantly greater in the flexion wrist position relative to the neutral and extension positions: neutral = 36.3 ± 58.0 kPa; 45° flexion = 79.5 ± 65.9 kPa; and 45° extension = 50.4 ± 42.6 kPa. Clear relationships existed between (1) the presence of a septum and increased internal pressure on the EPB side in the first compartment and (2) increased internal pressure with the wrist at 45° flexion compared with the neutral and extension position.

BACKGROUND: The preservation of soft tissues is an important factor for preventing dislocation after total hip arthroplasty. Anatomical studies have revealed that the inferior iliofemoral ligament (ILFL) contributes significantly to the native stability of the hip. This study aimed to investigate the anatomical structures of the iliocapsularis muscle (ICM) and ILFL from a surgical perspective. METHODS: In total, we assessed 50 hip specimens from 25 embalmed cadavers. The size and location of ICM and ILFL (at the upper, middle, and lower parts of the femoral head) were assessed in a neutral position. The ratio of ICM and ILFL widths to the femoral head was evaluated. RESULTS: The mean ICM and ILFL widths were 7.5 and 14.6, 12.0 and 14.2, and 12.8 and 15.2 mm at the upper, middle, and lower levels, respectively. The mean ICM thicknesses were 1.3, 9.0, and 9.1 mm at the upper, middle, and lower levels, respectively. The distributions of ICM and ILFL from the lateral edge of the femoral head were 21.1%-37.4% and 4.9%-36.5%, 9.5%-35.6% and 7.9%-38.7%, and 11.0%-38.7% and 9.5%-42.4% at the upper, middle, and lower levels, respectively. CONCLUSION: ICM and ILFL were located at the anterolateral side of the femoral head, and the medial edge of the ILFL corresponded to that of the ICM. ICM can serve as a landmark for preserving ILFL in total hip arthroplasty using the anterior approach.

We investigated the analgesic effects of tramadol and the arthritic changes following tramadol administration in the rat hip osteoarthritis (OA) model using mono-iodoacetate (MIA). The right hip joints of male Sprague-Dawley rats (n = 5 rats/group) in the Sham group were injected with 25 μl of sterile saline and 1% of fluorogold (FG) retrograde neurotracer. In the MIA + Vehicle and MIA + Tramadol groups, FG and 25 μl of sterile saline with 0.5 mg of MIA were injected into the right hip joint. The MIA + Vehicle and MIA + Tramadol groups were administered daily for 4 weeks, either sterile saline (10 mg/kg, intraperitoneal [i.p.]) or tramadol (10 mg/kg, i.p.). We assessed hyperalgesia every week after MIA administration. Histopathological changes and immunoreactive neurons for calcitonin gene-related peptide (CGRP) in dorsal root ganglia (DRG) were evaluated after 4 weeks of treatment. MIA injection into the hip joint led to mechanical hyperalgesia (p < 0.01), which was significantly reduced by tramadol administration (p < 0.01). Furthermore, daily i.p injection of tramadol significantly suppressed CGRP expression in DRG (p < 0.0001). MIA + Vehicle and MIA + Tramadol groups showed significant cartilage reduction and degeneration compared to the Sham group (p < 0.0001). Interestingly, OA changes significantly progressed in the MIA + Tramadol group compared to the MIA + Vehicle group (p < 0.0001).

Purpose: To determine the optimal timing of plate removal in patients with forearm diaphyseal fractures fixed with a locking plate via the analysis of bone atrophy over time. Methods: The study subject was a 56-year-old man. Computed tomography was performed at 0.5, 1, 1.5, 2, 3, 4, and 5 years after plate fixation. Finite element analysis was performed to measure the fracture load of the radius and ulna. The fracture loads of the affected and healthy sides were compared, and their ratio was calculated by dividing the value of the affected side by that of the healthy side at each time point. Results: The strength of the radius and ulna was 40.9% and 29.3%, respectively, on the healthy side at 1 year after surgery. The fracture load increased from the second to the third postoperative year; the strength of the radius and ulna was 62.2% and 37.3%, respectively, on the healthy side after the third year. However, after the third year, the fracture load declined and reached 38.8% and 18.9% for the radius and ulna, respectively, on the healthy side by the fifth postoperative year. Conclusions: The long-term fixation of forearm diaphyseal fractures using a locking plate leads to progressive bone atrophy. Future bone atrophy during long-term locking plate fixation without removal should be monitored. Type of study/level of evidence: Therapeutic IV.

