Hemangiomas are often seen in the spinal column, usually in the vertebral body and asymptomatic. Hemangiomas rarely extend out of vertebral body and to compress the spinal cord.
We report a case of an 82-year-old woman who presented with progressive numbness of the lower extremities and unsteady gait. Magnetic resonance imaging showed a tumor lesion at the third and the fourth levels of the thoracic spine, and the spinal cord was compressed by the tumor from the dorsal aspect of the lamina. A laminectomy of the third and the fourth thoracic vertebrae was performed in 2001. Histopathology of the lesion revealed a typical cavernous hemangioma. After one month, the patient showed normal voluntary power in the extremities.

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We have excised spinal cord tumors located in anterior or antero-lateral aspect of spinal cord or intraforaminal segment by pediculotomy in 5 cases. The tumors types were schwannoma (3 cases), meningioma (1 case), and meningial cyst (1 case). The tumors were at the T11/12 (2 cases), and the T6, T7/8 and T8/9 (1 case each) levels.
Pediculotomy provides a wider operative field than traditional posterior approaches such as wide laminectomy, laminoplasty or laminotomy and enables to extract spinal cord tumor safely. Traditional posterior approaches risk loss of neural function of the spinal cord, and damage to the spinal column during tumor resection, because it is necessary to exclude the spinal cord forcibly to the lateral side, and to sacrifice the facet joint. In contrast, pediculotomy enables an approach to tumors located in the anterior aspect without excluding the spinal cord, and without damaging facet joints. In all five of our cases neurological symptoms improved after surgery, and bone union was completed. Although pediculotomy has some disadvantages in slightly complicated surgical techniques and external fixation, it has important advantages for safely in approaching tumors located in the anterior or antero-lateral aspect of the spinal cord.

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We have reviewed the case records of 8 patients with odontoid fractures treated by anterior screw fixation. The mean age at the time of injury was 44.8 years old (range 17-91 years old). Of these patients, 6 were men and two were women. The mechanism of injury in all was high-energy trauma; 4 patients were injured in motor vehicle accidents, and 4 patients fell from a height. There were 7 patients with Anderson and D’Alonzo type II fractures and 1 with type III. The mean interval to the operation was 17.8 days (range 3-45 days). The mean follow-up period was 55 months (range 6-101 months). Clinical results were evaluated using X-ray, CT scan and MRI.
The mean operation time was 75 minutes (55-115 minutes). Of 8 patients, 7 (88%) achieved bony union by anterior screw fixation. One patient, in a case of non-union, required a secondary posterior fusion after anterior screw fixation. No patient developed infection or neurological injury after surgery. A full of range of motion was obtained in all cases.
We conclude that anterior screw fixation, although technically demanding, is an effective and relatively safe procedure in the treatment of odontoid fractures.

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Spontaneous Hemarthrosis of the Knee (SH) is a rare disease. Many authors have reported various kinds of operative treatment (synovectomy, meniscectomy, osteotomy etc.), and good outcomes. However, these conventional treatments are relatively invasive. Ablation technique provides accurate debridment limited to the diseased tissue, and enhances postoperative rehabilitation.
On November 2, 2002, a 72-year-old woman was referred to our hospital for SH. Three months later, she underwent arthroscopic ablation due to repetitive hemarthrosis despite conservative treatment.
Under arthroscope, synovial proliferation and bleeding were observed. Ablation was very effective for hemostasis. There was no recurrence for one year follow-up after the surgery.

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Ceramic-on-ceramic bearing surface has been used since 1970, mostly in Europe, to improve the wear resistance and longer life expectancy of the total hip prosthesis. In our country, KYOCERA Alumina Bearing Surface Cup (ABS Cup) had been used since 1998. However, because of the weakness of the ceramic inlay, the use of the implant was stopped in July, 2000.
We report a case of ceramic component failure of the ABS cup six years after total hip arthroplasy in a 51-year-old woman. At age 44 years, a Chiari pelvic osteotomy was performed on the patient’s right hip joint due to osteoarhritis, however the coxalgia was not improved, One year after the pelvic osteotomy, she had total hip arthroplasty (THA) with the ABS Cup. Six years after the THA, the breakage of the ceramic inlay was detected on the plain X-ray photograph and the cup and the head was replaced with polyethylene and metal. Due to the weakness of the ceramic-inlay system of the ABS Cup, the patients who have had THA with the same system should be observed meticulously throughout the clinical course.

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Three cases of delayed paresis of lower extremities after compression fractures of thoraco-lumbar vertebra caused by osteoporosis were operatively treated. The unstable posterior part of the fractured vertebra protruded into the spinal canal and compressed the spinal cord in all of the patients. These patients could not walk because of muscle weakness before operation. The operative method we used was posterior decompression and fixation with instrumentation (pedicle screws and rods). Transpedicular kyphoplasty using HA-block (PENTAX Co., Japan) was further performed in order to correct the vertebral alignment and support the stability of anterior column of vertebrae. After the operation, the muscle power of the lower extremities of all three patients recovered and patients were able to walk.

