We performed palmar locking plate (PLP) fixation on 75 patients (19 men, 56 women, mean age 64.4 years) with distal radius fracture (DRF). The mean follow-up period was 5.4 months. At the end of the follow-up period, range of motion and grip power were measured. Further, the radiographic end-point was measured at the time of injury, immediately after surgery and at the end of each follow-up period. In addition, we classified ulnar styloid process fracture (USF) in 37 patients (tip 15, base 22) with displacement degree and examined presence of pain and bone healing rate. Ulnar side pain remained in 9 of 75 patients (12%) and bone-healing rate of USF patients was 12 of 37 (32%). However, the poor resuluts concerning the presence of ulnar side pain could be attributed to ulnar variance at our final assessment. Even if bone-healing rate was not obtained for treated USF with PLP in merged DRF, we concluded that in the final assessment, ulnar side pain will not occur.

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We treated nine cases (4 men, 5 women, mean age 49.9 years old) of intra-articular distal radial fractures (AO23-C3) using 2-stage operation. External fixator with closed reduction was attached on the day of injury. The forearm was elevated to decrease swelling for several days after initial suegery. Open reduction and internal fixation was performed using a locking plate for second operation.
The results of 9 patients at a final follow-up (a mean follow-up period 11.0 months) were relatively good to compare with other results of AO23-C cases. This strategy to treat distal radial fractures is useful.

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Jehovah’s witness patients’renunciation to blood infusion is well known worldwide. We performed total hip arthroplasty for two Jehovah’s witness patients with the use of autotransfusion system cell saver without saving the autologous blood.
The first patient was a 47-year-old woman who had been treated for Rheumatoid Arthritis (RA) and right hip pain from May 2003. The patient refused Total Hip Arthroplasty (THA) in several hospitals due to the use of allogeneic transfusion and saving autologous transfusion. In February 2004, she underwent THA. Hypotensive anesthesia and perioperative autotransfusion using cell saver were used.
The second patient was a 51-year-old woman who had been treated for RA and right knee pain from April 2002. She underwent Total Knee Arthroplasty (TKA) with only postoperative autotransfusion using cell saver.
Preoperative informed consent to Jehovah’s Witness patients is very important because of their refusal of blood transfusions while still desiring medical treatment. A clear and satisfactory preoperative informed consent was provided to both patients and relatives.

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We evaluated the soft tissue balancing during total knee arthroplasty (TKA) using two kinds of tension device. Results showed varus deformity in 29 joints of 26 patients’ 18 females, 8 men with an average age of 72.3 years’. We used two methods in all patients, reflection and reduction of the patella, in a position of extension and flexion of the knee at 90°, to access and compare the joint gap (mm) and lateral balance (°) between two methods. The joint gap using the reduction method averaged 1.5mm larger than reflection method. However, the data varied between the reflection and reduction methods for a single patient. Our tension device measurement method of the reduction of the patella proved less time consuming and is applicable for minimum invasive surgery dealing with narrowed space vision. Future studies should evaluate more TKA patients with this method and improve upon the measurement method of joint tension for the stable and proper ligament adjustment.

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The purpose of this study was to evaluate the relation between soft-tissue balance at the time of operation and postoperative range of motion after total knee arthroplasty (TKA). The study involved 8 knees of 8 men, 37 knees of 35 women (mean age 73.3 years), who received primaly TKAin our hospital between May 2003 and July 2005. The follow up period was more than one year for each case. After osteotomy was performed, the gaps between femur and tibia, and valgus-varus laxity at 0° and 90° flex position were measured using the Stryker Knee Balancer device. The measured values were compared with follow-up postoperative range of motion results. No significant relation among the gaps between femur and tibia and postoperative range of motion were observed. We observed a significant decrease in range of motion only in the case of valgus laxity group at 90° flexion. The soft tissue balance of TKA did not effect postoperative range of motion except for valgus laxity of flexion.

