We report four cases of total Knee arthroplasty with corrective femoral or tibial osteotomy.
These cases included one deformity after supracondylar fracture of the femur, two deformities after fracture of tibial plateau, and one case of advanced osteoarthritis following high tibial osteotomy.
Corrective osteotomy for extra-articular deformities resulted in a good aligment of limbs and fair soft tissue balancing.
We concluded that this operative technique has a practical value not only in correcting three-dimensioal deformity about the knee joint, which leads a good aligment of the affected limbs, but also in providing total knee arthroplasty and fixation of the osteotomy site at the same time by using cement fixation of the component with long stem.

View full abstract

A cyst-arachnoid shunt procedure using a silicone tube with many small holes at both ends was performed in two patients having anterior cervical intradural arachnoid cysts. In one patient aged 44 years, preoperative symptoms of nape pain and radicular pain in both upper extremities disappeared immediately after the operation. With a follow-up of 4 years and 8 months, no recurrent arachnoid cyst was seen on MRI. The other patient, aged 5 years, had progressive tetraparesis preoperatively. His neurologic deficits rapidly improved after the operation, leaving no disability after a follow-up of one year. This procedure can be an excellent alternative if the complete removal of the arachnoid cyst is difficult to achieve.

View full abstract

A follow-up study was performed on 11 patients who had undergone surgical repair of rotator cuff tears. The patients included 6 males and 5 females ranging in age from 43 to 69 years (average, 57 years). McLaughlin's method was used for 9 joints and direct suturing for 3. The follow-up period ranged from 19 to 89 months (average, 47 months). Pain, range of motion in the shoulder joint, and function were evaluated by direct physical examination. The Japanese Orthopaedic Association's (JOA) scoring system was used to clinically evaluate the results. All patients showed a marked improvement upon final examination, with an average score of 92.0 as compared with 42.5 preoperatively. The scores increased from 8.8 to 26.7 points for pain, from 12.8 to 25.8 for range of motion points and from 6.2 to 19.5 points for function. Based on these results, we conclude that surgical repair is an effective method for treating rotator cuff tears.

View full abstract

We investigated 27 hips in 25 patients with a follow up ranging from a half year to 10 years (average 3 years) after Sugioka transtrochanteric rotational osteotomy for non-traumatic avascular necrosis of the femoral head.
The radiological success rate that defined non-appearance of postoperative collapse of the femoral head was 67%. The intact area of lateral part of the femoral head on postoperative anteroposterior view of the hip roentgraph was useful for predict outcomes.
8 hips, with the ratio of transposed intact articular surface of the femoral head was further 72% and as well as the ratio of transposed intact area of the lateral part in the femoral head was further 90%, were all succeeded.
we concluded that in addition to surface condition, functional area is important for predict postoperative progressive collapse of the femoral head.

View full abstract

Over a period of two years, beginning in September 1995, we treated 13 fingers (11 cases in all) with various tip injuries, using an occulussive dressing technique, with aluminium foil and Povidone-iodine gel. Using this method, epithelializatin occured within 4-8 weeks. In all cases, fingerprints and nails could be obtained. On the whole, patients were satisfied with the results. Total treatment costs an average of 1280 insurance points per case. As this method can be performed simply and can obtain good results, moreover, hold down the costs, we considered it as a useful method in the treatment of finger tip injuries.

View full abstract

We present our experience with one case of Slipped Capital Femoral Epiphysis (SCFE) with panhypopituitarism. The patient was a 27 years old male who was born with fetal distress and had low body height during childhood. At 18 years of age, he was admitted to our hospital because of growth retardation with lack of secondary sex characters, and was diagnosed with panhypopituitarism. He was administered growth hormone, thyroxine, cortisone and HCG-HMG. At 27 years of age, he suffered left hip pain with positive Drehmann's sign and was diagnosed as having the left SCFE. On blood test, LH, FSH, and testosterone were low, but free T4 and GH were within normal limit. Posterior tilting angle (PTA) of the femoral epiphysis was 6° at the right side, and 44° at the left. Southwich osteotomy was performed on the left hip and in-situ pinning was done on the right hip. Three months after the surgical operation, he could walk without pain and Drehmann's sign disappeared. PTA of the left femoral epiphysis as measured on X-ray was 30°. This case of SCFE suggests that imbalance of sex-steroid hormones and growth hormone may induce the disintegration of epiphysial growth plate of femoral head.

