Objective: Dog and cat bite wounds can sometimes be severe. This report covers key points for appropriate diagnosis and treatment at the initial visit, the effectiveness of primary wound closure in cases treated by incision, the importance of early sample collection for tissue culture and bacterial susceptibility testing, and the differences between dog-bite and cat-bite wounds.

Subjects and Methods: We reviewed the data of 205 cases of dog- and cat-bite wounds that were initially treated at our hospital over a 13-year period and statistically analyzed the data of 144 of these cases.

Results: Favorable healing was obtained in all 62 cases that were treated by incision/primary closure and intermittent irrigation with placement of a drain. Cat-bite wounds required a significantly longer time to healing than dog-bite wounds and also showed a higher infection rate with Pasteurella spp.

Discussion and Conclusion: Prompt and accurate assessment of the wound severity and determining the need for treatment by incision at the initial visit are critical. Misjudgment can lead to prolonged treatment or even worsening of the condition, with the risks being particularly high in subjects with cat-bite wounds. Local redness, swelling, tenderness, and subjective pain severity serve as indicators of the wound severity. For cases treated by incision, primary wound closure with drain placement is an outpatient procedure requiring only a single anesthesia session, followed by intermittent irrigation starting the next day. Prompt initiation of prophylactic administration of broad-spectrum antibiotics and early collection of tissue samples for bacterial culture and susceptibility testing are essential in cases treated by incision.

Introduction: This study was conducted to identify whether the bone mineral density (BMD) measured at the proximal femur by dual-energy X-ray absorptiometry (DXA) might differ between the left and right sides and whether it is relevant to the diagnosis of osteoporosis.

Methods: This study was conducted in a total of 557 patients aged 50 years or older with primary osteoporosis, consisting of 69 men and 488 postmenopausal women, who underwent BMD measurements between January 2009 and July 2018. The BMD was measured in the left and right proximal femurs by DXA. The measurement results were compared in the entire subject population as well as by the sex and age group.

Results: No significant side-to-side differences in the proximal femur BMD were observed between the right and left sides in either the entire study population or in the study subjects classified by sex and age group.

Discussion: While 60%-70% of people are known to be right-footed, the proximal femur BMD is nearly equivalent between the right and left legs; therefore, being right- or left-footed might have no impact on the measured BMD. This suggests that misdiagnosis of osteoporosis is unlikely to occur due to the choice of the left or right leg for BMD measurement.

Conclusions: There was no difference in the measured BMD between the left and right proximal femurs in this study, suggesting that proximal femur BMD measurement on either side alone would be sufficient for the diagnosis of osteoporosis.

 We treated two cases of patellar instability who presented with recurrent hemarthrosis accompanied by severe patellofemoral osteoarthritis (PFOA) by surgery. In both cases, coagulation disorder and tumor were considered as being unlikely as the underlying disease and we judged that some traumatic stimuli to the patellofemoral (PF) joint served as the trigger for the recurrent hematomas. Operative procedures available for treatment of PFOA include anteromedial displacement of the tibial tuberosity, total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA). Several reports have been published of PFA combined with medial patellofemoral ligament (MPFL) reconstruction performed for cases of PFOA accompanied by patellar instability. In our cases, the protrusion and depression of the PF joint surface were intense and the patella itself had become thin, which led us to estimate that PFA or MPFL reconstruction would be associated with a high risk. Because there were only mild osteoarthritic changes of the femorotibial joint, we did not select TKA. Instead, we selected patellofemoral joint surface smoothing and realignment surgery. Although the postoperative follow-up period is still short, both patients no longer suffer from hemarthrosis episodes and the patellar alignment has improved in both cases.

Objective: This research was performed to clarify factors influencing an individual's ability to squat, and to assess the effect of locomotive exercises for children on squatting.

Methods: Squatting ability, ankle dorsiflexion angle, long-seated forward bending distance, and one-leg standing time were assessed among 56 students. Seven students who could not squat performed locomotive exercises for children for 4 weeks.

Results: Forty students were able to squat and 16 were unable to squat. The ability to squat correlated significantly with ankle dorsiflexion angle (Y-axis), long-seated forward bending distance (normalized) (X-axis), and one-leg standing time. The scatter plots of the first two of these parameters reveal that the boundary line S (40X + Y = 41) indicates whether a person can squat. Seven students performed the prescribed exercises, and four became able to squat while another two showed signs of improvement.

Discussion: Increasing the rate of exercise implementation and extending the implementation period are expected to increase the number of people who can squat.

Conclusion: The ability to squat correlates significantly with ankle dorsiflexion angle, forward bending distance while sitting, and one-leg standing time. Combining the results of the first two is prognostically useful. Performance of locomotive exercises for children effectively enhances squatting capability.

