To evaluate the patients with cervical spinal cord dysfunction, we studied the potentials elicited from the first dorsal interosseous muscle (FDI) by magnetic stimulation with a double cone coil over the inion (In-MsEP). When the coil was placed at this site, the corticospinal tract was likely to be stimulated at the level of the foramen magnum (Ugawa et al., 1994). The M-waves and F-waves were also recorded from the FDI in response to electrical stimulation of the ulnar nerve at the wrist. Peripheral motor conduction time (PMCT) was determined using the formula as: PMCT (ms)=(M-wave latency+F-wave latency-1)/2, where one millisecond was subtracted from the F-wave latency to allow for the reaction time at the anterior horn cell. The difference between PMCT and the latency of In-MsEP was taken to represent cervical cord conduction time (CCCT).
We examined nine healthy adult volunteers and four patients with cervical myelopathy.
The CCCT was significantly (p<0.05) longer in the patients (3.7±0.3ms) than in the healthy volunteers (1.6±0.7ms), reflecting the damage to the cord in cervical myelopathy. It was suggested that this non-invasive method could be used to periodically monitor cervical cord dysfunction.

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We conducted a radiographic analysis for two age groups of patients with cervical spondylotic myelopathy (CSM), searching for findings that characterize CSM in elderly people. The elderly group consisted of 25 patients aged 75 and older, and the younger group comprised 25 patients aged between 55 to 65.
Plain radiographic measurements of the cervical spine revealed that the antero-posterior diameter of the spinal canal was significantly (P<0.05) wider in the elderly group than in the younger group at C5, but not at the other levels. This finding may explain the tendency to functionally spare the C5/6 level in the elderly group.
To estimate the constitutional factors in the development of CSM, we calculated the ratio of the cord diameter at C2 measured on midsagittal T1-weighted MRI to the antero-posterior canal diameter measured by lateral radiography at each vertebral level. The ratio was significantly (P<0.05) smaller in the elderly group than in the younger group at all the levels from C2 to C7.
This finding may imply a tenuous congenital predisposition to this condition in the elderly group, reflecting a late manifestation of myelopathy in elderly patients.

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Although, MRI is one of the most valuable examination for spinal disorders, recent studies warned the possibility of falsely positive results of this examination. In this report, we showed a typical inconsistency between the MRI findings and the clinical complain.
(Case) 38-years old woman who had a radicular pain of her right arm. The MRI examination showed the intervertebral disk herniation in the left side of C5/6 level, which was in the opposite side of her clinical complain. We performed discogram-CT, and found that the disk herniation was existed in the right side of C5/6 level which could explain the origin of her radicular pain. The operative treatment, anterior decompression and fixation, completely abolished her radicular pain in her right arm. We conclude that discogram-CT is useful in some clinical situation, for example, if the clinical complication cannot be explained by MRI findings.

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Enchondroma is a benign cartilaginous tumor that is rarely found in the vertebral column. We encountered a case of solitary enchondroma of the fifth cervical vertebra. The patient was a 12-year-old boy who complained of neck pain and paresthesia of the upper limb. Cervical spine X-ray films demonstrated destruction of the C5 vertebral body by a cystic lesion. The tumor was removed piecemeal from the involved vertebral body and a strut graft of iliac crest bone was inserted. Histological examination of the tumor revealed a benign chondroma with no signs of metaplasia or degeneration. Five months later, he underwent C4-C6 posterior fusion to prevent kyphotic deformity that could arise secondary to anterior fusion of the spine in childhood. The postoperative course was uneventful. Follow up at 10 years showed complete resolution of his pain and neurological deficit with no radiological evidence of tumor recurrence. Good vertebral alignment and adequate stability were demonstrated on lateral cervical spine films. We report this case with a review of the literature.