View full abstract

Vacuum phenomenon is not uncommonly seen in degenerated lumbar discs. However, we have not seen any reports of lumbar nerve compression associated with intradural gas formation.
The case study centered on a 66 year old male patient with a one year history of pain involving the left lateral thigh and in whose case conservative treatment had been unsuccessful. Preoperative plain lumbar radiographs showed deformation and narrowing of the intervertebral discs, while MRI and CT revealed gas formation in the intradural spaces at the L2-L5 intervertebral discs. During surgery, a gas containing tumor which had adhered to the cauda equina was observed. Moreover, it had conjucted to the intervertebral disc at L2-L3. After surgery, the patient recovered well. In this case, gas formation in the degenerated intervertebral disc migrated into the intradural space and caused nerve compression.
The CT findings were useful in diagnosis due to the low intensity area being clearly visible.

View full abstract

We report the outcome of anterior and posterior combined surgery to the lumbar degenerative spondylolisthesis. 14 patients (6 men and 8 women) were treated by conventional anterior interbody fusion and pedicle screw instrumentation and tried to get the early ambulation. Mean age at the time of surgery was 54.9 years (range, 39-70 years). The mean follow-up period was 16.5 months (range, 6-28 months). We evaluated the surgical outcome using the Japanese Orthopaedic Association back score (JOA score, full point is 15). The preoperative mean JOA score was 6.1 (range, 3-9) and was 13.7 (range, 10-15) at the time of follow up. In the x-ray evaluation, 13 cases revealed solid bone consolidation (92.8%). One case showed the collapse of grafted autogenous iliac bone, but bone fusion was found at 16 monthes after the surgery.
Recently, we can choose various methods of the surgical treatment for degenerative spondylolisthesis. We consider that this combined surgery is an acceptable method because of our good results of JOA scores and high bone consolidation rate.

View full abstract

We report a case of lumber disk herniaton associated with nerve root anomaly.
The patient was a 26-year-old man who had low back pain and left leg pain. Lumbar X-ray films showed lumbarization. MRI showed left lateral disk herniation at L5/S1, and myelography showed an anomalous right L5 nerve root. Discography of L5/S1 and left L5 root block caused or alleviated the same pain. According to Neidre & Macnab's classification, this case was Type 2A. He underwent osteoplastic laminectomy and the operative findings were the same as those of the myelogram. His JOA score improved after surgery.
In conclusion, myelography is useful for diagnosis and osteoplastic laminectomy is an effective operation.

View full abstract

Love's method is generally used for herniotomy from the back in cases of lumbar disc herniation, but it is difficult to perform a herniotomy when sequestration or extraforaminal lumbar disc lesions are involved. In cases like this, we carry out osteoplastic partial laminectomy. Osteoplastic partial laminectomy allow an extensive visual field as well as maneuvers to protect nerve root, making the extraction of large and floating herniation possible. Moreover, it is believed that repositioning the vertebral arch helps to preserve the organization of the back, preventing post-operative instability.

View full abstract

We followed the natural course of pre and early-osteoarthritis of the hip radiographically in 17 patients (20 hips) for an average term of 17 years.
We measured the Sharp's angle, CE angle, AC angle, acetabular head index, and radiographical stage at first consultation. Two of 11 hips developed early-osteoarthritis from pre-osteoarthritis and seven of 9 hips developed advanced-stage osteoarthritis from early osteoarthritis at the last consultation. However, no radiographical parameters have relationship with advance of stage. It was concluded that predicting advance of stage in osteoarthritis of the hip was difficult using radiographical parameters.

