We experienced three cases of supracondylar fractures of the femur after total knee arthroplasty (TKA), and discussed the risk factors of these fractures.
This type of fracture is associated with osteoporosis, notching of the anterior femoral cortex, limitation of ROM, and preexisting neurogenic disorders.
We do not recommend the use of a Rush pin for treatment of the communited type of this fracture.

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We report three quadriceps tendon rupture and avulsion fractures of the superior pole of the patella. These cases have been operated on and exercised as soon as possible, as a result, the patients can carry out an active daily life without complications. However they result in a decrease in the circumference of the thigh, patella baja and osteoarthritic change of patellofemoral joint. Concerning these problems, we have acquired the following knowledge through extended research. The difference between the circumference of the thighs was several centimeters at early stage after surgery, but was reduced gradually and finally reduced entirely. However, in regard to the patella baja, there was no difference between the T/P ratio just after surgery and that in the long term, and no loosening of internal fixation occured. Therefore we presume that the patella baja cannot be attributed to the method of operation, the period of external fixation and rehabilitation, in addition, the osteoarthritic change of the patellofemoral joint can be attributed to the incongruence of the joint surface caused by patella baja.

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Arthroscopic partial menisectomies were carried out on the 20 knee joints of the 20 patients (4 males, 14 females) aged over 40 (range 40 to 71, mean 52.3) with degenerative arthritis. Those knee joints had been clinically diagnosed to have torn menisci.
The length of the follow up ranged from 6 to 26 months (mean 14.3). Average JOA knee scores were 91.7, compared to 42.5 preoperatively with much improvement of functional capabilities. Two knees (10%) required additional surgical interventions due to reccurent pain with hydroarthrosis namely high tibial osteotomy (HTO) and distal femoral varus osteotomy.
The degree of degeneration in roentgenological and arthroscopic findings had negative correlation to postoperative JOA score. The history of trauma, configuration of the torn menisci and preoperative femorotibial angle were not associated with postoperative clinical results.
These results suggest that arthroscopic menisectomy may be an effective procedure for the middle aged patients with moderate degenerative arthritis, while a few of them need additional surgical intervention such as HTO later.

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The purpose of this study was to evaluate the clinical results of arthroscopic surgeries with the Holmium YAG laser on the knee joint. This study involved 32 patients (14 males and 18 females) with 33 knees. The follow-up period was 5.5 months on average (range, 1 to 15 months). Lateral meniscal injuries were 13 involving 4 discoid menisci, medial meniscal injuries were 12, rheumatoid arthritis were 3, others were 3. Inflammatory symptoms at a week after surgery and pre-and postoperative JOA scores were used for evaluation. Two patients complained of walking pain and 3 patients showed swelling on the knee joint. In all of the cases, the postoperative JOA scores were superior to that in the preoperative period.
We conclude that arthroscopic surgery of the knee joint with the Holmium YAG laser is very efficient for the elimination of the inflammatory feature.

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We studied bone and soft tissue neoplasms using three-dimensional computed tomography (3 DCT) in 14 patients. There are 3 male and 11 female whose age ranged from 14 to 69 years with a mean of 40 years. Pathological diagnoses are schwannoma in 3 cases, giant cell tumor of bone in 5 cases, chondrosarcoma in 2 cases, multiple exostosis in 2 cases, and 1 case each of ossifying fibroma and osteosarcoma.
In bone tumor, 3 DCT showed defect or prominence of cortical bone exactly and was useful for understanding of three-dimensional structure. Enhance 3 DCT could show soft tissue tumors that were enhanced and was useful for understanding of the relationship between tumors and blood vessels.

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Deafferentation pain disturbs daily life in patients spinal cord injury. Two spinal cord injury patients who had severe deafferentation pain were treated with antianxiety agents, anticonvulsants and other agents.
Case 1: A 35 y.o. man had a burst fracture of the thoracic spien and incomplete spinal cord injury (Frankel type B). He complained of crural and pain anxiety. He was treated with an antianxiety agent, a major tranquilizer, and other agents after psychiatric referred. After treatment, his pain and anxiety decreased. Case 2: A 60 y.o. man suffered cervical spine dislocation and complete spinal cord injury (Frankel type A). He also complained of crural pain. He was treated with an antianxiety agent, anticonvulsant, and other agents after psychiatric reffered. After treatment, his pain was decreased.
Treatment with antianxiety agents, major tranquilizers, anticonvulsants and other agents is a noninvasive and simple method for deafferentation pain.

