The purposes of this study were to evaluate the incidence of pulmonary embolism (PE) by means of lung perfusion scinti-scan and assess the efficacy of a rehabilitation program to prevent PE in patients with SCI. In this prospective review of patients with SCI evaluated by lung perfusion scan, the participants were 16 patients with acute traumatic spinal cord injury who were treated in our institute from 2002 to 2003. All of these were assigned to the same rehabilitation program. The patients' ages at injury ranged from 41 to 83, mean 63.6 years. Levels of injures were cervical lesion in 11 patients, thoracolumbar lesion in 5 patients. Severity of palsy was classified as ASIA B in 3 cases, C in 11, and D in 2. 10 patients underwent spinal surgeries. Lung scinti-scan was performed within 3 weeks after injury and followed-up after 6 months. Findings of the lung perfusion scan were divided into four groups: a large defect in 0 cases, segmental defects in 9, small defects in 3, and normal in 4. Nine patients (56.3%) with segmental defects were diagnosed as having PE based on scinti-scan, and 5 of the 9 demonstrated hypoxycemia clinically. PE appeared not only in tetraplegic patients but also in some cases with central cord syndrome. These results suggest that SCI has a potential for high incidence of PE, and that the rehabilitation program was not sufficient to prevent PE.

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It is difficult to find spinal tumor of thoracic spine early in patients of advanced age because of the masking effects of lumbar canal stenosis and cervical myelopathy. We report 2 cases recently diagnosed during treatment of other part of spinal cord. The first patient was 87-year-old woman who had been treated lumbar canal stenosis and gonarthrosis for a long time. She was referred to our hospital for motor disturbance of both lower extremities. MRI showed a thoracic spine tumor. She underwent operation. The second patient was a 73-year-old woman. She underwent laminoplasty of the cervical spine for numbness of her left arm. She was treated for cervial myelopathy and lumbar canal stenosis in another hospital, but symptoms worsened and she was to our hospital. We gave conservative treatment, but symptoms continued to worsen. MRI of cervical spine showed a thoracic spine tumor. She underwent operation.

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Cases in which limitations of ADL or re-compression during the long-term course, and persistent low-back pain are occasionally seen after fixation in a hyperextension cast is performed for fresh vertebral compression fractures. Between September 2003 and August 2005 vertebroplasty by filling with calcium phosphate cement (CPC) was performed in the thoracolumbar spine as a means of prevention on 53 vertebrae in 50 cases of compression fractures. The patients were 10 men and 40 women, and their mean age was 74.7 years (39-88 years). The vertebral compression rate decreased from 38.7% before surgery to 13.9% immediately after surgery, and at the time of the final examination a moderate loss of 25.9% was observed, but bone union had cccurred in every case. Pain decreased markedly during the postoperative course, and at the time of the final examination ADL had recovered to the pre injury level in all of the patients. This method of treating vertebral compression fractures was superior in terms of its early pain eliminating effect and was able to stop the progression of vertebral compression, and it appeared to be an excellent method of treatment.

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We evaluated the clinical results of anterior decompression and reconstruction using the Kaneda-SR system. Twenty-nine cases with the thoraco-lumbar injury (15 men and 14 women) with neurological deficits were treated by anterior decompression and internal fixation by Kaneda-SR system. There were 23 burst fractures, 2 flexion-dislocation injuries, and 4 cases of posttraumatic vertebral collapse. The mean age of the patients at the time of operation was 46 years (range 17-77 years). The mean follow-up was 26.6 months. The modified Frankel score improved more than one degree in 82.6% of the 19 paresis cases. Postoperative pain evaluation was scored with the Denis pain scale, and 82.8% of the 29 cases had good pain relief (P1 or P2). Bony union occurred in all cases. Mean loss of reduction was 2.8 degrees. Postoperative complications included 1 case of MRSA pneumonia,2 cases of superficial infection, 2 cases of urinary tract infection, and 1 case of postoperative vertebral collapse in the adjacent level.