Objective: Our knowledge of human neural crest stem cells (NCSCs) is expanding, owing to recent advances in technologies utilizing human-induced pluripotent stem cells (hiPSCs) that generate NCSCs. However, the clinical application of these technologies requires the reduction of xeno-materials. To overcome this significant impediment, this study aimed to devise a novel method to induce NCSCs from hiPSCs without using a feeder cell layer. Materials and Methods: hiPSCs were cultured in feeder-free maintenance media containing the Rho-associated coiled-coil forming kinase inhibitor Y-27632. When the cells reached 50-70% confluence, differentiation was initiated by replacing the medium with knockout serum replacement (KSR) medium containing Noggin and SB431542. The KSR medium was then gradually replaced with increasing concentrations of Neurobasal medium from day 5 to 11. Results: Immunocytochemistry and flow cytometry were performed 12 days after induction of differentiation and revealed that the cells generated from hiPSCs expressed the NCSC markers p75 and HNK-1, but not the hiPSC marker SOX2. Conclusion: These findings demonstrate that hiPSCs were induced to differentiate into NCSCs in the absence of feeder cells.

Background: The purpose of the present study was to assess the biomechanical strength and properties of a modified Krackow technique for side-to-side tendon repair with a short overlap length. Methods: The flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus muscles were harvested from 10 fresh frozen cadavers. Overall, 60 tendon repairs were divided into four groups based on the suture technique: modified Krackow technique repair (KT); weave suture repair (WS); mattress suture repair (MS); and composite technique repair (CT), a combination of the modified Krackow and weave suture techniques. Single loading mechanical tests were performed, and the results for each suture technique were compared. Results: Ultimate loads for KT, WS, MS, and CT were 155 ± 45 N, 122 ± 18 N, 92 ± 31 N, and 163 ± 22 N, respectively. KT and CT had significantly higher ultimate loads than the other groups. However, the difference between the KT and CT groups in terms of ultimate load was not significant. Conclusions: Based on the results from the single loading tests, the use of the modified Krackow and composite techniques appeared to provide stronger fixation than that with the use of the weave and mattress sutures with a short overlap length.

We used five fresh-frozen cadavers with 10 upper limbs to evaluate by finite element analysis (FEA) the plate fixation of distal radius fractures. The distal radius of the cadavers was fractured using a comminution fracture model. Plate fixation was performed using Synthes VATCP. Compression tests were performed on these specimens and force displacement curves were obtained. FEA was performed using Mechanical Finder. The Keyak, Keller vertebra, Carter, and Matsuyama conversion equations without contact analysis, and the Matsuyama equations with contact analysis, were used for the boundary conditions. We found strong positive correlations with the Matsuyama conversion equations either with or without contact analysis. The validated FEA model will be used for preoperative simulation of actual fractures.

Purpose: The triangular fibrocartilage complex (TFCC) is an important tissue stabilizer for the distal radioulnar joint, but stress distribution on the TFCC is not clear. The purpose of this study was to report the stress distribution of the TFCC using finite element analysis (FEA). Methods: Pathological specimens of the wrist joint from an 80-year-old man were imported into a finite element analysis software package, and regions of interest including bone, soft tissue, and TFCC were extracted to create a 3-dimensional model. The material properties were obtained from previous research using cadaver specimens. To allow large deformations, we used hyperelastic elements to model the TFCC and soft tissue. Bone was defined as a uniform tissue that did not break. With the carpals and radius constrained, the rotation axis was set at the center of the ulnar head and a force was applied to move the ulnar head in pronation and supination. Under these boundary conditions, the behavior of the TFCC was extracted as a moving image. The average value of the maximum principal stress for each component of the TFCC was extracted and graphed. Results: In the supinated position, the maximum principal stress was found on the palmar side of the TFCC (eg, on the tension side). In pronation, the maximum principal stress was found on the dorsal side. Conclusions: This study clearly showed the 3-dimensional structure of the TFCC and analyzed its stress distribution under load. In supination, mean values of the maximum principal stress were greater on the palmar fibers than the dorsal fibers. In pronation, mean maximum principal stress was greater on the dorsal fibers than the palmar fibers. Clinical relevance: Knowing the distribution of stresses in the TFCC is an important factor in developing treatment strategies for a pathologic TFCC.