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Ten cases of osteomylitis arising from chronic pressure sore in traumatic paraplegic patients are presented. Five patients have contacted pyogenic arthritis of hip joints (7 hips) and four patients have contacted suppurative lumber spondylitis. One patient suffered osteomyelitis of sacrum. All patients were male and age ranged 25-74 years old (mean 43 yrs) when they had received the diagnosis of osteomyelitis. The sores were repaired operatively but spondylitis were treated conservatively in four patients who had vertebral spondylitis. Two patients cured both pressure sore and spondylitis completely but other two recured spondylitis when their general condition deteriorated. Four hips performed Girdlestone's operation followed by closure of pressure sore using musculocutaneous flap of tensor fascia lata muscle. These patients cured completely both pyogenic arthritis and pressure sore. The rest of three hips were treated by only soft tissue closure without resection of hip joint. The recurrence of inflammation were observed in these three hips. The patient who suffered osteomyelitis of sacrum developed skin cancer (Squamous cell carcinoma), and died after 20 years' recurrence of pressure sore of sacrum.

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We experienced a rare case of hypertrophic pachymeningitis in a 18 year-old male. He experienced numbness in his right hand in June of 1996, and difficulty with fine movement of his right fingers and walking by September. In April of 1997, MRI revealed an abnormality in his cervical spine, and he was referred to our hospital. Myelography showed a narrowing of the subarachnoid space. We found that his myelopathy was due to his thickening of the dura. Thickend dura was subsequently resected to decompress his cervical cord as much as possible, and duraplasty was performed using his fascia tissue. The difficulty with fine finger movement persisted, but the difficulty walking and the numbness disappeared.

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This retrospective study of 95 patients on lumbar disc herniation for first operation concerned the relationship between extrusion of annulus fibrosus and end plate lesion, and the changes of facet angle. Before operation, the observation of the end plate lesion on MRI in the adjacent vertebral body of the herniated disc and the estimation of the facet angle on CT of the herniated disc level were performed. The rate of the end plate lesion was significantly higher in the vertebral body adjacent to the extruded annulus fibrosus than not so one (p<0.05). The facet angle of the herniated disc level was lower in the extruded annulus fibrosus than not so one (p<0.05). The extruded annulus fibrosus in lumbar disc herniation were suggested by the fact of end plate lesion and/or the lower angle of facet angle.

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We evaluated eight fractures in the distal part of the tibia which had been treated with closed, locked intramedullary nailing without the use of traction table.
There were four females and four males, of mean age 47 years (16 to 76). Fracture types due to AO (ASIF) classification were devided into A1, two; A2, one; A3, one; B1, one; and B2, three. Two Gustilo type II open fractures were included in Type B2 fractures, which were treated by the same method in the secondary stage. There were no delayed unions or infection so Functional recovery of the ankle joints was good to excellent in all patients. Moreover, all received normal tibial alignment, except for one patient in whom a slight 5-degree varus tibia deformity remained.
Based on these results, we recommend closed, locked intramedullary nailing for distal part fractures of the tibia.

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Eleven patients with tibial Pilon fractures have been treated operatively by using May anatomical bone plates. The patients were aged 36 to 74 years (mean, 57.0 years) and were followed up 3 to 23 months (mean, 11 months) after surgery. There were six patients (55%) in type I, two patients (18%) in type II, and three patients (27%) in type III Rüedi-Allgöwer fracture types. In five patients with type II or III fractures there were three (60%) good and two (40%) poor radiographical results. We concluded that anatomical reduction of the fibula and reconstruction of the articular surface of the tibia were necessary in the treatment of tibial pilon fractures.

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Since 1996, we have performed percutaneous laser disc decompression (PLDD) in the treatment of 22 patients (14 males and 8 females) with lumbar disc herniation (LDH). Nd: YAG laser device was used for this procedure. The average age at the time of operation was 38.2 years (range, 16 to 64 years) and the average duration of follow-up was 7.4 months (range, 3 to 12 months). PLDD was applied to the contained disc, with estimates based on preoperative magnetic resonance (MR) images. Twenty-six discs were operated on and 15 of them (57.7%) were L4/5 discs.
The short-term clinical results were better in the younger patients (below 30 years) than in the older. No serious complications were reported. Postoperative MR images showed that the size of the herniated disc was not reduced in most patients, even in those showing marked clinical improvement. Unsuccessful results were obtained in 6 patients. Open surgeries performed on 3 of them revealed an uncontained disc in one case.
Although PLDD is a minimally invasive surgery for LDH, it did not always produce good results. This study suggests that while PLDD is effective for young patients with contained disc, sufficient consideration must be made before its implementation.