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We report a case of suppurative arthritis of the hip. A 28-month-old boy had an elevated temperature 40°C and painful limitation of motion of his right hip. The white blood-cell count was 11500/μl and CRP was 22 mg/dl. The radiograph showed a widened hip joint space and magnetic resonance imaging (MRI) showed hip effusion. The diagnosis was established preoperatively by joint aspiration. The cultured organism was Haemofilus influenzae. Four days after the onset,we performed arthroscopic debridement and drainage. We used 2 arthroscopic portals and inserted 2 drain tubes through the arthroscopic sheath. One tube was used for intermittent injection of antibiotics into the hip joint and the other was used for continuous suction. After surgery, the body temperature and clinical indicators of inflammation improved immediately. We administered intravenous antibiotics for 10 days. No perioperative complications occurred. An MRI taken at 7 weeks after surgery showed a normal hip.
Hip arthroscopy, used as a therapeutic tool, is significantly more reliable than joint aspiration in such cases, and is less invasive than arthrotomy. Hip arthroscopy is a welcome alternative in treatment of the pediatric population.

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Subtalar dislocation is a rare injury. The incidence has been estimated to be about 1% of all traumatic dislocations. We report 3 cases of subtalar dislocation. Case 1: A 29-year-old man was injured in a traffic accident when driving a car. His right foot was deformed as in club foot. The injury was diagnosed as medial subtalar dislocation according to radiographic appearance. The CT scan finding revealed jamming of navicular and talus head. After unsuccessful manual reduction, open reduction was required. Radiographs at 6 months after the trauma show no avascular necrosis of the talus or arthrosis of subtalar joint, and he is free from complaint. Case 2: A 37-year-old man sustained an open left lateral subtalar dislocation caused by the fall of a heavy machine on his left lower leg. The talus head was exposed and the tibialis posterior tendon and flexor hallucis longus tendon were ruptured. The patient underwent open reduction under lumbar anesthesia. A year later, a radiograph shows no avascular necrosis of the talus or arthrosis of subtalar joint, and now he is free from pain. Case 3: A 21-year-old man suffered subtalar dislocation sustained in a traffic accident while riding a motorcycle. Open reduction was required because the tibialis posterior tendon was jammed into the talonavicular joint. Twenty months after the trauma, arthrosis of the subtalar joint was apparent on radiographs. He feels intermittent ankle pain while jogging. Further investigation and follow-up are necessary in such cases.

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A 50-year-old female experienced complete amputation of the left thumb, index finger and middle finger (zone 3) and a 35 year-old male had complete amputation of the right ring finger (zone 4). In both cases, strong spasms occurred from two days after replantation. The skin temperature fell to below 31°C, and SpO₂was around 80%. Therefore, local continuous intra-arterial infusion of Lipo PGE₁ was conducted. Lipo PGE₁ 10μg and heparin 6000 units were dissolved in physiological saline and totaled 48 ml. A 22G catheter was placed into the radial artery, and a syringe pump was used to infuse the solution continuously at a rate of 4-6 mg/h. Immediately after infusion was started, SpO₂ improved to over 96% and skin temperature also improved gradually. The catheter was removed after 14 days of infusion, and the replanted fingers survived. Lipo PGE₁ is effective in resolving arterial spasm at initial doses of 0.25-0.38 ng/kg/min and a maintenance dose of 0.13 ng/kg/min.

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A report of a calcified tendinitis with a drooping shoulder is rare. We report a case reduced in the fourth postoperative week. The patient was 53-year-old-woman, who companied of a strange feeling in her the right shoulder accompanied by ache, and motion pain at night. We recognized a crepitus on elevation at the anterior part of the acromion. A radiograph in anteroposterior view showed drooping shoulder with calcareous deposition of 20×9 mm between the acromion and the humeral head. We excised the calcium deposit by the Mini Open method for subacromial decompression and distal clavicle resection. We reconstructed the defect of the cuff tendon by Twinfix^®. The cause of the drooping shoulder seemed to be supraspinatus and deltoid muscle dysfunction.

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We report the clinical outcome of surgical treatment of distal radius fracture using external skeletal fixation. During the period 1998-2004, 26 patients (8 men and 18 women) with a mean age of 58.3 years (range, 18-80 years) were enrolled in this study. The fracture type was comminuted and unstable. The clinical outcome were evaluated with volar tilt (VT), radial tilt (RT), radial length (RL), and Saito’s point system. The postoperative VT, RT, RL improved remarkably in comparison to the preoperative measures. Scores of subjective symptons were excellent at 65.4% by Saito’s point system. Three cases were evaluated as ‘poor’due to reflex sympathetic dystrophy. External skeletal fixation is one of the most useful methods for the communited and unstable distal radius fracture because it is less invasive, allows easy reduction of the fracture, and is easy to maintain. New non-bridging type external skeletal fixation, which allows early mobilization, tends to prevent the reflex sympathetic dystrophy.