View full abstract

Osteonecrosis of the femoral head is usually progressive and once collapse of the femoral head develops, joint destruction almost invariably follows. Therefore, various methods of surgical treatment have been developed in an attempt to save the femoral head and maintain the natural function of the hip joint. We studied the histological findings of the necrotic lesion of cases of osteonecrosis of the femoral head following transtrochanteric anterior rotational osteotomy described by Sugioka and varus osteotomy. We were able to evaluate four hips followings osteotomy. They were all male with average age at operation being 36 years and with age range of 25-52 years. In two patients, osteonecrosis was associated with steroid administration and in he remaining two cases with alcohol abuse. According to the classification of the Japanese Investigation Committee, three hips were stage II and one was stage III. All four hips were obtained following removal of screws from 2 to 4 years postoperatively average of 2.9 years). The specimens were cut to thickness of 5μm and were subjected to hematoxylin and eosin stain and Pas-Alcian blue stain. Histologically, in three cases the preoperative necrotic lesion remained as necrosis without reparative reaction and in one case proliferation of new fibrous connective tissue and blood vessels was observed in the necrotic lesion. Though the number of osteoblasts and osteocytes was decreased, the bone structure was well preserved, indicating that the purpose of femoral osteotomy was achieved. It is necessary in future to study cases with a longer postoperative course by delaying the time of bone biopsy.

View full abstract

Fifty-six patients with fracture of distal radius were treated with intra-focal pinning at our hospital from May 1995 to May 1997. The elderly group (21 patients aged over 65 years) were compared with the younger group (35 patients) in respect to radiological findings, range of motions and postoperative functional evaluations.
Radiological evaluations included radial inclination, volar tilt, and radial shortening. Range of motions included palmar flexion, dorsal flexion, radial deviation, ulnar deviation, pronation, and supination. And postoperative functional evaluations were assessed using the point system proposed by Saito.
The results from radiographic analysis were as follows: As for radial inclinations and radial shortening, the elderly group were significantly worse compared with the younger group. But this result with radial shortening is not reliable because the ulnar variance generally increases with age.
As for the range of motions, there were no significant difference between two groups except palmar flexion and supination.
As for the postoperative functional evaluation, more than 90% patients in the younger group were “excellent”, and more than 95% patients in the elderly group were “excellent” or “good”.
From our study, we found that the intra-focal pinning for the fracture of distal radius is a useful surgical procedure even in the elderly patients.

View full abstract

Distal radial fractures are very common in elderly persons. It is generally considered that manual reduction of this fracture is easy but is difficult to maintain the reduced position in the case of unstable type. Since January 1997, the authors have used an intramedullary bone cementing technique in order to treat unstable distal radial fractures in elderly patients. The number of the cases treated by this method was 13. The cases were classified as follows: (1) extra-articular Colles' fracture (2 cases), (2) intra-articular comminuted Colles' fracture (11 cases). At the follow up time, in the radiological findings, the values of radial tilt, radial inclination and ulnar variance were measured as 7.9±9.5°, 23.4+6.4°and 1.8+1.7°in respectively. According to Saito's demerit point system, 9 fractures were evaluated in excellent, 4 were in good, and no case was in fair or poor.

View full abstract

In treatment of femoral neck fracture we have sometimes experienced complications of non-union and late segmental collapse (LSC) due to the anatomical characteristics. Study was made on 29 cases who were treated by osteosynthesis at our department and on whom follow-up observation could be made.
The subjects of the present study were 29 cases whose age at time of surgery ranged from 22 to 89 years with a mean of 57.8 years. When classified by Garden's criterion, there were 1 case in stage 1, 15 cases in stage 2, 7 cases in stage 3 and 6 cases in stage 4. These cases were examined radiologically for the presence of non-union and LSC.
Complication of non-union was observed in 1 case and LSC in 4 cases. In particular, LSC was seen in 14.3% of the cases of stage 3 and in 50% of the cases of stage 4. Furthermore, LSC was found in 5.3% of the cases injured by toppling, in 25% of the cases who fell from high place, and in 33% of the cases injured in traffic accident.
Stage 3 and stage 4 of Garden's criterion and high energy trauma caused by falling from high place and traffic accident can be considered to be risk factors of complication of LSC in femoral neck fracture.