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Sixteen patients 75 years old or older (range, 75-81 years; mean age, 77.5) with cervical myelopathy who underwent surgery were reviewed. There were 12 patients with cervical spondylosis, three with ossification of the longitudinal ligament, and one with disc herniation. Laminoplasty was performed in 12 patients, and anterior decompression with interbody fusion was performed in four.
The mean values of the preoperative Japanese Orthopaedic Association score (JOA score), postoperative JOA score, and recovery ratio (RR) were 9.2, 11.8, and 30.2%, respectively. The range of motion in the upper cervical intervertebral regions (C3/4, C4/5) was slightly larger than that in the lower regions (C5/6, C6/7) without significance. On magnetic resonance imaging (MRI), responsible lesions were detected in the upper intervertebral regions (C3/4, C4/5) in most patients. The mean Pavlov's ratio at the responsible lesion level was 0.68. The prevalence of preoperative complications and the incidence of postoperative complications were 87.5% and 43.7%, respectively.
In conclusion, cervical myelopathy in elderly patients tended to occur in the upper cervical levels and be associated with the severe disability. Therefore even in patients with mild cervical myelopathy, surgery should be performed if exacerbation is noted. However, preoperative and postoperative complications must be considered.

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The method of reduction and fixation for a case of traumatic fracture-dislocation of the fifth lumbar vertebra on the sacrum with cauda equina lesion are described.
The patient was a 32 year-old man who had been struck on his back with a heavy block.
His neurological deficit was evaluated on the Asia impairment scale as B at the time of injury. A routine operative method immediately after injury was considered inadequate due to severe skin and soft tissue damage of the lumbosacral area.
Reduction was therefore obtained by the postural reduction method with a direct femur traction. The fracture was then stabilized with a pedicle screw construct attached to the pelvis by means of the Galveston technique four weeks after injury. The patient recovered well with only residual weakness of extensor hallucis longus muscles at follow up, two years after injury.

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Four patients (three males and one female with mean age of 64.2 years) who had lumbar pyogenic spondylitis were treated by percutaneous curettage and continuous irrigation (PN continuous irrigation). The affected intervertebral lesions were L3-L4 and L4-L5 in one patient, T11-T12 and L4-L5 in other patient and L3-L4 in the others. The operative procedure was similar to those of percutaneous nucleotomy. After curettage of the affected intervertebral disc, suction drainage tube (outer diameter, 3mm) and epidural catheter tube were inserted in the intervertebral disc space. Then irrigation with antibiotics were continued for two weeks or more.
None of the patients had responded to systemic administration of antibiotics preoperatively in another hospital. Before the operation, all patients had a severe low back pain and average C-reactive protein was 3.0mg/dl (range, 0.3-6.6mg/dl). After the operation, low back pain disappeared immediately in all patients and C-reactive protein in three patients showed a rapid decrease to normal levels (within two weeks). The causative organisms identified postoperatively in three patients were enterococcus faecalis, candida tropicalis and staphylococcus aureus. No major complications were observed in any of the patients.
MRI showed postoperative improvement in the affected lesions of all patients. After removal of drainage tubes, a high intensity area of the affected disc space on T2-weighted image disappeared between 8 and 28 weeks (an average period, 15 weeks). Both a low intensity area of the affected vertebral body on T1-weighted image and an enhanced area of the affected disc space with Gadolinium-DTPA on T1-weighted image disappeared within 28 weeks. We found MRI to be useful to evaluate the effect of treatment of pyogenic spondylitis.

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Idiopathic herniation of the spinal cord is a rare disease with only 19 cases reported in the literature.
A 55-year-old woman with Brown-Séquard syndrome was diagnosed with spinal cord herniation, and underwent operation. During the operation, yellow ligament adhered to the dura mater, and the dura mater was thickened and reparated in three layers. In the latter lesion, a ventral part of the spinal cord was herniated from a defective area of the dura mater. This incarcerated cord was easily reduced and the defective area of the dura mater was sutured, but the patient's clinical symptons remained unchanged after operation.
An area of high signal intensity appeared in the cord on T2-weighted MRI one year after operation, and we thought that the nerve had degenerated. Our opinion is that spinal cord herniation should be surgically treated before the cord degenerates.

