We have treated 9 patients (10 hips) with infected hip prostheses. Removal of the implant was performed in 9 cases and 5 cases were treated with continuous irrigation, and 4 cases were treated with cement beads with antibiotics. After subsidence of infection, re-implantation was performed in five hips.
No case have showed recurrence of infection.

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Idiopathic necrosis of the femoral head is generally considered to be a rare disease, the etiology is unknown, it is usually progressive and once collapse of the femoral head develops, joint destruction almost invariably follows.
We have treated three patients with idiopathic necrosis of the femoral head, using an Omnifit HA coated stem. The patients were a 58 years-old male, a 29 years-old female and a 58 years-old female. After surgery, all patients showed a marked improvement as an early clinical outcome. They quickly returned to their jobs and social life.

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Based on the arthroscopic findings of 52 patients who experienced disability throwing a ball with full strength after complaining of posteromedial olecranon pain during the ball release phase, we were able to confirm findings on baseball elbow that could not be explained by attributing it to osteophytes on the posteromedial aspect of the olecranon alone. Baseball elbows have been classified into three types: 1) fractured osteophyte type, 2) dameged olecranon type like a stress fracture, 3) dameged cartilage type.
Based on these findings, we positively performed less invasive osteophyte osteotomy and olecranon osteoplasty with the aim of decompression without always limiting ourselves to arthroscopic surgery. Thereby, all our patients who were baseball players and who had a sense of successful ball throwing of less than 50 percent presoperatively were restored to the competitive level and were able to participate in games three months postsurgically.

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We reported 6 case of carpal scaphoid non-union. The period between the injury to the surgery was ten years or more; averaging 17 years. Four scaphoids were classified as SLAC stage 3, one as SLAC stage 1, and 1 had no degenerative change of the radiocarpal joint or intercarpal joints. The latter scaphoid was successfully united after osteosynthesis with bone graft. The SLAC stage 1 scaphoid continued in non-union. The remaining 4 scaphoids, SLAC stage 3, were indicated for partial or total wrist arthrodesis. In all cases wrist pain decreased, and functional status improved.

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The etiology of congenital pseudoarthrosis of the clavicle remains obscure. The authors treated a 4 years-old boy with this rare disease. Clinical history and radiographs confirmed the diagnosis. Surgical treatment of resection of the pseudarthrosis without bone graft and internal fixation with a small AO plate led to successful bone union.
Histological analysis of pseudoarthrosis showed that were cartilaginous caps on the proximal and distal bony ends. The appearance of the cartilaginous caps were developing. These observation support the hypothesis that the pseudarthrosis is caused by failure of 2 ossification center of fuse as was previously proposed by others.

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We report two cases of treatment of chronic osteomyelitis of the tibia and infection following total hip arthroplasty (THA) using hydroxyapatite (HA) impregnated with antibiotics. In both cases, after curettage and debridement HA impregnated with vancomycin (VCM) and gentamycin (GM) was inserted. Both cases, infection did not recurrented after the operation. We measured the serum and local concentration of antibiotics after inserting the HA impregnated with antibiotics. Both cases maintained low serum concentration and high local concentration. We obtained good results in treatment of bone and infection using HA impregnated with antibiotics.

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The authors treated a case of severe and progressive kyphotic deformity of thoracic spine caused by compression fracture. The patient was sixty-nine year old woman. In 1993, she pulled a carpet and felt severe back pain. Gradually, her back pain increased and kyphotic deformity progressed. Cobb's angle from T10 to L1 was 77° with T11, T12 compression fracture. She had difficulty in sitting for only 5 minutes and had appetite loss. A correction osteotomy with a single posterior approach was used. Cobb's angle was corrected to be 31°, and correction loss was only 1.5° nine months postoperatively.
In this case, correction osteotomy with a single posterior approach provided excellent sagittal correction with good stabilization.