Objective: This study was performed to clarify relationships among trunk muscle strength, trunk muscle mass, physical function, and bone mineral density.

Methods: This study included 314 female patients aged ≥ 60 years who were able to walk independently. We measured trunk flexion/extension muscle strength, trunk muscle mass index (TMI; trunk muscle mass (kg)/height (m)²), grip strength, one-leg standing time with eyes open (OLS), functional reach test (FRT), 3 m timed up and go test (TUG), 5 m walking speed, and lumbar spine and femur bone mineral density (BMD). Pearson's correlation and partial correlation analyses were performed using age as a control variable.

Result: Trunk extension muscle strength correlated significantly with all physical functions, and flexion muscle strength correlated significantly with OLS, TUG, and walking speed. TMI did not correlate significantly with any assessed physical function items. BMD did not correlate significantly with trunk muscle strength or muscle mass.

Discussion: Trunk muscle strength, especially extensor muscle strength, is associated with a variety of physical functions, suggesting that muscle training focusing on trunk extensor muscle strength is important for maintaining physical function in older adults.

Conclusion: Exercises that improve trunk extensor muscle strength are potentially useful for maintaining physical function and preventing falls in older women.

Purpose: We herein present three new 6-strand suture techniques, namely the Yoshizu #3 (Y3), Triple Tajima parallel (TTP), and 8-strand suture (Triple Tajima Tsuge [TTT]) techniques, devised by our research group. This study evaluated the tensile properties of these new suture techniques.

Methods: Thirty-eight porcine flexor tendons were transected and divided into three groups. One group underwent repair using the Y3 technique, which is a combination of the Yoshizu parallel (YP) suture (double threads of the Yoshizu needle placed longitudinally in a parallel fashion, with two tendon-grasping parts, similar to the Lim and Tsai technique) and the Tsuge suture with a looped thread (13 tendons). Another group underwent repair using the TTP technique, in which the YP technique was applied with three threads and two needles (Triple Tajima needle; 12 tendons). The remaining group underwent repair using the TTT technique, which employs the Y3 technique with a triple Tajima needle instead of a Yoshizu needle (13 tendons). The repaired tendons were subjected to linear, non-cyclic load-to-failure tensile testing using a tensile test machine to assess the 2-mm gap force.

Results: The TTP technique (19.8 ± 4.1 N) had a significantly lower mean load at the 2-mm gap than the Y3 (38.1 ± 12.7 N) and TTT (41.9 ± 8.7 N) techniques.

Discussion: This biomechanical study demonstrated that the Y3 and TTT techniques had the same 2-mm tensile load at the repair site to allow performance of postoperative early active motion (EAM) exercise. We believe that these two repair techniques are not necessarily equivalent because of the difference in the standard deviation.

Conclusion: The TTT technique withstood the tensile load during postoperative EAM more reliably than the Y3 technique.

Introduction: In 2022, a total of 183,681 patients underwent surgery for proximal femur fractures, including the first-ranking open surgery for fracture (femur) and fourth-ranking bipolar hip arthroplasty (hip joint) among orthopedic surgeries. The management fee for continuation of secondary fracture prevention is a fee that can now be claimed for measures adopted to prevent secondary fractures in patients with proximal femur fractures.

Purpose and methods: To investigate whether medical institutions claim the management fee for continued secondary fracture prevention, I conducted a web-based questionnaire survey of hospitals and clinics affiliated with the Japanese Clinical Orthopaedic Association (JCOA).

Results: Of patients with proximal femur fractures, the majority (67%) was transported to acute care hospitals by ambulance. Following discharge, they received treatment at the outpatient departments of acute care hospitals or from their primary care physicians, with limited involvement of orthopedic clinics. The proportion of patients receiving treatment for osteoporosis prior to the surgery was 39%.

Conclusions: The results of the survey indicated that Management Fee 1 was not claimed for about 30% of cases undergoing proximal femur fracture surgeries. The management fee for continuation of secondary fracture prevention is aimed at ensuring that the treatment for osteoporosis is continued for at least one year post-surgery. In addition, it is highly necessary to continue treatment for osteoporosis even beyond this period. Therefore, establishment of Management Fee 4 for providing care beyond one year post-surgery is also necessary.