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We reported 18 cases (12 men, 6 women, mean age 61.3 years) of degenerative spondylolisthesis that we treated by lumber posterior interbody fusion (PLIF). This procedure is associated with reduction of spondylolisthesis using reduction screw of Synergy spinal system. The mean follow-up period was 24.1 months (range from 4-41 months). The mean preoperative Japanese Orthopaedic Association (JOA) score improved from 10.5 points to 25.8 points at the last follow-up examination. Further more, mean slip decreased from preoperative rate of 17.1% to a postoperative one of 0.7%. Although the postoperative JOA score improved significantly to more than 26 points in 15 cases, it did not show satisfying results for three patients. However, these three cases showed additional spinal stenosis besides the spondylolisthesis. The results of our case studies suggest that PLIF for degenerative spondylolisthesis where no additional spinal stenosis is present can yield positive satisfactory results.

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We evaluated the results of enlargement of the lumbar spinal canal in 67 cases (30 men, 37 women, mean age 65.5 years) with degenerative spondylolisthesis (who received treatment between 1991 and 1999 at our department). Mean follow-up period was eight years. Preoperative mean JOA score was 14.4 points, those improved to 21.6 points at the final follow-up evaluation. The evaluations based on the Hirabayashi recovery rate were as follows; 48 cases good results (50-100%), 19 bad results (0-49%).
As a cause of the example of poor results, existence of increase of postoperative instability and the preoperative degenerative scoliosis can be considered.
It’s to reconsider bad result cases once more and observe passage, and it’s possible to get appropriate operation indication, and I think it’s possible to get better results.

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Medial patellofemaral ligament (MPFL) reconstruction is the popular procedure for patellar dislocation, but the plication procedure of the MPFL is not so popular. We reported two cases of plication of the MPFL, one following patellar fracture-dislocation and one following patellar dislocation. The first case was a 28-year-old man who suffered a left patellar fracture-dislocation. The patient underwent plication procedure of the MPFL and primary fixation of an osteochondral fracture three days after injury. Eight months after surgery, no discomforting symptoms were diagnosed. Radiography revealed good bony union and satisfying congruity of the patello-femoral joint. The second case was a 14-year-old girl who suffered a right patellar dislocation. The patient underwent the plication procedure of the MPFL and the Elmslie-Trillat surgery six months after injury. Six months after surgery, slight thigh muscle atrophy was diagnosed but the patient did not complain of any discomfort. Radiography revealed satisfying congruity of the patellofemoral joint and the MPFL was clearly observed by magnetic resonance imaging (MRI). The results of the plication procedure of the MPFL for both cases were satisfying at the last follow-up examination.

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We reported a case of ochronotic arthropathy in the hip joint. The patient was 64-years-old woman who complained severe pain of the right hip and dyabasia. The radiograph of the right hip showed rapid collapse of the femoral head. Total hip arthroplasty was carried out by the diagnosis of rapidly destructive coxarthopathy. The articulr cartilage of the femoral head and synovium displayed black pigmentation. And the urine turned black after alkalization and homogentisic acid was detected. Therefore we diagnosed as arcaptonuria. 1 year after the total hip arthroplasty, she can walk with a cane without pain and the prosthesis has no loosening.
Alcaptonuria is rare hereditary metabolic disorder that results from a deficiency of the enzyme homogentisic acid oxidase. It is associated with various systemic abnormalities related to the deposition of homogentisic acid pigment in connective tissues. These pigmentary changes are termed ochronosis. Diagnosis is usually made by the triad of degenerative arthritis, ochronotic pigmentation, and change of urine color. Nonsteroidal anti-inflammatory drugs and physiotherapy reduce joint symptoms in the early stage of ochronotic arthritis. In the late stage of arthritis, arthroplasty is undergone. In our case total hip arthroplasty was carried out.

