Introduction: We report our experience of a rare case of sesamoid bone fracture of the thumb.

Case: The patient was a 46-year-old woman. She injured her right hand, when she fell and struck her palm against a stone. Seventeen days after the injury, she visited our hospital. Examination revealed tenderness on the palmar radial side of the thumb and limited flexion of the metacarpophalangeal (MP) joint of the thumb. The fracture line was unclear on plain radiographs obtained in two projections. However, bone fracture was diagnosed based on the findings in oblique and axial images, and the diagnosis of radial sesamoid bone fracture was confirmed by computed tomography (CT). The patient was treated conservatively with a plain plaster cast and physical therapy, however, the pain was persistent. Three and a half months after the injury, a small dislocated bone fragment was removed, and the symptoms improved.

Discussion: It is important to suspect this fracture from the mode of injury and site of tenderness. CT is useful for confirming the diagnosis. Since the sesamoid bones are embedded in the volar plate, conservative treatment is effective in the acute phase. However, if the fracture is old or fails to respond to conservative treatment, surgical repair or removal of any dislocated bone fragment would be required.

Conclusion: Even though it is rather rare, it is important for clinicians to bear in mind the possibility of fracture of the sesamoid bone of the thumb in patients presenting with the relevant history.

OBJECTIVES: The purpose of this study was to examine the acute-phase response (APR) and discontinuation rates of once-yearly intravenous administration of zoledronic acid (ZOL) 5 mg for osteoporosis.

METHODS: Fifty-six patients (18 men and 38 women mean age, 74.3 ± 9.4 years) treated with ZOL between November 2016 and December 2018 were enrolled. They were examined to determine the rates of APR and antipyretic analgesic administration in those with (Acute group) and without APR (Non-Acute group). The discontinuation rates in 36 patients one year after administration of ZOL and the reason for the discontinuation were investigated.

RESULTS: The APR rate was 17.9% (10/56 patients) in all the patients. The antipyretic analgesic administration rate in Acute group was significantly lower than that in Non-Acute group (P = 0.01). The discontinuation rate was 30.6% (11/36 patients). The reasons for discontinuation were difficulty in visiting the hospital due to being elderly in 11.1% of the patients, death from a malignant tumor in 5.6%, deterioration due to cardiovascular disease in 5.6%, rejection because of APR at the first administration in 5.6%, and change of medicine in 2.8%.

CONCLUSION: When administering intravenous ZOL once yearly for osteoporosis, antipyretic analgesic such as acetaminophen or non-steroidal anti-inflammatory drugs must also be given to effectively manage the APR associated with the administration of ZOL. In addition, the individual underlying diseases and social background of elderly patients must be considered.

(Introduction) We report our experience of a patient with intractable proximal humeral fractures.

(Case) A 74-year-old man with alcoholic cirrhosis, chronic pancreatitis, diabetes mellitus and dementia presented with a proximal humeral fracture, which was treated by locking plate fixation. After the surgery, the patient fell again, resulting in displacement of the plate and re-fracture, and osteosynthesis with intramedullary nailing was performed. However, he visited us again with displacement of the intramedullary nail from the humeral head, and humeral head replacement was performed. Thereafter, the patient was transferred to a rehabilitation hospital for continued physical therapy. Although the elevation of the shoulder joint was reduced, the patient had no problems with the ADL.

(Discussion) Proximal humeral fractures are considered as a type of fragility fractures. Internal fixation is indicated for patients with fracture dislocation, and commonly, internal fixation using a locking plate or intramedullary nailing is performed. However, after these procedures, dislocation may still occur due to inadequate fixation strength and poor bone quality.

(Conclusion) In osteosynthesis for fractures in elderly people, it is necessary to adjust the duration of the fixation period and the bed rest level for each patient without excessively relying on the fixation strength of the implant.

Introduction: We present two cases of arthroscopic partial meniscectomy with peripheral tear repair for symptomatic discoid lateral meniscus.