 Extracorporeal shock wave therapy (ESWT) has emerged as a promising noninvasive treatment modality for musculoskeletal disorders, complementing conventional therapies such as pharmacological treatment, surgery, and rehabilitation. Shock waves are noncontinuous high-energy acoustic waves that differ from ultrasound waves in that they produce minimal thermal effects, enabling delivery of higher energy. Their therapeutic mechanisms are thought to involve two major biophysical effects: energy release at tissue interfaces owing to acoustic impedance differences and cavitation-induced microinjuries. These processes stimulate tissue repair and regeneration. Furthermore, ESWT induces mechanotransduction, whereby mechanical stress is converted into biochemical signals, leading to increased expression of growth factors such as vascular endothelial growth factor, transforming growth factor-β, and insulin-like growth factor; enhanced collagen synthesis; and promotion of angiogenesis. Additionally, its effects on free nerve endings and neuromuscular junctions are believed to contribute to analgesia.

 Clinically, two types of devices are available: focused ESWT, which concentrates energy on a specific target, and radial ESWT, which disperses energy over a wide area. Focused ESWT is recommended for localized lesions such as plantar fasciitis or nonunion fractures, while radial ESWT may be advantageous for widespread conditions such as myofascial pain or spasticity. Early application in acute injury may accelerate inflammation resolution, whereas later treatment may enhance tissue repair; studies indicate shortened recovery time and reduced reinjury rates in athletes.

 Although empirical protocols commonly involve 2000 shocks per session, once weekly for three weeks, the optimal energy flux density, total energy, and frequency remain to be established. Further studies are required to clarify the dose–response relationship. ESWT appears to be an effective, safe, and doping-free intervention for pain relief and functional recovery in those with musculoskeletal disorders, particularly athletes.

Background: Musculoskeletal (MSK) screening is crucial for early detection of disorders in school-aged children. The Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) guidelines outline six key screening items. However, the health questionnaires used in practice vary widely across local governments, posing a significant challenge for collecting nationwide data and implementing effective measures. In this study, we aimed to investigate the diversity of these questionnaires by comparing multiple versions used in Japan.

Methods: A total of 23 publicly available questionnaires were collected online from various organizations, local governments, and private schools. The questionnaires were systematically analyzed and compared based on five key aspects: the six items specified in the MEXT manual; unique questions not listed in the manual; questions regarding sports history and injury history; and the section for the school doctor's notes.

Results: Significant diversity was found across a wide range of items, including question formats, content, and options for instruction by school doctors. For instance, questions on scoliosis varied in their level of detail, and the instructions for school doctors ranged from a simple binary choice (e.g., “refer/do not refer”) to more detailed options (e.g., “refer for further evaluation,” “monitor,” or “no abnormalities”). While this diversity reflects the creators' efforts to improve screening effectiveness, it also leads to increased burden on parents and school staff, hindering nationwide data standardization and unified data collection.

Conclusion: For effective nationwide assessment of MSK disorders and implementation of appropriate measures, a discussion on standardizing these health questionnaires is essential. This is also crucial for the future utilization of Personal Health Records (PHR) and digitization of school health data.

 Since the 2004 Chuetsu Earthquake in Niigata Prefecture, the Great East Japan Earthquake, and the Kumamoto Earthquake, screening for deep vein thrombosis (DVT) has been consistently performed in the event of a disaster. This report describes DVT screening in the aftermath of the 2024 Noto Peninsula Earthquake and the September 2024 Noto Peninsula Heavy Rains.

Purpose: To investigate the clinical significance and evidence regarding buddy taping (BT) for finger and toe ligament injuries and fractures, based on a questionnaire survey conducted among members of the Tokyo Clinical Orthopaedic Association.

Methods: The questionnaire consisted of five items regarding treatment methods for finger and toe ligament injuries and fractures, two items on the advantages of BT, five items on its disadvantages, and one item assessing the appropriateness of reimbursement at 300 points, as proposed by the Japanese Health Insurance Federation for Surgery.

Results: BT was most frequently selected for collateral ligament injuries of the proximal interphalangeal joint of the fingers and for fractures of the toes. The most recognized advantage of BT was reduced joint contracture. Only a small proportion of respondents indicated that they refrained from BT solely due to the lack of insurance coverage. Notably, 78% of respondents considered the reimbursement value of 300 points to be appropriate.

Discussion: According to the 2023 statistics of the Ministry of Health, Labour, and Welfare, finger plaster or splint fixation (490 points) was performed in 140,000 cases. If 30% of these cases (approximately 42,000) were replaced by BT, a reduction of approximately 80 million yen in medical expenditure could be anticipated.

Conclusion: This study clarified the current practice and usefulness of BT and demonstrated the appropriateness of reimbursement at 300 points.

Background: Orthopedic private practitioners play a vital role in community healthcare in Japan but face multifaceted challenges, such as managing the practice, human resource issues, and adapting to healthcare policy changes.

Objective: To investigate the realities of orthopedic private practice in Japan, focusing on motivations for opening a clinic, the preparation process, post-opening management, work–life balance, academic activity, community engagement, and succession planning, and to provide recommendations for the future.