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We reviewed the case records of 7 patients who were treated conservatively for unstable vertebral fractures and back pain lasting for more than 1 month after injury, between October 2004 and July 2005. None of the patients had neurological deficit.
There were 4 men and 3 women with an average age of 81.4 years (73 to 97 years). The average follow-up period was 6.7 months (3 to 13 months). The patients kept their heads elevated up to 30 degrees in order to close up the superior and inferior end-plate.
The mean initial wedge-shaped deformity angle in the supine position was found to be 15 degrees (5 to 30 degrees); on sitting 26 degrees (15 to 35 degrees); on “heading up” 19 degrees (2 to 25 degrees). At the final follow-up examination, the mean wedge-shaped deformity angle in the sitting position was found to be 23 degrees (11 to 37 degrees). Five patients showed stability on dynamic radiographs. Instability in 2 patients remained at 3 and 5 degrees without back pain.
We attempted to classify the pedicle fracture morphologically into 4 types with computerized tomography. There was no significant difference between fracture types and clinical features.
This findings confirm that appropriate conservative management is indicated for unstable vertebral fractures if there is no neurological deficit.

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The treatment for the patients with lumbar disc herniation is generally conservative, but not a few patients require surgery. The intradiscal pressurized injection therapy conceived in 1992 by Yoshida is a method to avoid surgery.
The authors analysed cases of patiants younger than 40 years with lumbar disc herniation, who could not control their pain and had requested surgical treatment such as the intradiscal pressurized injection therapy. We injected a combination of 10 cc of saline, 2 cc of 2% Xylocaine and 2 cc of Decadron through the dura mater by the central approach with Isovist.
We reviewed 14 cases (10 men and 4 women, mean age 26.6 years). The average period from primary pain to the intradiscal pressurized injection therapy was 20 weeks (range 4-64 weeks). The mean Japan Orthopaedic Association (JOA) score for low back pain for the 14 cases was 11.4 points (range 2-20 points). The authors classified the effect at one week after the pressurized injection into excellent, good, fair and poor groups.
The excellent group had 7 patients, good group had 4 patients, fair group had 3 patients and the poor group had none. There were 2 patients in each group who required surgery. Three of four patients with the protrusion type on MRI underwent operation. Three patients in ten patients with the extrusion hernia required surgery. Two of 8 patients with central type herniation required surgery. Four of 6 patients with posterolateral herniation underwent operation. All who had high intensity in MRI T2 improved and could avoid surgery.
We expected the center approach would make the intradiscal pressurized injection therapy more effective for patients with central type herniation. One week after the intradiscal pressurized injection therapy, the patients were comfortable, but eventually half of the patients needed surgery.
We concluded that the intradiscal pressurized injection therapy was useful for some patients younger than 40 years with lumbar disc herniation on the condition that we gave thorough informed consent.

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In general, tibial bony avulsion fractures of the posterior cruciate ligament have been surgically treated using a direct posterior or posteromedial approach. These approaches provide excellent visua al fields and rigid fixation. However, it is difficult to investigate and treat other combined injuries in the knee joint because of the requisite prone position. In addition, there is fairly large surgical invasion due to extensive exposure of the popliteal lesion.
Recently, treatments by the arthroscopic fixation of such fractures with good results have been reported. In this paper, we report 2 cases of tibial bony avulsion fracture. The 2 women patients were 56 and 61 years old, and had no combined injuries in the knee joints. The bony fragment sizes (15 mm×15mm) were fixed with a cannulated cancellous screw inserted from the anterior tibia aspect using a posteromedial arthroscopic view. The time to union was about 3 months in both cases. There were no clinical symptoms at 7 months after surgery.
This technique can reduce the risk of injury to the posterior neurovascular complex and allow treatment of combined injuries in the knee joint. For these reasons, we conclude that arthroscopic internal fixation of tibial bony avulsion fracture using posteromedial view might be useful if the fragment size is large enough for screw fixation.