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Two cases of post-traumatic syringomyelia were treated surgically. A 24 year-old male and a 17 year-old male with spinal cord injury were found to have post-traumatic syringomyelia on MRI. The first case presented with motor weakness of upper extremities, the second case complained of severe neuralgia of his trunk. Laminectomy, microsurgical dissection of the arachnoid scar, decompression of the subarachnoid space with syrinx-subaracnoid shunting and a fascia graft to dura were performed. Their syrinxes shrank, however, in the second case it progressed caudally agter surgery. Their symptoms improved. Although the cause of post-traumatic syringomyelia is unknown, it seems reasonable to decompress the subarachnoid space with syrinx-subaracnoid shunting accompanied by a fascia graft.

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Intradural spinal lipomas that are not associated with spinal dysraphism are rare. Over a 2-year period, a 51-year-old male, developed numbness and muscle atrophy of the lower extremities. Plain roentogenograms showed no abnormalities. Conventional myelography showed an intramedullary spinal cord tumor in the thoraco-lumbar junction. CT myelography showed a low density mass lesion at the right dorsal aspect of the spinal cord. MRI showed a high intensity mass on both T1- and T2-weighted images. A sagittal section clearly showed a mass that was present at the dorsal aspect of the Th12-L1 level. The lesion was histologically comfirmed to be a lipoma.
Neurological improvement was obtained after partial removal of the lipoma.

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The incidence of deep-vein thrombosis (DVT) was evaluated prospectively in 46 patients receiving total hip arthroplasty (THA) or total knee arthroplasty (TKA). Incidence of total DVT was 54%, however; most occurred in the calf. Eighty-four percent of DVT occurred within 1 week after surgery. Incidence of DVT was 47% after THA and 71% after TKA, showing a significant difference by surgical site. There was a significant increase in postoperative D-Dimer among patients with DVT, and D-Dimer is considered a good exclusive marker for DVT.

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As a result of our reserch, we have found that deep vein thrombosis (DVT) is the main cause of pulmonary embolism, leading to post-operative sudden death after total hip arthroplasty (THA) or total knee arthroplasty (TKA). During our reserch, we reviewed 32 patients of which 25 had THA and 7 had TKA. We then performed a preand post-operative venography. Laboratory data, including PT, APTT, FDP, D-dimer and AT-III was checked at pre- and post-operative stages on the 1st, 3rd, 7th, 10th, 14th, 21st days. We detected 8 positive cases of DVT (32.0%) after THA and 4 (57.1%) after TKA. There was no difference PT, APTT, FDP and AT-III between positive and negative cases of DVT. However, we found that D-dimer was significantly higher in the group of positive DVT than in the negative group (p<0.01).

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Recently, the reported incidence of thromboembolic disease has been rapidly increasing not only in North America and Europe, but also in Japan.
We treated four cases of pulmonary embolism, diagnosed by lung perfusionscan. Each of our four cases had more than four risk factors for deep vein thrombosis. We subsequently started preventative treatment. Early post-operative physical activity (isometric calf, thigh, and hamstring contractions and deep breathing exercises) and elevation of the feet are routinely prescribed. A-V impulse and compression stockings are used in all patients.
Currently, we use heparin and warfarin for prophalaxis in most high-risk patients, in addition to the use of vena cava filter in some high-risk patients.

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A Case of total knee arthroplasty for osteoarthritis complicated with solitary bone cyst was reported. The patient was 65 years woman, who complained pain of the right knee joint. X-ray showed remarkable osteoarthritis, and CT very large bone cyst in the tibia. We performed operation using the NexGen type TKA with tibial stem extension. The depth of bone defect was approximately 15cm, and we packed autograft, allograft bone and A-W glass ceramics into the bone defect. Now, one year after the operation, she can walk without pain and no loosening of implants are observed.

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We have examined the meaning of resurfacing the patella in Total Knee Arthroplasty (TKA). We looked at 67 knee joints, including 38 osteoarthrosis (OA) and 29 rheumatoid arthritis (RA) patients. The implant (26 knees) and non-implant (41 knees) groups were comparable with respect to the age and length of the follow-up period. Clinical examination (anterior knee pain) and radiological measurement (patellar thickness and height, tilting angle, lateral shift and the change of degeneration of PF joint) were done, and JOA scores before and after surgery were compared.
We examined the relationship between the femoral rotational alignment, Epichondylar-AP line angle used by computed tomography, and the fitness of the patella after surgery.
We found a trend such that the groups whose fitness of the patella was worse after TKA had greater external rotation of femoral rotational alignment before surgery. Therefore, we conclude that the femoral rotational alignment is one of the standards we look for when deciding whether to resurface the patella or not before surgery.

