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Background Surgery for intertrochanteric fractures using intramedullary hip nails (IHNs) is among the most common surgical procedures in the orthopedic field. Although IHNs provide good overall outcomes, they sometimes cause complications, such as loss of reduction and cut-out. Here, we investigated the usefulness of IHNs with an anterior offset (Best Fit Nail® [BFN]) in maintaining fragment reduction and ensuring proper lag screw position compared with conventional non-offset nails (Proximal Femoral Nail Antirotation® [PFNA]), using postoperative computed tomography (CT). Methods Fifty consecutive patients with intertrochanteric fractures who underwent surgery with BFNs (BFN group) and 50 patients who underwent surgery with PFNAs (PFNA group) were retrospectively analyzed. Indices evaluated by postoperative CT were displacement distance of proximal fragment relative to distal fragment, reduction status (intramedullary, anatomical, and extramedullary types), lag screw direction, and angle between lag screw and femoral neck axis (deviation angle). Results Median [interquartile range] displacement distance was significantly smaller in the BFN group (0 [0, 0] mm) compared with the PFNA group (5.2 [3.6, 7.1] mm) (p<0.001). Reduction status was significantly better in the BFN group (anatomical type, 40 cases; intramedullary type, in 9 cases, and extramedullary type in 1 case) than in the PFNA group (anatomical type, 6 cases; intramedullary type, 43 cases; extramedullary type, 1 case) (p<0.001). Deviation of lag screw direction was observed in significantly fewer cases in the BFN group (20 cases; 40%) compared with the PFNA group (36 cases; 72%). Lag screw deviation angle was significantly smaller in the BFN group (−0.71°±4.0°) compared with the PFNA group (6.9°±7.1°). No adverse events related to surgery were observed in either group. Conclusions Intertrochanteric fracture surgery using offset BFNs exhibited significantly smaller displacement distance, better reduction status, and higher frequency of no deviation with central lag screw position, compared with surgery using non-offset PFNAs.

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: The purpose of this study was to determine whether patients and their families are thinking about notification of diagnosis of malignant tumor (cancer or sarcoma), and to determine the best means of informed consent in the Orthopaedic Department.A questionnaire on the notification of malignant tumor was distributed at Showa University Hospital in July 1995. We had 159 respondents; 58 males (average 52.7 years old) and 96 females (average 52.9 years old). A total of 31 patients wanted to be personally notified of the diagnosis of a malignant tumor, 92 respondents wanted both themselves and their families to be notified, 17 respondents preferred not to be personally notified and 5 respondents wanted neither themselves nor their families to be notified. When family members were asked about notification of the diagnosis of malignant tumor of family members, 47 respondents would want the patient him/herself to know the truth, while 48 would not want the patient to be notified. Regarding notification of the necessity to perform amputation of a limb of a child patient suffering from malignant tumor, 60 respondents answered that they would request the doctor in charge to give an explanation to their children about the disease. There was a discrepancy between patient and family perceptions of the need to notify about a diagnosis of malignant tumor.Awareness of a need for recasting of the Japanese traditional paternalistic doctor-patient relationship has become sufficiently pervasive that the medical profession itself has accepted the need to incorporate informed consent into orthopaedic practice.

: Fifty-one anterior cruciate ligament reconstructions were performed using the bone-tendon-bone method from April 1991 through March 1996. In these 51 cases floor plasty was not performed in 23 cases, of which 12 cases were judges to be failed ACL reconstructions because of instability of 3 mm or greater relative to the healthy knee and confirmation of rupture with arthroscopy.These 12 cases of failed reconstruction (in 2 men and 10 women) were 6 cases of femoral tunnel (notch), 1 case of femur-side K-screw tip, 3 cases that can be considered tibia tunnel remodeling, and 2 cases that can be attributed to the tibia-side K-screw.