Background: No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors. Methods: Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class. Results: Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight. Conclusions Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.

Fat embolism syndrome (FES) is a serious complication of orthopedic surgery. We describe a woman in her 30s, who experienced cerebral FES after extensive femoral tumor resection and intercalary endoprosthesis for a malignant soft tissue tumor of the thigh. Before the surgery, the patient was able to walk with a single axillary crutch, capable of independent self-care and had no cognitive problems. After the surgery, the patient developed respiratory and central nervous system symptoms, which are characteristic of FES. After critical care, we provided rehabilitation treatment, which included getting out of bed, basic motion training, cognitive rehabilitation treatment, and Activity of Daily Living (ADL) training. At the time of commencement of the rehabilitation treatment, the patient presented with higher brain dysfunctions, such as cognitive dysfunction (Mini Mental State Examination：MMSE score 21 points), attentional dysfunction and left unilateral spatial neglect (USN). However, apparent motor paralysis of the extremities was not detected. On the 95th day after the surgery, the patient's MMSE score was 29 points, and the attentional dysfunction and USN were resolved. Additionally, the patient was again able to walk with axillary crutch. Six months after the surgery, the patient could walk independently without the aid of a crutch. One year after the surgery, the patient's reinstated to work. Cerebral FES may be accompanied with higher brain dysfunction；present a variety of higher brain dysfunctions；however, the symptoms may be reversible and resolved with rehabilitation treatment.

Background: Dual SC screw (DSCS) is a unique concept internal fixation device consisting of a sliding screw and barrel assembly that enables compression force to be applied to the femoral neck fracture side. There are two types of barrels: a thread barrel and a plate barrel that has a one-holed side plate to prevent varus deformity. We report clinical results of the application of a DSCS with combined use of a thread barrel screw as an anti-rotational screw and a plate barrel screw as a compression hip screw. Methods: We used DSCS for femoral neck fractures in 196 hip joints of 190 patients between November 2005 and June 2017. Among them, 70 hips in 66 patients (13 men and 53 women; mean age, 73.2 years) were followed up for at least 24 months. There were 53 nondisplaced fractures (Garden’s classification stage 1 or 2) and 17 displaced fractures (stage 3 or 4). We evaluated the postoperative walking ability of the patients who were followed up for at least 24 months and examined details of all complications. Results: The mean follow-up period was 37.4 months (range, 24–144 months). Forty-two (64%) out of the 66 patients who were followed up for at least 2 years were able to walk independently with or without a cane. The incidence of complications was 11.5% in nondisplaced fractures and 17.5% in displaced fractures, and arthroplasty was required in 5.8% and 5.0%, respectively. The most frequent complication was secondary displacement including cutout and shortening of the femoral neck, but no implants showed varus displacement. Conclusions The application of DSCS for the treatment of femoral neck fractures had satisfactory results. The complication rate was low, and there was no postoperative varus displacement of DSCS in either displaced or nondisplaced fractures. We suggest DSCS is a reliable option for both displaced and nondisplaced femoral neck fractures.

Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.

Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient's elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient's ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.

Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.

Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient’s elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient’s ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.

Fat embolism syndrome (FES) is a serious complication of orthopedic surgery. We describe a woman in her 30s, who experienced cerebral FES after extensive femoral tumor resection and intercalary endoprosthesis for a malignant soft tissue tumor of the thigh. Before the surgery, the patient was able to walk with a single axillary crutch, capable of independent self-care and had no cognitive problems. After the surgery, the patient developed respiratory and central nervous system symptoms, which are characteristic of FES. After critical care, we provided rehabilitation treatment, which included getting out of bed, basic motion training, cognitive rehabilitation treatment, and Activity of Daily Living (ADL) training. At the time of commencement of the rehabilitation treatment, the patient presented with higher brain dysfunctions, such as cognitive dysfunction (Mini Mental State Examination：MMSE score 21 points), attentional dysfunction and left unilateral spatial neglect (USN). However, apparent motor paralysis of the extremities was not detected. On the 95th day after the surgery, the patient’s MMSE score was 29 points, and the attentional dysfunction and USN were resolved. Additionally, the patient was again able to walk with axillary crutch. Six months after the surgery, the patient could walk independently without the aid of a crutch. One year after the surgery, the patient’s reinstated to work. Cerebral FES may be accompanied with higher brain dysfunction；present a variety of higher brain dysfunctions；however, the symptoms may be reversible and resolved with rehabilitation treatment.

To reduce the stress on the medial tibial cortex and to decrease the risk of fracture, a varus cut of the tibia appears to be a reasonable alternative to the orthogonal cut by conventional methods. We present a new instrument and procedure, which enables a varus tibial cut for Oxford unicompartmental knee arthroplasty. We used a custom-made, slidable fixator instead of the standard fixator to set the extramedullary rod on the leg. We also made a numeric formula and a chart to arrange the varus cutting angle using the length of the mediolateral shift of the distal end and the longitudinal extension length of the extramedullary tibial rod. A varus cut up to 4.5° can be controlled. This technique is a simple and useful means of obtaining a varus tibial cut for Oxford unicompartmental knee arthroplasty.

The under-vastus approach (UVA) is a modification of the conventional subvastus approach for knee arthroplasty. Our modified UVA allows the muscles to be spared while offering good exposure of the operative field and facilitating anatomical repair of the capsule and fascia. A medial parapatellar incision is made and the vastus medialis fascia is incised along the same line. The muscle belly is not incised but detached from the surrounding fascia and retracted laterally. The suprapatellar pouch capsule is then laterally incised under the vastus muscles. The patella can then be easily retracted laterally and adequate exposure is possible. After the procedure, both capsule and fascia can be anatomically repaired. We use this approach for all primary arthroplasties in our practice. There has been no case in which an additional muscle incision was required, and there were no intraoperative complications. The modified UVA allows for excellent exposure of the operative field as well as muscle retention in both primary total and unicompartmental knee arthroplasties.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Fascia ; Intraoperative Complications ; Knee ; Muscles ; Osteoarthritis ; Patella ; Quadriceps Muscle