We report a case of gluteal muscle necrosis (GMN) following transcatheter angiographic embolization (TAE) for unstable pelvic ring fracture. The patient, a 34-year-old woman, was injured by a fall from the 4^th floor of a building. On arrival in the emergency room, she was in a hemodynamically unstable state. X-ray and CT scan demonstrated a vertically unstable pelvic ring fracture, AO 61-C1. At first, TAE was performed for arterial bleeding and the patient was then transferred to the operation room for application of an external fixator for the unstable pelvic ring fracture and treatment of the associated injuries. On day 5, her buttock skin appeared to be necrotic and GMN was diagnosed by MRI. The pelvic ring fracture was fixed with an ilio-sacral screw as a minimal invasive method and diverting colostomy was performed to prevent contamination. After the necrotic area had been demarcated, debridement of the necrotic tissues was performed on day 21, and the open wound was placed under negative pressure (vacuum-assisted closure: VAC therapy). On day 35, a split-thickness skin graft was placed on the wound. The skin subsequently healed with no evidence of infection. GMN following TAE is rare, but can be a potentially fatal complications. The focus of treatment for GMN is to prevent infection and subsequent sepsis. Colostomy and VAC therapy are considered to be useful methods for treatment of GMN.

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Recurrent shoulder dislocation is often combined with rotator cuff tear, Bankart lesion or superior labral anterior posterior lesion in older patients. We performed both arthroscopic Bankart and cuff repair simultaneously in a 76-year-old woman. The patient showed no loss of motion arc and a satisfactory outcome, and no complications occurred after the operation. Although arthrofibrosis can occur when both cuff and Bankart lesions are repaired simultaneously, arthroscopic surgery is less invasive, and thus advantageous for surgery aimed at treatment of both lesions.

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The purpose of this study was to evaluate the usefulness of arthroscopic surgery for osteoarthritis (OA) of the elbow. We investigated 13 elbows with OA, 10 in men and 3 in women (mean age: 51 years), treated by arthroscopic surgery. The causes of OA were injuries due to sports (6 elbows) or physical labor (7 elbows). The arthroscopic surgery was performed with the patient in lateral recumbency under general anesthesia along with brachial plexus block. Ten of the 13 patients were allowed active range of motion exercise (ROM) on the day after surgery without any postoperative fixation. The mean follow-up period was 7 months. The treatment outcome was evaluated on the basis of elbow ROM, the Japanese Orthopaedic Association (JOA) score, the visual analog scale (VAS) pain score, plain radiography and CT images. Postoperatively, the average ROM improved from extension -19° and flexion 103° to extension -9° and flexion 127°, the average JOA score improved from 66.5 to 84.9 points, and the VAS pain score was reduced from 5.9 to 2.4 points. We consider that arthroscopic surgery is minimally invasive and effective for osteoarthritis of the elbow, providing an improved ROM.

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We report a case of subtrochanteric femoral shortening oblique osteotomy in high dislocation of the hip with total hip arthroplasty. A 71-year-old woman, suffering from a dislocated hip (Crowe type IV), was treated with a modular femoral component (S-ROM-A). The operation was carried out through a posterior approach. The acetabular component was placed at the level of the true acetabulum. The lengthening of the treated limb was 40mm. At follow-up, she reported significant pain relief and functional improvement. The osteotomy appeared to be healed on radiograph by 3 months. This technique minimizes potential complications, allows for correction of severe femoral neck anteversion, and gives excellent rotationary stability, while preserving the proximal femur for better press-fit cementless fixation. THA for Crowe type IV developmental hip dysplasia is a safe and effective procedure, that can improve not only hip function, but also lumbosacral and knee pain owing to a dramatic correction of static body balance. However this procedure poses a wide spectrum of difficulties and can present a serious risk of complications. A successful result depends on a complete preoperative assessment of the patient, attention to the details of the surgical procedure performed with an adequate prosthesis, and a reasonable selection of indications.

