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Toshinobu Umeki, Hirokazu Hashiguchi, Yoshimasa Takahashi, Hideaki Kis ...
2009 Volume 58 Issue 1 Pages
1-6
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report two cases of septic arthritis of the lumber facet joint treated after operation.
Case 1: A 58-year-old woman had fever and severe low back pain. Simple X-ray and CT showed osteolysis at the right L4/5 facet joint. MRI showed abscess at the paravertebral muscle and epidural space. The diagnosis was therefore septic arthritis of the lumbar facet joint. Operation was performed and LBP decreased immediately after operation.
Case 2: A 62-year-old woman had fever and low back pain. She was treated with medication but LBP only slightly increased. Simple X-ray and CT scan showed destruction of the left L5/S facet joint, MRI showed epidural abscess near the left L5/S facet joint, and bone scintigraphy showed uptake at the same region, resulting in the diagnosis of septic arthritis of the lumbar facet joint. LBP decreased after operation.
Conclusion: In both two cases, we found that bacteria caused septic arthritis of facet joint and that effective antibiotics can be administered. LBP significantly decreased after operation.
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Erina Fukunaga, Yoshihisa Kawauchi, Koji Sameshima, Natsuko Tomimura, ...
2009 Volume 58 Issue 1 Pages
7-9
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Recently, Methicillin-Resistant Staphylococcus aureus (MRSA) infections are increasing in the orthopaedic field. They however remain difficult to treat due to the antibiotics for MRSA. We report our successful treatment of MRSA spinal infection disease with linezolid (LZD).
The records of five patients with pyogenic spondylitis were reviewed. Four had hematogenous infection and one had postoperative complication in one. LZD was used because vancomycin was not effective in four and one was allergic to vancomycin. LZD was used for 15 to 86 days (an average 41.4 days) at a dosage of 1200mg/day. After using LZD, C-reactive protein level returned to normal, and symptoms such as fever and/or pain disappeared in all patients. But three patients had pancytopenia, and four patients had loss of appetite.
We obtained good results for MRSA spinal infection disease by treating with LZD.
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Tetsuo Hayashi, Kenzo Shirasawa, Akihisa Yamashita, Hidehiko Kido, Tak ...
2009 Volume 58 Issue 1 Pages
10-15
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Surgical site infection in instrumented spinal fusion is often caused by bacteria resistant to antibiotics. Management of infection is hard and persistent postoperative infection often requires removal of implant. However, early removal of implant in PLIF or TLIF is not recommended because of instability and nonunion. We report three cases in wnom debridement and proper and strong chemotherapy with Vancomycin or Linezolid provided control of infection and salvage of implant. In case of postoperative deep infection after PLIF with cages, removal of implant is not necessary.
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Hiroyuki Nakahara, Hisashi Sakamoto, Kuniyoshi Tutiya, Masashi Sasaki, ...
2009 Volume 58 Issue 1 Pages
16-18
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report a patient with necrotizing fasciitis whose life was saved by left shoulder disarticulation. A 82-year-old woman had water blister and swelling in the left forearm. On the next day after she visited other hospital, her water blister and swelling became severe She therefore came back to our hospital on foot. Within a few hours, skin lesion aggravated, and spread to her axillary region. Necrotizing fasciitis was diagnosed and Streptococcus pyogenes was cultured in her water blister. She undergone emergency left shoulder disarticulation. Intravenous antibiotics, including piperacillin and clindamycin, were added just after operation. About one month after operation, her general conditions improved.
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Takahiko Aoyagi, Toshiyuki Tsuruta, Mitsuhiro Katoku, Hiroko Mine, Tak ...
2009 Volume 58 Issue 1 Pages
19-22
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report one case of clavicular shaft nonunion caused by MRSA infection. The case was a 17-year-old man who was admitted to our hospital, complaining of pain and redness of the clavicula after osteosynthesis for clavicular shaft fracture at another hospital. The laboratory tests were significant for elevated C-reactive protein. Pus cultures were positive for MRSA.We performed curettage and filled up the dead space with antibiotic-impregnated cement beads. About one month later, infection had clinically improved. Plate fixation with iliac bone graft was then performed, and union was obtained within four months.
Filling up the dead space with antibiotic-impregnated cement beads can be an effective technique for the treatment of the clavicular shaft non-union caused by MRSA infection.