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The authors retrospectively investigated the incidence and shape of the degenerative lumbar scoliosis by roentgenograms in orthopaedic outpatients. The authors examined 1309 consecutive patients who had lumbar roentgenograms, and found 109 patients (30 males, 79 females) had lumbar curves greater than 10°. The mean age was 71.7 years (25-94 years). The authors excluded idiopathic scoliosis. Curves were measured by the Cobb's method. The incidence of degenerative lumbar scoliosis was 8.3%. The mean Cobb's angle was 14.9°(10-56°). The incidence of the degenerative lumbar scoliosis were 0.3% in the patients under 40 years old, 2.8% in 5th decade, 5.1% in 6th decade, 8.1% in 7th decade, 18.0% in 8th decade, 15.0% over 80 years older. The incidence of scoliosis increased with age.
We classified the scoliosis into single and double curve patterns. The single curve pattern was seen in 66 patients and the double curve pattern was seen in 43 patients. There were no significant differences between the two groups regarding the Cobb angle, vertebral rotation or clinical findings. The greatest degenerative wedge deformity of the disc space was found at L3/4 in single curves (48.0%) and L4/5 in double curves (83.7%).

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The authors report a case of Klippel-Feil syndrome associated with atlantoaxial dislocation and basilar impression treated with transoral odontoidectomy. An 8-year-old girl was admitted to the author's hospital with a two-year history of weakness in the upper and lower extremities and recent development of dyspnea. The neurological examination revealed spastic tetraparesis. Radiological examination showed a fused vertebrae at C2 and C3, atolantoaxial dislocation and basilar impression. The patient underwent atlantoaxial arthrodesis by the Brooks method. The atlantoaxial dislocation could not be reduced so the authors decompressed the foramen magnum, and performed C1 laminectomy and occipito-axial fusion. Consequently tetraparesis and dyspnea gradually improved. Eleven months after the second procedure, tetraparesis had gradually worsened and the patient was readmitted to hospital. The reason for the change in tetraparesis was attributed to progression of anterior compression of the medulla oblongata by the odontoid. The authors performed transoral odontoidectomy to achieve anterior decompression. The authors dislocated the bilateral mandible joints, opened the mouth for 4cm and released the soft palate, and removed the odontoid. Post operatively symptoms gradually improved.

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The authors performed a retrospective study of 6 consecutive patients (3 men and 3 women) who had a fresh combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) (Grade III) due to recreational sporting accident treated with ACL reconstruction alone using bone-patellar tendon-bone from 1997 throuth 1998. The mean age was 26.3 years (range: 16 to 43 years). The mean follow-up interval was 25.3 months (range: 13 to 37 months).
All patients showed improved valgus instability on the stress radiography. The Lachman and N-tests were negative in all patients. There was no difference of KT-2000 side-to-side difference between this group and the group of ACL injury alone with ACL reconstruction using bone-patellar tendon-bone for the same period. JOA score was relatively good. All patients have returned to the recreational sports.
The authors think that in some patients performing at recreational sports level the fresh combined injury of the ACL and MCL could be treated with ACL reconstruction alone.

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The authors studied redisplacement of distal radial fracture after conservative treatment in 16 patients who were older than 60 years. The purpose of this study was to determine which primary fixation angle should be used in conservative treatment of distal radial fractures. Saito's classification was used for clinical evaluation. Fourteen of 16 patients were evaluated as “excellent” or “good”, the others as “fair”. In the patients whose primary fixation angle was over 10 degrees in ulnar bending, the progression of ulnar plus variant was less than 1mm 12 weeks after reduction. The progression of volar tilt by more than 10 degrees was found in 4 out of the 5 patients whose primary fixation angle was below 25 degrees in palmar flexion. The findings of the current study indicate a primary fixation angle of the wrist over 10 degrees in ulnar bending and over 25 degrees in palmar flexion may avoid excessive redisplacement of the fracture.

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From October 1988 to April 2000, 7 patients with 7 distal femoral fractures were treated with a retrograde intramedullary nail. The average age was 68 years. The average follow-up interval was 11.6 months. The average operation time was 94 minutes and the average estimated blood loss was 105g except 1 patient who had ipsilateral tibial plateau fracture as well. On average, postoperative partial weight-bearing began at 6 weeks and range of motion exercise began at 6.4 days. The average knee flexion at the most recent evaluation was 106°.
Distal locking screws broke in two cases. The failure were apparently caused by the length, the position and the strength of the distal locking screws, and by inadequate weight-bearing. After distal locking screws broke, those fractures healed.
The average ROM was fair. That was apparently affected by soft tissue damage and adhesion, and arthrotomy.
Retrograde intramedullary nailing is useful for distal femoral fractures in elderly patients, however, those with poor callus development require appropriate dynamization to prevent breakage of the distal locking screws.