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The purpose of this retrospective study was to evaluate the clinical results of ostheosynthesis for basicervical fracture of the femur. We treated 27 patients (6 men and 21 women) with a mean age of 86 years between 2005 and 2008. We investigated the methods of fixation, operation time, tip apex distance (TAD), location of lag the screw, sliding length, dislocation of the fracture site during or after surgery and presence of lag screw cut-out.
The fixation method employed was CHS+C-CHS in 5 cases, DHS blade in 6 cases and PFNA in 16 cases. Mean operation time was 46.6 min for CHS+C-CHS, 33.5 min for DHS blade, and 28.1 min for PFNA. Mean TAD was 15.3 mm. The lag screw was located in an adequate position in 23 cases. Mean sliding length was 6 mm. Dislocation of the proximal fracture site during surgery was seen in 4 cases (all involving PFNA). Dislocation of the proximal fracture site with rotation after surgery was seen in 4 cases (including all methods of fixation). Cut-out of the lag screw did not occur in any of the cases.
PFNA is associated with dislocation of the proximal fracture site during surgery. Surgery using CHS+C-CHS took significantly longer then with the other two methods. We conclude that DHS blade is the most practical method for basicervical fracture of the femur.

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We evaluated 4 feet in 3 patients (all females) who underwent surgical treatment for rheumatoid forefoot deformities between December 2008 and June 2009. The average age of the patients was 53.3 years, and the mean follow-up period was 8.3 months. Shortening oblique osteotomy of the metatarsal neck of the lateral toes was performed for all 4 feet. Two feet of 2 patients were subjected to arthroplasty with a Swanson implant in the first metatarsophalangeal joint. In the remaining 2 feet in 2 patients, Mitchell's osteotomy was performed in the first metatarsophalangeal joint. X-ray assessment was performed using the hallux valgus angle (HVA), 1^st-2^nd intermetatarsal angle (M1-M2), and 1^st-5^th intermetartarsal angle (M1-M5). Clinical assessment was performed using the rheumatoid arthritis foot and ankle scale, hallux scale, and lesser toe scale, as recommended by the Japanese Society for Surgery of the Foot (JSSF). The average HVA, M1-M2 and M1-M5 improved postoperatively. Good clinical results were confirmed using the JSSF scales in all patients. Resection arthroplasty has often been performed for rheumatoid forefoot deformities. However, we think that shortening oblique osteotomy of the lateral toes and either flexible hinge toe implant arthroplasty or Mitchell's osteotomy of the great toe should be considered as a surgical reconstruction option for rheumatoid forefoot deformities.

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Arthroscopy is very useful for treating patients with paralabral cysts of the shoulder because associated labral tears can be repaired simultaneously. However, it is not known whether arthroscopic treatment would be effective for paralabral cysts without associated labral tears. We report a 25-year-old, right-handed volleyball player who presented with a 2-year history of right shoulder pain associated with overhead activities. MRI showed a cystic lesion adjacent to the superior glenoid labrum. CT arthrography did not show any connections between the cyst and the glenohumeral joint. Physical examinations revealed no evidence of suprascapular nerve palsy. Arthroscopic examinations demonstrated neither labral pathology nor rotator cuff tears. Capsulotomy was performed near the posterior superior labrum, and the capsule and paralabral cyst drained into the glenohumeral joint. One year after surgery, the patient was pain-free and was able to return to sports without restrictions. The JSS score was improved from 50 points preoperatively to 90 points at the latest follow-up. MRI at the final follow-up showed no recurrent cyst. Arthroscopic decompression of the paralabral cyst was effective even though intraarticular pathology was absent. Intraoperative needle aspiration through the glenohumeral joint makes it easy to determine the proper position of the capsulotomy.

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Total knee arthroplasty in valgus knees represents a greater challenge than in varus knees because of the greater difficulty in achieving ligamentous equilibrium and good patellar tracking.
The purpose of this study was to clarify the utility of the modified lateral approach for valgus knee and to describe useful technical tips. Ten valgus knees were treated using the modified lateral approach starting in May 2005 (lateral group), and compared with 6 valgus knees treated using the medial approach before May 2005 (medial group). Clinically, both groups achieved good outcomes. Radiologically the lateral group showed better improvement for patellar tracking than the medial group. We conclude that the modified lateral approach provides better results than the conventional medial approach in valgus knee.