Methods: A web-based questionnaire survey was administered to 122 members of the Japanese Clinical Orthopedic Association engaged in private practice. The questionnaire covered opening background, financing, facility and equipment, staffing, management status, work–life balance, academic involvement, community activity, and closure plans.

Results: The major motivations for opening a clinic included increased income, implementing personal medical policies, and contributing to community healthcare. The key challenges were securing staff and adapting to medical fee revisions. While income generally increased compared to hospital-based practices, more than 50% of participants reported declining revenue due to decreasing patient numbers. Academic activities markedly decreased after opening, and community outreach was limited. Approximately 70% of respondents planned succession for family members or third parties.

Conclusion: Although orthopedic private practitioners enjoy professional autonomy and financial stability, securing human resources, adapting to system changes, and sustaining academic activities remain significant challenges. Education regarding management and human resource strategies, support for Information and Communication Technology utilization, and structured succession planning are essential for sustainable practices.

 One of the goals of “Healthy Japan 21 (the third term)” for locomotive syndrome is to promote healthy longevity by decreasing the number of older adults with low back and leg pain. Locomotion training is designed for older adults to safely strengthen their lower limb muscles even if they have low back and leg pain. The Japan Stop the Locomo Council, a certified NPO corporation, conducted verification on whether the specific techniques used for the locomotion training can actually contribute to reducing pain and improving motor functions in older adults. At the same time, the locomotion training, specifically designed to improve lower limb motor function, was compared with dance, which involves whole-body movements, enrolling participants in a dance class. The results showed that both the locomotion training and dance improved the motor functions over time, identifying their distinct characteristics and benefits.

 Although total knee arthroplasty (TKA) is a reliable surgical intervention for end-stage knee joint diseases, 10%-20% of patients are dissatisfied with their outcomes owing to residual pain, limited range of motion, or component malpositioning. To address these issues, computer-assisted surgery (CAS) technologies including navigation and robotic systems have been introduced to improve surgical accuracy, reproducibility, and soft tissue balancing. TKA using semi-active robotic systems has gained particular popularity in recent years, with multiple studies reporting its utility in achieving optimal alignment and soft tissue balance. Despite these technical advantages, evidence demonstrating CAS superiority over conventional TKA in long-term clinical outcomes remains sparse. The limitations of traditional mechanical alignment, where doctors aim to achieve neutral alignment for all patients regardless of individual anatomy, have been increasingly recognized. As a result, interest in personalized alignment strategies that consider each patient's unique ligamentous and bony morphology is increasing. We have adopted a functional alignment technique using robot-assisted TKA, and have observed favorable early clinical results compared to conventional mechanical alignment. Personalized alignment approaches that consider patient-specific soft tissue balance may further improve functional outcomes and patient satisfaction following TKA. Future studies are needed to validate these findings and determine the long-term benefits of personalized alignment using robot-assisted techniques.

Objective: To evaluate the accuracy of leg length discrepancy and offset changes in total hip arthroplasty (THA) using the CT-based AR navigation system, HoloNavi^® One (HoloNavi Medical Technology, Aichi, Japan).

Materials and Methods: We retrospectively reviewed 44 primary THA cases performed using the HoloNavi^® One; the cohort comprised 8 males and 36 females, with an average age of 72 years and average BMI of 24 kg/m². All patients had hip osteoarthritis as the primary disease. The anterolateral supine approach was used. Pre- and postoperative leg length discrepancies relative to the contralateral limb and global offset were measured using pre- and postoperative plain radiographs. The difference between pre- and postoperative measurements was defined as the leg lengthening amount and offset change, respectively. Absolute error between the intraoperatively displayed values and actual leg lengthening and offset changes was evaluated. Multiple regression analysis was used to assess factors influencing the absolute error, including age, sex, BMI, preoperative leg length discrepancy, leg lengthening amount, and offset change.

Results: The absolute error for leg lengthening and offset change was 3.0 ± 2.6 mm and 3.5 ± 2.6 mm, respectively. The leg lengthening accuracy was within 3 mm and 5 mm for 28 (64%) and 41 (93%) joints, respectively. The accuracy of the offset change was within 3 mm and 5 mm for 20 (45%) and 38 (86%) joints, respectively. No factors significantly influencing the absolute error were identified.

Discussion: The accuracy of leg lengthening and offset changes in THA using HoloNavi^® One was favorable.

 Total knee arthroplasty (TKA) is primarily performed using the mechanical alignment (MA) technique. Until date, consistent outcomes have been reported. However, it has also been reported that about 20% of patients undergoing TKA by this technique express dissatisfaction postoperatively. Therefore, the kinematic alignment (KA) technique has been proposed as a technique that could provide higher patient satisfaction. In this article, we report the results of a study conducted to compare the patient satisfaction levels and postoperative outcomes between patients undergoing TKA by the MA and KA techniques at our hospital.