Case presentation: The first case involved a 9-year-old girl whose chief complaint was a clicking sensation. We diagnosed her condition as peripheral tear of the anterior horn of the discoid lateral meniscus, as magnetic resonance imaging (MRI) revealed a posterior and central shift of the lateral meniscus. Arthroscopic findings revealed a completely discoid lateral meniscus and a peripheral tear of the anterior horn. We repaired the peripheral tear after partial meniscectomy. The second case involved a 16-year-old boy whose chief complaint was the feeling of knee dislocation. We made a diagnosis of peripheral tear of the posterior horn of the discoid lateral meniscus, as MRI revealed a wide space between the posterior horn and posterior capsule and the absence of a popliteomeniscal fascicle. Arthroscopic findings revealed a completely discoid lateral meniscus and a peripheral tear of the posterior horn. We repaired the peripheral tear after partial meniscectomy.

Discussion: Preservation of the lateral meniscus is imperative, and characteristic MRI findings are necessary to locate the meniscal tear.

Conclusion: We report positive outcomes of arthroscopic partial meniscectomy with peripheral tear repair for symptomatic discoid lateral meniscus. Characteristic preoperative MRI findings are necessary for diagnosis and proper treatment.

Objective: To evaluate usefulness of supportive care provided by orthopaedic clinicians after examination of the locomotive organs.

Subjects and Methods: Of elementary school children and middle school students residing in Area K of Kyoto City, those with positive signs/findings on locomotive organ examination were enrolled in an aftercare program of physical exercise guidance. The children and students were first assessed as to the degree of their understanding of a leaflet concerning the locomotive organs distributed to them at the time of the examination. In addition, details of the counseling sought at a locomotive organ consultation were reviewed and analyzed.

Results: A total of 14 elementary school children and 30 middle school students participated in the aftercare program; all of them indicated that they had not taken a good look at the leaflet distributed to them at the time of the examination. As for details of the participants' consultation, the counseling pertained most frequently to posture (8 elementary school children) and physical disabilities (30 middle school students).

Discussion: In the aftercare provided after examination of the locomotive organs, mere distribution of printed material does not suffice, and the school children and students should be provided direct instructions during the aftercare program. The important elements that needed to be focused on at the site of aftercare provision were instructions on posture for elementary school children and instruction for proficiency in locomotor activities and measures to cope with disabilities for middle school students.

Conclusion: The intervention of orthopedic clinicians after examination of the locomotive organs can clarify the important elements that need to be focused on at the school site while providing the guidance needed for subjects with positive signs/findings in examination of the locomotive organs.

In this article, we report successful cooperation with the medical dentistry department at our clinic. The study subjects were 251 patients about whom information was exchanged between our clinic and the dentists before and during the administration of bisphosphonates (BP) from April 2017 to December 2018. Among the 251 patients, 196 were eligible to receive a BP, while BP administration was suspended in 47 patients and withheld altogether in 8 patients (based on opinions). BP therapy was started in all the 196 eligible patients and continued throughout the study period. All the 47 patients in whom BP was suspended received drugs that do not cause osteonecrosis of the jaw (ONJ). Among these, 25 were initiated on a BP after the completion of dental treatment. Among the remaining 22 patients, 13 continued to receive drugs that do not cause ONJ, and 9 dropped out of the study. Information exchanged between our clinic and the dentists contributed to avoiding treatment that was disadvantages to the patients.

Pertinent data from 72 female patients suffering from insufficiency fracture of the spine were reviewed and analyzed. The patients ranged in age from 49 to 89 years (mean: 74.4 years) and their average body mass index (BMI) was 22.8. The most frequent sites of fracture were fractures in the T12 to L3 region, and only a single vertebral body fracture was noted in 66 patients. The mean lowest young adult mean (YAM) of the lumbar/femoral bone mineral density (BMD) was 60.5. Insufficiency fractures of the spine occurred more frequently during the low-temperature, short-sunshine duration season in elderly subjects with low BMD and low BMI. Nevertheless, many patients who were relatively young and had no appreciable decrease of the BMD and had a high BMI were also encountered.

