Objective : In Europe, carbon dioxide therapy has been used for treating cardiac disease and skin problems for a long time. Previously, we demonstrated that transcutaneous carbon dioxide (CO₂) application facilitated dioxygen (O₂) dissociation from hemoglobin (Hb) in the human body. Additionally, we proved that transcutaneous CO₂ application to the lower limbs of rats increased the expression of peroxisome proliferator-activated receptor (PPAR) gamma coactivator-1α (PGC-1α), vascular endothelial growth factor (VEGF) and silent mating type information regulation 2 homologs 1 (SIRT1). It also increased the number of mitochondria, and changed IIB fiber to IIA fiber in similar manner to the change that occurs after exercise. The transcutaneous CO₂ application caused a similar effect to that of exercise training in skeletal muscle and indicated the possibility of improved endurance strength. However, the effect of transcutaneous CO₂ application on endurance exercise and the recovery of muscle fatigue has not been studied. Methods : In this study, we investigated the performance of endurance exercise in rats with/without transcutaneous CO₂ application and analyzed the muscle fiber changes, capillary density and mitochondrial DNA number of the skeletal muscles after training, using activity wheels. Results： Training with CO₂ application resulted in a higher percentage of TA muscle transformed to IIA and/or IID than training alone, suggesting that transcutaneous CO₂ application may increase the production of ATP, mitochondria number, and capillary density. Therefore, transcutaneous CO₂ application might lead to muscle damage recovery. Conclusion : We suggest that transcutaneous CO₂ application has a therapeutic potential for recovery of damaged muscle after excessive exercise and rehabilitation.

BACKGROUND: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. METHODS: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. RESULTS: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. CONCLUSIONS: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.
Aged ; Aged, 80 and over ; Algorithms ; Arthroplasty, Replacement, Hip/*adverse effects ; Female ; Femoral Fractures/classification/etiology/radiography/*surgery ; Hemiarthroplasty/adverse effects ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures/classification/etiology/radiography/*surgery ; Retrospective Studies

Background: Tibial fracture after cementless Oxford unicompartmental knee arthroplasty (OUKA) is a rare but serious complication. It is reported more frequently in Asian countries. The aim of this retrospective study was to assess the morphological characteristics of the tibia by using a simple novel measurement method in patients with tibial fractures after OUKA. Methods: Six knees (all women) with tibial fractures after cementless OUKA (fracture group) and 150 knees without an obvious complication after cementless OUKA (control group) were examined retrospectively at our institution between January 2016 and April 2017. We drew a medial eminence line (ME line) defined as a line extending from the tip of the medial intercondylar eminence parallel to the tibial axis. The ME line was classified into two types (intramedullary type [type I] and extramedullary type [type E]), and the proportion of each type was compared between fracture patients and controls. Results: In the fracture group, there were four (66.7%) type E cases and two (33.3%) type I cases; in the control group, there were 18 (12%) type E cases and 132 (88%) type I cases. Fisher exact tests showed that the proportion of type E was higher in the fracture group than in the control group (p < 0.01). Conclusions Measurement of the ME line can be recommended as a useful method to assess the risk of postoperative fracture after cementless OUKA.

BACKGROUND: In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. METHODS: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. RESULTS: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. CONCLUSIONS: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.
*Bone Nails ; *Dimensional Measurement Accuracy ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Hip Fractures/*surgery ; Prospective Studies ; Reproducibility of Results

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

This case report describes the effect of exercise therapy on a patient with plasmacytoma diagnosed with chemotherapy-induced peripheral neuropathy (CIPN). A man in his mid 70s was diagnosed with plasmacytoma and received outpatient chemotherapy. He developed glove-and-stocking numbness and balance disorder and underwent 16-week multimodal exercise therapy consisting of resistance and balance training, and aerobic exercise. He attended one session per week of exercise therapy at a hospital under the supervision of a physical therapist and completed five sessions of home-based exercise. His symptoms and physical function were evaluated at baseline and after intervention using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE), Functional Assessment of Cancer Therapy-Neurotoxicity subscale (FACT-Ntx), modified Total Neuropathy Score (mTNS), Stand-up test, and Berg Balance Scale (BBS). After the 16-week intervention, clinician-assessed CIPN symptoms were stable (CTCAE：Grade 2 at baseline, Grade 2 after intervention), whereas patient-reported CIPN symptoms improved beyond the minimal clinically important difference (FACT-Ntx score increased from 22 to 29 points). Although the components of mTNS such as motor symptoms and strength improved, the total mTNS score remained stable. The Stand-up test and BBS scores improved, and better physical function led to improvements in activities of daily living. Thus, exercise therapy may effectively reduce the symptom burden and improve physical function in patients with CIPN.