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Takehiro Miyazaki, Akihiko Hijioka, Natuki Hara, Satoru Ookuma, Naoki ...
2009 Volume 58 Issue 1 Pages
23-26
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report a case of pyogenic arthritis of hip treated with calcium hydroxyapatite blocks impregnated antibiotic. A 76-year-old male with a history of diabetes visited our hospital with high fever and right hip pain. He was diagnosed with MRSA arthritis of the hip by magnetic resonance imaging and culture. Immediately, curettage and closed continuous irrigation of the hip was performed. Unfortunately the inflammation relapsed three months later. As a second operation, we used hydroxyapatite blocks impregnated with vancomycin in the femoral bone. The patient was healed and he could walk after one year and three months from the second operation.
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Kenjiro Fujimura, Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, T ...
2009 Volume 58 Issue 1 Pages
27-31
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We assessed clinical results and problems of pyogenic arthritis of knee joints retrospectively. Seventeen patients treated for pyogenic arthritis of the knee in our hospital were evaluated. The mean age of the patients was 69.5. Eight were male and nine were female. Our strategy for treating the pyogenic arthritis was systemic administration of antibiotics and emergency operation based on arthroscopic synovectomy followed by closed irrigation. The clinical results for the joint function according to Ballard's evaluation at the time of discharge of our hospital were "good" in two, "fair" in 13, "poor" in one, and "death" in one patient, respectively. Statistical analysis suggest that MRSA-induced pyogenic arthritis prolongs duration of the treatment and deteriorates osteoarthritis, causing "poor" functional results.
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Masuo Hanada, Hiroshi Hagihara, Naoyuki Kuga, Masao Teramoto, Tomoaki ...
2009 Volume 58 Issue 1 Pages
32-36
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report a case of bilateral femoral head osteonecrosis with bilateral subcapital fractures.
A 56-year-old male visited a clinic complaining of bilateral thigh pain.
There was no history of steroid use, but he consumed 80 mg of alcohol per day, and he dived to a depth of 10 m for six hours per day, 50 days per year for 15 years since he was 30 years old. X-rays showed bilateral subcapital fractures, and he was introduced to our hospital for surgical treatment. CT showed the bone cyst occupying nearly the entire right femoral neck, and that the fracture occurred at the proximal edge of the cyst. In the left hip, subcapital fracture was also observed, but there was no cyst formation. We perfomed total hip arthroplasty on both sides, and symptoms disappeared.
Histological findings of the retrieved right femoral head showed empty lacnae and were consistent with that of osteonecrosis.
Eextensive osteonecrosis is considered to cause subcapital fractures. Sometimes, cyst formation is observed in osteonecrosis of femoral head, but giant cysts like this case are very rare. There is also a possibility that cyst formation caused the right subcapital fracture.
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Takuya Ikuta
2009 Volume 58 Issue 1 Pages
37-41
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Four acetabular revison arthroplasty surgeries were performed with allograft using the KT plate. The average age of the patients at the time of revison was 83.4 years. Their acetabular bone defect was classified into type II (2 cases), type III (1 case) and type IV (1 case) according to Gustillo's classification. The mean follow-up of the series was 1 year and 10 months. The mean JOA hip score improved from 44.5 points to 72.3 points. No loosening prosthesis were observed. This study indicated that acetabular allograft reconstruction reinforced by the KT plate provides satisfactory clinical and radiological results.
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Ryuya Ochi, Tetsuo Nakano, Daisuke Inaba, Hiromichi Yasuoka, Yoshikazu ...
2009 Volume 58 Issue 1 Pages
42-46
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Object: This prospective cohort study was designed to determine the incidence and risk factors of deep vein thrombosis in patients with femoral and tibial shaft fractures. Patients: Eleven patients undergoing femoral shaft fracture surgery (average age 73.1 years) and 21 patients undergoing tibial shaft fracture surgery (average age 63.9 years) were included in this study. Methods: DVT was detected by contrast computed tomography preoperatively and postoperatively. No patient received pharmacological prophylaxis for DVT. Results: The incidence of DVT was 36.4% (4 of 11) in patients with femoral shaft fracture and 14.3% (3 of 21) in patients with tibial shaft fracture. Two (40.0%) of the five patients with open fracture had proven DVT. Conclusion. These results suggest that high incidence of DVT is observed in patients with femoral shaft fracture compared to patients with tibial shaft fracture. Open fracture is a high-risk factor of DVT.