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19 patients with intramuscular hemangioma (IMH) in the extremity have been treated at our institution over the last 15 years. The average age was 20 years (range, 1 to 70 years).
Involved sites were the lower extremity in 12 patients, and the upper extremity in 7. The mean follow-up period was 5.1 years (range, 0.5 to 15 years). Longstanding pain and swelling were common symptoms. Plain X-ray showed phlebolith in 10 patients. Magnetic resonance imaging, 13 patients, delineated the extent of the lesions, and revealed characteristic structures within the tumors. These two imaging modalities were informative for diagnosis and surgical treatment planning. Angiography and compued tomography were less valuable, although they also showed the lesions to some extent. Diagnosis of IMH was obtained preoperatively in 8 patients, however, the remaining 11 patients needed open biopsy. Extirpation of the tumors was performed in 17 patients, one of whom also received radiotherapy. Of the remaining two patients, one receieved only radiotherapy. The other, tumor was left untreated, because it was too extensive to be excised without significant morbidity. These two patients, had no major disability at the latest follow-up. Local recurrence occurred in 2 of the 17 surgically-treated patients. Complete extripation is needed for local control of the disease, but feasibility of the surgery depends on the tumor's location and size. Low dose radiotherapy may be a useful alternative, when the lesion is extensive, and the symptoms warrants.

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We compared the result of proximal humerous and distal humerous malignant tumors in operation with Howmedica Modular Resection System (HMRS) prosthesis. This report was based on clinical results of 2 patients with malignant bone tumors of humerus who were treated with HMRS by the authors. The patient in case 1, a 51 year-old man with chondrosarcoma of the right proximal humerus, received wide resection and reconstruction with HMRS prosthesis. Four months after surgery, the prosthesis was removed because of rupture of the wound by foreign body reaction. And vascularized fibula graft was performed. The patient in case 2, a 76 year-old man with matastatic bone tumor of the right distal humerus, received marginal resection and reconstruction with HMRS prosthesis. At the last follow-up, seven months after surgery, symptoms of inflammation and infection were not found and the results were good.

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Many authors have recommended surgical treatment for an unstable type of distal clavicle fracture. However it is usually difficult to achieve stable fixation in some cases especially with small distal fragments and comminuted fragment.
Nineteen patients with distal clavicle fracture who had operative treatment between January 1996 and June 2000 in the author's hospital were used in study. There were 16 males and 3 females, aged 10-66 years; average 34.5 years. All cases were classified as distal clavicle fractures Neer II type. We treated 12 fractures with Kirschner wires+figure 8 wiring (KW), 5 fractures by AO small T plate (T-plate), 3 patients by Wolter clavicle plate (Wolter plate).
Ultimately all patients had mature union of fracture, did not have any residual pain or functional disorders. There were some complications in the KW cases, 1 delayed union case, 2 deformed union cases, and 1 reoperated case used a Wolter plate because of wire cut out. T-plate cases and Wolter plate cases did not have any complications caused by instability.
KW fixation had usually good results in unstable types of distal clavicle fractures. But in some cases with small distal fragments and comminuted fragments, the KW method alone did not yield successful stable fixation. The authors found that the Wolter clavicle plate was a useful augmentation in these cases.

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Although suppurative osteomyelitis frequently occurs in long bones such as the femur and tibia, it rarely develops in flat bones because of their composition (mainly cancellous bone) and vascular supply. In this paper, the authors report an extremely rare case of patellar osteomyelitis in a child. The patient was a 7-year-old girl who injured her right knee and received treatment for the wound when a fistula developed. Subsequently, additional debridement was performed when pus was observed in the wound. Debridement was performed again on day 24 after the injury because symptoms such as fever had occurred in spite of immobilization and treatment with antibiotics. The infection subsided when granulation tissue was removed and the patellar lesion was curetted and continuously irrigated. Escherichia coli was identified as the causative organism. Follow-up at about 2 years after the operation showed that she had no functional deficit and could perform daily activities without any problems, although X-ray films showed abnormal patellar growth. Although early diagnosis and administration of antibiotics are important in the treatment of suppurative osteomyelitis, the lesion should also be surgically curetted and irrigated.