From among 860 patients who underwent checkup with a fracture risk assessment tool (FRAX®) in the past approximately 3-year period, those who gave consent were subjected to measurement of the bone mineral density; of the latter patients, 275 received treatment for osteoporosis. Analysis of the data revealed a negative correlation between the results of FRAX® and the bone mineral density, and indeed, the number of patients treated for osteoporosis at this hospital has increased. These findings show the effectiveness of FRAX® assessment as a clue to the need for bone mineral density measurement as well as treatment of osteoporosis. There was, nevertheless, a decrease in the number of patients being followed up with the current treatment by roughly one half, suggesting the need for countermeasures to ensure treatment continuation. The results also indicate the importance of screening checkups for subjects from their sixth decade of life onward.

The Osteoporosis Liaison Service Program (OLSP) has been introduced into this hospital to prevent secondary fractures in osteoporosis patients, and we have conducted investigations of the changes in the treatment introduction rate and treatment continuation rate with time following the introduction of this program. Of the 198 patients admitted with fragility fractures, the inpatient treatment introduction rate was 74%, the overall post-discharge treatment rate was 67%, the treatment rate at 6 months post-discharge was 51%, and the treatment continuation rate at 6 months post-discharge was 76%. The treatment introduction rate was comparable to the rates reported by other investigators. The post-discharge treatment rate of as low as 67% suggests the need for a review and further refinement of the program.

Serum 25-hydroxyvitamin D (25(OH)D) levels were determined in female patients over 60 years of age diagnosed as having primary osteoporosis, and the data obtained were analyzed to explore the associations between the serum 25(OH)D levels and such factors as the risk of fragility fractures and risk of deterioration of physical activity levels. The percentage of patients with serum 25(OH)D levels in the normal range was 1.9%. Depression of physical activity was frequently seen among patients with fragility fractures and those with severe 25(OH)D deficiency. The present results show the importance of aggressive orthopedic interventions, such as exploration of any risk factors for fragility fractures by X-ray examinations, and locomotive organ rehabilitation, in addition to vitamin D supplementation in patients with osteoporosis.

In the position paper dealing with antiresorptive agent-related osteonecrosis of the jaw (ARONJ), no precise preventive measures against ARONJ are described, but it is stated that “a close collaboration between physicians/surgeons and dentists is of prime importance in preventing the development of ARONJ; therefore, construction of a close, collaborative relationship of physicians/surgeons and dentists is strongly advocated.” We have therefore worked out a system to fortify close collaboration among physicians/surgeons, dentists and pharmacists, whereby a collaboration path is used for prevention and treatment of ARONJ, including a thorough dental checkup prior to prescription of antiresorptive agents.

[Objective] We compared the effects of 2 teriparatide formulations prescribed for the treatment of osteoporosis at our hospital.

[Methods] Gender, treatment continuation rate, age, and rate of increase of the bone mineral content were evaluated in patients with osteoporosis receiving daily teriparatide and those receiving weekly teriparatide.

[Results] A total of 45 patients received daily teriparatide, while 20 patients received weekly teriparatide. There were no differences in gender, treatment continuation rate, age, or rate of increase of the bone mineral content.

[Discussion] There were no significant differences in effects between the 2 formulations.

[Conclusion] Age, treatment continuation rate, and rate of increase of the bone mineral content were compared.

Subjects among the Sakai Cutlery Festival participants seeking physical checks were surveyed to determine the degree to which the subjects recognized locomotive syndrome (LS) and the LS score, to check their locomotor capability, under the sponsorship of the Industrial Health Panel of Sakai Medical Association.

The survey revealed that both the degrees of recognition and comprehension of LS were below the national averages. The degree of recognition was higher in females and increased progressively with advancing age. The LS score also increased with advancing age. Those subjects who found it difficult to rise to their feet suffered from a number of motor function problems according to the assessment by the Locomo 25 scale. The importance of grasping one's own motor functions through an understanding of LS needs be stressed to prolong healthy life expectancy.