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The purpose of this study was to describe our arthroscopic suture fixation technique of the tibial eminence fracture in children, and to report the short-term results. Three patients (all boys) with Meyers and McKeever type II (1 patient) or IIIA (2 patients) fracture underwent arthroscopic pullout suture fixation using 3 No.2 Fiberwire sutures. The patient’s ages at the time of surgery were 7, 9 and 11 years, respectively. Mean duration of follow-up was 11 months (6-20 months). At the final follow-up evaluation, physical examination showed no limitation of range of motion, and Lachman test did not demonstrate anterior instability in any of the patients. Plain radiographs showed complete union, and none of the children suffered physeal damage or leg-length discrepancy. All of the children returned to their previous sports activity within 3 months postoperatively. We concluded that our suture fixation technique is useful for the displaced tibial eminence fractures in these children.

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We have examined the results of anterior cruciate ligament (ACL) reconstruction combined with high tibial osteotomy (HTO) for ACL-deficient and osteoarthritic knees done from 2003-2005.
The patients were one man and two women with an average of 55 years (range 48 to 62 years) at the time of surgery. The average period from the injury to the operation was 35 years (range 30 to 39 years). The average follow-up period after surgery was 17 months (range 9 to 24 months). All of the patients underwent ACL reconstruction using hamstrings combined with closed wedge HTO.
Evaluation was based on the Lachman test, Pivot shift test, radiographic documentation, Japanese Orthopedic Association osteoarthritis knee score (JOA score), and Lysholm score. Lachman test and Pivot shift test results improved from positive to negative. The average femorotibial angle (FTA) was 182° before surgery and 170° after surgery. Osteoarthritis had not progressed after the operation. Total JOA scores, and Lysholm scores were improved after surgery.
We concluded that ACL reconstruction combined with HTO was a useful procedure for improving the knee instability of ACL-deficiency and the pain of osteoarthritis in such cases.

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Early changes in knee osteoarthritis (OA) have been investigated with magnetic resonance imaging (MRI). In most reports, meniscus changes have been discussed. We studied the records of 12 cases of cartilage defect at the medial femoral condyle without meniscal tear and early osteoarthritis of the knee. The purpose of our analysis was to compare them with 15 cases of meniscal tear without cartilage defect.
The study included 12 patients (10 women, 2 men) with cartilage defect (ages 42-61 years), and 15(10 women, 5 men) with meniscal tear (ages 45-61 years). All patients had relatively early OA changes (Kellgren grade 2) at the medial side of the knee on radiographs. Ligament injuries by trauma were excluded. We measured the medial meniscus (MM) displacement ratio on MRI, and femoro-tibial angles (FTA) and Mikulicz line on radiographs. MM displacement ratio was the length of MM lesion that protruded from the edge of the tibial medial joint surface to the MM width. We examined the relationship among the parameters between the cartilage defect groups and meniscal tear groups.
The MM displacement ratio and FTA were smaller, and the Mikulicz line was more central at the tibial plateau in the cartilage defect cases without tear than in the cases with meniscal tear. Significant differences were observed between the two groups for all parameters.
We believe a cartilage defect at the medial femoral condyle is an important and interesting lesion in early osteoarthritis of the knee.

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Tibial avulsion fracture of the posterior cruciate ligament (PCL) is a rare condition, and surgical fixation of the fragment is a controversial treatment. In the present study we report three cases (two men and a woman) of PCL avulsion that were treated with screw fixation through the posterior approach. Injuries resulted from a fall in one man and the woman, in the remaining patient it was the consequence of a car accident. The X-rays and MRIs revealed that the PCL was detached from the tibial attachment with relatively big fragments, for that reason the PCL was relaxed. The fragment was reduced and fixed at the anatomical position with cannulated cortical screws by using the direct posterior approach.
Full range of motion and attained good stability of the knee without pain was achieved within six postoperative months in all patients.
In conclusion, the screw fixation of the fragment through the posterior approach is a safe and effective treatment for tibial avulsion fracture of the PCL.