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Hisato Tanaka, Mitsunori Komine, Nanae Akiyama
2009 Volume 58 Issue 1 Pages
47-48
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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In some reports, the onset of postoperative cognitive dysfunction is said to trigger development of dementia in 35% to 65% of persous over 80. Moreover, studies have also reported an association between postoperative cognitive dysfunction and hypoxia. To determine the influence of postoperative hypoxemia, we have studied the effects of oxygen therapy on the occurrence of postoperative cognitive dysfunction. We investigated 75 femoral neck fracture in patients older than 80 in our unit. The patients were divided into two groups: Non-oxygen therapy group and oxygen therapy group continuance receiving oxygen continuously for two to three days. Nineteen of the 39 (48.7%) non-oxygen therapy patients with femoral neck fracture developed postoperative cognitive dysfunction. On the other hand in the oxygen therapy group, only five out of 36 (13.9%) developed postoperative cognitive dysfunction. We conclude that postoperative oxygen therapy by nasal cannula for two to three days reduces the onset of postoperative cognitive dysfunction.
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Noboru Ide, Hideo Watanabe, Kenji Kubota, Yuichiro Oda
2009 Volume 58 Issue 1 Pages
49-54
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We attempted spinal orthosis for vertebral fracture by a flexible plastic cast. In this study, we made several types of spinal orthoses for vertebral fracture and investigated the restriction of activities of daily living (ADL). We made spinal orthoses, namely Knight-Taylor type, Jewett type, corset type, quick made orthosis, crossband type, and plaster of Paris casting for one healthy adult male. We compared the ADL score and the degree of trunk fixation with these orthoses and cast. Quick made spinal orthosis showed good ADL score and trunk fixation, and was considered useful orthosis for spinal fracture.
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Ryo Motokishita, Shunji Matsunaga, Hiroaki Koga, Hitoshi Hihota, Masah ...
2009 Volume 58 Issue 1 Pages
55-57
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We investigated the prognosis of non-operative super-elderly patients with proximal portion fracture of the femur. Out of 350 patients over 85 years with proximal femur fracture admitted to our hospital from 2000 to 2007, we studied 50 patients including 20 patients (group B) who did not undergo surgery due to risks and 30 patients (group A) who refused surgery. The average age of injury was 89.3 years old, in the range of 85 to 100 years old. We conducted an investigation on the prognosis after injury and the cause of death. Five patients died within one month after injury, and the cause of death was pneumonia in all cases. The cumulative survival rate was 82% after onset in two months, 63% in 12 months, and 50% in 24 months. There were no significant differences in the cumulative survial rate between group A and group B.
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Tomohiro Horikawa, Takeshi Yamashita, Tateki Segata, Kensuke Yonemura
2009 Volume 58 Issue 1 Pages
58-62
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We experienced three elderly cases with simultaneous ipsilateral subcapital and intertrochanteric fracture of the femur. All cases were women, and their average age was 91 years old. The causes of the fractures were due to low energy trauma such as falls. The fracture type was subcapital fracture and intertrochanteric fracture in two cases, and subcapital fracture, intertrochanteric fracture, and subtrochanteric fracture in the remaining case. Prosthesis replacement was performed on one case, and prosthesis with cable plate on two cases. The average follow-up period was 103 days. The three cases more or less recovered to the level of gait ability before their injuries.
To our knowledge, only 20 elderly cases of simultaneous ipsilateral subcapital and intertrochanteric fracture of the femur have been reported. Four were over 90 years old. Prosthesis replacement was performed on all cases older than 80 years old. Our cases showed good short-term results. Prosthesis replacement is considered a useful method for this type of fracture.
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Teruyasu Ohno, Tetsuro Kishimoto, Shuzo Mihara, Hiroshi Onaka, Akira O ...
2009 Volume 58 Issue 1 Pages
63-66
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The complication of rasping in cementless hemiarthroplasty includes fracture of the femur and subsidence of the prothesis. The Woodpecker uses high frequency vibration and rasps the femoral canal. For minimizing the complication of rasping, we used the Woodpecker during rasping femral canal in 22 hip hemiarthroplasties. Mean age at surgery was 80.9 years. 19 of 22 patients could undergo cementless hip hemiarthroplasty. Seven of the 19 patients had stovepipe type. There were no fractures in our series. But only one case inserted with prothesis due to malalignment had subsidence of the prothesis, but the case was the first patient using the Woodpecker. Our findings suggested that the Woodpecker is preferable for patients with osteoporosis in cementless hip hemiarthroplasty.