 Intra-articular injection of a hyaluronic acid formulation mixed with lidocaine caused iatrogenic pyogenic arthritis. Of 39 patients who received the injections, 11 patients (12 knees) developed knee joint pain. Arthroscopic joint debridement was performed in 7 patients (8 knees). Inadequate adoption of infection control measures was suspected as the cause of the iatrogenic pyogenic arthritis, such as repeated aspirations from a potentially contaminated bottle, use of solutions prepared in advance and stored, and insufficient implementation of aseptic precautions and environmental control. An on-the-spot inspection by the public health office was conducted, which then provided guidance on infection prevention measures.

 This report presents the results of a questionnaire survey conducted by the Japanese Clinical Orthopaedic Association (JCOA) in fiscal year 2024 of schoolchildren who visited a medical institution after receiving the results of a musculoskeletal examination at school. Reports were obtained for a total of 3,083 cases. Scoliosis was the most frequently (59.5%) made diagnosis. Other diagnoses included Osgood-Schlatter disease, lumbar spondylolysis, disc herniation, baseball elbow, etc. Lower limb contractures due to body stiffness was diagnosed in 2.4% of the children, for which attention is needed. Follow-up after the diagnoses included observation and guidance in 54.3% of cases, surgery in 0.1% of cases, and referral to other specialists in 2.8% of cases. Of all the cases of scoliosis identified, there were four cases with a Cobb angle of 50 degrees or more.

 The current status of school-based musculoskeletal examinations in Ehime Prefecture, a program that is in its 10th year now, was surveyed using data from the School Health Statistics Survey and questionnaires distributed to schools in the prefecture. The results of the survey revealed inconsistencies in the format of the Family Background Questionnaire and examination procedures carried out by the school physicians, affecting the quality of the examinations. Especially, issues are highly likely to be overlooked with the use of the simplified form of the Family Background Questionnaire. Therefore, standardization is essential to ensure accuracy. Going forward, it will be necessary to establish a sustainable examination system that would reduce the burden on the examiners and improve their diagnostic accuracy.

Purpose: To examine factors affecting the home exercise adherence rate in patients with low back pain.

Methods: We conducted a questionnaire survey of 84 patients with low back pain to measure 1) the severity of low back pain, 2) activities of daily living using the Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ), and 3) motivation for exercise. Then, we performed a hierarchical cluster analysis using the Ward's method in order to build a tree diagram and measure the relationships.

Results: Clusters of patients with the closest forms of identified regulation were generated. To improve the adherence rate, it is important to adopt an approach towards identified regulation, not merely through instruction but through autonomous motivation.

 Bone and soft tissue tumors are rare and under-recognized. Even until today, there are issues about the initial diagnostic process and access to appropriate medical institutions. The current survey was conducted to determine the awareness concerning bone and soft tissue tumors of general orthopedic outpatients, including those with bone and soft tissue tumors. The results of the survey revealed problems with access to specialized medical institutions, insufficient regional collaboration, and premature suspension of follow-up. Going forward, it will be necessary to strengthen the collaboration between core hospitals and clinics, along with enhancing the information service system using information technology, etc.

 With the super aging of society in Japan, the number of patients with fragility fractures of the pelvic ring (FFPs) due to osteoporosis is increasing. In the majority of cases, the fractures are non-displaced. However, it has been reported that displacement can occur during conservative treatment. We evaluated the postoperative prognosis following surgical treatment in 3 patients with non-displaced type IIc FFPs (according to the Rommens classification) at our hospital.

 In recent years, the Japan Federation of Gerontological Societies and the Japan Geriatrics Society have classified the elderly into three groups and developed guidelines for the prevention of lifestyle-related diseases in the elderly. On the other hand, the existing osteoporosis guidelines do not specifically target the elderly and do not adequately address the geriatric population. The elderly are characterized mainly by the presence of multiple comorbidities, cognitive impairment, decreased activities of daily living (ADL), and locomotive syndrome, with large individual differences. Therefore, maintenance of the quality of life (QOL) is crucial in their treatment. Taking into account these points, we propose the development of “Guidelines for the Treatment of Osteoporosis in the Elderly (tentative title).”