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Fingertip amputation is often performed at the nail level and various procedures for its reconstruction have been reported. The graft on flap method introduce by Hirase et al. was performed on four fingers (2 men, 2 women, mean age 45 years), all amputated at subzone II level. The volar side of the reattached fingertips was covered by thenar flaps in three cases and an oblique triangular flap in one case. All grafts survived the treatment and postoperative sensory recovery was nearly satisfactory. However, in the case of the oblique triangular flap, sensory recovery was superior to the three cases with thenar flaps. The method used is easy to perform and obtains good results. It was further suggested that in the future the reattached fingertips should be covered by an oblique triangular flap instead of thenar flaps when possible.

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It is generally accepted that negative pressure dressing promotes wound healing and granulation. But in conventional way of sealing, exercises should be limited in order to keep the seal. For that reason, we developed the bag-type negative pressure dressing using a gas sterilized plastic, enabling the patient to perform therapeutic exercise and prevent any joint contractures.
A 24-year-old woman was refered to our institute 1 month after suffering from degloving injury on her left lower limb. After the debridement of necrotic tissues, bag type negative-pressure dressing was applied. After 7 weeks of using this therapy, flat granulation had formed and the wound size was reduced. The wound was closed with sutures and split-thickness skin grafts. The patient complained of itching of covered leg during the therapy, but no other complications including contractures were observed.

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Erdheim-Chester disease is a rare non-Langerhans form of histiocytosis. We report the case of a 40-year-old man who presented with bone pain. Both femurs showed diffuse and symmetrical sclerosis on plain radiographs, CT, and Gd-MRI. Specimens obtained on open biopsy fulfilled the criteria of Erdheim-Chester disease. The patient was treated with prednisolone (20mg/day), methotrexate (7.5mg/week), and bisphosphonate (5mg/day), and has achieved a sustained clinical response.

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Pulmonary Thromboembolism (PE) is one of serious complication in orthopaedic patients. Unfortunately, diagnosis of PE at early stage is difficult. Therefore, clear standards have been established as the Japanese Guideline for preventing PE. We reported two cases of PE out of 504 patients with hip fractures.
Case 1: A 65-year-old woman with obesity and hypertension sustained a left femoral neck fracture. She had undergone direct traction, and 13 days later she underwent an operation. In operation, her blood pressure suddenly fell. She was presented to the emergency room and she was immediately treated with tPA and heparin.
Case 2: A 75-year-old woman with obesity and diabetes sustained a right femoral trochanteric fracture. Nine days following the initial injury, she underwent an operation. The SpO₂ suddenly dropped the next day. The angiographic study revealed PE in the pulmonary artery. She was treated using tPA and heparin.
Because obesity and long-term confinement to bed are preoperative risk factors for PE, anticoagulant therapy or intermittent pneumatic compression treatment should be considered to prevent PE. In this paper we argued that the most important approach to prevent PE would be to put more efforts into early diagnosis for PE.

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Cyclops syndrome can be present after ACL reconstruction in rare cases. We reported a case of Cyclops syndrome described by Jackson, in a 17 year old male patient. The post operative course after arthroscopic ACL reconstruction using a patellar tendon autograft was good without any extension disturbance. Acute knee hemarthrosis happened when the patient kicked a rugby ball at 8 months after operation. Arthroscopy revealed a mass coming out from the tibial side where the ACL graft was implanted in the intercondylar fossa. Arthroscopic excision of the mass resulted in symptoms relief. Pathological examination revealed the presence of synovial tissues with moderate fibrosis, coagulation, necrosis, evidence of old bleeding, and hemosiderosis. To our understanding, these findings were caused by repeated impingements. We thought the Cyclops syndrome was happened when the small Cyclops region grown from the debris was impingede to intercondylar fossa.