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In trochanteric femoral fractures, AO 31-A3 reverse oblique type fractures are the most unstable, so they are often difficult to treat surgically. In the past 2 years we surgically treated 22 fractures of this type. (In total we surgically treated 193 trochanteric femoral fractures.)
In operations for this type of fracture, we usually use a traction table and 2 image intensifiers, and as a rule, closed reduction. We used \-nails for 6 fractures, long \-nails for 8, and small PFN for 8, as implants.
Full weight bearing is permitted 4 weeks after operation. Operation time is from 39 to 91 minutes. (average 54min.) Bleeding is less than 100ml (average). All patients got bone union.
The intramedullary implants such as \-nails, long \-nails and small PFN are available for unstable AO A3 type trochanteric femoral fractures. We had good results by using these implants.

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We operated on 35 patients (11 males and 24 females) with 35 trochanteric fractures between 1998 and 1999. The age range was from 50 to 97 years with a mean of 80 years. We have performed the operations with Ender nails or friction notch antimigratory intramedullary nails (FN nail) for trochanteric fractures, by turns. We used four or five nails on each patient. We compared 17 patients with Ender nails (group EN: 6 males and 11 females) to 18 patients with FN nails (group FN: 5 males and 13 females). There was no stastical difference between group EN and group FN as to distal migration and proximal migration. In group EN, we used 4 nails for 12 patients and 5 nails for 5 patients, while in group FN, we used 4 nails for all patients. There was significant difference among two groups as to the number of nails.
In conclusion, we could operate on patients with trochanteric fractures with a smaller number of FN nails than Ender nails.

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We compared the invasion of Gamma nails (GN) and Compression hip screws (CHS) in operations to determine blood loss.
25 trochanteric fractures treated with GN, and 24 with CHS were available for prospective study. We exchange the amount of transfuse blood for the rate of change of hemoglobin content (Hb), and investigated the difference of it. Hb for GN was more reduced compared to Hb for CHS from time of operation to the next morning. But external blood loss for GN was less compared to CHS.
We concluded that internal blood loss for GN was much higer than CHS, so the invasion of GN is not low in the point of blood loss.

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This report concerns a case of Giant Cell Tumor (GCT) of the proxymal radius reconstracted by floating radial-head prosthesis. The prevalence of GCT in the proxymal radius reported was about 0.5%. The patient was a 73 y.o., female who had had left elbow pain for 2 years. Plain radiographs demonstrated a bubble-like radiolelucent area in the proxymal radius, so histopathological diagnosis after biopsy was a GCT. Intralesional excision and reconstruction using a floating radial-head prosthesis was performed in Feb. 25. 1999. So far, there has been no recurrence of the tumor or dislocation of the prosthesis. The pain has disappeared and the range of motion after surgery has improved. Although high frequency of recurrence after surgery for GCT makes its treatment difficult, this method of reconstruction is considered effective.

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To avoid the occurrence of osteoarthrosis, recent practice requires accurate and exact reduction of the intra-articular fractured distal end of the radius.
In conventional reduction techniques, this is done under x-ray or open reduction. However, there have been cases in which conventional techniques were not enough to obtain necessary information for reduction of the fractured parts.
Our team has been experimenting with the introduction of arthroscopy as means of assistance in treating such fractures. This report will discuss this technique together with study cases. The subjects are eight hand joints on which we have performed reduction fixation with the assistance of arthroscopy over the past three years. The types of fractures are; four Chauffers and four Colleses.
The results were satisfactory, especially in the cases involving minor depression of the surface of joints or minor comminution to the damage of the direct examination of the fractured part, enabling maximum reduction to the damage of joint capsules and ligament structures.