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We assessed the effectiveness of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with acetabular dysplasia. In 2004, we carried out primary cementless THA on 41 hips, using femoral head autografts on 31 hips. The cup was placed at the level of the true acetabulum and bone from the femoral head was used as the graft. A retrospective study was made of 31 hips (30 females and 1 male, average age 62 years). The average proportion of the acetabular cup covered by the femoral head autograft was 49.1% (range, 39.6-71.4%), and 10 hips had a cup coverage of more than 50%. The average follow-up period was 5 years. All autografts were united to the host bones. No autograft collapsed, and no component from the hip became loose in any of patients. THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulting from hip dysplasia can achieve a favorable outcome.

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We performed ligament reconstruction arthroplasty for 13 thumbs with osteoarthritis of the carpometacarpal joint. One patient was male and 12 were female, with an age range of 52-78 (mean 63.8) years. The follow-up period was 5-43 (mean 20) months. The operation procedure was based on the method described by Burton and Pellegrini, but tendon interposition was not performed. At final follow up, three joints had mild pain after strenuous work, and one joint had slight difficulty with the use of a kitchen knife, but all patients were satisfied with the operative outcome. Range of motion and key pinch strength were improved. The average trapezoidal space was decreased from 7.7mm to 6.9mm, but there was no significant difference. Shortening of the trapezoidal space was not related to clinical outcome. We conclude that ligament reconstruction arthroplasty is useful for osteoarthritis of the carpometacarpal joint of thumb, although tendon interposition is not indispensable.

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Undercarboxylated osteocalcin (ucOC) is a marker of vitamin K deficiency, and an increased ucOC level is considered a predictor of hip fracture. In this study we evaluated the effect of anti-osteoporosis drugs and bone turn-over on the serum ucOC levels.
We measured serum ucOC levels in 115 patients with osteoporosis (average age 76.5 years). Forty patients had been taking vitamin D, 9 had been taking bisphosphonate, 12 had been taking bisphosphonate+vitamin D, and 10 had been taking vitamin D+vitamin K, each for at least 6 months. Forty-four patients had received no therapy for osteoporosis. Patients whose serum ucOC level was above the normal limit (4.5ng/ml), were prescribed additional vitamin K medication for 6 months.
The average serum ucOC level was 6.84±6.56ng/ml. The serum ucOC level exceeded the normal limit in 50.4% of the patients, but was low in patients who had taken vitamin K or bisphosphonate. The ucOC level tended to be higher in patients with a high urinary level of type 1 collagen cross-linked N-teropeptide (NTX). No significant difference in lumbar BMD was seen between patients with normal and abnormal ucOC levels. The serum ucOC level returned to normal in 64.9% of patients after they had received additional vitamin K medication.
In conclusion, our findings support the suggestion that not only vitamin K but also bisphosphonate may normalize the serum ucOC level in patients with osteoporosis, as the serum ucOC level is affected by not only vitamin K deficiency but also bone turn-over.

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Purpose : There is no clear standard guideline for the use of biological agents during the perioperative period. We investigated the adverse effects of a biological agent in patients who underwent orthopedic surgery for rheumatoid arthritis.
Subjects and Methods : The subjects were 5 women, with a mean age of 53 years (range : 39-66 years). Three patients had knee lesions, one had an elbow lesion, and one had a cervical spine lesion. The mean postoperative follow-up period was 19 months (range : 7-35 months). All patients had been receiving etanercept preoperatively. The adverse effects of etanercept were investigated at the start of administration, during the peri-surgical suspension period, and after re-administration postoperatively.
Results : Preoperative administration of etanercept was suspended for an average of 6 weeks (range : 2-20 weeks) and postoperative re-administration was started at an average of 9.8 weeks (range : 2-40 weeks) after surgery. Due to delayed wound healing, etanercept was readministered at 3 weeks after surgery in one patient, and at 40 weeks after surgery in another patent. All patients who were able to resume etanercept treatment did not develop joint inflammation.
Discussion : We consider that flexible decision-making is necessary when judging the timing of postoperative re-administration of etanercept in individual cases, in order to avoid recurrence of arthritis.