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A retrospective review was performed of 32 cases of failed back surgery syndrome from 1993 to 1997, to analyze the reasons for failure at primary discectomy, the outcome of the revisions-there were 5 female and 27 male patients, with an average age of 46 years (range 20-80 years) at the time of operation and failed back, and factors that influenced those outcomes.
The same level and side as first operation is most of revisions. The reasons for failure was true recurrence, new herniation, left herniation, instability and psychogenic. True recurrence is most in them. By Hirabayashi evaluation way, good to excellent results of non-complained was obtained is 76.5%. But excellent results of complained were not, and good results were in 60%. In revisions the number of male is more than of female.
The same level and side as first operation are number of cases. The reasons for failure were true recurrence, new herniation, left herniation, instability and psychogenic.

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A study of 122 patients with disc herniation, degenerative spondylolisthesis, and spinal canal stenosis was undertaken to test the hypothesis that asymmetry of the facet joints is associated with the lumbar spinal diseases. The facet joint angles were measured at the L 3/4, L 4/5, and L5/Sl levels. The differences between the right and left facet joints were calculated. The results showed that in cases of disc herniation, there was a significant difference in the facet angles. There was no relation between facet joint asymmetry and degenerative change of the intervertebral disc. These results support the hypothesis that facet asymmetry is associated with lumbar disc herniation.

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We report two cases of talus fracture-dislocation sustained in traffic accidents. Both were Type IV fractures by the Marti-Weber classification, and were treated surgically using screws. The Hawkins criteria scale was used to evaluate the results. In both cases, surgery was performed within 3 days, and the results were excellent. We conclude that early anatomical reduction is important in order to obtain good results and prevent avascularnecrosis.

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From 1970 to 1997 the operative procedure was conducted on 32 feet of 21 cases composed of 11 males and 10 females. Classification by the number of central ray defects showed 3 feet with no central ray defect, 9 feet with one central ray defect, 9 feet with 2 central ray defects, 11 feet with 3 central ray defects. In cases of no and one central ray defect, surgical cleft reduction was conducted in all 12 feet; in cases of 2 and 3 central ray defects, surgical cleft reduction was conducted on 9 feet and double pedicled flap on 7 feet; and silicone block insertion was perfomed on 4 feet. Opening of the cleft was observed in 3 cases with all cases showing 2 or 3 central ray defects. In cases of no and one central ray defect, satisfactory results were obtained in all cases by surgical cleft reduction. In cases of 2 and 3 central ray defects, it was difficult to obtain satisfactory shape by surgical cleft foot reduction. We employed silicone block in cleft plasty. For correction of foot deformity accompanying growth, combined use of metatarsal osteotomy is considered to be necessary.

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We studied the clinical findings in five cases of fracture-dislocation of the elbow joint. Dislocation of the humero-ulnar joint was associated with fracture of the medial epicondyle (N=1), fractures of the coronoid process (N=3) and fractures of the radial head or neck (N=3). In treatment of fracture, we operated on one case in three cases of fracture of coronoid process, one case in three cases of fractures of the radial head and one case of avulsion of the medial epicondyle. In treatment of ulnar collateral ligament, we repaired on unstable three cases. According to the criteria of Wheeler et al., the results of the treatment were excellent in two, good in two and poor in one which was a case of opened dislocation-fracture. It is important to restabilize bone anatomically and repair ulnar collateral ligament.

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A retrospective study of six patients with floating knee fractures is presented. Seven fractures legs in six patients (5 males and 1 female) were selected for this study, with a mean follow up period of 3 years and 2 months (range, 1 year and 3 months-5 years). We treated all cases surgically. Femoral condyle fractures treated by plate and femoral or tibial shaft fracture treated by interlocking nail. The results of clinical treatment were affected by complications and the time ROM exercise was started.

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Of the 59 primary total hip arthroplasties (THA) performed between 1993 and 1996, five posterior dislocations occurred (8.5%). Two hips had single dislocation, while the remaining three hips had more than one dislocation.
Radiologically, the angle of acetabular component was not significantly different between the control group and the dislocated group.
The findings of this study suggest that the factors which most likely influenced dislocation after THA were socket malposition and component design.