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We report a case of bilateral recurrent patellar dislocation. The patient was a seventeen-year-old woman who had received Roux-Goldthwait procedure at the age of seven for left patellar dislocation. After surgery at the age of fourteen the left patellar dislocation recurred, and right patellar dislocation occurred at the age of sixteen. The patient complained about apprehension feeling in her patellar. A bilateral patellar reconstruction was performed using medial patello-fomoral ligament (MPFL) reconstruction with the tendon of gracilis muscle. At the end of the follow up period, nineteen months, patella dislocation was not present, and apprehension was absent. This treatment provided satisfactory short term results. The MPFL is the main stabilizer for the unstable patellar. The poor outcome associated with the Roux-Goldthwait procedure may be due to the insufficient repair of the MPFL.

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The purpose of this study was to evaluate the inter- and intra-observer reliability of mechanical alignment of the lower extremity with digital computed radiographs of frontal view of the whole leg using a new computer-assisted method. Three examiners measured the alignment of the whole leg in 105 legs of 73 subjects who had osteoarthritis of the knee with a Kellgren-Lawrence grade of >1. A line of mechanical axis from the center of the femoral head to the center of the ankle was drawn, and the alignment of the leg was assessed by the measurement of the perpendicular distance from the middle of the proximal tibial condyles to the mechanical axis (Fuji film OP-A), then calculated as a percentage of its ratio.
The inter-observer mean difference was 2.9% (SD; 2.7), the intra-observer mean difference was 2.1% (SD; 2.2). The inter-observer mean intraclass correlation coefficient (ICC) was 0.96, the intra-observer mean ICC was 0.99. Our computer-assisted method was simple, easy, rapid, and should be considered as an alternate method for the measurement of the alignment in whole leg.

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We reported a recent case of osteonecrosis of the patella that required multiple operations. A 44-year-old man underwent arthroscopic partial medial meniscectomy and the resection of osteochondroma of left knee. He complained of left anterior knee pain during rehabilitation, which was diagnosed as osteonecrosis of the patella. He underwent arthroscopic drilling of the patella 3 months after the first operation, but his complaints had not been improved. Then he underwent the combined procedure of both mosaicplasty and the anterior displacement of the tibial tuberosity 10 months after the second operation. Sixteen months after the third operation, his symptoms were improved. We supposed that in cases of osteochondral lesion not only treatment for the lesion itself, but also removal of the cause should be required.

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We treated a patient who had a tumoral calcinosis generated at the elbow joint. A 73-year-old man with no evidence of increased serum calcium levels and hyperphosphemia presented with infection on the left elbow bursa. The mass was partially resected in July 2005. It was consisted of a framework of dense fibrous tissue containing a yellow-gray chalky, milky substance. Chemical analysis of the calcified material revealed a variable mixture of protein, calcium phosphate and a little uric acid. At the first surgery, total excision was impossible because the mass extended into the subcutaneous tissue and triceps muscles. Postoperative infection occurred and the required re-operation was done on September first. The wound was closed and there were no muscle weakness and no loss of joint mobility.4 months after the re-operation there was no recurrence.

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We report a case of extraskeletal osteosarcoma (ESOS) arising in the subcutaneous tissue of the right buttock. The patient, a 32-year-old woman, noticed the mass formation in the right buttock two years ago. The tumor had gradually enlarged and she consulted our hospital. MRI showed a round and well-circumscribed mass, which had a low intensity area on T1-weighted images, a high intensity area on T2-weighted images, and peripheral enhancement in T1 Gd-enhanced images. An incision biopsy was performed and ESOS or MFH was suspected. We performed a wide resection and diagnosed the mass as ESOS. However, chemotherapy was not given since patient consent was not obtained. After 11 monthes, there was no recurrence and no distant metastasis.
ESOS is a rare malignant tumor, which accounts for 1-2% of all soft tissue sarcomas. It is usually characterized as a high grade matrix-producing neoplasm with clinically aggressive course. The tumor in this case was comparatively low grade (pathological malignancy was grade 2) but MIB-1 was about 30%, a high rate, so it is necessary to carry out careful follow-up.