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We report a case of medial plica syndrome with unique features. The patient was a 53 year old woman with severe knee pain. On the basis of physical examinations, medial plica syndrome was suspected, caused by a tumor-like mass in the plica synovialis. Impingement of the mass in the patellofemoral joint was evident. MRI showed a smooth, distinct region with a diameter of 3 cm in the plica synovialis. We performed arthroscopic extirpation of the inflammatory synovium and ruptured plica including the tumor-like mass. The pathological diagnosis was a mixture of acute and chronic synovitis. All the symptoms were disappeared immediately after surgery. Some cases of intraarticular soft tissue tumors causing mechanical symptoms in the knee joint have been reported previously. Mechanical impingement of tumor-like tissues or synovial masses should be considered in the differential diagnosis of knee pain.

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Acute ulnar nerve palsy with distal radius fracture is extremely rare. An 18-year-old male suffered a distal radius fracture in a traffic accident. His wrist showed fork deformity and his hand claw deformity. A week later, the fracture was treated surgically using a volar locking plate, and then conservative treatment was adopted for the ulnar nerve. Six weeks later, we carried out neurolysis of the ulnar nerve at the Gyon tunnel, because of persistent and complete ulnar nerve palsy. The nerve was intact and had no adhesions, and 3 months later, the ulnar nerve palsy was completely resolved. Acute nerve palsy involves 3 factors : , nerve injury, physiological conduction block, and acute neuropathy. However, differential diagnosis is very difficult in the early period. Therefore, in this case, we should have performed neurolysis earlier.

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Locking compression plate (LCP) has been developed by deferent concepts compared with conventional plate (CP), and these advantages have been described in many studies. But there were a few reports pointing out problems. In this study, we considered complications of LCP, compared bone union periods with or without locking screws, and discussed indications and limitations of LCP.
In proximal humerus fracture, 7 of 76 cases were varus deformity. In one clavicle fracture case and 1 femoral shaft fracture case, loosening of plate was occurred and required second surgery. Two cases of distal tibia fracture, screws in the proximal bone fragment were broken. In bone union period of femoral shaft and distal femur fractures, LCP cases were 15.3 weeks, whereas CP cases were 11.8 weeks. One case of LCP have been delayed union and required revision operation.
Locking screws are inserted fixed direction, so in carved bone, they are not inserted center of the bone. LCP were more rigid by block fixation, but there is a limitation in remarkable osteoporotic bone. Locking screws in distal tibia fracture are too slim to early weight bearing, so we are required to make attention to screw breakage. In distal femur fracture, there is loosening between screws and plate by using CP, loosening makes varus deformity and fracture gap is decreased. In the result, compared to CP, deformity is less, but bone union period is longer with LCP.

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Arthroscopic Bankart repair (ABR) is one of the common procedures for recurrent anterior dislocation of the shoulder. This study was conducted to verify the clinical results after ABR. Twenty-seven patients (20 males and 7 females) who underwent ABR were included. The mean age at the time of surgery was 27.8 years (range : 14 to 56 years). The mean follow-up period was 12.6 months (range : 6 to 24 months). The preoperative and postoperative SIS score, restriction of external rotation of the shoulder with the arm at the side (ER1) and at 90° of abduction (ER2), postoperative X-ray, and the rate of recurrence were evaluated. The postoperative SIS score was improved to 93.1 points from 60.9 points. The restriction of ER1 and ER2 was 5.6° and 11°, respectively. Osteoarthritic changes were found in two cases postoperatively. Enlargement of the anchor holes was found in four cases. The recurrence rate was 7.1%. ABR was a good procedure for treatment of anterior instability of the shoulder. However, care should be exercised with regard to OA changes or enlargement of the anchor holes.