Patients with the musculoskeletal ambulation disability symptom complex at this hospital were examined by the functional reach test (FRT) and two-step test (2stepT) to assess whether the results of these tests might be correlated with the single-leg standing time and Timed Up and Go test (TUG) data, both of which are used to establish the diagnosis of this disorder. The analysis failed to demonstrate any correlation of the results of either the FRT or the 2stepT with the single-leg standing time, whereas the results of both were negatively correlated with those of the TUG. These findings suggest the potential usefulness of FRT and 2stepT as adjunctive tests for the diagnosis of the musculoskeletal ambulation disability symptom complex.

Considering that inadequate excursion of the metatarsophalangeal (MTP) joints of the toes might account for the poor body balancing capability in the elderly, we introduced, into rehabilitation for post-total knee arthroplasty (TKA) patients at this institution, a procedure which comprises dorsiflexion exercises of the toes using a method called Body Trunk Switch (BTS), in an attempt to potentially effect stabilization of the trunk. The results of the trial showed a significant reduction in the duration of hospitalization and significant prevention of worsening of the performance in the Functional Reach Test (FRT) and quadriceps muscle strength in the BTS training group. The present results seem to indicate that BTS training may serve as a new prophylaxis for locomotive syndrome.

Lecture meetings on locomotive syndrome and locomotive syndrome grading tests for local residents represent good opportunities to improve the awareness of people about locomotive syndrome and about effective countermeasures for the condition. The importance of aggressive countermeasures against locomotive syndrome, such as habitual physical exercises and dietary ingenuity, has become evident for delaying the deterioration of motor function with aging.

Locomotion training, which refers to self-training by standing on one leg with eyes open and squat training, has proven to clearly contribute to improvement of locomotor function. Many elderly patients reported that they began to feel much less liable to a fall, so that the training eventually contribute to improvement of the balancing capacity as well. However, the results revealed that short-term cessation of the training led to long-term loss of the effects of training, underscoring the importance of continuous practice of the training. As knee pain and low back pain constitute the main causes for discontinuation of locomotion training, orthopedic surgeons have a crucial role in ensuring continuation of locomotion training.

We conducted a comparative study of two cases of treatment of bursitis associated with a rotator cuff tear in the elderly: a case in which steroid arthropathy developed as a result of repeated steroid injections, and a case in which hyaluronic acid injections had been used. Underlying disease, bone fragility, external force, etc., as well as steroid dose, number of doses, and period of time, were among the factors present in the development of steroid arthropathy. Local rest is important in the treatment of bursitis associated with rotator cuff tears, and hyaluronic acid injections are desirable when the inflammation persists.

A total of 128 patients who underwent arthroscopic rotator cuff repair at our clinic and were monitored for 2 years following the surgery were included in the study. We compared the results of surgery between the 116 cases with good repair integrity and 12 cases of retear. In both groups, the Japanese Orthopaedic Association (JOA) score showed a trend toward improvements until 2 years after the surgery. Retears appeared to be particularly common in those cases in which the injury was associated with a concomitant subscapularis tendon rupture, the tear was large in size, and the fat infiltration as detected in preoperative imaging was greater, suggesting the necessity for careful postoperative care in these patients.

We analyzed the physical findings in patients who received short-term inpatient treatment for throwing shoulder injuries (including 76 patients who received injection therapy [injection group] and 105 who did not [non-injection group]), to determine the appropriate timing of the injection therapy. The injection group had a higher proportion of patients with abnormal hyper external rotation test (HERT) results at admission than the non-injection group. In addition, exercise therapy did not improve the results of the combined abduction test (CAT), horizontal flexion test (HFT) or HERT, and the patients received injection therapy 3 to 4 days after admission. As a result, the physical findings at discharge were similar between the injection and non-injection groups, suggesting that the appropriate timing of injection is 3 to 4 days after the start of exercise therapy.