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Polyethylene wear is one of the most important problems of total hip arthroplasty. We reported 10 cases of revision THA because of large bone absorption of acetabulum due to osteolysis. The patients underwent initial THA with the Kyocera Perfix between January 1997 and January 2000. The liners were not made of cross-linked polyethylene. The patients were 3 men and 7 women with an average age at operation of 66 years (range, 45 -80 years). The average period from the initial THA to the revision was 74 months (range, 45 -91 months). The results showed that liner wear rates were 0.28 mm/year and 107.5 mm³/year. The acetabular component had significantly high clinical wear rates. Care must be taken to avoid osteolysis and to avoid revision THA.

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Total hip arthroplasty (THA), generally, is planned by applying a template sheet to plain radiographs, and a thorough evaluation of plain radiographs is necessary. However, accurate planning is sometimes difficult, especially in dysplastic hips. To achieve accurate preoperative planning, we have been using 3D-CT template since 2004. Herein, we report the result of our study of 3D-CT based preoperative planning of THA and its problems. The subjects were 22 hips (22 patients) that were preoperatively planned on both plain radiographs (radiographic planning) and 3D-CTs (CT planning). The 22 hips consisted of 20 hips with OA and 2 hips with rheumatoid arthritis. The Crowe classification was Group I for 15 hips, Group II for 3 hips, and Group III for 2. The matching rate was defined to be the rate of complete match between the planned size and the implanted size of the prosthesis. The matching rate of the stem was 59% by radiographic planning and 77% by CT planning, and the matching rate of the cup was 36% by radiographic planning and 73% by CT planning, indicating that both matching rates were higher by CT planning than by radiographic planning. In group I, the matching rate of the cup was 47%(8/17) by radiographic planning and 70%(12/17) by CT planning, while in groups II and III, it was 0%(0/5) by radiographic planning and 80%(4/5) by CT planning, indicating that CT was more useful for accurate planning for severely dysplastic hips. Furthermore, the anteroposterior diameter of the acetabulum, the location of bone spurs and bone defects, and bone morphology, such as the femoral anteversion angle, could be more accurately evaluated by CT planning than by

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We treated 7 patients (8 hips) with coxarthrosis caused by acetabular dysplasia. The average age of the patients was 43 years (range from 28 to 54 years). The average follow-up period was 3 years 1 month (from 9 months to 7 years 8 months). The average postoperative JOA score improved from 81.4 to 94.9 points.
We performed the modified Spitzy shelf operation in all of the cases. The shelf operation has fewer complications, and is less invasive than the rotational arthroplasty or the Chiari osteotomy. It has been reported that clinically good results of the modified Spitzy shelf operation were achieved in patients with mild or moderate acetabular dysplasia, slight or no narrowing of the hip-joint space, and whose age at operation was less than 30 years. We attribute our good results of this operation to careful patient selection according to that indication. And some patients with advanced coxarthrosis can get long asymptomatic term by this operation.

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The aim of this study was to investigate whether periarticular injection of high concentration lidocaine could attenuate chronic pain existing in the medial compartmental osteoarthritic knee in the elderly.
Twenty patients who had tenderness and pain during walking at the medial compartment of degenerative femorotibial joint for more than 6 months were examined in this study. The mean age of the participants was 81 years (67-91 years). One-milliliter volume of 10% or 1% lidocaine solution was injected once in each patient, into the periarticular tissue of the most painful tenderness point of the medial femorotibial joint in a double-blind manner. Visual analog scale (VAS) scores for pain during walking, pressure pain thresholds (PPT) for tenderness, and the Japanese Orthopaedic Association(JOA) scores for knee osteoarthritis recorded before (controls), at 2 weeks and 4 weeks after the injection, and at the final follow-up (mean; 10 months, range; 9-12 months) were analyzed.
VAS scores were significantly lower than control scores throughout the 4 weeks after injection of 10% lidocaine. PPT for tenderness was significantly higher than the controls 2 weeks after the injection of 10% lidocaine. At the final follow-up, VAS scores and JOA scores were significantly improved in the 10% lidocaine group. In contrast, there were no significant differences in any of the scores at the three timepoints after the injection of 1% lidocaine.
These results suggest that the periarticular injection of 10% lidocaine at the medial compartment of the knee joint produces more effective and long-term analgesia for chronic pain associated with osteoarthritis of the knee compared with the injection of 1% lidocaine.