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Toru Honda, Toshiyuki Matsumoto
2009 Volume 58 Issue 1 Pages
67-70
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Sixty-percent of hip fracture patients adapted to the regional critical pathway for hip fracture (RCPF), and QOL recovery was satisfactory. It is important to maintain QOL.
According to the 2006 guidelines on prevention and treatment of osteoporosis, hip fracture patients should take medication against osteoporosis. Last year, about 160,000 people suffered hip fractures in Japan. We carried out a simulation of medication combined with RCPF, assuming that 80,000 hip fracture patients adapted to RCPF, took medication, and 80% of them continued the medication.
Such medication costs 57.6 billion yen/year, but it is cost-effective because it saves 24.6 billion yen/year for fracture treatments and 67.7 billion yen/year for care.
According to the same guidelines, children of hip fracture patients have the risk factor of vulnerability fracture, and are aware of need to prevent bone fractures. When bone mineral density tests are recommended to them, most female children agree. We started medication on most of them for their low bone mineral density.
It is effective to combine medication against osteoporosis with RCPF, and bone mineral density tests should be recommended to children of hip fracture patients.
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Takuya Ikuta, Futoshi Kuga, Kenichi Yawatari, Junichiro Ishikawa, Tomo ...
2009 Volume 58 Issue 1 Pages
71-74
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Three children with femoral fracture were treated surgically using locking plate. Their ages at fracture were 8, 9, and 10 years.
The mean time until partial weight bearing was 4.3 weeks. The mean duration of admission was 4.3 weeks. All cases achieved bone union without malunion or limb shortening, and had full range of motion at the knee joint.
Osteosynthesis using locking plate is a useful method for treating femoral fractures in children from elementary school, allowing early cutch-assisted gait and early return to school.
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Motonori Sato, Tsutomu Hannita
2009 Volume 58 Issue 1 Pages
75-77
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Between 2006 and 2007, we reviewed the results of pilon fractures operated with the double plating method. The mean age of the patients was 47 years (26-64). Fracture type of AO was one B-2, one C-1, three C-2, and two C-3. The mean duration of operation was nine days. The mean time of weight bracing was 30 days. All patients achieved union. We think that it is important to operate on pilon fractures with plate and rehabilitation from an in early time.
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Koichiro Sakimura, Takayuki Yamaguchi, Hiroyuki Kitahara, Yoshihiro Ya ...
2009 Volume 58 Issue 1 Pages
78-81
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Fracture of the lateral process of the talus is an uncommon injury. We present three cases of these fractures.
Case 1; A 25-year-old woman had sprained her ankle and was diagnosed with displaced fracture of the lateral process of the talus. Open reduction and internal fixation were performed. Case 2; A 63-year-old man was diagnosed with displaced fracture of the lateral process of the talus and pronation-abduction ankle fracture. Open reduction and internal fixation were performed. Case 3; A 10-year-old girl was diagnosed with undisplaced fracture of the lateral process of the talus and pronation-external rotation ankle fracture. A non-weight bearing short leg cast was applied for the undisplaced lateral talar process fracture, and open reduction and internal fixation were performed for the displaced medial malleolus fracture.
Two of three cases had concomitant ankle fractures of the pronation type. The mechanism of injury was eversion of the foot.
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Noriyuki Nakagawa, Hiroshi Hagihara, Naoyuki Kuga, Masao Teramoto, Tom ...
2009 Volume 58 Issue 1 Pages
82-84
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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In Japan, shotgun wound treatments are sometimes experienced due to hunting and clay shooting accidents. In this case, we treated the gunshot wounds of four victims of a random shooting incident which took place at a gym in Sasebo in December 2007.
We performed operation to remove the bullets, but complete removal of the lead slug was difficult.
We report the treatment and complications of the gunshot wounds of these patients.
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Noriaki Miyata, Masakazu Murata, Akira Hozumi, Shoichi Kuba, Kazumasa ...