We investigated the correlation between throwing motion and physical findings in the lower extremities of 50 athletes engaged in sports activities involving overhead throwing motions, who presented with throwing shoulder injuries. Pelvic retroversion at the knee high position on the non-throwing side and early glove motion start and trunk extension at the foot-ground contact position on the non-throwing side were evaluated from video-recordings of the motions. The patients were classified into two groups according to the data obtained, the pelvic retroversion group and non-pelvic retroversion group, and the physical findings were compared between the two groups. The results revealed a lower hip internal rotation angle on the throwing side in the pelvic retroversion group as compared to that in the non-pelvic retroversion group. The hip internal rotation angle on the throwing side represents an important indicator in the evaluation of throwing shoulder injuries.

The clinical outcomes and repair integrity of a total of 51 patients who had undergone cuff tear repair, including arthroscopic subscapularis tendon repair, were assessed at 2 years post-operation.

The Japanese Orthopaedic Association (JOA) score had improved from 54.0 prior to the operation to 97.8 at 2 years post-operation; 9 patients had suffered a re-rupture (supraspinatus tendon, 6 patients; subscapularis tendon, 3 patients).

The clinical outcomes were gratifying even in the cases of supraspinatus tendon re-rupture, insofar as the satisfactory status of the affected subscapularis tendon repair.

The present results indicate the importance of reconstruction of the force couple for improving the clinical outcomes.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is defined as a syndrome with a favorable outcome, that is characterized by seronegative symmetrical synovitis with pitting edema. We report 7 cases of RS3PE in this article. In middle-aged patients with RS3PE who presented with edema of the dorsum of the hands and feet, treatment with a small dose of corticosteroids led to prompt improvement of the symptoms.

With the aim of learning the impressions and opinions in regard to their current status of 161 rheumatoid arthritis patients attending the outpatient clinic of our hospital, and comparing them with data on a nationwide scale, i.e., 7041 patients' replies, we requested replies to 34 excerpted and partially modified questions in the Japan Rheumatism Friendship Association (JRFA) 2015 edition of the Rheumatism White Paper (White Paper). Although the results will not serve as an accurate indicator of the improvement and aggravation of each individual's condition, because they make it possible to make comparisons with the treatment status and patients' overall opinions and medical condition at our hospital, we consider them to be very useful.

We report our surgical experience on a 64-year-old woman with rheumatoid arthritis who presented with flexor pollicis longus tendon rupture. The patient presented with a one-month history of not having been able to bend the thumb for no particular reason and was referred to our hospital. Plain x-ray, computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound were performed to establish the diagnosis, and tendon transfer surgery of the fourth superficial digital flexor tendon was carried out. The patient was started on early rehabilitation, and at 2 years after the surgery, the thumb function was found to be favorable. Prior to performing the surgery, risk of damage of the tendon to be transferred, the severity of the joint deformity, and the disease activity need be taken into consideration.

The author examined the use of Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA) at our hospital: 8 patients were treated with tofacitinib, and 5 were treated with baricitinib. The tofacitinib treatment group consisted of 2 treatment-naïve patients and 6 patients switched from another treatment. Currently, tofacitinib treatment is being continued in 4 patients, and baricitinib treatment in 3 patients. The proportion of female patients was higher. The patients in this study were elderly. Methotrexate (MTX) was used in all patients. An improvement in the modified Health Assessment Questionnaire (mHAQ) score was observed with both drugs. Herpes zoster occurred in 5 patients receiving tofacitinib and 1 patient receiving baricitinib. In this report, patients treated with JAK inhibitors are presented and discussed.

A total of 97 regular members and 454 staff members of the Osaka Clinical Orthopaedic Association (OCOA) responded to the questionnaire survey conducted concerning the Osaka north earthquake that occurred on June 18, 2018. Various disasters have occurred in the northern region of Osaka, near the seismic center of the earthquake. The questionnaire data clearly showed discrepancies between physicians and other staff members with respect to their stand on and recognition of an emergency. The results of the survey suggest that some 80% of medical facilities may still lack refined disaster prevention plans. While the facilities seemed to be vaguely exploring effective countermeasures, no clear working plan has yet been formulated.