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This report concerns three cases of distal periprosthetic and extra-prosthetic femoral shaft fracture following Hip Arthroplasty. According to the criteria of Johansson, one case was classified as a Type-II fracture and two cases were classified as Type-III fractures. These three fractures were treated with open reduction and internal fixation using the BMP^TM Cable Plate System and the May^TM Anatomical Bone Plate. The BMP^MT Cable Plate could be applied to fractures both above and below the prosthetic tip and provided immediate rigid fixation allowing early mobilization. We recommend the use of the BMP^TM Cable Plate System for Type-II and Type-III fractures.

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Twelve children (6 boys and 6 girls with mean age of 12.3 yrs and age range of 8-16 yrs) who had benign bone tumor were treated with curettage followed by the implantation of hydroxyapatite (HAP). The children were followed for an average of four years and ten months after operation.
Clinical results were excellent in all cases and there were no toxic effects or abnormal laboratory findings. No local recurrence of tumor was seen except in one 8-year-old boy who had fibrous dysplasia in his right humerus. New bone formation surrounding HAP was observed on radiogram within two months after operation in all cases. Postoperative bone scintigram showed high uptake at the site of packing with HAP. Longitudinal and transverse bone growths were not disturbed compared with normal side. In two cases in whom HAP was implanted close to the growth plate, no functional abnormalities of growth plate were observed.
In conclusion, implantation of HAP is a safe and useful method for children.

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Postoperative results were evaluated in twenty-eight patients with metastatic spinal tumor who underwent surgical treatment during the last two years. There were fifteen males and thirteen females with a mean age of sixty-three years (range, thirty-seven to seventy-nine). The primary tumor was lung cancer in six patients, multiple myeloma in six, breast cancer in five, prostate cancer in two and uterine cancer in two and so on.
Surgical procedures consisted of laminectomy and posterior fixation in twenty-two patients, vertebral replacement and anterior and posterior fixation in five, and partial sacrectomy in one. For fixation, spinal instrumentation was employed in all patients.
As a result, the rate of survival was 82 per cent (twenty-three of twenty-eight) at three months and 69 per cent (nineteen of twenty-eight) at six months. Mean survival time was 7.2 months in fifteen patients who died.
According to the system of Frankel grading scale, twenty-three of twenty-seven patients who had had a neurological deficit (grade A, B, C or D) preoperatively had complete or partial recovery. Pain relief was achieved in twenty-one of twenty-five patients.
In patients with severe pain or pregressive paralysis, surgical treatment was agressively indicated if the general condition was favorable. Although duration of survival was limited, surgery proved to be beneficial for improving the quality of life.

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The goal of surgical treatment for metastatic spinal tumor is to improve the quality of the patient's remaining years by pain relief and preservation or restoration of neurological function. Between 1987 and 1996, we performed surgical intervention for metastatic spinal tumor on 19 patients (10 males and 9 females). Age range was from 38 to 77 years with a mean of 61. We conducted the posterior stabilizations with Luque rods on 18 patients and Harrington rods on one. All rods were fixed with sublaminar wires at two vertebral levels above and below the level of the lesion. After surgery, all patients were relieved of pain, 12 of 18 (67%) had noticeable neurological improvement, and 6 of 14 (43%) achieved improvement in activity level. Four complications occurred loosening of wire, prolonged wound healing, and protrusion and failure of rods. Fifteen patients (79%) survived for more than three months after stabilizations. On the basis of these results, we concluded that posterior stabilization with Luque or Harrington rods is a reliable procedure for treatment of metastatic spinal tumor.

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We evaluated the results of surgical treatment of 15 metastatic lesions affecting long bones in 14 patients. Pathological fractures occured in 7 patients preoperatively. Pain due to bone metastasis subsided after the operation in 12 of 14 lesions with pain preoperatively. Since after surgery pain subsided in patients who had not suffered a pathological fracture preoperatively, we considered that prophylactic surgical treatment would be effective to control pain due to bone metastasis in a long bone. In this series, the results of surgical treatment were excellent in 4 patients, good in 6, and fair in 2. Intramedullary fixation would be a useful treatment on bone metastasis affecting long bones. Wide resection should be attempted in patients who may have a good prognosis.

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This case report concerns an intraarticular bone tumor of the knee joint causing loss of flexion. A 41-year-old man complained of pain and loss of flexion in his right knee joint. He was diagnosed with degenerated lateral meniscus and treated. However, the symptoms didn't improve. After 3 years, resection of the bone tumor on intracondylar notch of distal femur resulted in an improvement from a pre-operative loss of flexion of 60° to 135° after surgery. This tumor was diagnosed as osteoma in the histopathological study.
The lateral meniscus was discoid and degenerated, and the tumor was not found on X-ray film (A-P, lateral view). Thus, diagnosis of loss of flexion caused by osteoma was uncharacteristically delayed. An MRI was used to help understand the tumor.