2009 Volume 58 Issue 1 Pages
85-88
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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[introduction] We report two cases with massive hemorrhage after a pelvis fracture was misdiagnosed as a slight injury in X-ray. [Case 1] A 87-year-old woman fell on her backside and broke her left pubic ramus. CT showed a large quantity of hemorrhage in the pelvis vagina. Because active bleeding was noted in angiographic CT, both obturator artery was embolized after artery angiography. Her state was stable after TAE and she was discharged from the hospital in 53 days. [Case 2] A 85-year-old man fell from height of 2 meters and broke his left ischial ramus. Because active bleeding was seen in angiographic CT, obturator artery was embolized after artery angiography as in case one. His state was stable after TAE and he was discharged from the hospital in 38 days. [Conclusions] We must not be optimistic even if pelvis fracture shows slight injury in X-rays.
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Takashi Hisashi, Tsutomu Hannita, Masamichi Fujii, Motonori Sato, Moto ...
2009 Volume 58 Issue 1 Pages
89-92
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We treated distal end fracture of the radius with a locking plate by the palmar approach. We studied the surgical results comparing young adults and older population. Surgeries were performed on 20 patients from February 2006 to July 2007.
We divided the patients into two groups at 70 years of age. The young group consisted of six men and four women, and the older group consisted of three and seven women.
Excellent radiological and clinical results were achieved not only in the young group, but also in the older group.We concluded that the locking plate by palmar approach provides good internal fixation even for older population more than 70 years of age.
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Masao Teramoto, Hiroshi Hagihara, Naoyuki Kuga, Masuo Hanada, Tomoaki ...
2009 Volume 58 Issue 1 Pages
93-97
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We performed volar locking plate fixation on 43 patients (13 men, 30 women, mean age 58.8 years) with distal radius fracture. The mean follow-up period was 11 months (range: 6-21 months). We measured the radiographic parameters at the time of injury, immediately after surgery, and at final follow-up. At the final follow-up, the mean radial inclination was 22.4°, the mean volar tilt was 10.9°, the mean ulnar variance was 0.4 mm, and the loss of correction was minimal. At the final follow-up, range of motion and grip power were measured. According to Saito Score, the results were excellent in 39 cases and good in four cases.
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Tetsuya Umezaki, Shinji Watanabe, Etsuo Chosa
2009 Volume 58 Issue 1 Pages
98-103
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We performed callus distraction using the bone extension appratus (Mini Hoffman extension apparatus and Orthofix Mini Rail System) for six brachymetatarsia of the toe in four cases. The average age of the cases at operation was 17 years old (8-40 years old). Three cases were 4th metatarsus, and another was 1st metararsus. The average gain in length was 16.4 mm, the average gain rate in length was 42.5%, and healing index was 77.8 day/cm. Complications in the four cases were infection, post operation deformity, early bone union, and accidents of bone extension apparatus. There were some problems of callus distraction, but this method might be effective for cosmetic improvement and maintaining gait.
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Takahiro Ushijima, Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, ...
2009 Volume 58 Issue 1 Pages
104-110
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Percutaneous closed reduction and pin fixation based on the Westhues's method and open reduction and plate fixation are indicated for surgical treatments of intra-articular calcaneal fractures. We have mainly been performing the Westhues's method with some modifications. Between 1998 and 2007, 26 patients underwent osteosynthesis based on the Westhues's method for intra-articular calcaneal fractures. They consisted of 17 men and nine women with the mean age of 54.9 years. For these patients, we investigated clinical results, complications, and surgical problems of the Westhues's method.
We assessed the clinical results by Maxfield classification that resulted in eight excellent feet, 17 good feet, and three fair feet. Radiographycally, the average Bhler's angle and width index in final follow-up were worse in joint depression type- than in tongue type-fracture, but they were not related with the clinical results statistically.
Although many surgical procedures for calcaneal fractures have been reported, we prefer the Westhues's method to other open procedures because it is less invasive and have few complications. However, the surgical technique of this method for the joint depression type is difficult and requires great skills, especially reduction and sustenance using the Steinmann pin for depressed fragments containing subtalar joint surface. We conclude that closed reduction and percutaneous pin fixation based on the Westhues's method with accurate indication and exact technique are useful not only for tongue type-fractures but also joint depression type-calcaneal fractures.
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Masakazu Murata, Itaru Furuichi, Noriaki Miyata, Akira Hozumi, Shouich ...
2009 Volume 58 Issue 1 Pages
111-115
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Seven cases of proximal humeral fracture were treated by open reduction and internal fixation (ORIF) with locking compression plate systems (LCP). Patients were six males and one female. Average age was 53.4 years old. Fracture type by AO classification was one A2, one B1, one B2, three C2s, and one C3. The postoperative results were an average of 80.7 points according to JOA score.