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The success of total knee arthroplasty (TKA) depends on the correct alignment of the implanted component and soft-tissue balancing. Recent developments in computer-assisted surgery have focused on systems for improving TKA.
The purpose of this retrospective study was to investigate whether the use of a navigation system during TKA lead to significantly better results than a conventional technique. A total of 24 patients (21 osteoarthritis and 3 rheumatoid arthritis) treated from January 2002 to September 2005 were included in the study. They were 5 men and 19 women, with a mean age of 74 years (range from 64 to 86 years). We divided them into two groups: N group (14 patients; 3 men and 11 women, a mean age 74 years; range from 64 to 86, 13 OA and 1 RA) patients had TKA using the Stryker knee navigation system and M group (10 patients; 2 men and 8 women, a mean age 74 years; range from 70 to 78, 8 OA and 2 RA) without navigation. Three surgeons performed all of the operation and all of the patients received Scorpio SuperFlex^® without cementing. Alignment of the leg and the orientation of components were determined on post-operative standing full-length weight-bearing anterior and lateral radiographs. We also analyzed operative time and complications (infection, fracture, pain of inserted pin) in all of the patients.
The computer-assisted TKA showed better alignment in all parameters although operation time was significantly longer in the N group. Analysis showed a highly significant difference between the two groups with regard to the sagital femoral axis. Complications could not be detected in either group. The use of a navigation system provided improvement of the alignment accuracy.

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Osteosynthesis failure occurred in two hemodialysis (HD) patients out of 24 femoral neck fracture patients during during recent four years. Both patients were Garden type I fracture. Both patients were reoperated with femoral head presthesis. Renal osteodystrophy and amyloid bone lesions of HD patients often induce osteosynthesis failure. Therefore, caution is necessary during femoral neck fracture treatment in HD patients.

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In a prospective semi-ramdomized study, the Hansson pin technique for internal fixation of fractures of the femoral neck was compared with the cannulated cancellous hip screw technique (CCHS). The series consisted of 121 patients followed clinically and radiographically over 4 months, 101 women and 20 men, with a mean age of 77.7 years. There were 63 patients treated with Hansson and 53 with CCHS.
Fourteen complications had occurred, 10 in the Hansson and 4 in CCHS (p<0.05). The incidence of nonunion were 3 cases (5.7%) in CCHS and 8(12.7%) in Hansson. One (1.9%) of CCHS and 2(3.2%) of Hansson were found cut out of screw or migration. In Hansson,7 of 35(20.0%) of the Garden’s stage III or IV were found complications and in CCHS,3 of 41(7.3%) were found (p<0.05). Eight of 10 complicated cases in Hansson showed varus and rotation deformity. This displace pattern was called “Chop stick phenomenon” and we need be careful for this.
We conclude that on the basis of our experience and results, the cannulated cancellous hip screw technique gave better results than the Hansson pin technique for internal fixation of femoral neck fractures of the Garden’s stage III or IV.