A questionnaire survey of the opinions/views of regular members of the Osaka Clinical Orthopaedic Association (OCOA) was conducted to determine the clinical practice disturbances experienced due to Typhoon No. 21 that passed through the Osaka area on September 4, 2018. Responses were received from 92 member orthopedists. The responses revealed that about 60% of the medical institutions had decided that they would base their decision on whether to keep their institutions open or closed depending on the forecasted weather conditions on the day of the storm. As for the situation on the day of the storm, about 53%, or more than half of the number of institutions, were closed either all day long or in the afternoon alone on the day. Clinical practice was suspended or interrupted due to a power cut in about 12% of the institutions, most frequently causing problems with electronic medical charting and use of elevators. The survey revealed that conventional countermeasures failed to allow satisfactory coping with the disaster.

The results of this disaster awareness questionnaire survey have clarified the present circumstances, that there is insufficiency of minimal food and water stocks needed for survival and an actual lack of preparedness for preventive countermeasures against disasters, despite pertinent general awareness, among most residents. It may be concluded that it is an urgent task for us, as healthcare professionals, to raise the awareness about disaster prevention and mitigation among general residents through conducting continual and regional disaster drills and lecture meetings in cooperation with administrative organizations and/or regional residents' organizations in the community.

Duloxetine hydrocloride was administered to 41 cases of osteoarthritis of the knee with persistent moderate to severe pain, to assess its efficacy. There was a significant positive correlation between the mean improvement rate of the visual analogue scale (VAS) score (50.9%) and the mean improvement rate of the Japanese Knee Osteoarthritis Measure (JKOM) score (42.9%). Adverse reactions were reported in 17 patients (41.5%), which is considered to be relatively high. Although the drug needs to be administered with special caution in the elderly, duloxetine was found to exert favorable treatment efficacy.

Pain is classified into four types: inflammatory pain, neuropathic pain, psychogenic pain, and unexplained pain.

Medicines used to treat pain can be classified into non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, extract from inflamed cutaneous tissue of rabbits inoculated with vaccinia virus, opioids, neuropathic pain medicines, and antidepressants such as duloxetine.

It is important to use different pain medicines according to whether they are effective against acute, chronic, or neuropathic pain.

Duloxetine was administered at a daily dose of 20 to 60 mg to 164 patients with chronic low back pain and 53 patients with knee joint osteoarthritis to assess its efficacy. The pain intensity was graded on a scale of 0 (no pain) to 10 (pain intensity equivalent to that prior to the duloxetine administration). Among the 164 patients with chronic low back pain, the visual analogue scale (VAS) score for pain intensity was 10 in 13 patients (no pain alleviation), and 0 in 24 patients (complete relief). Among the 53 patients with knee joint osteoarthritis, the score was 10 in three patients (no pain alleviation), 0 in one patient (complete relief), and 1 in six patients (near-complete relief). Duloxetine was considered to be useful as it exerted some degree of efficacy.

Platelet-rich plasma (PRP) was injected intraarticularly in 56 patients with osteoarthritis of the knee (knee OA), to assess the rate of improvement of the Lequesne index of severity at week 12. The improvement rate was −59.3 ± 25.3% in the group of patients that exercised regularly (at least twice a week for more than 30 minutes each over a period of at least 1 year) (N = 23), which was significantly superior to the rate in the group of patients that did not exercise regularly (−19.5 ± 57.7%) (P = 0.003). The results indicated that habitual exercise may enhance the effects of PRP in patients with knee OA.

The author encountered a patient with mucoid degeneration of the posterior cruciate ligament, whose incidence is very rare, and the author investigated the mechanism of the degeneration and the mechanism of symptom expression based on the magnetic resonance imaging (MRI) findings, arthroscopic findings, and histopathological findings. The contrast MRI findings and histopathological examination showed that vascular occlusion contributed to the development of the mucoid degeneration. Because no limitation of the range of motion of the knee joint was observed under general anesthesia, the author concluded that the cause of the range of motion limitation was a functional ROM limitation due to a reciprocal nerve reflex.

