The local Medical Association in Fuchu City, Hiroshima Prefecture, supported by the Labor Standards Inspection Office, analyzed 196 upper extremity injuries sustained in the workplace by 162 individuals in this area.
The injuries included 57 fractures (28% of the total), 51 crush injuries (26%), 34 cut wounds (17%), 24 amputations (12%) and 10 bruise or sprain injuries (5%).
Fingers were involved in 151 of the injuries (77% of the total), forearms in 24 (12%), palms in 10 (5%), wrists in 8 (4%) and upper arms in 3 (2%). The high ratio of finger injuries was due to use of the right hand in the extended position and grasping or pinching movements of the left hand.
Announcements made in the workplace just after the start of the work period and a few hours before the end of it can be effective for prevention of labor-related injury. Further detailed research with the cooperation of local labor offices and hospitals, and the adoption of standardized nomenclature, are desirable.

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The present case was a 63-year old man undergoing treatment for liver cirrhosis and diabetes, who presented with a subjective symptom of mild left knee pain that first developed in 1978. The patient was diagnosed with rheumatoid arthritis upon examination by a local physician for swelling in the right wrist joint in 2001, and with steroids, gold, and anti-inflammatory analgesic drugs was administered.
As exacerbation of symptoms the patient first visited our clinic in June. As X-ray examination revealed giant geodes in the lateral and medial femoral condyles as well as in the tibial condyle, in addition to joint destruction and tibial plateau fracture, total knee arthroplasty (TKA) with a stem was performed for both the femur and tibia. Since the geodes showed massive bone defects, artificial bone was used concomitantly with resected autologous bone, and the implant was using bone cement fixated. The patient did not have any difficulty in walking at 4 months follow-up study.
TKA for the RA patients with geodes has been reported in a number of studies using resected bone in most cases. Grafts such as autologous iliac bone, artificial bone, and allogeneic bone in addition to resected bone, as well as cement filling may be necessary in cases of giant geodes. However, the factors such as age and activity level of the patient and early fixation of the artificial joint should be considered for the treatment in cases of giant geodes.

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We analyzed the healing of the posterior cruciate ligament (PCL) using magnetic resonance imaging (MRI) in a 42-year-old man with PCL injury. He was treated nonoperatively and was able to return to his daily activities without complications. MRI scan was performed at the time of injury, and at 1 month, 2 months, 7 months and 14 months thereafter. The follow-up examinations revealed that the PCL fibers had changed gradually from high signal intensity to low signal intensity on T2-weighted MRI, and continuity of the ligament was evident at 14 months. However, we suspected that the healing process was not complete, because the posterior capsule still showed high signal intensity on T2-weighted MRI. A check-up confirmed that the improvement of posterior stabilization was insufficient. It is suggested that additional examinations are necessary for further evaluation of the PCL substance and secondary restraint structures such as the joint capsule.

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In total knee arthroplasty (TKA), the patellofemoral articulation is still a source of various complications such as anterior knee pain, patellar fracture and dislocation of the patellar component. Patellar clunk syndrome (PCS) is another of these complications, and arises through impingement of soft tissue under the patella. Here we describe a case of PCS in a 63-year-old woman with rheumatoid arthritis (RA), who underwent minimally invasive TKA (MI-TKA) via a mini-mid vastus approach. Four months after the operation, she became aware of painful catching in the knee, and was diagnosed as PCS under arthroscopic inspection. Arthroscopic debridement was performed to remove a fibrous nodule in the intercondylar notch of the femoral component (PFC Sigma RP-F, DePuy), and this symptom was relieved. It has sometimes been reported that in MI-TKA the visualized area is insufficient, especially under the quadriceps tendon. In the present case, resection of soft tissue around the patella may have been inadequate, and/or synovial proliferation of RA may have recurred. Furthermore, in this procedure, care must be taken to avoid any increase in the posterior tibial slope in order to prevent anteroposterior instability, especially in the deep flexion femoral component design, as this may cause inflammation around the patellofemoral joint.

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A variety of techniques for posterior atlantoaxial fixation have been described. Although the transarticular screw fixation technique introduced by Magerl achieves excellent biomechanical stability, it is technically demanding and has a high rate of complications, such as vertebral artery injury. Recently, many authors have reported that a combination of a C1 lateral mass screw and a C2 pedicle screw for posterior atlantoaxial fusion gives excellent biomechanical stability with a lower complication rate.
We used this technique for five cases of altantoaxial instability, and bone union was achieved in all cases. Cerebellar infarction occurred in one case because of left vertebral artery injury at the vertebral foramen of the atlas. Although the C1 lateral screw is relatively safe, meticulous preoperative planning is essential for safe and accurate surgery.