 We performed arthroscopic repair using the suture-bridge (SB) technique in 9 shoulders and the triple-row (TR) technique in 3 shoulders of 12 patients with fosbury flop tears (FFTs), and evaluated the short-term outcomes (range of motion, JOA score, and recurrent tear rate). After a mean follow-up of 12.7 months, significant improvement was seen in the shoulder joint range of motion and JOA score. Recurrent tears occurred in 1 of the 9 shoulders treated by the SB technique, but in none of the 3 shoulders treated by the TR technique. Despite the limited sample size and absence of any statistically significant differences, we considered that the TR technique yielded more favorable results in patients with FFTs, with no recurrent tears.

 We reviewed the data of 120 patients with proximal femoral fractures treated at our hospital, including data on the age, sex, height, weight, presence/absence of cognitive impairment (defined as Abbreviated Mental Test Score (AMTS) ≤ 6), physical status as measured by the American Society of Anesthesiologists Physical Status (ASA-PS) classification, fracture type, surgical method, ability to stand on the day after surgery, and interval to initiation of wheelchair transfer post surgery. Patients were divided into ambulatory and non-ambulatory groups based on their activity level at 120 days post-hospitalization, and the data in the two groups were compared. The results showed that the presence of cognitive impairment (AMTS ≤ 6) and initiation of wheelchair transfer on or after the third postoperative day were risk factors for developing walking difficulties at 120 days post-hospitalization.

 I searched for and reviewed previous studies on strategies that have been adopted to foster healthy musculoskeletal development from childhood, as this is regarded as the starting point for lifelong strategies for preventing osteoporosis and fractures. The review revealed that a multidimensional approach involving a 6-month to 1-year school-based exercise program combined with nutritional care, appropriate diet, appropriate environment, and appropriate education is effective for the promotion of children's musculoskeletal health. The findings also suggested the possibility that interventions tailored to gender and developmental stage may contribute to the prevention of future osteoporosis.

 The impact of different vitamin D formulations (native vitamin D and eldecalcitol) used concomitantly with denosumab on the changes in the serum calcium concentrations (Ca), estimated glomerular filtration rate (eGFR), and bone mineral density was examined in 4 groups of patients classified by the renal function (normal and chronic kidney disease [CKD]). No significant differences in the serum Ca or eGFR between patients receiving native vitamin D and eldecalcitol were observed in any of the four groups. However, among patients receiving native vitamin D, a significantly lower increase of the bone mineral density at the lumbar spine was observed in the CKD group as compared with the normal renal function group. There were little differences in the results of blood tests between patients receiving the two formulations. These results suggest that use of eldecalcitol in combination with denosumab might be preferable in patients with CKD.

 Calcifying tendinitis commonly affects the shoulder but can also occur at other sites. In the cases that I encountered at my clinic over the past 8 years and 6 months, the predominant sites of involvement other than the shoulder joint were the joints around the hip joint, including the greater trochanter (the attachment site of the gluteus medius) in 4 cases, the anterior inferior iliac spine (the attachment site of the rectus femoris muscle) in 3 cases, the fibular head (the insertion site of the biceps femoris) in 2 cases, and the pisiform bone (the site of insertion of the flexor carpi ulnaris) in 4 cases. Acute severe inflammation was present at the initial visit but improved in a relatively short period of time in all cases. The time to symptom resolution was 7.9 ± 3.7 days.

 We compared the data of 165 patients who had undergone posterior discectomy for lumbar disc herniation classified into two groups: a group that had undergone removal of both the herniated disc and the nucleus pulposus (HD + NP group) and a group that had undergone removal of the herniated disc alone (HD alone group). Among patients of the HD + NP group, low back pain worsened at 6 months after surgery in the group with Pfirrmann grades II to III, while long-term low back pain improved in patients with Modic changes. Concerning the cause of chronic low back pain in the patients, we concluded that discogenic low back pain was more common among patients with Modic changes, whereas radicular low back pain was more common among patients with Pfirrmann grades II to III.

 We investigated the relationship between the therapeutic effects of platelet-rich plasma (PRP) therapy and knee extensor strength before the treatment. The results revealed that the greater the knee extensor strength prior to treatment, the earlier the knee pain improvement post PRP therapy. The results suggested that, for accelerating the effectiveness of PRP, exercise intervention targeting the knee extensor muscles needs to be started prior to the treatment.

 To identify factors associated with low levels of 25-hydroxyvitamin D (25OHD) in patients with proximal femur fractures, we examined the data of 215 patients admitted to our hospital. The major data examined were the age of the patients, place of residence at the time of injury, and use of osteoporosis drugs before the fracture. Serum 25OHD levels were low overall in the study subjects. Especially, significantly lower levels were found in patients who were residing at care facilities or admitted at a hospital at the time of injury.