View full abstract

Between December 1993 and February 1998, a total of 16 patients of subtrochanteric fractures were treated. We experienced 3 cases without the anatomical reposition by closed intramedullary nailing. 13 cases except 3 were treated satisfactorily. In these 3 cases, the greater trochanter and the lesser trochanter existed in the proximal bone fragment. And in these 3 cases, the fractures were oblique-spiral types extended proximal-medially to the distal-lateral side. There was not a “wall” of cortical bone in the medial-posterior region of the proximal bone fragment. And also the intramedullary nails were located in medial-posterior region of the proximal bone fragment of the femur. Therefore, the anatomical reposition was not maintained after the intramedullary nails were inserted. We indicated that it was the most important thing to expect the dislocation for treatment of such cases.

View full abstract

We have treated 42 total hip arthroplasty (THA) revision on 40 hip joints since 1976. We supposed that not only the technical skill, implant, and individual frame as well as the patient's quality of life (QOL) influenced recovery after THA. Then we studied our revision cases on the aspect of their QOL.
Half of the patients were obese and tended to put on weight rather than reduce weight despite our advice. We advised them to avoid squatting positions. Only cases using western-style lavatories improved completely. Patients of stubborn, goodnatured or restless character were dominant. None of the male patients whose job were heavy lavor did not changed their job. Eleven percent of the female patients had the bedridden families who needed to be cared. Such patients tended to result in the revision.
On the other hand, some patients have escaped the revision by improving these factors. Furthermore, other patients have been controlled well by taking our advice, even though findings of their X-ray showed that they need further operations.
Therefore, we suggest that we have to consider the patient's QOL and their character when making decision of THA and THA revision, especially in young patients.

View full abstract

In order to evaluate the effect of open door expansive laminoplasty on senile patients with cervical spondylotic myelopathy (CSM), 68 patients operated from July 1993 to Nov. 1997 were studied. The average follow-up duration was 26 months. Magnetic resonance imaging (MRI) were examined before and at least 6 months after surgery. The therapeutical effects were assessed with respect to Japanese Orthopaedics Association (JOA) score, improvement rate and parameters of MRI. The measurements were performed at senility group (32 patients of 65 and over 65 years old) and non-senility group (36 patients under 65 years old).
Both preoperative and postoperative JOA scores of senility group were significantly lower than those of non-senility group. The improvement rate of senility group was lower than that of non-senility group, but no significant statistical difference was recognized. When analysing the MRI, we found that in the senility group the most serious compression level of spinal cord was significantly higher and the anteroposterior diameter of spinal cord before surgery was significantly shorter, but the ratio of preoperative area of spinal cord over postoperative had no significant statistical difference.
In conculusion, the authors suggest that, refer to their symptoms, views of MRI, etc, senile patients need timely operative therapy.

View full abstract

We studied the surgical results of 35 patients with cervical compression myelopathy using sagittal T1-weighted magnetic resonance imaging (MRI). There were 15 cases of cervical spondylotic myelopathy (CSM) and 20 cases of ossification of the posterior longitudinal ligament (OPLL). The preoperative compression rate and restoration rate at the maximum involved level, and the spinal cord curvature were measured on MRI. Clinical results were assessed using the Japanese Orthopaedic Association (JOA) scare. The mean preoperative JOA score of 11.5±2.3 points was significantly different compared to the postoperative score of 14.2±1.9 (p<0.0001, paired t-test). The mean recovery rate of the JOA score was 45.2±31.3%. The mean preoperative compression rate was 54.3±12.1% and the mean restoration rate was 44.5±30.6%. The compression rate and restoration rate significantly contributed to the outcome (p<0.0001 and p<0.003 respectively), as shown by multiple regression analysis which assessed the influence on the recovery rate of age, duration of symptoms, preoperative JOA score, original disease, compression rate, multiplicity of involvement, the type of operation, restoration rate and the spinal cord curvature. Our results suggested that the compression rate can predict the surgical results preoperatively and that restoration of the involved spinal cord significantly influences the postoperative clinical results.

View full abstract

We reported three patients of tethered cord syndrome with lumbosacral lipoma. The patients are two 7-year-old females complaining of urinary incontinence and a 27-year-old male complaining of low back pain. The lipoma was subtotally removed and the spinal cord was untethered in all cases. After surgery, the two females with bladder dysfunction improved slightly. The urinary incontinence of one female was stopped, but the urinary incontinence of the other female still remains, besides the frequency of her incontinence has decreaced. The male with low back pain improved. The purpose of this surgery is to improve symptoms and to prevent the progress of to neurological disorders in the future.