Among the 5 cases with infections complicating intraarticular injection into the knee joint, 3 were treated with hyaluronic acid while the remaining 2 were treated with corticosteroids. Methicillin-sensitive Staphylococcus aureus was identified as the infecting organism in 4 cases, and Group B streptococcus in the remaining one case.

The infection rate was 5 per 308 773 procedures, which was equivalent to 1 per 61 755 procedures (0.0016%). The infection rate was 3 per 292 690 procedures, equivalent to 1 per 97 563 procedures (0.001%) for hyaluronic acid, and 2 per 16 083 procedures, equivalent to 1 per 8042 procedures (0.012%) for corticosteroids.

PHYSIO SHOCKMASTER (Sakai Medical Co. Ltd.) and MASTERPULS MP100 ultra (Storz Medical AG) were loaned to us as demonstration units for the duration of one week each. We used them to treat 6 patients to assess their efficacy. These shockwave generators were effective for the treatment of enthesitis. The treatment was effective for breaking the calcific deposits, although they were less effective for improving the pain caused by calcific rotator cuff tendinitis. These devices require the handpiece to be held in position during the therapy.

We report a case of osteosarcoma of the distal right femur in a young adult. The patient began to experience pain on the anterior aspect of his right knee 2 weeks previously. He was diagnosed with right jumper's knee and was instructed to rest. Four weeks after the initial examination his symptoms had failed to improve, and repeat plain radiographs of the right knee and plain magnetic resonance imaging (MRI) of the right knee were performed. A diagnosis of osteosarcoma of the distal right femur was made, and the patient was referred to a university hospital, where multimodality therapy was instituted. We concluded that an early detailed examination by means of repeat plain radiographs and other modalities is necessary in young adults whose knee pain worsens.

The mobile finger prosthesis, X-Finger® (Didrick Medical Inc., USA), which was approved in Japan in fiscal year 2018, is equipped with joint mechanisms and allows mobility of the finger, unlike conventional cosmetic prosthetic fingers; thus, it appears to be potentially useful for improving digital functions in amputees. Based on our limited experience with the device, we present, herein, our comments pertaining to its usefulness, the practical problems associated with its use, and the future perspectives of the mobile finger prosthesis, X-Finger®.

We report 38 patients with 42 skin defects who were treated with TERUDERMIS. The affected regions included fingers and toes in 81.0% and 11.9% of cases, respectively. Complications included fractures and nail bed defects in 35.7% and 31.0% of cases, respectively. Severe skin defects were seen in more than half of the cases, while a single mild skin defect was observed in 45.2% of cases. Skin graft surgery was performed in 26.2% of cases, whereas 71.4% of cases, that is, the majority, showed healing without receiving skin graft. TERUDERMIS enhances the healing mechanism in wound regions, and is of clinical significance in that it allows safe and easy wound management.

The pathogenesis of ingrown toenails with granulation tissue is considered to involve a vicious cycle, consisting of continuous mechanical stimulation generated by contact between the nails, skin and granulation tissues, and of regeneration of granulation tissue. A combination of the following treatments was given to 6 patients with 6 halluces: (1) resection of granulation tissue, (2) nail wiring, and (3) cotton filling adherence method (developed by Hasegawa). The mean treatment period was approximately 3 weeks. This approach was extremely useful in treating ingrown toenails with granulation tissue that has conventionally been thought to be intractable.

We assessed the gross operative findings in 25 cases (26 elbows) of lateral epicondylitis. The origin of the extensor carpi radialis brevis muscle (ECRB) was avulsed in every case. We classified the avulsions according to grade of severity, and the avulsion was mild in 10 elbows, moderate in 7 elbows, severe in 4 elbows, and very severe in 5 elbows. Steroid injection had been performed in 25 of the 26 elbows, and we concluded that the findings we observed were findings that had been affected by the steroid. A single blow while engaged in a racket sport was responsible for 4 of the 5 very severe avulsions, and we concluded that preoperative diagnosis by magnetic resonance imaging (MRI) is easy and that early surgery is desirable.