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A case of a giant cystic lesion in a proximal area of the leg of a 35 year old man is presented. The size of this tumor was the size of a fist. This tumor didn't lead to the knee joint capsule on Arthrography.
MRI demonstrated a cystic lesion which showed uniformity.
Bursitis, synovitis, hematoma, synovial hemangioma, synovial sarcoma, ganglion, parameniscal cyst and pigmented villonodullar synovitis were considered.
He was unsuccessfully treated with injected steroids and anesthetic.
Therefore we treated him with excision of the tumor.
Pathologically of chronic bursitis was diagnosed.

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Two cases of benign chondroblastoma around the knee are reported. The patients, both teenagers, complained of knee pain and joint stiffness. On plain X-ray and computed tomographic film, the tumors formed an oval defect and calcification surrounded by a sclerotic rim in the involved bone. On T1-weighted MR images, the tumors were hypo-iso intense. The T2-weighted images showed spotty hyperintensity, which was enhanced with Gd-GTPA. The tumors were surgically treated with bone grafting after curettage. The risk of recurrence is 11-24%; therefore sufficient curettage is necessory while avoiding injuries of epiphysial catilage.

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In the present study we report two cases of secondary chondrosarcoma arising from osteochondroma. The first case was a 54-year-old male who had a large mass in the right pelvis, which arose from multiple osteochondroma. The second case was a 34-year-old male who had a cartilaginous mass arising from solitary osteochondroma of distal fibula. Radiological examination showed irregular calcification and thick caltilaginous cap in both cases. The secondary chondrosarcoma arising from solitary osteochodroma such as in the second case, is extremely rare. There has been only one previous report of a case in which secondary chondrosarcoma arose at distal fibula. In the present two cases, we resected the two tumors by wide margin. The clinical course of these patients was good and they returned to their jobs.

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Ulnar dislocation of the extensor digitorum communis tendon is often observed in multiple rheumatoid arthritis, but trumatic dislocation is relatively rare. We recently encountered 2 patients with traumatic dislocation.
Both patients sustained bruise in the dorsum manus. Pain and swelling were observed on the dorsal side of the M. P. joint of the right middle finger. In the M. P. joint of the right middle finger, the extensor tendon was ulnarly dislocated in slight flexion of the finger and reduced with extension. At operation, a hemorrhagic focus was present on the radial side of the extensor tendon of the M. P. joint, and rupture and reversal of the sagittal band were observed.
We consider that surgery is more effective than conservative therapy for preventing re-dislocation of the finger extensor tendon. We have obtained good results in fresh cases also by operation in which the extensor tendon in drawn to the radial side using suturing of the sagittal band and juncture tendineum accorrding to Morohashi's technique.

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Subjects were 8 tendons of 6 digits in 6 cases (3 males, 3 females). Two cases were caused by trauma. The other 2 were affected with RA, one hemodialysis, one malunited distal radius fracture. The time interval from the onset to the surgery is 2 weeks at shortest and 4 months at longest, averaging 2.1 months. Operated seven tendons in 5 patients had been disruptured at tendinous portion. Three tendons were reconstructed by free tendon grafts, one by tendon transfer. The other 2 tendons were repaired by end-to-end suture. Surgical results were excellent in one case, good in 2, fair in 1. Underlying disease delayed the surgery.

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We experienced two cases of subcutaneous rupture of the flexor digitorum profundus tendon of the small finger. Both patients were treated by surgical means, one by direct repair and the otherone by tendon transfer. Good results were achieved in both cases.

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False aneurysm is a rare disease. A report will be presented on our study of false aneurysm developing in the upper extremity.
The subjects of the present study are 7 cases of false aneurysm we experienced during a period of 32 years from 1965 and 1996. By gender, 3 cases were male and 4 cases were female; ages at the time of operation ranged from 11 to 86 years with a mean of 36 years. The causes involved were cut wound in 3 cases, puncture wound in 3, and internal fixation material used for fracture repair in 1. The damaged arteries were the bracial aretery in 1 case, the radial artery in 2, the ulnar artery in 1, the common digital artery in 1, and the digital artery in 2. The observed clinical symptoms and signs were swelling in 6 cases, pulsation in 4, and 2 each of tumor formation, redness local heat and hypesthesia. Following surgical resection of aneurysm, end-to-end anastomosis was performed for the brachial artery in 1 case, for the radial artery in 2, and for the ulnar artery of the palm in 1. Artery ligation was performed in 3 cases: on the common digital artery in 1 and on the digital artery in 2. The postoperative course was satisfactory in all cases.

