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Atypical fractures have been reported as a complication of long-standing bisphosphonate therapy and occur commonly in the subtrochanteric region or shaft of the femur showing typical radiographic features. We encountered a case of atypical fracture of the proximal one-third of the shaft of the ulna. Radiographic findings of this case differed from previously reported cases of ulnar fracture in terms of showing a transverse fracture line with cortical thickening and an oblique fracture line with anterior cortical spike. On the other hand, these findings were similar to radiographic features of atypical femoral fractures. The present case was managed surgically and union of fracture was achieved after 6 months. As there are possibilities of occurrence of atypical fractures in sites other than the femur, the physicians should cautiously examine the patients' history and radiographic findings.

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Background: The purpose of this study was to assess the functional outcomes of simultaneous distal radius fractures (DRFs) and ipsilateral elbow injuries (IEI) and to evaluate whether the DRFs and IEI affect each other’s outcomes. Methods: From February 2008 to March 2015, 29 of 846 patients treated for DRFs were found to be associated with IEI and 26 patients with follow-up over 12 months were enrolled. There were 12 men and 14 women with a mean age of 55 years (range, 17–86 years). Associated IEI was divided into fracture group (10 patients) and dislocation group (16 patients). Clinical outcomes of DRFs and IEI were evaluated using the Gartland and Werley score and Mayo Elbow Performance Score, respectively. A correlation between the wrist scoring and the elbow scoring was analyzed. In addition, the wrist scoring between fracture group and dislocation group of the elbow was compared. Results: The DRFs was rated as excellent in 14 patients, good in seven patients, and fair in five patients. The IEI was rated as excellent in 12 patients, good in 11 patients, fair in two patients, and poor in one patient. Acceptable outcome rate of both DRFs and concomitant IEI was 73%, although that of DRFs and IEI was 81% and 88%, respectively. A correlation between the wrist outcome and the elbow outcome showed a negative linear relationship (Spearman rho = −0.435, p = 0.026). In addition, there was no difference in the outcome of DRFs between ipsilateral elbow fractures group and dislocation group. Conclusions: As a correlation of DRFs and ipsilateral IEI have a linear relationship, the functional outcomes of both injuries are related to each other. Therefore, we recommend that combined injuries should be managed appropriately at the same time for contended recovery of the wrist and elbow.

The treatment of a large segmental defect of over 6 cm in a long bone is a challenging procedure. Treatment options include cancellous bone graft (e.g., the Masquelet technique), vascularized fibular graft (VFG), and internal bone transport (IBT) with an external fixator. These methods may be performed with intramedullary (IM) nailing or plate fixation to enhance stability or to lessen the time of external fixation. Each method has its own advantages and limitations. This study aimed to describe the advantages of additional plate augmentation and autologous bone grafting after IM nail implantation. Three patients with large segmental femoral bone defects were treated with IM nail implantation; then, one- or two-stage autologous iliac bone grafting with additional plate augmentation was performed. All patients achieved bony union without metal failure. We describe a technique involving additional plate augmentation and autologous iliac bone grafting for treating large femoral defects after restoring the length of the femur using an IM nail implantation and an external fixator.

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Purpose: This work aimed to explore in depth the genomic and molecular underpinnings of hepatocellular carcinoma (HCC) with increased 2[18F]fluoro-2-deoxy-d-glucose (FDG) uptake in PET and to identify therapeutic targets based on this imaging-genomic surrogate. Experimental Design: We used RNA sequencing and whole-exome sequencing data obtained from 117 patients with HCC who underwent hepatic resection with preoperative FDG-PET/CT imaging as a discovery cohort. The primary radiogenomic results were validated with transcriptomes from a second cohort of 81 patients with more advanced tumors. All patients were allocated to an FDG-avid or FDG–non-avid group according to the PET findings. We also screened potential drug candidates targeting FDG-avid HCCs in vitro and in vivo. Results: High FDG avidity conferred worse recurrence-free survival after HCC resection. Whole transcriptome analysis revealed upregulation of mTOR pathway signals in the FDG-avid tumors, together with higher abundance of associated mutations. These clinical and genomic findings were replicated in the validation set. A molecular signature of FDG-avid HCCs identified in the discovery set consistently predicted poor prognoses in the public-access datasets of two cohorts. Treatment with an mTOR inhibitor resulted in decreased FDG uptake followed by effective tumor control in both the hyperglycolytic HCC cell lines and xenograft mouse models. Conclusions: Our PET-based radiogenomic analysis indicates that mTOR pathway genes are markedly activated and altered in HCCs with high FDG retention. This nuclear imaging biomarker may stimulate umbrella trials and tailored treatments in precision care of patients with HCC.

Background and Aims: Despite the epidemiological association between intrahepatic cholangiocarcinoma (iCCA) and HBV infection, little is known about the relevant oncogenic effects. We sought to identify the landscape and mechanism of HBV integration, along with the genomic architecture of HBV-infected iCCA (HBV-iCCA) tumors. Approach and Results:We profiled a cohort of 108 HBV-iCCAs using wholegenome sequencing, deep sequencing, and RNA sequencing, together with preconstructed data sets of HBV-infected HCC (HBV-HCC; n = 167) and