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In the case of isthmic spondylolisthesis, intervertebral foramen becomes a hidden zone. It is extremely difficult to make a differentiation of the pathogenesis by myelogram and CTM. In order to elucidate the pathogenesis of radicular pain, a detailed study was conducted with emphasis placed on MRI coronal images and radiculogram.
Of the 78 patients who underwent microdecompression in our department during the past 11 years from 1988 to 1999, a study was carried out on 47 cases whose MRI coronal images and radiculogram could be reviewed. The mean age at the time of operation was 57. The study was conducted of the compression morphology and the compression site of the disturbed nerve root.
Abnormal MRI findings were observed in 21 out of 47 cases (45%).
The radiculogram revealed abnormal pathways of the nerve sheath in 43 out of 47 cases (91%). The number of cases with abnormal nerve sheath pathways being observed around the isthmus accounted for about 70%. Radiculogram is useful for radiographic evaluation, and the pathogenesis of radiculopathy of isthmic spondylolisthesis was mainly compressive entrapment around the isthmus. We suspect that the accurate understanding of the pathogenesis will leads us to select a surgical procedure with minimal invasion.

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We report on the outcomes of postero-lateral fusion as the treatment for the degenerative lumbar diseases. Thirty-six patients (24 males and 12 females) were studied. Patients were divided into three groups.
Group 1) Postero-lateral with local bone
Group 2) Postero-lateral fusion with iliac bone
Group 3) Postero-lateral fusion with instrumentation.
The mean age at the time of surgery was 65.0 in Group 1, 65.5 in Group 2, and 65.2 in Group 3. We compared the three groups with regard to the degree of bone union observed on X-ray films.
Good bone union was achieved in 36.8% of Group 1 (local bone fusion group), 62.5% of Group 2 (iliac bone fusion group) and 77.8% of Group 3 (instrumentation).
Thus, it appears difficult to obtain rigid union with local bone in posterolateral fusion, it is better to use iliac bone or instrumentation in such cases.

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Three cases previously treated with intrasacral fixation (Jackson technique) were reviewed. Two cases were L5 isthmic spondylolisthesis, 1 case was L4 and L5 degenerative spondylolisthesis, and their degrees of slip rate were over 25 degrees. Both PLIF and PLF, one had only PLF. Liberty spinal system was applied for intrasacral fixation. All of them had obtained bony fusion. Their low back pain and leg pain disappeared. The surgical technique of contouring of stiff rods and attaching to the spine with screws was too difficult to reduce their slip.

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Between Apr. 1992 to Sep. 1999, there were 209 cases of patients (75 men and 134 women) were having degenerative spondylolistesis upon whom we performed semi-circumferential decompression operation without fusion at our hospital. The mean age at the time of the operation was 68.5 years (41 to 87 years). 57 cases had Cauda equina symptoms, 83 cases had Radicular pain, and 69 cases had both Cauda equina symptoms and Radicular pain (Combined). The mean slip angle was 3.4 degree in cases with cauda equina symptoms, 3.3 degree in cases with radicular pain, and 3.9 degree in cases with combined symptoms. The percentage of slip was 13.4% in cases with cauda equina symptoms, 14.2% in cases with radicular pain, and 15.6% in cases with combined symptoms. The ROM was 10.5°in cases with cauda equina symptoms, 7.9°in cases with radicular pain, and 11.7°in cases with combined symptoms. Disc height was 7.2mm in cases with cauda equina symptoms, 5.0mm in cases with radicular pain, and 5.1mm in cases with combined symptoms. These studies show no correlation between the symptoms and the radiographic findings.

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We investigated the clinical and radiological results of the surgical procedures selected for the pathology of degenerative spondylolisthesis. The procedures included fenestration, decompression with posterolateral fusion, and decompression with posterior lumbar interbody fusion in which the tricortical iliac bone or Titanium Fiber Mesh Block as the bone substitute was grafted. The procedures were selected based on segmental instability, sagittal alignment, disc height, and the activity of daily living. Eighty-six patients with a minimum 12 month follow-up period (average 45.1 months) were included in this study. The clinical score assessed using the Japanese Orthopaedic Association scoring system and the radiologic results were acceptable in all procedures selected based on the criteria. These results show our surgical strategy is reasonable and can be recommended for patients with degenerative spondylolisthesis.