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The cervical pedicle screw is the most powerful implant for cervical fixation, and was introduced clinically in 1994. However, as it is associated with technical difficulties and risks to nerves and arteries, this implant has not been widely accepted for clinical use. We performed pedicle screw fixation for 10 patients with cervical spine instability, comprising three cases of malignant bone tumor, three cases of traumatic fracture/dislocation, one case of myelopathy with kyphosis of the cervical spine, one case of congenital anomaly of the atlas, and two cases of proximal fixation for upper thoracic OPLL. A total of 48 screws were inserted from C3 to C7, and posterior bone grafts from the iliac crest were performed in all 10 patients. Rigid fixation was obtained in all patients without serious complications such as nerve injury or vertebral artery injury. Although the insertion procedure carries a technical risk, cervical pedicle screw fixation is a useful implant for treatment of cervical spine instability.

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The incidence, risk factors, and outcome of treatment for infections after prosthetic joint replacement were investigated.
Prosthetic joint replacement was conducted on 1487 joints in our hospital between 1987 and 2007, and postoperative infection affected 30 joints (2.01%). Risk factors for infection included rheumatoid arthritis (n=13), diabetes/malignancy (n=10), aging/malnutrition (n=24), multiple surgical procedures (n=14), treatment with steroid/immunosuppresants (n=4), obesity (n=3), chronic infection (n=3), and dermatitis (n=2). Implants were retained in 19 patients treated soon after the onset of infection. The average time from surgery until the occurrence of infection was 13.7 days in the 11 patients with early infections versus 4 years and 1 month in the patients with late infections. Causative bacteria included MRS (n=7), MRSA (n=6), Staphylococcus aureus (n=2), Pseudomonas aeruginosa (n=1), and Enterococcus faecalis (n=1). Causative bacteria could not be identified in 13 patients. With appropriate understanding of the postoperative risk factors, adequate prevention of MRSA and MRS infection, and early diagnosis and treatment of prosthetic joint infections, 63% of the implants were retained.

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We describe three cases of anterior decompression via a posterior approach with instrumentation for surgical treatment of thoracic ossification of the posterior longitudinal ligament (OPLL). Before surgery, two of the patients were unable to walk and one found walking difficult. Their OPLLs were large, beak-shaped and located at the top of the kyphosis. At surgery it was possible to remove the OPLL completely in two cases and dropped down to scrape the posterior part of the vertebral body in one case. All the patients showed improvement of myelopathy after the operation and during follow-up (average 38 months). The averaged Japanese Orthopaedic Association Score for thoracic myelopathy (full mark 11 points) improved from 3.5 points (0-7.5) preoperatively to 6.5 points (5-8) postoperatively. The two patients who could not walk before surgery gained the ability to walk with canes. Bladder dysfunction in two patients was resolved postoperatively. Although this method is technically difficult, it is effective for cases in which the spinal cord is extremely compressed from the anterior by OPLL at the kyphosis.

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In recent years, the number of spinal operations in elderly patients has been increasing with the aging of the population. It is generally recognized that there are many complications during and after surgery in the elderly. However, many points remain unclear regarding the frequency and content of complications associated with surgery. We investigated postoperative complications of 129 spinal surgery cases in elderly patients aged 75 years or older in our hospital. As postoperative complications, we recognized 10 cases of respiratory disorder, 9 cases of cardiovascular disorder, 13 cases of digestive disorder, 3 cases of mental disorder, 1 case of infection, 1 case of pulmonary infarction, and 3 other conditions. We examined the factors that affected the onset of complications. Age at surgery, operation time, intraoperative blood loss and surgical technique did not show any definite relationship with the onset of postoperative complications. For preoperative systemic evaluation, we used the ASA (American Society of Anesthesiologists) physical status scale (from PS 1, mild case, to PS 5, the severest case). There were 49 cases of PS 1, 60 cases of PS 2 and 20 cases of PS 3. The frequencies of postoperative complications were 18.4% in PS 1, 30.0% in PS 2 and 40.0% in PS 3, showing that the higher the preoperative PS value, the higher the frequency of complications. It may be useful to recognize complications of spinal surgery in the elderly in order to reduce complications and for obtaining proper informed consent.

