BACKGROUND: The Japanese Clinical Orthopaedic Association conducted a survey to comprehensively analyze the risk factors for bone fragility fractures, which are a great threat to independence in older adults.

MATERIALS and METHODS: New fragility fracture was the main outcome, and basic patient attributes, bone mineral content, existing bone fragility fractures, the 5-question Geriatric Locomotive Function Scale, and balance-related symptoms were the survey items.

RESULTS: Locomotive syndrome (≥6 on the 5-question Geriatric Locomotive Function Scale) was diagnosed in 477 of 799 subjects. New bone fragility fractures occurred in 54 of 699 subjects in the follow-up survey and new falls occurred in 129 subjects. A prospective analysis of risk factors for bone fragility fractures was conducted, and correlations were found between falls in the follow-up period, balance-related symptoms, and calf circumference.

DISCUSSION: The present results indicated that analysis of not only bone mineral content but also comprehensive motor balance function is needed to identify risk factors for bone fragility fractures.

CONCLUSION: Falls in the follow-up period, balance-related symptoms, and calf circumference were correlated with bone fragility fractures.

OBJECTIVE: We report the utility of buprenorphine transdermal analgesic patches in elderly patients with chronic pain.

METHODS: We studied 38 patients (14 male and 24 female). The average age was 78.5 years (range, 65-91 years). We investigated the persistence rate, efficacy, and occurrence of side effects of buprenorphine transdermal analgesic patch use.

RESULTS: The persistence rate was 63.2%. Patients continued to use the analgesic for an average of 17.8 weeks. The average visual analogue scale (VAS) score before using buprenorphine transdermal analgesic patcheswas 80.4mm, and the VAS score decreased to 50.8mm thereafter. There were many cases in which a statistical significant difference was found. Discontinuation due to side effects, primarily nausea and dizziness, was reported in 14 cases.

DISCUSSION: Buprenorphine transdermal analgesic patches are considered useful for patients with chronic pain who have medical complications. Buprenorphine transdermal analgesic patches are also useful for patients who are unable or unwilling to use injectable or oral medications. Despite the side effects identified at the beginning of treatment, the persistence rate was relatively good.

CONCLUSION: Buprenorphine transdermal analgesic patches were effective in elderly patients with chronic pain.

OBJECTIVE: In this article, we reveal the relationship of the presence/absence of locomotive syndrome (hereinafter simply referred to as locomo) detected using Locomo-25 with kyphotic posture and the spinal range of motion.

SUBJECTS and METHODS: The subjects were 92 outpatients aged 60 years or older who visited our hospital. On the basis of the assessment using Locomo-25, the patients were assigned to the locomo group or non-locomo group. Rising assessment and the two-step test were carried out, and the kyphotic index, thoracolumbar rotation range of motion, and thoracolumbar extension range of motion in the prone press-up position were measured and compared between the groups; the relationship between the results of Locomo-25 and other measures were also evaluated.

RESULTS: The rising assessment and two-step test showed significant differences between the groups. As for the functions of the spine, the thoracolumbar extension range of motion showed significant differences, while the kyphotic index and thoracolumbar rotation range of motion showed no significant differences between the two groups. The results of Locomo-25 were correlated with the results of rising assessment and the two-step test, and with the thoracolumbar extension range of motion, but not with the kyphotic index or thoracolumbar rotation range of motion.

DISCUSSION: The function of the spine most closely related to the development of locomo is the thoracolumbar extension range of motion. Severe kyphotic posture does not necessarily result in locomo, and a decreasing extension range of motion is considered to be associated with an increasing severity of locomo.

CONCLUSIONS: In addition to the currently used assessments, static posture as well as range of motion of the spine should also be assessed. Especially, assessment of the extension range of motion is essential in patients with locomo.

INTRODUCTION: We report the imaging findings and treatment course in two patients with Sinding-Larsen-Johansson disease.

