We reviewed 318 hospitalized patients with fragility fractures from April 2013 to March 2014 in our hospital retrospectively. We had tried early administration of osteoporosis drugs to them and 84 cases in which the bone mineral density of the lumbar spine or the proximal femur was followed for more than half a year were investigated. Bone mineral density of the lumbar spine was increased in every administrated drug, but of the femur, decreased in many cases at half a year and showed a large variation over time. We consider that, as declining of activity of daily living after fragility fracture, bone mineral density decreases due to strong bone resorption occurring at an early phase, so the early administration of osteoporosis drugs is considered an effective treatment for the secondary fracture prevention.

Tibial shaft fracture with ipsilateral tibia plateau fracture or segmental tibial shaft fracture with large fragment are frequently caused by high energy trauma and ideally treated by intramedullary nailing for the preservation of the soft tissue structure. However, the treatment can be very troublesome due to the extended fracture line into the nail insertion site of tibial plateau fracture or the difficulty of holding the fracture reduction of segmental tibia fracture for nail insertion. Here we report 3 cases of tibial fractures more simply treated by intramedullary nailing combined with plate fixation of the proximal fragment.

Twenty-one patients with AO type C1 patella fractures were treated using modified tension band wire fixation. Loss of reduction before healing was noted in two cases. This early complication was occurred in elderly patients, distal segment of patella complex without displacement. It is difficult to insert the K-wire under fluoroscopic AP view. Therefore, it is necessary to use self-locking pin or other augmentation for fractures involved these risk factors.

We report clinical outcomes of fourteen cases that had treated with volar locking plate for volar displaced distal radius fractures. The loss of reduction occurred in three cases. We considered that there is higher buttress effect for volar lunate facet fragment by reducing accurately fractures and setting distal plate of shallow bend angle.

But when patients with volar lunate facet fragment is less than 15 mm, communited or lunate subsidence, the use of rim fracture plate might also useful for this kind of fractures.

Background: Femoral neck fracture occurs frequently in elder people and affect, not only functional outcome, but their life prognosis. Although several factors affect the surgical outcome, a few studies reported that the long time interval for surgery was a risk factor for functional and biological prognosis. The purpose of this study is to evaluate the role of early surgery for femoral neck fracture.

Material/Method: One hundred cases of femoral neck fracture who underwent open reduction and internal fixation were evaluated. Reduction failure, post-operative ADL and the rate of local complications including nonunion and late segmental collapse were evaluated as a primary outcome.

Result: Reduction failure and the rate of local complications were significantly decreased in early surgery group (<48 hr) compared with late surgery group. No post-operative ADL change was observed between two groups.

Discussion: The present study revealed that the better functional outcome could be obtained in early surgery group for femoral neck fracture. We are now making an effort to shorten the time interval for surgery by reviewing diagnosis process and preoperative examination with anesthesiologist. The femoral neck fracture should be recognized as the emergency disease.

The periprosthetic femoral fractures have been increasing along with a rise in the cases of total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) during recent years. In this study, we evaluated ADL before the injury (pre-injury) and at 4 months after the surgery (4M post-op) using Barthel Index (BI) for periprosthetic femoral fractures following THA and BHA. The study consists of 9 patients (9 hips). BI at 4M postop significantly decreased from pre-injury, however, 8 cases were able to be back theirs home within 4 months follow-up. There was no significant difference in the mobility score between pre-injury and 4M post-op, although the grooming, bathing, stairs, and dressing scores at 4M post-op became significantly lower compared with pre-injury. The age, hospitalization period, and timing of surgery following the injury showed a negative correlation at 4M post-op. Furthermore, the level of - independence in daily activities of the patients had declined after the surgery. It should be recognized that BI would decline after the treatment of periprosthetic femoral fracture.

In adult spinal deformity (ASD) patients with a compensatory decrease in thoracic kyphosis (TK), both TK and the PJA (proximal junctional angle) increase postoperatively following surgery for restoration of lumbar lordosis. According to existing definitions this postoperative PJA progression is classified as PJK (proximal junctional kyphosis), but in ASD how does the magnitude of this progression correlate to the incidence of proximal junctional failure (PJF)? We retrospectively reviewed pre- and post-operative radiographs of 40 patients with ASD (mean age, 68.5 years) who underwent corrective spinal surgery (from T10 to sacrum and ilium) in our institution for lumbar kyphotic deformity. From these we compared two sub-groups where the P (positive) group (16 cases) had a preoperative PJA≥5°, and the N (negative) group (8 cases) had a preoperative PJA≤-5°. The preop to final follow-up PJA change was significantly greater in the N group than in the P group, but no other differences were found in other sagittal plane radiographic parameters, or HRQOL, or the incidence of PJK and PJF. In spinal deformity patients with compensatory thoracic lordosis, the preoperative PJA does not correlate to the incidence of junctional failure such as PJK or PJF.

The purpose of this study is to investigate whether the scoring system based on ultrasonographic (US) evaluation of vascularity and elasticity is able to distinguish between malignant soft tissue tumors (STTs) and benign STTs. Seventy-three STTs confirmed pathologically were included in this study. The tumor size, depth, vascularity index (VI) and maximal shear velocity (MSV) were evaluated preoperatively and an original scoring system (SS) based on these parameters was established. In two-parameter SS comprised of VI and MSV, area under curve (AUC) was 0.95 by receiver operating characteristic analysis, and the sensitivity and specificity for diagnosis of malignant STT was 73% and 98%, respectively. In four-parameter SS of combined tumor size and depth, AUC was 0.96, and sensitivity and specificity was 82% and 95%, respectively. These results suggest that an SS based on US evaluation of vascularity and elasticity is able to distinguish between malignant STTs and benign STTs.