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We report a rare case of acute transverse myelitis (ATM) in a 7-year-old boy. He showed muscle weakness, segmental sensory loss and hyporeflexia of the left arm. Bilateral hyperreflexia of the lower limb and left ankle clonus was also present. On MRI of the spinal cord, a high-intensity lesion on T2-weighted images was identified at all cervical levels, and the lesion was also enhanced by gadolinium on T1-weighted images. Steroid pulse therapy was administered twice, followed by oral steroid therapy, and the neurological symptoms improved immediately. Follow-up MRI scan showed that the T2 signal abnormalities were reduced. Six months after onset, tendon reflex abnormalities still remain, but the symptoms of sensory disturbance have disappeared. For differential diagnosis of ATM, MRI and Gd-enhanced MRI are effective. Early diagnosis facilitates prompt treatment, and this ensures a better prognosis.

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We reported a case of traumatic dislocation of the peroneal tendons. The patient was a 38-year-old woman who complained of right ankle pain and a feeling of dislocation while walking. We diagnosed right dislocation of the peroneal tendon and treated the patient surgically using the procedure of Das De. We confirmed the formation of a false pouch by stripping the periosteum from the lateral malleolus in the superior peroneal retinaculum. We then carried out reattachment of the periosteum to drill holes in the fibula. The incision in the superior peroneal retinaculum was then closed. A below-knee cast was used for three weeks.
The Das De Procedure is a soft tissue reconstruction that preserves self-tissue and is an anatomical method for repair of dislocation of the peroneal tendons. Our patient was able to return to work early after the surgical procedure. Consequently, we consider that operative therapy using the Das De procedure is a good method for repair of peroneal tendon dislocation.

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Many techniques have been described for late surgical reconstruction of lateral ankle instability. The traditional surgical procedure is complicated, and it is difficult to obtain a consistent outcome. Five patients underwent anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. The average follow-up period was 9 months (range, 4-15 months). We used both a free semitendinosus tendon graft and interference screws for anatomical reconstruction of the anterior talofibular and calcaneofibular ligaments. Good outcomes were noted on objective clinical, radiological evaluation and patient subjective self-assessment at final follow-up in all patients. In this series, lateral ankle reconstruction with the proposed method resulted in good ankle stability with minimal loss of ankle motion, only a small incision, sufficient strength at the tendon graft-bone tunnel junction and marked reduction of pain at an average follow-up point of almost 9 months. We conclude that this treatment is simple and yields an excellent outcome.

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We report the clinical results in five patients (average age 38.4 years) treated with early active motion and weight-bearing after open repair with cross-stitching for fresh Achilles tendon rupture. All tendons were repaired by a combination of core suture and cross-stitch peripheral suture. The core suture was performed by the modified Bunnel method in one case, the four-strand modified Kessler method in one, and the six-strand modified Kessler method in two. Active motion exercise of the ankle was started on the day after surgery. The average period until partial weight-bearing and total weight-bearing was allowed was 14.2 days (range 7 to 21) and 4.4 weeks (range 3 to 6) after surgery, respectively. As a complication, although no rerupture occurred, one patient had wound pain due to cicatrisation. Early exercise after Achilles tendon repair using cross-stitching helps athletes return to work and sports activity in a shorter period than conventional methods.

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Arthroscopic meniscal repair is a common treatment for meniscal tears, and several techniques including all-inside, inside-out, and outside-in meniscal sutures are currently available. The FasT-Fix meniscal repair system (Smith & Nephew) is one of the major devices for all-inside meniscal repairs.
Methods : The results of 19 meniscal tears in 18 patients who underwent all-inside meniscal repairs with the FasT-Fix suture device were retrospectively evaluated. Nine of 14 medial meniscal tears were localized to the posterior compartment and sutured by the FasT-Fix device. Five tears in the middle compartment of medial menisci were treated using the FasT-Fix suture device without technical difficulty. Meniscal suturing with the FasT-Fix was performed for 8 tears of lateral menisci, located in the posterior compartment. The average follow-up period was 8 months (range, 2 to 17 months). Clinical results were assessed on the basis of the Lysholm knee score.
Results : The postoperative Lysholm scores improved significantly (average, 67 preoperative and 94 postoperative). No case of postoperative extra- or intra-articular complication was encountered.
Conclusions : The FasT-Fix meniscal repair system provides a simple all-inside meniscal suture procedure and is a safe technique for repairing vertical meniscal tears in the middle to posterior compartment.