Varus deformity occurred in three cases and cut out of proximal locking screws was recognized in two cases.
LCP can provide angular stability by locking mechanism.
However, we must bear in the risk of screw penetration due to insufficient internal fixation in cases with comminuted fracture and/or osteoporosis.
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Akihisa Hatakeyama, Shigeki Nishida, Zenzaburo Ishihara, Satoshi Nishi ...
2009 Volume 58 Issue 1 Pages
116-118
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report one example of rhabdomyolysis to the triceps brachii caused by push-ups. A 16-year-old male case demonstrated pain and swelling of both humerus, and winding limitation of both elbows the day after doing push-ups in extracurricular activities. Serum CK rose with 28000IU/l. A high signal was presented in the T2 emphasis image, and an equal signal was presented in the T1 emphasis image at the head inside the triceps brachii on MRI, and it was diagnosed as rhabdomyolysis. The symptom and CK value gradually improved, and normalized with rest and fluid replacement on the 12th day. In this case, push-ups caused rhabdomyolysis even though done at a normal rate, indicating that push-ups may cause rhabdomyolysis, and caution is necessary even when done at the usual rate.
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Masahiro Nakamura, Shinji Yoshino, Masaru Higo
2009 Volume 58 Issue 1 Pages
119-123
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Although it is commonly believed that the leg deformity associated with hypophosphatemic vitamin D-resistant rickets can be prevented by medical therapy beginning in childhood, cases of residual deformity requiring invasive treatment are sometimes encountered. We recently performed corrective surgery in 3 cases of bowleg deformity. Case 1 was a 14-year-old boy whose varus deformity of the tibia was corrected gradually using the Ilizarov technique, with correction of internal torsion subsequently performed because of residual toe-in gait. Case 2 was a 14-year-old boy who underwent acute correction of the femur, internal fixation with Ender pin, and gradual correction of varus deformity and internal torsion of the tibia using the Ilizarov technique. However, loss of correction occurred in the femur due to inadequate fixation. Case 3 was an 11-year-old girl who underwent acute correction of the femur with an Orthofix external fixator as well as gradual correction of varus deformity and internal torsion of the tibia using the Ilizarov technique. Our experience with these cases indicates that when dealing with patients requiring correction of leg deformity associated with rickets, acute correction of the femur with a unilateral external fixator and gradual correction of the tibia with a circular external fixator are advisable.
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Hirotaka Okubo, Hiroaki Hanzawa, Hiroki Maehara, Fuminori Kanaya
2009 Volume 58 Issue 1 Pages
124-129
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Gossypiboma is an iatrogenic mass lesion caused by a retained surgical sponge. Most have been found in the abdominal cavity, with few in the extremities. We report a case of gossypiboma in the thigh. A 41-year-old man, who had a history of open reduction and internal fixation for left femoral shaft fracture 25 years ago, complained of swelling and a ulcer in the left thigh. Radiograph revealed osteolytic lesion in the shaft of the femur. Magnetic resonance imaging showed a large mass, which was low-intensity on T1 weighted images, mixed low and high-intensity on T2 weighted images, and low intensity wavy strips were found within the mass on T2 weighted images. Open biopsy revealed two or three sheets of surgical sponges within the mass. Histopathological examination revealed foreign body reaction related to surgical sponges without any evidence of malignancy. To our knowledge, only 10 cases of gossypiboma in the lower extremity have been described.
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Tomonori Tabata, Takuya Ikuta, Kenichi Yawatari
2009 Volume 58 Issue 1 Pages
130-134
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Abstract
Two patients with oseteoid osteoma of the lesser trochanter femur were diagnosed with arthritis. CT scanning is probably the best supplement to clinical examination for subperiosteal juxta-articular osteoid osteoma. Complete removal of nidus is required to cure the disease.
It is important to consider the possibility of masked oseteoid oseteoma in patients with arthritis with night pain or rest pain.
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Masato Tomita, Kenji Kumagai, Takayuki Nakamura, Takayuki Shida, Tomon ...