View full abstract

Four cases of impalement injury of the lower extremities were reported in this study. There have been only a few reports regarding impalement of the lower extremities. Impalement injuries have been usually associated with neuro-vascular complications because of both blunt and penetrating trauma. Extensive exposure and careful remove of the impaling object, and elaborate irrigation and debridement are required for the initial management.

View full abstract

A case of lumbar spine fracture and visceral injury associated with a lap-type seat belt is discussed. A 23-year-old man was a passenger in the rear seat of a vehicle and was wearing a lap-type seat belt. He was injured when the car hit a telegraph pole. The pre-impact speed was estimated to have been 40 kilometers per hour. In the emergency room, he complained of back pain without any neurological deficits, and X-ray films showed slight compression fracture of the first and second lumbar vertebrae. Abdominal CT scans showed no abnormalities. Ten hours after injury, the patient started to complain of abdominal pain and fullness. Repeat CT scans revealed abnormalities around the right kidney which suggested hematoma and free air. Laparotomy was performed fifteen hours after injury, revealing perforation of the duodenum and a jejunal hematoma. This case was interesting in that the patient had injuries to the abdominal viscera although the trauma and bony injuries were minor. We should pay more attention to the possibility of viscerai injury after car accidents, because many authors have suggested that a high rate of abdominal visceral injury is associated with lap-type seat belts.

View full abstract

We evaluated the long-term results of 20 patients (29 feet) with congenital club foot who underwent posterior release (PR) in our hospital.
They were classified into two groups according to further treatment. Group I included patients that required subsequent posteromedial release or medial release and group II included patients who received only early posterior release. They were evaluated radiographically according to the T-C index and talo-1st metatarsal angle (TMA) and clinically according to the McKay's evaluation. The mean TC index of group I was higher than group II after an additional operation. The mean TMA of group I was lower than group II after the additional operation. Nine feet were clinically graded as satisfactory (excellent or good) and 20 feet as unsatisfactory (fair or good) at the time of the most recent follow-up. We were not satisfied with their clinical results. In conclusion, we recommend complete subtalar release for congenital club feet.

View full abstract

This is a case of sacral chordoma requiring resection of the rectum. The patient is a 44 year old male, whose chief complaint was urinary retention. Both CT and MRI showed a large tumor in the pelvis, which was diagnosed as chordoma by biopsy. Resection of the tumor and Mile's operation were done because Ba enema demonstrated the invasion to the rectum. The level of resection of the sacrum was S_2/3. Walking ability is consequently almost normal, but incontinence and mild hypoesthsia remain. There is no recurrence and he has returned to his occupation 15 months after the operation.

View full abstract

Thirty-one AGC-S total knee systems employed in 21 patients were reviewed with a minimum follow-up of 6 months. The mean follow-up period was 2.5 years. There were 17 women and 4 men. The mean age at operation was 73.4 years. The JOA score was used to assess the clinical status before and after surgery. Radiographic evaluations included measurement of the femoro-tibial angle (FTA), placement of each prosthetic component, and patello-femoral (PF) congruence. Radiolucent areas were also recorded. Average JOA score for osteoarthritis was 47.5 before surgery and 72.7 at the latest follow-up examination, while the score for rheumatoid arthritis was 27.6 and 63.2, respectively. The average range of motion improved from 103.4 degrees to 113.0 degrees. FTA and placement of each component were almost the same as planned preoperatively. There was no marked incongruency in PF joint. A radiolucent area around tibial component was present in 7 knees, however, there were no clinical signs of loosening. The design of this prosthesis ensures good alignment, good range of motion and good PF congruence.

View full abstract

The subjects were 34 patients who underwent 44 arthroplasties with Miller-Galante (M-G) II prostheses. They were evaluated clinically and radiographically, between one year and 5 months and 6 years and 2 months after surgery. The clinical results were evaluated by the functional evaluation score system proposed by 3 universities. The average score at the time of follow-up was 83.1 points. Radiographic subsidence of bilateral cementless tibial components of a patient was observed, and a non-progressive partial radiolucent line at the bone-prosthetic interface of the cemented tibial component was detected in another patient. Nineteen knees showed tilting or lateral shift of the patellar component.