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Six cases for chronic calcific tendonitis of the rotator cuff which had failed to respond to conservative treatment for over six months underwent arthroscopic surgery. The cases were four males and two females, with an averaged age of 46 years old. The duration of disorder ranged from eight to twenty months with an average of 13 months. The mean follow-up period was 10 months. Preoperative plain radiography and a three-dimensional computerized tomography were done on all patients in order to determine the localization of the calcium deposits in the cuff. Following arthroscopic subacrominal decompression (ASD), calcium deposits were removed through a small incision made on the cuff. The incision on the cuff was closed in five cases. All patients were evaluated by the shoulder score of the Japan Orthopedic Association (JOA score), the range of motion and plain radiography.
The average postoperative JOA score of 64 points was better than preoperative score of 94 points. Preoperative range of motion exercise with an average of flex 125°, abd 120°, ER 45° improved to flex 172°, abd 170°, ER 60° postoperatively. The calcium deposits in the cuff of all patients were not delineated by postoperative plain radiography.
We concluded Arthroscopic surgery was very useful for the treatment of chronic calcifying tendonitis of the rotator cuff, which had failed to respond to conservative treatment.

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We report a case of tuberculous spondylitis. The patient was 52-years-old woman who had severe low back pain and right lower leg pain. The X ray film showed destructive lesion of L4 vertebral body. On the other hand, she also had stiffness on her right breast. After open biopsy of breast lesion, the histological result was breast cancer. We diagnosed the lumbar lesion as metastatic bone tumor. As CT guided needle biopsy for lumbar lesion showed no abnormal findings, the operative open biopsy followed by posterior fusion was planned. The intraoperative histology of L4 vertebral body was tuberculosis, though the metastasis of breast cancer had been expected. We underwent curettage of destructive lesion, bone grafting, and posterior fusion. Chemotherapy for tuberculosis was done postoperatively for one year. The clinical result was good, and she had no complaint after 1 year follow up. Tuberculosis must be suspected in case of destructive spondylitis.

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Conservative treatment for patients with ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine is often ineffective, requiring operative treatment for most patients after the conservative treatment. However, conventional operative procedure has high risks for the patients, and clinical results are not satisfactory. In this paper, we undertook a combined method of extensive cervicothoracic laminoplastic decompression and posterior spinal fusion at the thoracic spine, and reported the clinical outcomes of the procedure in three patients (1 man, 2 women, mean age 62.3 years). The follow-up periods ranged from 6 to 15 months (mean 12.0 months). The rates of narrowing measured by computed myelography in the spinal canal were 44% at the Th4/5 level, 56% at the Th2 level and 43% at the C7/Th1. The mean Japanese Orthopaedic Association (JOA) score for cervical myelopathy in the three cases improved from 10.7 points (range 7.5-13.0) to 12.3 points (range 8.5-16.0). However, kyphosis at the fusion segment did not progress after the surgery. Furthermore, a temporary C5 paralysis occurred in two cases, but the patients had fully recovered by the time of the final follow-up examination. We concluded that a combined method of extensive cervicothoracic laminoplastic decompression and posterior spinal fusion at the thoracic spine was useful for prevention of the progressive kyphosis and the posterior decompression of the spinal cord.

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We reviewed 171 new comers who visited “osteoporosis clinic” in our hospital between May 2005 and October 2006 to evaluate the achievements of the clinic.
130 people were diagnosed as osteoporosis.
We prescribed bisphosphonates or raloxifene for the osteoporosis patient, and added calcium preparation and vitamin D to the patient whose calcium intake was under 600mg/day.
Sixty-eight relatively active patients were treated with alendronate. The markers of bone turnover improved well and the bone mineral density (BMD) of the lumbar vertebrae rose 7.5% 1 year later.
Thirty-eight patients with underlying diseases or osteoporotic fractures were treated with risedronate. Though increase of BMD was not significant statistically, urine NTX/Cre showed significant declines, and there were only 2 patients in whom a bone fracture occurred after the treatment started.
Raloxifene was prescribed for 14 patients. Its effect was not clear in this study, but the continuation rate of taking raloxifene is high even in the patients who cannot take bisphosphonates.
These medicines are recognized effective in the “Guideline 2006 for Preventation and Management of Osteoporosis”. We will manage osteoporosis considering the condition of each patient to improve total continuation rate of taking these medicines.

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