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It is recognized that meniscal injury is commonly associated with anterior cruciate ligament (ACL) injury. The purpose of this study was to clarify the characteristics of the meniscal injury after ACL reconstruction, though the antero-posterior stability was good. The subjects were 6 patients (2 men and 4 women) who had an operation for meniscal injury from 2001 through 2004 after ACL reconstruction by a bone-patellar tendon-bone method. The mean age was 28 years (range, 19 to 43 years). The mean period from ACL reconstruction to the operation for meniscal injury was 40 months (range, 10 to 87 months). Five patients continued to play sports after ACL reconstruction. Only 1 patient suffered a non-sport accident at the time of meniscal injury. Four menisci were medial and 2 menisci were lateral. Lachman test was negative in all patients. Pivot shift test was slightly positive in 3 patients. The mean KT-2000 side-to-side difference was 0.1 mm (range, -3.3 to +3.2 mm). Arthroscopically the tension and the synovial coverage of the reconstructed ACL was relatively good in all patients. We supposed that the slight rotational instability and the sports activity after ACL reconstruction caused the meniscal injury.

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Fourteen medial unicompartmental knee arthroplasties (UKA) using a minimally invasive solution (MIS) system were performed from 2002 to 2003. The M/G UKA System (9 knees), Oxford UKA System (5 knees) were used in the procedure.
The mean age at the operation was 76 years (66 to 85), and the mean follow-up was 12 months (9 to 21). Mean operation time was 115 minutes, except in the first to third cases. There was little bleeding. Mean preoperative hemoglobin content decreased from 11.9 g/dl to 11.0 g/dl on the next day of operation. No blood infusion was necessary in any case. The mean range of motion was 140 degrees before the operation and 132 degrees at the latest review. Postoperative maximal flexion was 130 degrees or more in 12 cases of the 14 cases. Mean days to stable 1 cane gait were 9.7 days (6 to 21). The mean JOA score for OA improved from 61 to 89 points.
The main advantage of this operation was minimally invasiveness and early functional recovery in patients over 70-years-old.

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Five elderly patients with femoral subcondylar fractures were treated with MIPO Methods (Minimully Invasive Plate Osteosynthesis) using the A. O. condylar buttress plate (4 cases), or the Mizuho N plate (1 case). The mean age at the time of the operation was 84.4 years (range 76 to 92 years). The follow-up period ranged from 12 to 25 months. Using the AO/ASIF classification, 5 fractures were classified as 1-A1, 2-A2, 2-A3, 1-C2.
The mean flexion was 2°-105°at final follow-up. The mean postoperative femora-tibial angle (FTA) was 177.2±2.1°, which changed to 176.5±2.7°at final follow-up. There were no cases of loss of angle to varus. The mean Neer score was 81.2 points, 4 cases were exellent, and 1 case was satisfactory.
Because the MIPO method uses indirect techniques, it gives better stability, which allows early ROM exercise, and has more acceptable alignment than anatomical reduction.
We are satisfied with the outcomes, and think that the MIPO method is an exellent procedure for reduction of femoral supracondylar fracture in the older patients.

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We report a case of subchondral insufficiency fracture of the left femoral head which occurred after subcapital fracture of the right femoral head.
A 81-year-old woman, who was 143 cm in height, 60 kg in weight, and obesity (Body Mass Index (BMI); 29.3), has a history of hypertension, mild cerebral infarction, thyroid cancer (post-operation) and mild osteoporosis (Young Adult Mean 77%).
The patient complained of pain in the right hip joint in January 2004. A radiograph of the right hip joint showed no evidence of fracture and there was no history of trauma. Three months later, the patient had subcapital fracture of the right femoral head and underwent surgical replacement of the right femoral head.
After the operation, the patient was able to walk using a T cane. At four months after the operation, the patient complained of pain of the left hip joint without history of trauma. A radiograph of the left hip joint showed no evidence of fracture, although MR imaging demonstrated a subchondral area of low signal intensity on T1 and T2-weighted images, and a CT examination showed an irregular, sclerotic line on a subchondral region of the femoral head.
The diagnosis was subchondral insufficiency fracture of the left femoral head, and the patient underwent surgical treatment of the left femoral head. The pathological diagnosis was the reparative phase of fracture without malignancy and avascular necrosis of the femoral head.
It is necessary for us to observe the clinical course carefully even if the radiograph shows no evidence of fracture in such cases among older, obese female patient.

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We performed a retrospective study of the influence of dementia on ambulatory ability after operation for trochanteric fracture of femur.
Between 1997 and 2004 we operated on 94 patients for trochanteric fracture of the femur. There were 25 men and 69 women who were, at operation, from 59 to 96-years-old (mean 84 years). We divided them into two groups. There were 44 patients with dementia (D group), and 50 patients without dementia (ND group). We classified ability of ambulation into 4 grades: I) walking with/without one cane, II) walking with walker, III) wheel chair, IV) bed rest.
We performed osteosyntheses with Ender’s nails for all people.
The patient’s ambulatory ability before injury was compared to that after operation in all 94 cases. In D group, patients of grade I had significantly reduced postoperative walking ability, while in ND group, they didn’t. In the D group, there was no postoperative improvement in ambulatory ability after 5 weeks, but postoperative improvement in ND group continued for 8 weeks after operation.

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