View full abstract

We reported two cases of the patients with tangential osteochondral fracture (TOCF) which were treated with poly-L-lactic acid pins and fibrin glue. We obtained good results in both cases using external support with knee braces after surgery instead of rigid fixation with casts.
We recommend these materials for the treatment of osteochondral fracture associated with patellar dislocation.

View full abstract

Two cases of tendon rupture on chronic haemodialysis were reported. The rupture occurred spontaneously without any special strain. In one case, a brachial triceps tendon was ruptured and in one case a quadriceps tendon was ruptured.
Radiological findings showed that in both cases, a flake of bone that avulsed with the tendon from the olecranon or the patella was seen. Laboratory findings showed that in both cases, the high levels of alkaline phosphotase and PTH confirm the existence of severe secondary hyperparathyroidism.
The ruptured tendons were repaired and we obtained satisfactory results. Pathophisiological mechanisms of tendon rupture in chronic haemodialysed patient remain to be answered, however, secondary hyperparathyroidism is suggested as one of factors of tendon rupture. In both cases, parathyroidectomy was carried out after the episode of tendon rupture.

View full abstract

We report a case of flexor tenosynovitis of the finger as a manifestation of sarcoidosis.
The patient, a 53-year-old woman complained of swelling and limited motion in her left middle finger. Her past medical history revealed that she had been diagnosed as having sarcoidosis 2 years previously. The physical examination showed slight tenderness, and the skin over the swollen area was reddish. Active range of motion of the distal and proximal interphalangeal and metacarpophalangeal joints was 0-20, 0-50 and 0-65 degrees, respectively.
Laboratory findings were normal except, for an elevated sedimentation rate (25mm/hr) and a high angiotensin-converting enzyme level (42.3IU/L). Plain radiographs of the left hand revealed nothing abnormal. A chest X-ray showed bilateral hilar lymphadenopathy. A magnetic resonace image of the left hand indicated tenosynovitis of the middle finger.
Surgical tenosynovectomy was performed, and the histologic findings of the tenosynovium indicated noncaseating epithelimoid granulomas. Cultures of the tenosynovium for bacteria and tuberculosis were negative. The patient's hand was splinted for 2 weeks, after which she was allowed to do active exercises. There was no recurrence of tenosynovitis 7 months after surgery.

View full abstract

In the treatment of Kienböck's disease in the progressive stage and in middle-and advanced-age patients, we selected replacement arthroplasty using a bone-cored fascial ball, while in Kienböck's disease in the early stage and in young patients we employed radial wedge osteotomy.
Since 1994, radial wedge osteotomy was performed on 8 patients, aged 20 to 38 years (average 26 years). Lichtman classification prior to operation was IIIA in 4 cases and IIIB in the other 4. Ulnar variance was zero in all patients, and radial wedge osteotomy of 15°and shortening of approximately 1mm were conducted. The postoperative follow-up period ranged from 7 months to 3 years and 2 months (average 1 year and 5 months).
Preoperatively, 3 patients had pain at rest and 7 had pain in movement, but at the time of follow-up, pain at rest had disappeared in 3, and pain in movement remained in only 1 patient. Range of motion of palmar and dorsal flexion of the hand joint increased from 83 to 98°: however, the increase was not significant. Grip, in comparison with the contralateral side, showed a significant average increase from 58 to 79%. Radiologically, carpal height ratio and Ståhl's index showed no change at follow-up when compared to the preoperative findings. No evidence of progression could be observed. According to Nakamura's evaluation criterion, the results were excellent in 2 cases, good in 4, and fair in 2. All 8 patients are now engaged in work.
For Kienböck's disease, this study proved that through radial wedge osteotomy in selected cases there was radiologically no progression in disease stage, and the clinical results were good.