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Deep vein thrombosis (DVT) is a serious complication of total knee arthroplasty. However, there have been few reports on the incidence of DVT in patients undergoing unicompartmental knee arthroplasty (UKA) using minimally invasive surgery (MIS). We performed MIS-UKA operations in 22 patients between 2006 and 2007, and 3 patients (13.6%) developed DVT. In the same period, we performed TKA operations in 39 patients, of whom 9 (23.1%) developed DVT. The plasma D-dimer (DD) levels evaluated one week after surgery were similar in the two groups: 8.2μg/ml for MIS-UKA and 8.0μg/ml for TKA. The lower rate of DVT after MIS-UKA than after TKA was attributed to the minimal invasiveness of MIS-UKA, allowing more rapid patient recovery. Nevertheless, DVT rates after MIS-UKA were approximately 14%. Pneumatic compression treatment and anticoagulant therapy must therefore be considered in order to prevent DVT.

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We report the clinical results of treatment for distal radius fracture (DRF) with a Palmer locking plate (PLP). Thirty-nine patients (14 males and 5 females, mean age 58.4 years) were evaluated between June 2005 and April 2007. The mean follow-up period was 7.6 months. The DRFs comprised 4 type AO-A2 cases, 9 type A3 cases, 5 type B3 cases, 3 type C1 cases, 11 type C2 cases, and 5 type C3 cases. We measured the period of external fixation, volar tilt (VT), radial inclination (RI), and ulnar variance (UV) at surgery and at the end of the follow-up period radiographically, and also the range of motion (ROM) of the wrist at the end of the follow-up period. The mean period of external fixation was 16.6 days. The mean loss of correction of VT, RI, and UV was 0.8°, 0.1°, and 0.63mm, respectively. The mean ROM of the wrist at the end of the follow-up period was 60.4° of dorsal flexion and 48.6° of palmer flexion. Treatment for DRF with PLP enables patients to start ROM exercise earlier, with little loss of correction. The results of this series were generally good.

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Proximal femoral nail antirotation (PFNA) is often used for treatment of femoral trochanteric fracture. However, nail insertion is sometimes difficult. We compared the insertion point of the nail between PFNA and the peritrochanteric nail (PTN).
We studied 10 cases of PFNA use and 10 cases of PTN use among 20 patients who underwent surgery in our hospital between January 2006 and November 2007. We compared the difference in angle with the distal femur and nail in distal, presence of contact between the femoral bone cortex and nail, and the insertion point of the screw(blade) in the femoral head. The difference in angle between the femoral and nail was 2.2° for PFNA and 0.5° for PTN. Proximal contact between the femoral cortex and nail was seen in 8 of the 10 cases of PFNA, and 2 of the 10 cases of PTN. Distal contact between the femoral cortex and nail was seen in 5 of the 10 cases of PFNA, and 0 of the 10 cases of PTN.
Our findings suggest that insertion to the proper position is easy in PTN because there is little contact with the femoral bone and cortex and only a small difference in the angle.

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We used a new nailing system for trochanteric fractures of the femur and evaluated its utility with reference to other models and the shape of the nail.
Forty-seven trochanteric fractures were treated surgically in our hospital with an intra-medullary nailing system between January and June 2007. We investigated fracture type, type of implant, operation time, amount of bleeding, adaptability of nails to the medullary space, position of lag screw, tip-apex distance (TAD), and degree of sliding after surgery.
Among the 47 cases, 29 were treated using a ¥-Nail (group 1), and 18 using a Peri Trochanteric Nail (PTN^TM) (group 2). There was no significant difference in the amount of bleeding between the two groups, but the operation time was longer in group 2. The adaptability of the nail was acceptable in both groups, and there was no significant inter-group difference in the degree of postoperative sliding.
To treat trochanteric fractures of the femur with a nailing system, various nails have been developed that are suited to the femur of elderly Japanese patients. The bending point in these two models was proximal, and this seemed to fit the medullary space well. There were no cases of jamming or intra/postoperative fracture. In addition, the Telescoping Lag Screw of the PTN^TM was valuable for preventing postoperative lateral thigh pain, as it did not project laterally.