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Magnetic resonance imaging (MRI) was performed in 71 wrists of 39 rheumatoid arthritis patients. There were 2 males (3 wrists) and 37 females (68 wrists) with an average age of 55.4 years. Synovial proliferation and bone erosion appeared as low intensity areas on T1-weighted MRIs and as high intensity areas on T2-weighted images. Discrimination of synovial proliferation was improved by Gd-DTPA enhancement. These lesions could be detected in early rheumatoid arthritis patients whose plain X-ray images lacked abnormal findings. We found MRI to be a useful method for detecting bone and soft tissue lesions of RA, especially of early RA patients. MRI is also useful in evaluation of drug therapy and pre-operative planning.

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Chondrodysplasia punctata is a rare congenital bone disease. The disease includes shortening of the extremities, nanism, and skin or eye disorders. The diagnostic radiographic feature is punctate-calcified shadows in the epiphyses, called “stippled epiphyses”, due to disturbance of intracartilage ossification.
A case of chondrodysplasia punctata was encountered which is Conradi-Hunermann type. A female neonate, born at 38 weeks gestational age weighing 2436g, had skin abnormalities with squama, erythema, and erosion. She also had asymmetrical shortening of the extremities, and facial abnormalities with a flat face and saddle-like nose. Radiographs revealed punctate calcification in the epiphyses of the humerus, carpus, and tarsal bones. The skin lesion disappeared completely four months after birth, and the punctate ossification tends to disappear gradually. We report the case with review of the literature.

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The coagulation factor XIII is known to play an important role in wound healing. However, there are few reports about factor XIII in the field of orthopaedic surgery. We measured the serum level of coagulation factor XIII in 30 patients with orthopaedic disorders. The patients were 12 males and 18 females, with an average age of 45.5 years.
13 patients had musculoskeletal tumors (malignant in 5 patients and benign in 8 patients), 4 patients had spinal disorders and 13 patients had arthropathies.
Before operation, there were 6 patients whose level of factor XIII was lower than normal. The recombinant coagulation factor XIII (Fibrogammin) was used for the six patients whose wound healing was delayed. Administration of the factor XIII improved their wound healing. The level of factor XIII in the pateints with musculoskeletal tumors had a tendency to be lower than that of those with other orthopaedic disorders. We could not detect any correlation between the level of factor XIII and other factors; age, duration of the operation, and the amount of blood loss. However, the level of factor XIII in patients who lost large amount of blood (over 3000ml) during operation was very low.
These results suggest that it is important to check the level of factor XIII before and after invasive operation such as excision of musculoskeletal tumor, hindquarter amputation and spinal operation using wide instrumentation, and to consider using factor XIII for patients with impaired wound healing.

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We report a 17-year-old male who presented iliopsoas hematoma as the first manifestation of hemophilia A. At the initial examination he complained of severe pain around his right anterior hip joint, and then gait disturbance. The iliopsoas position suggested the presence of iliopsoas myositis or related diseases. After considering all clinical and laboratory findings including coagulation factor VIII, we diagnosed his case as hemophilia A with difficulty. He was treated with replacement therapy. The clinical course was favorable and he returned to high school life. Only a few such cases have been reported previously. If iliopsoas hematoma is suspected, it is important that the orthopaedic surgeon investigates a blood coagulative disorder as soon as possible.

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A case of traumatic pancreatitis with subsequent intraosseous fat necrosis and osteonecrosis is presented. A 23-year-old female patient suffered from acute pancreatitis caused by a traffic accident in 1994. Pain and limited motion of the right elbow joint occured in 1996.
X-ray and ^99mTc bone scintigraphic examinations revealed multiple osteonecrotic lesions of both shoulders, the right elbow, both hips, both knees and both ankle joints.
Magnetic resonance (MR) images showed avascular necrosis in the right humeral epicondyle, both femoral heads, and the left femoral and tibial condyle. Multiple foci of abnormal signal intensity, in the marrow of the distal femur, were recognized by MR images as being compatible with the fat necrosis secondary to traumatic pancreatitis.
Lymphocytosis, deposition of hemosiderin, osteonecrosis and fat necrosis were observed in histological studies of the left tibial condyle.

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