 I measured the body mass index (BMI) and bone mineral density in 128 patients with osteoporosis at my hospital in order to examine the relationship of these parameters with the physical activity levels. In the middle-aged group, the BMI was less than 20 in the majority of patients. On the other hand, in the early elderly group, most of the patients weighed more than normal. The bone mineral density was significantly higher in the group that met or exceeded the recommended physical activity levels. About one-third of the patients did not exercise habitually. These findings suggest the importance of establishing physical activity routines. Challenges include improving the BMI in younger underweight and incorporating a certain amount of exercise into the routines of the elderly after taking into consideration the presence of any underlying diseases. Achievement of these goals would be accelerated if orthopedic doctors engaged in raising patients' awareness.

 The new rules for calculating medical expenses under compulsory automobile liability insurance, proposed in fiscal year 2023, adopted a unit price of 12 yen for drugs and materials and an additional technical fee of 20% according to the Workers' Compensation Standards. However, the medical treatment fees based on health insurance standards do not reflect the actual costs and have therefore resulted in serious financial deficits at acute care medical institutions. A large cost gap exists especially for severe cases and inpatient/surgical/ICU management, making it difficult to maintain the institutions' capability of accepting patients. The compulsory automobile liability insurance system requires an independent fee assessment system distinct from health insurance.

 Individuals certified as needing support face larger deductions if they need to continue outpatient rehabilitation (outpatient rehab) for more than 12 months, due to the Nursing Care Fee Revision. This necessitates the users to graduate from the outpatient rehab. Therefore, we investigated the improvements in physical functioning observed at 6 and 12 months of outpatient rehab as compared with baseline measurements. Physical functioning was measured using the Time Up & Go rest, Two-Step test, and Standing Up test in patients divided into two groups, a support-needing group and a care-needing group. Results showed that individuals needing support showed improvement after one year of outpatient rehab, suggesting that this group can prepare for graduation from outpatient rehab.

 In this article, we report two cases of cuboid depression fracture in which use of external fixation led to favorable outcomes. Cuboid fractures are extremely rare. Surgery is indicated in cases with ≥ 1 mm articular surface displacement and ≥ 3 mm shortening of the lateral column. Plate fixation is considered for isolated fractures. However, for depressed cuboid fractures, the concomitant application of external fixation was useful. The external fixation resulted in restoration and maintenance of the crushed articular surface, elongation and maintenance of the shortened lateral column, and also prevented complications associated with progressive swelling.

 We performed occlusive composite grafting for avulsion amputation of the fingertips in 4 fingers in 4 patients. We performed the treatment using composite grafting followed by application of an occlusive dressing. Engraftment was achieved in all four fingers. Shortening of the affected finger was observed in two cases, and atrophy in one case. The advantages of this technique are that it does not require microsurgery and that it can be performed in an outpatient setting. On the other hand, the disadvantages are the longer time to healing and shortening/atrophy of the replanted finger. This technique is considered a viable treatment option for avulsion amputation of the fingertips.

 We evaluated the association between the severity of knee osteoarthritis (KOA) and functional morphological changes in the infrapatellar fat pad (IFP) using an ultrasonography (US) in 37 knees of 37 patients diagnosed as having KOA. The severity of osteoarthritis and the mean change in the angle formed by the patellar ligament and the anterior surface of the proximal tibial shaft (PTT angle) were examined. At knee flexion angles of 10° to 90°, the severity of KOA was not correlated with the changes in the PTT angle. The changes in the PTT angle were greater in the early phase of knee flexion in patients with Grade 4 KOA. This suggested the involvement of changes associated with the progression of KOA, including increased knee joint instability and reduced elasticity of the patellar tendon.

 We evaluated 120 shoulders of 109 patients who had undergone silent manipulation (SM) for frozen shoulder. The patients were divided into two groups, a group in which rehabilitation (rehab) could be completed at the end of 3 months and a group that required more than 3 months of rehab. We compared the two groups in terms of the range of motion (ROM) of shoulder joint flexion and external rotation, hand-behind-back ROM, initial pain score, and the rehab frequency. At 1 month after SM, significant differences were observed in all the ROMs, but no significant differences were found in the initial pain score or the rehab frequency. The ROMs in patients who could complete rehab at the end of 3 months after SM could be related to the ROMs recorded at 1 month after the SM.

 In recent years, the number of patients with cancer-related locomotive syndrome (cancer-locomo) has been increasing. As a result, at clinics also, an increasing number of patients are diagnosed with and treated for cancer-locomo. The author reviewed patients diagnosed with and treated for cancer-locomo at our clinic, and discusses the characteristics and limitations of clinics for cases of cancer-locomo and the importance of and problems related to collaboration with hospitals. Patient-centered rehabilitation for cancer-locomo at the clinic level was found to be useful. Clinics must strive to not only make an early diagnosis of cancer-locomo, but also ensure timely referral of patients to facilities capable of providing appropriate treatment.