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To elucidate the advantages of posterolateral fusion (PLF) and posterior decompression as a treatment for degenerative spondylolisthesis, we compared the radiographic and clinical results of patients treated with PLF and posterior decompression (Group 1) and those who were given no particular treatment (Group 2). Group 1 consisted of six females and Group 2 consisted of two males and 12 females for a total of 14 subjects. Both groups were evaluated by the Japanese Orthopaedic Association score for low back pain for clinical outcome. The radiographic findings of both groups were also studied to assess the progression of slippage or instability of the lumbar spine. The JOA scores of both groups were not significantly different. However, the low back pain score of Group 1 was significantly higher than that of Group 2. Although there was no difference between %slip of the involved level of the first consult and those of the last follow-up in both groups, disc height of the involved level in Group 1 was significantly decreased during the follow-up period. There was no correlation found between %slip and JOA score. There were no marked radiographic changes of the adjacent disc levels observed in either groups in this study. The patients in Group 2, who did not undergone surgery, presently suffer from severe low back pain and desire relief from this pain. The advantage of PLF and posterior decompression is to provide relief from low back pain and PLF and posterior decompression should be considered when severe low back pain is present in degenerative spondylolisthesis.

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The subjects studied were 13 individuals who underwent the operations for degenerative spondylolisthesis more than 10 years ago. They included four males and nine females and their average age at the time of operation was 60.4 years. Their postoperative courses were investigated. Three of them underwent decompression alone, while 10 of them underwent postero-lateral fusion following decompression. The degree of improvement was evaluated according to JOA score and their average improvement rate was 55.1%. Eight individuals who showed appreciable improvement were classified as“excellent”or as“good.”The outcomes of operations depended on whether age-related conditions impairing ability to walk developed or not rather than the selection of surgical procedures. X-ray findings showed that the postoperative slip percentage increased by more than 5% in four cases. However there existed no relationship between the selected surgical procedure and increase in the postoperative slip percentage. After postero-lateral fusion, nearly half the patients suffered from the degeneration between neighboring vertebrae. This degeneration seemed to adversely affect the outcome of surgical treatment in some cases.

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Three fresh ruptures of the patellar tendon and 4 fresh avulsion fractures of the patellar tendon, 2 inferior pole of the patella and 2 at the tibial tubercle, were surgically treated by modified McLaughlin's procedure in order to do early rehabilitation. 5 of them were men, and 2 were women. The mean age was 43.0 years (range: 20 to 72 years). The ruptures or the avulsion fractures were repaired, and the AO wire suture was placed just proximal to the patella through the quadriceps tendon, made figure-of-eight over the patella and was anchored to the AO cortical screw through the tibial tubercle. The wire tension was determined so as not to incur significant tension at the repair site on knee motion, this resulted in slight patella infra. The wire was removed 2 to 3 months after surgery. The clinical result was excellent on simple injury, and was worse on combined injury. The patella infra was improved after removal of the wire on simple injury in young patients.

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We studied fifteen patients (7 males and 8 females) who had surgical treatment for tibial plateau fractures with a mean follow up period of 1 year and 4 months. We treated all cases surgically by plate (8 cases), or cancellous screws (7 cases) with bone graft.
Normal painless gait was restored to all patients. Range of motion was limited in 2 patients who were both elderly (68 and 71 years).

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We reported the usefulness of the Rosenberg's Method to detect the osteoarthrosis of the knee in an early stage in which the narrowing of the joint space could not be detected by the non-weight bearing roentgenogram. The joint space of the medial and lateral compartment were measured in 53 patients (69 knees) that were diagnosed as suffering from osteoarthritis of the knee. The average age of the group was 63.7 years old and consisted of 12 males and 41 females.
Of the 69 knees (53 patients) in the OA that in the early stage 45 knees were diagnosed as the OA by the extension weight-bearing anteroposterior roentogenogram and the further 10 knees were recognized to have the OA by the Rosenberg's Method. From comparing these joint spaces, the former was the average of 2.6mm in the medial compartment of 39 knees and 2.0mm in the lateral compartment of 6 knees, indicating narrowing of the joint space, the latter was the average of 2.2mm in the medial compartment of 47 knees and 1.6mm in the lateral compartment of 8 knees, revealing more narrowing of the joint space.
From this observation it could be said that RM is a superior method than weight bearing roentgenogram to diagnose the OA. It seem that the position of 45 degrees knee-flexion gives the highest contact pressure in daily life in spite of the contact areabeing the smallest. Due to this reason the cartilage will easily give rise to the OA in the early stage.