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The authors report two cases of Candida spondylitis. The first case was a 68-year-old woman who complained of sever lumbago. She had became unable to walk during the surgical treatment of the ileus, and she had diabetes mellitus. Pyogenic spondylitis in L2, 3 was suspected after physical examination, laboratary findings, and radiographic studies. The second case was an 83-year-old woman who complained of sever lumbago during treatment of pneumonia. She used 7 kinds of antibiotics. She showed almost the same findings as the first case in her L3, 4 level. The authors debrided the focuses of both patients and did anterior spinal fusion. Candida albicans was identified in their pathological specimens. Both patients were administered Fluconazole 200mg/day after operation, and started the rehabilitation of gait exercise. Pyogenic spondylitis had not recur at last follow-up. The possibility of fungal infection should be considered during treatment selection for pyogenic spondylitis, especially in the compromised patient.

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We present the case of a 68 year-old patient who sustained necrotizing fasciitis of a lower extremity two years and six months after an artificial vessel substitution for an aneurysmal rupture of the abdominal aorta. The substitution was done in 1997.
The patient reported local heating and swelling progressively deteriorating on his right thigh along with an attack of fever. Clinical evaluation revealed a wide intramuscular abscess of the right thigh and the systemic inflammatory response syndrome. The initial treatment included irrigation and open drainage with a drug regimen of antibiotics. Immediately after this treatment, he experienced septic shock with marked acidosis and acute renal failure. During a three-month period following this episode of septic shock, the patient experienced two similar episodes Reexamination of computed tomography scans revealed an adhesive fistula between the substituted artificial vessel and the adjacent jejunum. The artificial vessel and jejunum were removed. Artificial reconstruction was performed by left axillo-femoro bypass using a GORETEX Vascular Graft and left external iliac-right external iliac bypass using a saphenous vein graft.
In a patient with an infection of the lower extremity and a past history of substitution of an artificial vessel for the abdominal aorta, the artificial vessel should be considered as a possible origin of the lesion.

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This short-term follow-up of retrospective analysis of femoral neck fractures in 24 patients (1 man, 23 women, mean 92.8 years old) in 90 years and older was designed to compare such fractures in patients in their 90s with those in their 80s (1 man, 29 women, mean 85.0 years old) and in their 70s (8 men, 22 women, mean 75.4 years old). The patients 90 years and older were treated from 1991 to 1999, and the patients 80s and 70s were from 1996 to 1999. These samples were consecutive, and the patients treated conservatively treated were excluded. The walking ability of posttreatment was assessed at discharge from our hospital (mean admission was 52.7 days). They were treated by open reduction and internal fixation or implantation of femoral head prosthesis. The patients were divided into four groups according to walking ability and the authors assigned a rating scale consisting of four points to independent walking or with a cane group, three points to the walking by walker group, two points to the wheel chair group and one point to the non-ambulatory group. In the group 90 years and older, the walking ability before their injury was 3.6 points, in the 80 years and older group it was 3.2 points, and in the 70 years and older group it was 3.1 points. After the treatment, the walking ability in the patients 90 years and older was 3.1 points, in 80s was 2.6 points and in 70s was 2.6 points. The differences of walking abilities between before and after the treatment were not significant in each generation. In conclusion, the treatment of femoral neck fractures for patients 90 years and older could be performed with expected resulting walking ability to be comparable to that of patients in younger generations.

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Blount's disease in pairs of twins has been reported rarely. The authors report identical twin girls, each affected in both legs. The girls were delivered normally at birth and were generally healthy. They had normal parents and elder brothers.
The authors first examined the girls at the age of 2 years. Both girls had marked bilateral gene varum. In one twin, the deformities appeared to be progressing in severity, therefore correction of O-leg deformity, avoiding irreversible change of proximal tibia epiphysis, and corrective osteotomy was done by lateral open wedge at the age of 2 years and 6 months. The authors latest follow-up examination was at the age of 3 years, 6 months after operation, the deformities have almost recovered, both legs showed good alignment.
X-ray films of the second girl showed Metaphyseal-Diaphyseal Angle (MDA) has recoverd, but proximal tibia epiphysis was classified as represented langenskiöld stage II. The patient's condition continues to be followed closely.
Blount's disease is suggested to be under genetic control, and there are a few reports about familial occurrence. In those reports the mode of inheritance was thought to be an autosomal dominant, recessive, or multifocal disorder, but its genetic association remains unclear as in our cases.

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