View full abstract

The purpose of this follow-up study was to compare the efficacy of our new treatment for fractures of the clavicle with the standard Yasunaga method and conservative therapy. Our new treatment involves the techniques of closed reduction and internal fixation based on the anatomical structure of the clavicle and uses Kirschner wire (1.8mm in diameter) bent into a hook at a distance of about 10mm from the tip. This method involves no special instruments or techniques. Of the 32 patients studied, 5 received our new treatment, 9 received the standard Yasunaga method (straight Kirschner wire with a diameter of 2.4mm), and 18 received conservative therapy. Our technique obtained good anatomical reduction and there were no cases of non-union or infection. Results indicate that this method is an effective treatment for fractures of the clavicle and offers significant advantages over both the standard Yasunaga method and conservative therapy.

View full abstract

[Purpose] We encountered a rare case of glenoid fracture that was considered to be due to dislocation associated epileptic attacks. [Case] A 23-year-old male with pain in the left shoulder. Present illness: He noticed pain and limited motion in the left shoulder when he got up in the morning. Since no improvement was observed after treatment at a local hospital, he visited our department 2 days later. Past history: He developed the first epileptic attack at the age of 5 years. Recently, attacks frequently occurred. Findings at the initial examination: He was 178cm tall and weighed 103kg. The range of motion was markedly limited. Bloody fluid (20ml) was obtained by arthrocentesis. Imaging findings: Plain X-ray examination showed a bone defect in the lower area of the glenoid fossa and slight inferior instability of the humeral head. CT revealed a Hill-Sachs lesion of the humerus on the upper rim of the glenoid fossa and a bone defect involving the anterior 1/3 portion in the lower area of the glenoid fossa. The bone piece was located posterior to the joint, which was confirmed by 3D-CT. Treatment: The bone piece was removed by the posterior approach. Since loaded plain X-ray examination, arthrography, and contrast CT showed the persistence of inferior instability, osteosynthesis was performed using the bone piece that had been frozen and preserved. Discussion: A few patients with shoulder dislocation due to epileptic attacks have been reported, but those in whom dislocation resulted in glenoid fracture have been rarely observed. CT was useful for evaluating fracture in the glenoid fossa and 3D-CT for evaluating the 3D location of the bone piece. When the ratio of the fracture to the articular surface was high, surgery should have been considered.

View full abstract

We report a case of a posterior fracture dislocation of the shoulder, which required open reduction surgery. Using the superior approach, the open reduction surgery was performed without difficulty. We made use of a screw for osteosynthesis.
Three weeks later a rehabilitation regiment was started. Six months after the operation movements of the shoulder were almost full range and painless. The fracture was united radiologically. A bone scan showed increased uptake of the humeral head.

View full abstract

In the past 5 years we surgically treated 10 patients with distal humeral fracture. Of these patients 2 were male and 8 were female. The mean age of the patients was 76.1 years old (61-97). We classified the patients according to the AO classification system. Five of the patients had the AO Type A fractures and the remainder, AO Type C. We used a bilateral humeral approach for the Type A fractures and a transolecranon approach for the Type C fractures. We basically fixed the fracture with screws.
Clinical results were assessed by both JOA and Jupiter functional scales. Postoperatively, the mean JOA score was 84.4 and 9 of the patients ranked “Good” in Jupiter classification. It is important to fix the fractures stably with screws so that we can start ROM excersise in 2 or 3 weeks after the operation.

View full abstract

From 1984, we have treated for unstable supracondylar fracture of humerus in children with external fixation. Of the total 60 patients, 26 patients attended the follow-up examination 3-15 years (average 8.6 years) after treatment. There were 19 boys and 7 girls, aged 2-13 years (average 7.2 years). The fracture were divided into three groups by Gartland classification. 11 cases (42%) of the fractures in this series were Type 2 and 14 cases (58%) were Type 3. There was none of Type 1. Moreover, we included 1 transcondylar fracture into this study. 8 cases (31%) had nerve injuries at the initial time, however all patient with nerve injuries recovered completely at least within a several months. By Flynn's criteria, results were excellent in 21, good in 3 and fair in 2. There were no poor cases. There were none of cases with complaint and their inability. We had only one patient with cubitus varus deformity. We consider that external fixation is ideal for management of displased supracondylar fracture in children.

View full abstract