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Since 2005, we have performed cementless MIS-THA in a lateral position using a CT-based navigation system. However, in some cases the cup inclination and anteversion differed between the intraoperative navigation measurement values and postoperative CT evaluations. We herein report a comparison of the errors before and after four changes had been made to improve the accuracy of the procedure. The pin inserted into the iliac crest was moved into the wound so that the fixed pins for navigation would not interfere with the retractor. This made it possible to prevent the pin from loosening during the operation. In addition, the setting of the pointer-based registration was changed from the plain surface of the anterosuperior acetabulum, an area which we believed would be minimally affected by osteophyte, to the wider plain surface of the rim of the acetabulum to reduce intraoperative errors. We compared the intraoperative navigation measurement values with the postoperative CT scan evaluations of the cup angle. As a result of our comparison of the margins of error for 30 cases before and after the changes, errors have decreased. By improving the methods of MIS-THA using navigation, it is possible to perform more accurate operations.

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Idiopathic adhesive capsulitis of the shoulder has been thought to be self-limiting and to respond well to the physical therapy. Some of them, however, fail to respond to nonoperative management and require surgical interventions. For such refractory cases, we have performed arthroscopic release of a tight portion of the capsule which is responsible for loss of motion range in specific directions.
The purpose of this study was to evaluate clinical outcomes after arthroscopic capsular release in 9 patients with refractory frozen shoulder. There were 3 men and 6 women with a mean age of 60.7 years (range 53 to 74 years). Follow-up averaged 19.2 months (range 6 to 36 months). There were no preoperative complications. Anterior or anteroinferior capsular release was performed in all patients. Posterior capsular release was not done, except for one patient with severe restriction in internal rotation.
Passive range of motion improved significantly: with mean passive elevation improving from 97 degrees preoperatively to 159 degrees postoperatively, mean abduction from 62 degrees preoperatively to 151 degrees postoperatively, and external rotation at the side from 12 degrees to 47 degrees. Internal rotation improved by mean of 4 levels. The mean preoperative JOA score of 55 improved to 95 postoperatively. There was marked improvement of the mean pain score, from 7 preoperatively to 29 postoperatively.
Arthroscopic capsular release is a safe and effective method for management of refractory adhesive capsulitis, offering pain relief and significant gain in motion.

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Symptoms of lumbar spondylolysis in young adults without remarkable slippage arise from two types of pathology. Synovitis in a pseudoarthritic site of a pars defect may cause lower back pain. Alternatively, a bony ragged edge of spondylolysis and/or a fibrocartilagenous mass around the defect may impinge on the nerve root. These two pathologies may sometimes be combined. In such cases, we perform decompression of the nerve root and direct repair of the defects.
For direct defect repair, we use the percutaneous pedicle screw and hook-rod system as a minimally invasive procedure. The most important point of the surgery is to remove only the ragged edge impinging on the nerve root in order to preserve the area for a bone graft.
Although the short-term clinical outcomes are good, attention should be paid to the union rate of the defects and changes in the discs adjacent to the level of repair.

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Osteochondritis dissecans (OCD) in the lateral femoral condyle of the knee is sometimes accompanied by discoid meniscus. We report a case of large OCD with a torn discoid meniscus that was treated by internal fixation with a bone peg.
A 16-year old male complained of knee pain and locking after playing soccer. Roentgenograms showed a large area of OCD affecting the lateral femoral condyle. MRI confirmed the OCD lesion with a torn lateral discoid meniscus. The patient was treated arthroscopically by partial excision of the discoid meniscus and drilling of the OCD lesion. However, 7 months later, he again suffered locking of the same knee after playing soccer. MRI showed that a large loose body had become detached from the lateral femoral condyle. We performed reattachment using bone peg fixation from the proximal part of the tibia. No displacement of the fragment was observed postoperatively 9 months after the operation, and union of the fragment was also confirmed by MRI and CT scan.
We think that bone peg fixation is a good option for treatment of OCD associated with a large free fragment in order to preserve the articular cartilage.

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The treatment of recurrent patellar dislocation with an open growth plate is very complicated. Many procedures have been reported, but there is still no consensus as to which are superior. We report an 8-year-old girl who presented with patellar dislocation. We performed arthroscopic lateral release but re-dislocation occurred 6 months later. At the age of 11 years, she began to complain of knee pain, and was admitted for surgical treatment. Arthroscopy demonstrated slight patellofemoral cartilage fibrillation but no chondromalasia patellae. We performed the modified Insall method, which consists of lateral release, vastus medialis advancement, and finally medial retinaculum plication. At 1 year after the second operation, the patient had no subjective complaints, no limitation of motion and a Kujara score of 100 points. We believe that the modified Insall method is less invasive and reliable for treatment of recurrent patellar dislocation with an open physis.