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During the period 1986-2008, 40 total elbow arthroplasty (TEA) were performed for 36 patients with rheumatoid arthritis at our hospital. According to Larsen’s scoring system, one elbow was grade 3, 19 were grade 4, and 20 were grade 5. Thirty-three and 7 elbows were operated using unlinked and linked TEA, respectively. The average Japanese Orthopedic Association elbow score, which was 33.8 points before surgery, improved to 71.3 points after surgery. The TEA for rheumatoid arthritis has high satisfaction of the patient, and it is good clinical resalt. However, measures to subsidence of humeral component are necessary, the unlinked TEA has a limit to severely damaged joints. The improvement of surgical technirues should be necessary.

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Calcaneal avulsion fracture of the Achilles tendon attachment is a relatively rare condition. We reviewed cases of this type of fracture treated with open reduction and internal fixation. Five patients with this fracture were treated in our department between July 1999 and July 2009. The patients comprised 1 woman and 4 men, who ranged in age from 31 to 91 years (mean 50.6 years). The follow-up periods ranged from 3 to 28 months (mean 11.6 months). In 4 patients the bone fragments were fixed with cancellous screws, and in 1 patient a small bone fragment was sutured to the attachment using a suture anchoring system. These 5 patients were investigated for postoperative displacement of the fragment and completion of bone union in terms of X-ray findings, residual heel pain, limitation of ankle range of motion, and skin trouble. The patient who underwent suture anchoring fixation suffered postoperative displacement of the fragment, and one patient who was treated using cancellous screws suffered partial refracture of the fragment with heel pain. However, the latter patient finally obtained reunion. Giving due consideration to fragment size and bone quality, it is necessary to develop appropriate fixation tools and postoperative protocols to reduce the incidence of the above complications.

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We report a case of volar fracture dislocation of the PIP joint. The patient was a 44-year-old man who had been injured when he fell from a motorcycle and sustained a blow to the left ring finger. We performed percutaneous pinning together with external skeletal fixation. After surgery, we performed early ROM exercise for prevention of joint contracture. The fracture healed in osseous union and a good ROM was obtained. We conclude that this method may an effective treatment for this type of injury.

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The purpose of this study was to evaluate the clinical results of treatment for proximal humerus fractures using PHILOS, which can provide angular stability using a locking mechanism.
We treated 18 patients (5 men and 13 women, mean age 65 years) between 2006 and 2009. The mean follow-up period was 9.5 months. Fracture type by the AO classification was 11-A2 in 3 cases, 11-A3 in 2, 11-B1 in 2, 11-B2 in 5, 11-C1 in 2, and 11-C2 in 4. The fractures united in 17 patients, but in one patient the distal screw broke and back out after the operation. There were no cases of infection or head necrosis. Varus deformity occurred in two cases postoperatively. The mean JOA score was 84 points.
We conclude that PHILOS is a good tool for treatment of humeral fractures, although the risk of implant-related complication must be borne in mind.

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Preoperative range of motion affects postoperative range of motion after total knee arthroplasty. This study investigated the results of high-flexion total knee arthroplasty. Between January 2005 and December 2008, 54 TKA (PFC sigma RP-F) procedures for osteoarthritis were performed. Forty-four knees in 37 patients were studied (in 3 males and 34 females ; mean age 74.5 years), with a mean follow-up period of 24 months. The preoperative mean flexion angle improved from 114.2° to 122.6° after TKA.
Twenty-eight knees achieved high flexion of more than 130° after surgery. There was a statistically significant correlation between the preoperative and the postoperative flexion angles. The Japanese Otrhopaedic Association knee rating score (JOA score) was improved from 52.9 to 79.8, the Knee Society score (knee score) from 50.6 to 96.7, and the Knee Society score (function score) from 35.1 to 72.8. Patellar clunk syndrome occurred in one knee.
In the present study, the PFC sigma RP-F was associated with an improvement of flexion accompanied by a good clinical outcome. The preoperative flexion angle affected the postoperative flexion angle after high-flexion TKA.

