Language：English   Publishing type：Research paper (scientific journal)  

Fixation using cephalomedullary nails (CMNs) with additional cement augmentation (CA) was developed as a novel treatment option for the osteosynthesis of osteoporotic trochanteric fractures, though the effectiveness of CA on early postoperative mobility remains uncertain. This multicenter prospective cohort study aimed to estimate the effectiveness of CA on early postoperative mobility in patients with trochanteric fractures. We enrolled patients with femoral trochanteric fractures aged >60 years who were able to walk independently before the injury. The primary outcome was the postoperative 3-day cumulated ambulation score (CAS); the secondary outcome was the visual analog scale (VAS) pain score at rest and during movement on postoperative days 1−3. The outcomes of the patients treated using CMNs with or without CA were compared. Sixty-three eligible patients were categorized into CA (n = 32) and control (n = 31) groups. In univariate analysis, the CA group had significantly higher CAS values, lower VAS scores at rest on day 1 postoperatively, and lower VAS scores during movement on day 3. In multivariable linear regression analyses, the CA group had significantly higher CAS values (beta, 2.1; 95% confidence interval, 0.5 to 3.6; p = 0.01). The CA group had a negative adjusted beta value in their VAS scores during movement. This study indicated that CA was associated with a high CAS value in patients with geriatric trochanteric fractures. However, CA was not associated with pain reduction at rest and during movement during the initial postoperative days.

DOI： 10.3390/jpm12091392

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Language：English   Publishing type：Research paper (scientific journal)  

Osteochondral fractures of the medial femoral condyle accompanied by medial wall fracture are rare. Surgeons often have difficulty in selecting the most appropriate treatment, especially the plating technique for internal fixation since the available femoral locking plates are made to fit the femoral lateral condyle and there is no anatomical plate for the medial condyle. We, herein, report a case of a 44-year- old female patient who suffered from an osteochondral fracture of the medial femoral condyle accompanied by medial wall fracture treated by a low-profile mesh plate contoured to fit around the fracture site. Bone union was achieved at postoperative week 12 and the patient was able to return to her normal activities. At the 16-month follow-up exam, the patient's functional and clinical outcomes were satisfactory. Her Oxford knee score was 47 points, and the Western Ontario and McMaster Universities Arthritis Index scores were 2 points for pain and 5 points for physical function. We believe that the mesh plate has several advantages. This is the first report of using a mesh plate for the femur, and we were able to achieve good results. We conclude that treatment with a mesh plate can be applied in well- selected patients with medial femoral condyle osteochondral fracture and has the potential to be applied to the treatment of fractures in various regions in the future.

DOI： 10.5152/j.aott.2022.21325

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Geriatric trochanteric fractures are a major global issue, and their incidence is steadily rising. Bone quality, fracture type, fracture reduction quality, implant selection, and implant placement affect bone-implant stability in osteoporotic fractures. Our aim in this study was to evaluate the association between bone-implant stability factors, including nail construct, and the rate of reoperation in a more extensive case series with comprehensive variables. METHODS: This was a retrospective cohort study of 390 patients with trochanteric fractures aged ≥60 years and treated with intramedullary nailing. The primary outcome was the rate of reoperation due to any cause. Univariate and multivariable logistic regression analyses were used to identify factors associated with reoperation. RESULTS: In this study, 15 patients (3.8%) required reoperation. Univariate analysis showed that the following variables were significantly different between patients who required reoperation and those who did not: T-score at the total hip and lumbar spine, cortical thickness index, fracture type, and reduction quality. Multivariable logistic regression analysis showed that the odds ratio (OR) for A3 fracture type was 2.76 (95% confidence interval [CI], 0.77-9.76; p=0.116) and that for inadequate reduction, assessed by computed tomography, was 2.94 (95% CI, 0.89-9.69; p=0.076). These were independent predictors of reoperation. There was only one case (6.7%) of reoperation among patients with a distal femoral fragment fixation ratio (FR) >0.8. Considering the intraoperative decision-making process, the combination of inadequate reduction and an FR ≤0.8 were associated with the highest reoperation at a rate of 9.3% (OR, 3.327; 95% CI, 1.091-10.142; p=0.043). CONCLUSIONS: Risk factors on bone-implant stability for reoperation were the reduction quality and fracture type. Regarding the intraoperative decision-making process, the selection of a nail length with an FR >0.8 is a better option when the intramedullary reduction has been maintained intraoperatively.

DOI： 10.1016/j.injury.2021.04.048

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Language：English   Publishing type：Research paper (scientific journal)  

Immune checkpoint inhibitors including anti-programmed cell death 1 (PD-1) antibody have recently improved clinical outcome in certain cancer patients; however, osteosarcoma (OS) patients are refractory to PD-1 blockade. Oncolytic virotherapy has emerged as novel immunogenic therapy to augment antitumor immune response. We developed a telomerase-specific replication-competent oncolytic adenovirus OBP-502 that induces lytic cell death via binding to integrins. In this study, we assessed the combined effect of PD-1 blockade and OBP-502 in OS cells. The expression of coxsackie and adenovirus receptor (CAR), integrins αvβ3 and αvβ5, and programmed cell death ligand 1 (PD-L1) was analyzed in two murine OS cells (K7M2, NHOS). The cytopathic activity of OBP-502 in both cells was analyzed using the XTT assay. OBP-502-induced immunogenic cell death was assessed by analyzing the level of extracellular ATP and high-mobility group box protein B1 (HMGB1). Subcutaneous tumor models for K7M2 and NHOS cells were used to evaluate the antitumor effect and number of tumor-infiltrating CD8+ cells in combination therapy. K7M2 and NHOS cells showed high expression of integrins αvβ3 and αvβ5, but not CAR. OBP-502 significantly suppressed the viability of both cells, in which PD-L1 expression and the release of ATP and HMGB1 were significantly increased. Intratumoral injection of OBP-502 significantly augmented the efficacy of PD-1 blockade on subcutaneous K2M2 and NHOS tumor models via enhancement of tumor-infiltrating CD8+  T cells. Our results suggest that telomerase-specific oncolytic virotherapy is a promising antitumor strategy to promote the efficacy of PD-1 blockade in OS.

DOI： 10.1007/s00262-020-02774-7

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞人工股関節全置換術(total hip arthroplasty;THA)・人工膝関節全置換術(total knee arthroplasty;TKA)の間で骨折をきたす大腿骨interprosthetic fracture(IFF)の報告が近年多くなっている。さまざまな分類と治療法が提唱されているが,インプラントにゆるみがない場合は骨接合,ゆるみがある場合は再置換術が一般的である。Plateと人工関節をoverlapさせ応力集中を避けるなど治療戦略と手術手技上の工夫が必要である。

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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