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A case of spontaneous atraumatic subluxation of the sternoclavicular joint was reported. The patient, a 27-year-old female, complained of pain, click and the bony prominence in her right sternoclavicular joint when raising her right upper extremity. The X-ray, CT and 3D-CT showed subluxation of the right sternoclavicular joint, and arthrography showed pooling of the contrast medium. The joint was stabilized surgically using the fascia lata and the subclavius muscle. The post operative course was satisfactory, without further subluxation and pain. Spontaneous atraumatic subluxation of the sternoclavicular joint is a rare disease. The sternoclavicular joint has an unstable bony structure and it's stability depends on the ligaments (costoclavicular, sternoclavicular and interclavicular ligaments) and capsule. lt is believed that the subluxation occurred due to weakness in these supporting tissues.

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Between May 1994 and April 1999, we treated 21 fractures of the middle third of the clavicle in 21 patients by fixation with 4mm intramedullary cannulated pin. All these fractures (8 displaced two-fragment fractures and 13 displaced and comminuted fractures) were retrospectively evaluated, both clinically and radiographically.
There were 17 men and 4 women. The average age at the time of operation was 46 years (12 to 72). There were 11 right- and 10 left-sided injuries. Most fractures were caused by traffic accidents (67%).
Twenty of the 21 fractures united. One patient had some evidence of brachial plexus irritation, and so the pin fixation had to be exchanged for the plate fixation. Four patients had local tenderness and 3 had cosmetic abnormalities. No patient had residual pain or impairment of range of movement and shoulder strength.

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A follow-up study was performed on 17 patients who were 65 years old or over and had undergone treatment of soft tissue sarcoma from 1988 to 1999.
The patients included 7 males and 10 females ranging in age from 66 to 87 years. The follow-up period ranged from 4 to 130 months. Pathological diagnosis 9 cases were MFH, 5 cases were liposarcoma.
11 cases were high grade sarcoma. With adjuvant therapy 12 cases were radiated on focus, and limb-salvage surgery was perfomed on 12 cases.
In 2 cases local recurrence occured, and metastasis to the lungs occured at the same time. Only 4 cases among 9 cases of high grade remain alive.
Radiation was effective for local controls, however we consider that chemotherapy is necesarry for high grade sarcoma to improve.

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This report was based on our clinical results of 7 patients who were treated with Kotz knee arthoplasty from 1990 to 1998. Primary bone tumors were 5 osteosarcomas, 1 malignant fibrous histiocytoma, and 1 giant cell tumor. The average age at the time of operation was 22 years (11∼47) and the average duration of follow-up was 43 months. The clinical results were estimated by ISOLS system. Rizolli X-ray method was applied to evaluate the condition of the stem. At the latest review, the average of ISOLS score was 24 (80%). On X-rays, 4 cases were classified as stage A. The other 3 cases were calssified as stage B, C, and D respectively. The X-ray of the case scored as stage D was taken only 6 months after the operation. All patients were able to walk without any assistance. These results were satisfactory.

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Magnetic resonance imaging has been increasingly used in recent years to screen patients with osteoporotic posttraumatic vertebral collapse. However, it is difficult to evaluate MRI findings of severe vertebral collapse. In this study, we reported the MRI findings of mild vertebral collapse only. Twenty-one fractures of eighteen patients were available for study and the average patient age was 72.2 years. We divided these cases into three types for MRI T1-weighted image intensity. There were 8 cases of cranial type, 5 of central type, 6 of whole type and 2 cases of other type. The vertebral collapse rate was advanced in the cases of cranial type from 0.85 to 0.7, central type from 0.75 to 0.76, and whole type from 0.8 to 0.78. We concluded that the cases of central type showed good results regarding kyphotic spinal deformity after trauma.