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We report a 9-year-old girl with ankle deformity and leg length discrepancy (4.5 cm) caused by partial premature epiphyseal closure of the distal tibia after treatment for clubfoot. A malalignment test developed by Paley et al. was used to determine the degree of joint alignment and joint orientation. The mechanical medial distal tibial angle was 70°, the mechanical axis of the hip, knee, and ankle was collinear, and the orientation of the knee joint was normal. The center point of the plafond was also the apex of the deformity. To correct the varus and equinus deformity, acute correction was performed through a supramalleolar wedge osteotomy with the center of rotation at the level of the plafond. In order to minimize medial translation, an Ilizarov external fixator was used. To prevent recurrence of the deformity, the Langenskiöld procedure was performed with free fat graft interposition. To correct the leg length discrepancy, gradual mechanical distraction with an Ilizarov external fixator was used. The length of distraction reached 4.6 cm. The external fixation index was 63 days/cm. Although excellent leg length and alignment were obtained, the recurrence of deformity for the future must be carefully observed.

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The purpose of this study was to clarify coronal laxity after total knee arthroplasty for varus-deformed knees using varus and valgus stress radiography. Thirty patients (5 men and 25 women, 40 knees) were followed up for 1 to 36 months (mean 9.7 months) after surgery. The mean patient age was 77.9 years (range : 69 to 85 years). NexGen LPS-Flex-type TKA was used for all patients.
JOA score was improved from 50.9±8.6 before surgery to 78.0±7.8 after surgery. On stress radiography, varus laxity was 2.4±1.8° and valgus laxity was 3.3±1.9°. Total coranal laxity was 5.7±2.6° and the difference between varus laxity and valgus laxity was 1.9±1.9°. Increased varus instability was associated with lower JOA score, especially with walking ability.
Coronal stability after total knee arthroplasty for varus-deformed knees was relatively good, however, caution may be necessary for varus instability after surgery.

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The world Health Organization (WHO) issued the Fracture Risk Assessment Tool (FRAX) in order to estimate the 10-year fracture probability for patients with osteoporosis. We computed 10-year fracture probabilities using FRAX and compared them with lumbar spine bone mineral density (BMD).
This study included 124 patients (13 men and 111 women, aged 50-86 years, mean age 69.8 years). The mean 10-year probabilities for a major osteoporosis-related fracture in individuals aged 50, 60, 70, and 80 years were 5.8%, 10.5%, 19.7%, and 25.1%, respectively. The relationship between the 10-year fracture probability and lumbar spine BMD was negative (r=−0.406). The mean 10-year fracture probabilities for a lumbar spine BMD of under 70%, 70∼79%, and over 80% were 18.4%, 13.9%, and 13.2%, respectively.
We considered that the FRAX cut-off value for reduction of osteoporosis-related fractures was 15%. Although FRAX is useful for screening of osteoporosis patients, we think that the 15% cut-off value is not suitable for patients over 80 years of age.

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The purpose of this study was to evaluate the clinical results of arthroscopic decompression for paraglenoid labral cysts. We retrospectively evaluated 4 patients (all males) with paraglenoid labral cysts treated by arthroscopic decompression between July 2006 and April 2008. The average age was 36 years (range 21 to 50 years), and the average follow-up period was 11.3 months (range 6 to 18 months). All of the patients had shoulder pain on the handedness side, and 2 had weakness on external rotation and atrophy of the infraspinatus muscle. Preoperative MRI showed cystic lesions adjacent to the spinoglenoid notches in all patients, for whom capsular release was performed under arthroscopy. The symptoms (shoulder pain and muscle weakness) were relieved after the operation in 3 cases. Postoperative MRI showed disappearance of the cysts, and no recurrences. We suggest that paraglenoid labral cysts can be treated successfully by arthroscopic decompression.