2009 Volume 58 Issue 1 Pages
135-140
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We experienced a case of multiple enchondromatosis, who was treated by correctional osteotomy on the femur for the valgus deformity of the knee joint, and discrepancy of the lower limb length. The case was a 6-year and 7-month old girl. Her mother took her to our clinic when she noticed the deformity of her daughter's knee. In the first visit, we could see valgus deformity of her left knee joint, and about 4 cm discrepancy of her legs. X-ray showed radiolucent lesion on the proximal and distal sides of her left femur, and above left acetabulum. After one-year and four-months, valgus deformity of her left knee joint progressed and the discrepancy of her legs increased. We diagnosed the lesion as enchondroma by open biopsy and performed surgery. In the operation, first chondromatous lesion at her distal femur was curetted completely, after that artificial bone graft (β-tricalcium phosphate (β-TCP)) was administered at that site. Next, we performed correctional osteotomy at the diaphysis of her femur, and internal fixation with plate. After nine months, bone union was achieved at the osteotomy site on X-ray, and her walking status improved.
Conclusion: Despite short-term follow-up, we obtained relative good results in this case. But long-term follow-up is required in this case, because increase in discrepancy of the legs or deformity of the knee joint may occur with growth in the future.
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Hiroo Sato, Toshitake Yakushiji, Shigeta Yorimitsu, Kiyoshi Oka, Hiros ...
2009 Volume 58 Issue 1 Pages
141-145
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report two long-term survival cases of extraskeletal osteosarcoma with recurrent pulmonary metastases after wide excision and chemotherapy. Case 1 was a 58-year-old male of a tumor arising in the soleus muscle of the calf. Pre-operative chemotherapy with cisplatin was administered, and wide excision was performed. Post-operative chemotherapy with vincristine, adriamycin and cyclophosphamide was administered. One year and four months after the primary surgery, right pulmonary metastasis occured and right upper lobectomy was performed. Chemotherapy with adriamycin and ifosfamide was restarted. At present, seven years and two months after the primary surgery, the patient is alive and disease-free. Case 2 was a 36-year-old male with a tumor arising in the vastus lateralis muscle of the thigh. Wide excision was performed, and post-operative chemotherapy with adriamycin and cisplatin was administered. Two years and five months after surgery, multiple pulmonary nodules were detected by CT. Chemotherapy with adriamycin and ifosfamide was restarted, and the multiple pulmonary nodules disappeared completely. At present, nine years and four months after surgery, the patient is alive and disease-free. Patients with extraskeletal osteosarcoma who are treated only with surgery generally have a very poor prognosis. In these cases, the combination of chemotherapy and surgery is thought to contribute to their long survival.
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Yasuomi Kawasoe, Masahiro Yokouchi, Yoshiya Arishima, Kanehiro Matsuya ...
2009 Volume 58 Issue 1 Pages
146-148
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report 22 patients who underwent surgical management for lower limbs metastasic bone tumor after 2001. The average ageat the time of operation was 66.5 years old. The patients cousisted of 12 males and 10 females. In the preoperative PS, nine patients were 0, 11 were 1 and two were 2 Seven patients showed pathological fracture before operation, 15 had no pathologic fracture, and their Mirels score was an average of 9.5. At the time of the last observation, 13 were DOD three were AWD three were DF, and one was DOOC amongst 20 patients who could be evaluated. We recognized local recurrence in postoperative one year and the reccurence of sharp pain in one example patient who underwent marginal resection and bone cement filling for tibia lesion. At present, although the convalescence of various types of cancer patients is improving with the progress of treatments as a result of collective studies performed bone metastasis cases are increasing. Because some cases also need long-term convalescence, operation adaptation and methods must be consideved carefully.
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Yuki Furukawa, Osei Tsuji, Taihei Kohguchi, Shinya Matsumoto, Keishiro ...
2009 Volume 58 Issue 1 Pages
149-152
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Recently, various screws are being developed for scaphoid fractures, and good outcome is being achieved. We used Acutrak Screw® and evaluated the screw positions for five scaphoid fractures by CT. The subjects were five cases in five hands operated in between November 2006 and December 2007.
Three cases were operated by the palmer approach and two cases by the dorsal approach.
Evaluation was carried out by the Fujitani method. All cases achieved bone fusion and all cases were excellent according to the Cooney wrist functional score. The screws of the palmer approach and dorsal approach were not positioned at the center of the scaphoids in any of CT images. In particular Especially, the screw position of the palmer approach was not located at the center of the scapoid. Technical failure and the shape of the proximal scapoid are considered to be causes of the poor screw position.
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