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There are many conservative therapies for patients with osteoporosis. We have treated them with active vitamin D and calcium, and evaluated their bone mass.
The subjects consisted of one man and 30 women diagnosed with primary osteoporosis. All patients were treated with active vitamin D (alfacalcidol, 1α OHD₃, 1μg/day) and calcium lactate (1-3g/day). Their mean age was 71 years (range: 51 to 84 years). The period of administration ranged from 1 year to 10 years with a mean of 4 years and 4 months. Patients were examined with the digital image processing (DIP) method.
The mean ∑GS/D Values calculated using the DIP method were 2.04mmAl before treatment and 2.07mmAl at the follow-up, while there was no significant increase. There was no significant increase of bone mass at the follow-up in the patients whose ∑GS/D values before treatment were higher than 2.00. On the other hand, there was statistically significant increase of bone mass at the follow-up in the patients whoes ∑GS/D Values before treatment were lower than 1.99.
We concluded that administration of active vitamin D was useful treatment for primary osteoporosis.

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We treated 36 cases of developmental dislocation of the hip in 28 children between the ages of 4 months and 18 months and rechecked them after a mean follow-up period of 3 and a half years. We observed a success rate in closed reduction using overhead traction (OHT), and analyzed the relationship between the criteria of arthrography after reduction and the final radiographic results.
Twenty-seven of the hips (67%) could be corrected successfully by means of closed reduction, and open reduction was needed in 9 hips. Although a success rate of closed reduction by OHT was 80% (20 of 25 hips) in children less than 9 months old, it was 36% (4 of 11 hips) in children more than 9 months old. The shape of the limbus and the soft-tissue interposition at the acetabular floor were not directly related to the final radiological results.
We concluded that not only the antero-posterior view of arthrography but also the stability of the hip and the lateral view should be considered before performing open reduction. We further concluded that the skeletal maturity of the hip cannot be predicted through the findings of arthrography alone.

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The iliopectineal bursa is the largest bursa in the human body. Iliopectineal bursitis causes enlargement of the bursa and may lead to groin pain, groin mass, femoral nerve palsy or compression of the femoral vein. We reported a case with bilateral iliopectineal bursitis associated with dialysis arthropathy of the hip. Treatment is mainly conservative as with bedrest and aspiration of cyst contents. However, surgical treatment may be indicated in case of heavy groin pain or the compression and obstruction of adjacent structures. In addition, treatment of the existing arthropathy is necessary to prevent reccurence and synovectomy must be done at the same time.

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The purpose of this study was to evaluate the effects of electric stimulation as a countermeasure to prevent disuse atrophy of skeletal muscles by assessing energy metabolism in the working muscle by 31P-MRS. Sprague-Dawley rats were used and divided into three groups: control group (C), hindlimb suspended for 7 days (HS), and HS plus percutaneous electric stimulation for 7 days (ES). Electric stimulation for training of the gastrocnemius-plantaris-soleus (GPS) muscles was attained at 1Hz for 1 hour everyday. For 31P-MRS measurements, contraction of the GPS muscles was induced by electrical stimulation of the sciatic nerve at 0.25Hz for 10min following a 2-min rest, then the frequency was increased to 0.5 and 1.0Hz every 10min. During the stimulation, twitch forces were recorded by a strain gauge simultaneously. The energy metabolism in the working muscles was analyzed from the 31P-MR spectra. Maximum tension was measured at the muscle contraction induced by 0.25Hz; the wet weight of the whole GPS muscles was also measured. The weight of the whole GPS muscles decreased significantly (p<0.05) in HS and ES groups. The maximum twitch tension in HS was significantly smaller than that in C (p<0.05) while in ES it did not differ from that in C. The oxidative capacity of muscles decreased within one week in HS; however, it was maintained for one week when electric stimulation was applied to the suspended limb. These data indicated that twitch electric stimulation did not prevent atrophy, but prevented deterioration in the muscle functions, such as maximum tension and oxidative capacity. induced by disuse during one week.

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