CASE: The first case was a 10-year-old boy who was a member of a soccer club. He gave a history of feeling slight pain in the left knee after soccer practice. Subsequently, his knee pain became severe when he landed from a high jump in a physical education class. The pain worsened markedly, making it difficult to walk, and he presented to our department. On the basis of the plain x-ray, computed-tomographic (CT) and magnetic resonance imaging (MRI) findings, we made the diagnosis of avulsion fracture-type Sinding-Larsen-Johansson disease. The patient was treated conservatively, and 8 months later, the radiographs showed union of the calcified lesion and patella. The second case was a 12 year-old boy who belonged to a kendo club. He developed left knee pain upon landing from a height during practice for a hurdle race in a physical education class at school. The pain resolved with rest. However, the knee pain recurred when the boy jumped for a running broad jump, and he presented to our department. On the basis of the clinical, plain x-ray and MRI findings, we made the diagnosis of avulsion fracture-type Sinding-Larsen–Johansson disease. The patient was treated conservatively, and by one month later, the pain had resolved and the treatment was completed.

DISCUSSION: We have few opportunities to encounter Sinding-Larsen–Johansson disease, however, the findings on physical examination, such as tender points, CT and MRI, were useful for the diagnosis of the disease in our patients.

CONCLUSION: We encountered two cases of avulsion fracture-type Sinding-Larsen-Johansson disease and were able to observe the time-course of changes in the radiographs until healing in one of the cases. In both cases, conservative treatment alleviated the symptoms and yielded good outcomes.

INTRODUCTION: Lipomas are most frequently encountered in the limbs and trunk, and are rarely found in the palms. In this article, we report the cases of two patients that we encountered with lipomas of the palm.

CASES: The first patient was an 83-year old woman who visited our hospital with the chief complaint of a swelling in the left palm. Ultrasonography confirmed the presence of a mass which appeared to be firmly attached to a tendon, with a positional relationship to blood vessels. Magnetic resonance imaging (MRI) showed that the mass had the same signal intensity as fat. Surgical findings revealed a tumor located deep to the superficial palmar arch, which was firmly attached to the flexor tendon of the index finger. The second patient was a 74-year old woman who visited our hospital with the chief complaint of a swelling in the left palm. Ultrasonography showed the mass compressing and displacing the vessels deeper into the palm. MRI showed that the mass had the same signal intensity as fat. Surgical findings revealed that the tumor was located within the thenar muscles, being firmly attached to muscle. In both cases, the histopathological diagnosis was lipoma.

DISCUSSION: While in our present two cases, the presenting symptom was limited to a swelling in the palm, soft tissue tumors occurring in the deep palmar space are unlikely to be detected until they become relatively large.

CONCLUSIONS: For lipomas developing in the palm, MRI and ultrasonography were useful for differential diagnosis and for identification of the positional relationship between the lipoma and the muscles, tendons and neurovascular bundles of the palm.

INTRODUCTION: Fracture dislocation of the 4th and 5th carpometacarpal joints (CM joints) is a relatively rare injury, which occurs when longitudinal pressure is applied to the metacarpal bone.

STUDY SUBJECTS and METHODS: The study subjects were three patients with fracture dislocation of the 4th and 5th CM joints who received treatment at our hospital during the 5 year period from 2010 to 2014. All the three patients were treated by surgery. For fracture of the base of the 5th metacarpal, osteosynthesis with pinning was performed. For hamate body fracture, screw fixation with pinning was performed. For hamate body fracture associated with capitate fracture and fracture of the base of the 3rd metacarpal, pinning fixation was performed after reduction of each fracture.

RESULTS: In all 3 patients, good fracture reduction was achieved, with consequent bone fusion. Thus, good clinical results were obtained.

DISCUSSION: Radiographic images taken in two directions alone are insufficient for making an accurate diagnosis of fracture dislocation of the 4th and 5th CM joints. When fracture dislocation of the 4th and 5th CM joints is suspected, it is necessary to examine radiographic images taken in 4 directions, including images obtained at 30-degrees internal rotation and 60-degrees external rotation. Computed tomography (CT) is also useful.

CONCLUSIONS: For fracture dislocation of the 4th and 5th CM joints diagnosed accurately, good treatment outcomes can be achieved by fracture reduction and fixation.