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We reported 3 cases of Revision Total Knee Arthroplasty (TKA) in a relative early stage of wear of the polyethylene tibial insert.
The periods to the revision TKA from the primary surgery were 4 years 4 months,7 years 9 months and 10 years 5 months. All cases had polyethylene wear, breakage, and metallosis, and one case also had an anterior dislocation of the tibial polyethylene insert. The symptoms in the 2 cases without dislocation were occasional unstable feeling of the knee and slight pain. During regular radiographic follow-up examination, joint space narrowing was discovered on standing A-P view images, and the diagnosis was polyethylene wear. A posterior stabilized prosthesis was used in all revision TKA operations. A stemmed femoral component was used in one case.
Recently reports of failure because of polyethylene wear are increasing. If wear is diagnosed at an early stage, correction is possible by a minimally operation to exchange the polyethylene insert. Because there was no or little pain even in cases of advanced wear, it is important to evaluate the X-P view carefully at the regular radiographic examinations to diagnose polyethylene wear at an early stage.

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We have reviewed the case records of 92 patients with avascular osteonecrosis following osteoporotic vertebral fracture treated by percutaneous vetebroplasty (PVP) with PMMA (polymethylmethacrylate). The mean age at the time of operation was 76 years (range 63-91 years). The mean follow-up period was 13 months (range 2-25 months).
Pain indicated on a visual analog scale was significantly decreased from a mean of 9.1 before PVP, to 1.9 immediately after operation, and to 3.0 after 12 months or more. Extravasation of a small amount of cement into the disc space and perispinus region was seen in 19.5% of the 123 procedures. These leaks were asymptomatic in all patients. Vertebral fracture in the vicinity of a cemented vertebra occurred in 21.7% of the 92 cases. They were treated with repeat PVP or the use of a spinal orthotic braces and had pain relief at the time of maximal follow-up. No severe complication occurred after PVP.
We conclude that PVP with PMMA is an effective and relatively safe procedure in the treatment of avascular osteonecrosis following osteoporotic vertebral fracture.

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We report a case of melorheostosis in the foot. The patient was a 22-year-old woman who complained of pain of the right foot when she presented in 2003. Radiographs showed sclerotic changes in the right foot (the second and third metatarsal and lateral cuneiform). Bone scintigrams with ^99mTc-MDP disclosed increased uptake in radiologically abnormal areas. These bony changes corresponded to the S1 segment of a sclerotome. Segmental distribution of hyperostosis implies damage to a segment of the neural crest during embryogenesis.

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Seal closes wounded area in film dressing materials, and there is Vacuum-Assisted Closure (following VAC) for soft tissue defect with severe open fracture for the purpose of fixing appropriate humectation habitat by removing additional interstitial fluid. The procedure is widely used to treat chronic skin ulcers such as bed sores, and VAC is the mainstream therapy used in European and American hospitals now.
VAC systems are manufactured in Europe and the United States but not in Japan. We add a maneuver device, and we perform V.A.C for infected wound after severe open fracture this time and report it because we obtained good consequence.

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Fracture of coracoid process is relatively rare. We treated two coracoid fractures, one in a 59-year-old man and one in a 28-year-old man. One was struck by a fallen long log and sustained an acromio-clavicular joint injury, and the other fell down while skiing and sustained a distal clavicular fracture. At 11 days and 6 days after injury, respectively, only the clavicle injuries were treated operatively. After the fixation of clavicle injuries, coracoid fracturesf underwent simultaneous closed reduction. After 6 months, both coracoid fractures had healed without complication. The firm reduction and fixation of the clavicle allows closed reduction and union of coracoid fracture without open reduction of the coracoid fracture.

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The purpose of this study was to investigate the clinical results of osteosynthesis of the femoral trochanteric fractures. Thirty-three cases (6 man, 27 women) of the femoral trochanteric fractures, treated using compression hip screw (CHS) from April 2003 to March 2004. The mean age was 80.1 years (range, 49-91 years). The mean follow up period was 5.1 months (range, 1-24 months). Using the AO classification, 22 fractures were classified as type A1, 11 were type A2. Osteosynthesis of the femoral trochanteric fractures failed in 3 cases (1 cut out of lag screw, 1 malunion, 1 refracture).

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