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Juvenile idiopathic arthritis (JIA) is a disease that is difficult to diagnose. Here we report a case of JIA that was treated with combination of methotrexate (MTX) and salazosulufapyridine (SASP) for several months, resulting in amelioration of joint destruction. The patient was a 14-year-old girl who had swelling and pain of the right wrist involving the second and third MCP joints. Joint pain had been evident from the beginning of 2005. At a checkup in August, only medication for external application was prescribed. She underwent re-examination in September and this revealed bone destruction, but did not attend again as there was no inflammation reaction. A further consultation in March 2006 confirmed bone destruction in the joint and narrowing of the joint space, suggesting a diagnosis of JIA. Treatment by NSAID and PSL was started, but the symptom showed little improvement, and so combination of MTX and SASP was administered. Within several months, restoration of the bone erosion and improvement of the joint space were recognized. The present case of JIA shows that cure is possible if MTX treatment is started at an early stage.

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We report two cases of hip replacement arthroplasty for ankylosis of the hip joint, together with some bibliographical discussion.
(Case 1) A 74-year-old male with left coxalgia and ADL disorder. At the age of 14, he developed ankylosing spondylitis and underwent conservative treatment. Around the age of 66, he developed gait disorder characterized by crossing of the lower extremities. Subsequently, the left coxalgia gradually worsened. Before surgery, the left hip joint was in an ankylosed position with a flexion angle of 60 degrees and an adduction angle of 30 degrees. After the operation, the pain subsided, and the angle became 90 degrees for flexion, 0 degrees for extension, 30 degrees for abduction, and 20 degrees for adduction.
(Case 2) A 66-year-old female with gait difficulty and left knee joint pain. At the age of 25, she had suffered from purulent coxitis and underwent hip arthrodesis. Around the age of 50, she developed left knee joint pain. This symptom worsened, and she developed gait difficulty. Before surgery, the left hip joint had been fixed in the abduction-excycloduction position with a flexion angle of 25 degrees, an abduction angle of 20 degrees, and an excycloduction angle of 45 degrees.
The operation was conducted via the posterolateral approach. The femoral neck was incised with a chisel in the anterior-posterior direction, at one finger width proximal to the lesser trochanter, and the bony connection between the hip cup side and the femoral side was cut. At present, she is able to walk using a crutch without coxalgia.
The benefits of THA for ankylosis of the hip joint include the alleviation of pain in adjoining joints, such as the lower back and knee, and securing mobility of the hip joint. On the other hand, there is a high possibility of complication due to contracture after long-term fixation, destruction of soft tissue after surgery, or infection, and therefore advanced surgical techniques are required.
In both of these two cases, the patients regained mobility after the operation, and their activities of daily living were improved, with a high satisfaction level.

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The purposes of this study were to evaluate the efficacy of expansive laminoplasty in elderly patients with cervical myelopathy and to analyze the effect of preoperative prognostic factors on outcome. Sixty patients who underwent spinous process-splitting laminoplasty were investigated. The patients were divided into two groups of 30 patients older than 70 years and 30 patients younger than 70 years. Patients were clinically evaluated using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. There was no significant difference in the recovery score (the difference between the post- and preoperative JOA scores) between the elderly and younger groups. In elderly patients there were no significant differences between those with and without lumbar canal stenosis and, those with and without osteoarthritis of the knee in terms of lower extremity motor function recovery score. However, both the duration of symptoms and the severity of spinal cord compression significantly affected the clinical outcome in elderly patients. Surgical decompression for cervical myelopathy was benetifical even in elderly patients. To ameliorate disability in elderly patients, surgery must be performed as early as possible before irreversible changes occur in the spinal cord.

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We report a case of delayed diagnosis of cervical fracture-dislocation in a paient with multiple trauma. A 58-year-old woman sustained multiple trauma in a traffic accident. She was unconscious, and suffering from brain contusion and an open fracture of the left fibula. Because of sedation for general control, a cervical fracture-dislocation (C6/7) was overlooked until 5 days after hospitalization. At this point the patient had quadriparesis (Frankel C) due to this cervical lesion. Anterior and posterior fusion was performed on the same day when the cervical fracture-dislocation was discovered. Neurological deficits improved dramatically after the operation and the patient had almost fully recovered at the 18-month follow-up examination. In cases of head injury in patients with high-energy multiple trauma, cervical spine injury should always be borne in mind, and we suggest that MDCT would be more useful in this situation.

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