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Ideberg type III glenoid fractures are relatively rare, and the mechanisms of injury and treatment strategies remain controversial. We reviewed the fracture patterns and final radiological findings in four cases. All fractures were wider on the medial side than on the side of the articular surface. All patients had multiple ipsilateral rib fractures; three out of four patients had a concomitant acromion fracture. Therefore, the mechanism of injury for the fracture is assumed to be external force applied in the caudal direction to the medial side of the body of the scapula. The superior shoulder suspensory complex was disrupted in most cases. A good clinical outcome was obtained in two patients with percutaneous screw fixation for the glenoid fracture and rigid plate fixation for the acromion fracture and in one patient who did not have an acromion fracture. However, one patient who did not undergo fixation of the acromion fracture developed osteoarthrosis of the shoulder joint. In this type of fracture, it is important to stabilize the acromion fracture at the same time as fixation of the glenoid fracture.

Background: The purpose of this study was to investigate the effect of the main fragment fracture type (oblique or transverse) on the union rate of femoral shaft fractures., Methods: Patients who underwent surgical treatment with an antegrade intramedullary nail for femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopaedic Trauma Association; AO/OTA type 32 type B or C) between January 2009 and March 2021 were included in this study. Patients with oblique fractures of the two main fragments on radiographs immediately after surgery were classified into the oblique fracture group. Patients with at least one of the two main fractures being transverse fractures were classified into the transverse fracture group. We investigated age, sex, height, weight, body mass index (BMI), AO/OTA classification, time from fracture to surgery, intramedullary nail length and diameter, number of interlocking screws, and bone union rate., Results: A total of 55 fractures were included. The mean age was 34.4 ± 16.7 (range, 16-77) years. There were 41 fractures classified into the oblique fracture group and 14 fractures classified into the transverse fracture group. There was a significantly higher proportion of men in the transverse fracture group. Patients in the transverse fracture group were significantly younger and taller. Only 1 of 41 (2.4%) patients in the oblique group experienced nonunion, while 3 of 14 (21.4%) patients in the transverse group experienced nonunion (p = 0.030)., Conclusion: Comminuted femoral shaft fractures with transverse fracture components are more prone to nonunion.

Introduction: The aim of this study was to describe the clinical and radiological results of reverse obliquity intertrochanteric fractures treated with dynamic distal locked intramedullary hip nails., Materials and Methods: Patients with a reverse obliquity intertrochanteric fracture (AO/OTA type 31 A3.1 or A3.3) underwent surgical treatment with a dynamic distal locked intramedullary hip nail between August 2017 and September 2020. Fracture type, reduction quality, change in the position of the distal bone fragment, bone union, complications, and walking ability were evaluated., Results: Ten patients with reverse obliquity intertrochanteric fractures (seven females and three males) underwent dynamic distal locked intramedullary hip nailing. The mean age was 72.0 ± 18.9 years. Two patients were classi fied as having A3.1 fractures; eight patients were classified as having A3.3 fractures. Anatomical reduction was achieved in six patients, medial displacement remained in three patients, and lateral displacement remained in one patient postoperatively. In 9 out of 10 patients, the center of the proximal end of the distal bone fragment had moved laterally between the time immediately after surgery and the time of the final evaluation. Bone union was obtained uneventfully without any additional treatments in all patients. There were no complications such as infection or implant failure. Walking ability decreased in four patients., Conclusion: In all patients, bone union was achieved due to good contact of the medial cortices or the migration of the distal bone fragment into the proximal bone fragment. This procedure can be an option for treating reverse obliquity intertrochanteric fractures.

Suicidal jumper's fractures are transversal fractures of the upper sacrum. The treatment for this type of fracture remains controversial. We present a case of a Roy-Camille type 2 suicidal jumper's fracture treated with reduction by hyperextension of the lumbosacral junction, the joystick method, and percutaneous fixation on the day of injury. After the operation, the sacral canal at the S2 level was enlarged and both lower extremities began to move gradually. At 19 days after the injury, direct decompression via sacral laminectomy was performed to promote further neurological improvement. At 10 months after the injury, cauda equina syndrome and radicular symptoms were completely resolved. Considering its minimal invasiveness, we recommend trying hyperextension and the joystick method to treat Roy-Camille type 2 suicidal jumper's fractures on the day of injury., Competing Interests: The authors declare that they have no conflicts of interest in connection with this paper. All authors confirm that they have no financial or personal relationships with other people or organizations that could inappropriately influence this work., (© 2021 The Authors.)

"Hybrid exercise" utilizing combined electrical stimulation and voluntary muscle contraction has been developed as a muscle exercise method. Although our previous studies have confirmed the effectiveness of the procedure, the mechanisms of its efficacy still remain unclear. In the present study, we identified genes that are specifically expressed in disused muscles, using the semitendinosus muscle from patients who underwent anterior cruciate ligament (ACL) reconstruction. Preoperative exercise was performed by four ACL-injured patients, who were subjected either to hybrid exercise (n=2), electrical stimulation (n=1), or no electrical stimulation (n=1), in addition to standard weight training for 4 weeks. Cross-sectional area (CSA) of the semitendinosus muscle was measured before and after the exercise by magnetic resonance imaging (MRI). A piece of the semitendinosus muscle was isolated during the surgery, and comprehensive analysis of the gene expression in this sample was performed using DNA microarray analysis. CSA increased in size by 4.2 and 14.7%, respectively, after hybrid exercise, and by 1.4% after electrical stimulation. However it shrunk by 7.7% without electrical stimulation. DNA microarray analysis revealed that hybrid exercise was more effective at stimulating the expression of signal transduction-, transcription- and cytoskeleton-related genes in semitendinosus muscles than electrical stimulation alone. In particular, gene ontology analysis revealed that hybrid exercise induced significantly higher expression of eukaryotic translation initiation factor 5A (EIFSA), peroxisomal biogenesis factor 6 (PEX6) and histone cluster 1 H4 (HIST1H4), compared with electrical stimulation alone. The expression of signal transduction-, transcription- and cytoskeleton-related genes may play an important role in muscle bulk increasing mechanisms in hybrid exercise.

Extreme skeletal muscle atrophy is rampant in astronauts exposed to extended periods of microgravity (muG), and it is one of the main problems in human space exploration. A "Hybrid training" (HYB) method utilizing combined electrical stimulation and voluntary muscle contraction has been developed as a possible solution. A wearable HYB device and a virtual reality (VR) system were developed for use in space, and were verified at muG generated by parabolic flight (PF). A 36-year-old male subject performed HYB of reciprocal flexion and extension as a knee joint exercise training in a seated position at 1G, 2G and muG. The wearable HYB device and VR system developed for the study functioned well during the flight. However knee extension was insufficient at 1G and 2G, and the maximum knee extension angles at 1G and 2G were smaller than at muG. The extension velocity in the latter half of each motion was slower than in the first half at 1G and 2G, but no difference in velocity was observed at muG. The subject could extend the knee joint sufficiently and keep a constant extension velocity, because his legs were weightless at muG. The congruity between the subject's actual joint motions and instructed joint motions during muG was improved, when VR was employed with or without body fixation; accordingly, the subject was able to perform the desired joint motion. The VR system improved HYB exercise performance at muG during PF. HYB is considered a useful training method for future human space exploration.