Keizo Wada, 三上 浩, Shun-ichi Toki, 甘利 留衣, Michihiro Takai and Koichi Sairyo : Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography, Injury, Vol.51, No.11, 2682-2685, 2020.
(Summary)
Intertrochanteric fractures are common fragility fractures in elderly patients. The importance of a reliable classification system for these fractures has been increasingly recognized. The aim of this study was to test the hypothesis that three-dimensional classification by CT has better intra- and inter-observer reliability than conventional two-dimensional classification. Two hundred and three consecutive patients (39 male, 164 female; mean age 84.5 years) with intertrochanteric fracture were included in the study. In each case, the fracture was classified using the two-dimensional Evans-Jensen and AO/OTA systems that rely on plain radiographs and using a three-dimensional fragment-based CT system. The second evaluation was performed 1 month after the first evaluation by the same examiner to determine intra-observer reliability. Another blinded examiner also classified each case to assess inter-observer reliability. The kappa coefficient was used for determination of intra- and inter-observer reliability. The kappa values for the two-dimensional Evans-Jensen and AO/OTA classification systems showed moderate intra-observer reliability (κ=0.65 and κ=0.61, respectively) and slight inter-observer reliability (κ=0.20 and κ=0.19). The intra-observer kappa value for the three-dimensional classification system was 0.88, indicating almost perfect reliability; the inter-observer kappa value was 0.70, indicating substantial reliability. The findings of this study confirm that the fragment-based classification system has high reliability. Surgeons should be aware that the three-dimensional fragment-based CT system for classification of intertrochanteric fractures has better intra-observer and inter-observer reliability than the conventional two-dimensional systems.
Shota Shigekiyo, Toshihiko Nishisho, Yoichiro Takata, Shun-ichi Toki, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Intracanalicular Osteochondroma in the Lumbar Spine., NMC Case Report Journal, Vol.7, No.1, 11-15, 2019.
(Summary)
resection of the osteochondroma with the ligamentum flavum relieved the symptoms. Spinal osteochondroma occurs relatively frequently in elderly individuals compared with peripheral lesions and mimics a degenerative spinal disorder. Careful physical examination and imaging evaluation can reveal this tumor and surgery is effective for relieving the symptoms.
Kaori Momota, Toshihiko Nishisho, Ryo Miyagi, Shun-ichi Toki, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, Toru Maeda and Koichi Sairyo : A Rare Case of Acute-Onset Spastic Quadriparesis Caused by a Chondroma of the Cervical Spine., Case Reports in Orthopedics, Vol.2019, 2019.
(Summary)
Chondromas are benign cartilaginous tumors that occur very rarely in the spine. Moreover, chondromas of the extraskeletal origin are also very rare. In this case report, we describe an extremely rare case of chondroma arising from the ligamentum flavum in the cervical spine. A 67-year-old man presented to our clinic with acute-onset spastic quadriparesis. We performed emergent magnetic resonance imaging and found an epidural mass in the right ligamentum flavum at C4-C5. The acute-onset presentation was suspicious for intraligamentous hematoma in the ligamentum flavum at this level. We performed emergency decompression surgery and en bloc removal of the epidural mass with the right C4 and C5 lamina. The lesion had the appearance of cartilaginous tissue rather than hematoma. Based on the histological investigation, the final diagnosis was intraligamentous chondroma of the cervical spine. The quadriparesis improved postoperatively, as did the results of manual muscle testing in the affected area, and he was able to resume walking independently with a cane. At the one-year follow-up, the manual muscle testing results were almost normal. Surgeons should keep in mind the possibility of benign tumors including chondroma of the cervical spine when a patient presents with acute-onset quadriparesis.
Keizo Wada, Hiroshi Mikami, Rui Amari, Shun-ichi Toki, Michihiro Takai and Koichi Sairyo : A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 362-366, 2019.
(Summary)
A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems. J. Med. Invest. 66 : 362-366, August, 2019.
Masashi Kano, Toshihiko Nishisho, Ryo Miyagi, Fumio Chikugo, Eiji Kudo, Shoichiro Takao, Seiji Iwamoto, Shun-ichi Toki and Koichi Sairyo : Intimal sarcoma arising from the common iliac artery presenting with artery occlusion : a case report and literature review., The Journal of Medical Investigation : JMI, Vol.66, No.1.2, 205-208, 2019.
(Summary)
We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery. J. Med. Invest. 66 : 205-208, February, 2019.