 We evaluated the functional and morphological changes in the infrapatellar fat pad (IFP) in patients with knee osteoarthritis by diagnostic ultrasonography and examined their relationship with the presence of anterior knee pain. No correlation was observed between the change in the angle formed by the patellar tendon and the anterior surface of the proximal tibial shaft and the presence/absence of anterior knee pain. The probable cause for this is that the occurrence of anterior knee pain is influenced by various factors such as inflammation, in addition to an increase in the IFP pressure. Another cause may be that the functional and morphological changes in the IFP are influenced not only by the stiffness of the IFP, but also by the severity of knee osteoarthritis, etc.

 In this study, we compared the severity of early postoperative pain between patients undergoing lumbar spine surgery by unilateral biportal endoscopy (UBE) and microsurgery. The study was conducted in patients who underwent single-level lumbar spine surgery for herniated disc excision, decompression, or interbody fusion. The UBE group showed lower scores on a postoperative numerical rating scale and also lower increases of the serum creatine kinase levels, suggesting reduced muscle damage in patients undergoing UBE. Thus, UBE is a useful minimally invasive procedure associated with a lower severity of postoperative pain.

 A survey of 21 522 full marathon participants in the past three Mie Matsusaka Marathons was conducted to determine the incidence of marathon-related injuries and illnesses. The results showed that 486 participants used first-aid stations, including 71 participants (15%) for injuries, 254 participants (52%) for musculoskeletal joint injuries, 61 participants (12%) for hypothermia, and 100 participants (21%) for other conditions. In this survey, we found no cases that needed use of an automated external defibrillator (AED). However, middle-aged and older participants in full marathons are at a relatively high risk of developing cardiac arrest. Therefore, 56 AEDs were installed to ensure that the medical aid stations were fully equipped.

 Among patients treated at my clinic for chronic musculoskeletal pain in the low back and legs, I conducted this study in 150 patients who showed limited improvement with drug therapy or physical therapy. The use of a systemic transdermal patch containing diclofenac sodium improved the residual pain in the low back and legs, particularly pain radiating from the low back to the thighs, in these patients. Therefore, I consider additional use of a systemic transdermal patch containing diclofenac sodium as meaningful for improving the activities of daily living (ADL) and quality of life (QOL) in patients with chronic low back pain.

 We prospectively evaluated the clinical and ultrasound findings every two weeks in 16 patients with Osgood-Schlatter disease. Increased blood flow in the patellar tendon and infrapatellar fat pad was observed only in the acute phase. Increased blood flow was no longer seen by 2 to 4 weeks, so that we considered it as a useful indicator for the patient to resume exercise. On the other hand, hypoechoic areas in the deep infrapatellar bursa were more likely to persist beyond 4 weeks. This finding, suggestive of a chronic change, was important for determining the amount of gradual load increase.

 The damage and restoration status of facilities belonging to members of the Ishikawa Prefectural Clinical Orthopaedic Association following the 2024 Noto Peninsula Earthquake were examined through three questionnaire surveys. Facilities in Nanao City, Shika Town, and Hakui City, which were near the epicenter, suffered significant damage; the infrastructure damage and manpower shortages caused by the absence of staff were major problems. One year after the earthquake, 50% of the damaged facilities were found to have completed repairs, while 40% of medical institutions continued to experience income reduction. For the affected facilities, support from the Japan Clinical Orthopaedic Association Disaster Team is anticipated.

 We investigated the course of changes in range of motion (ROM) of frozen shoulder patients who were treated conservatively. The subjects were the 32 patients (32 shoulders) who had been diagnosed with frozen shoulder in our hospital and treated conservatively for at least 5 months, and we measured their ROM (flexion, external rotation in the neutral position, and belt-tying movement) at their first visit, at 3 weeks, 3 months, 5 months, and at the time of the final observation. No ROM exercises were performed during the inflammatory stage, but significant improvement in all of the ROM parameters in comparison with the first visit was observed from 3 weeks onward, and ROM values that are considered necessary to perform activities of daily living were achieved within 6 months.

 This study was conducted in baseball players admitted with pitching injuries to compare the qualitative characteristics of the infraspinatus muscle between pitchers and position players. The study subjects were 31 pitchers and 22 position players. The infraspinatus muscles on the throwing side of the players were examined by ultrasonography. The MODE value was significantly lower in the pitcher group than in the position player group at hospital admission, while no significant difference was observed at discharge. During the short period of inpatient treatment, the MODE value increased significantly in the pitcher group, but remained unchanged in the position player group. These findings suggest that the lower MODE value at admission in the pitcher group could have been associated with muscle edema.