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We reported two cases of large osteochondritis dissecans (OCD) of the knee after skeletal maturity treated by refreshment of the original beds, drilling, and biodegradable pin fixation of the osteochondral fragments.
In the first patient, a 19-year-old male, left knee pain occurred without apparent cause, after one day he consulted our hospital. MRI of the left knee demonstrated an osteochondral defect in the medial femoral condyle and an osteochondral fragment in the intercondylar fossa. Arthroscopic examination revealed an osteochondral defect measuring about 30×20 mm in the medial femoral condyle. We refreshed the original beds and performed drilling, then fixed the osteochondral fragment with three biodegradable pins. After 8 months, the ROM of the left knee was full, and the patient was able to jog without pain.
In the second patient, a 16-year-old male, the right knee had been twisted while playing handball, and after two days, he consulted us. MRI of the right knee demonstrated an osteochondral defect in the lateral femoral condyle, the lateral discoid, and an osteochondral fragment in the intercondylar fossa. Arthroscopic examination revealed an osteochondral defect measuring about 30×20 mm in the medial femoral condyle. We fixed the osteochondral fragment with four biodegradable pins as the first case. After 7 months, the ROM of the left knee was full, and the patient was able to jog without pain.
Biodegradable pin fixation of the osteochondral fragments with refreshment of the original beds and drilling were effective for these cases of OCD.

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The Taylor Spatial Frame (TSF) is an external fixator used for treating complex deformities by gradual correction with the aid of a computer program. We describe a 22-year-old woman with idiopathic excessive lateral torsion of the bilateral legs was treated surgically using the TSF. Her legs showed 10° varus and 30° lateral rotation deformities on the right side and 7° varus and 25° lateral rotation on the left side before surgery. Percutaneous osteotomy of the proximal tibia combined with resection of 2 cm of the fibula was performed at the age of 21 years on the right side and at 22 years on the left. Correction was started at 7 days after surgery on both sides. The patient suffered temporary superficial peroneal nerve palsy on the right side during correction. Correction was completed at 3 weeks after surgery on both sides. In order to prevent contact correction loss, we lengthened the bilateral tibiae by 1 cm and successively shortened after correction by 5 days. The period of TSF attachment was 14 weeks on the right side and 15 on the left. The patient was satisfied with the outcome of the correction, and her knee pain that had been present before treatment disappeared. This experience suggests that the TSF is very effective for correction of rotational deformity of the legs.

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Recently, microendoscopic surgery has been widely adopted for minimally invasive surgery of the spine. Our hospital has actively adapted microendoscopic surgery for lumbar disc herniation and lumbar spinal canal stenosis since 2008.
We investigated the short-term results of microendoscopic surgery in 54 patients who underwent the procedure between May 2008 and July 2009. There were 20 cases of lumbar disc herniation, and 34 cases of lumbar spinal canal stenosis. The duration of surgery, blood loss, complications, and rates of improvement in the JOA score, along with a visual analog scale (VAS), and the Roland-Morris Disability Questionnaire (RDQ) were investigated. Furthermore, we evaluated the utility of microendoscopic surgery using the Self-Rating Depression Scale (SDS) because of the possible connection of the mental factor with pain. The results showed that the mean duration of surgery was 129 minutes, mean blood loss was 22 ml, and that 3 cases had complications. The mean JOA score, VAS, RDQ, and SDS improved, and the mean JOA improvement rate was 86.9%. While the short-term results were satisfactory, we conclude that the long-term results require careful attention.

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We treated 72 patients (31 males, 41 females, mean age 65.9 years) with PLIF between April 2006 and March 2009. In this series we experienced 3 cases of radiculopathy because of adjacent segment disorders.
The first patient was a 56-year-old woman who developed a lumbar disc hernia at the L5/S level 18 months after L4/5 level PLIF. She was treated surgically by L5/S microendoscopic discectomy (MED). However, 2 weeks after surgery, she suffered lumbar disc hernia at the same level again, and was treated surgically with MED.
The second patient was a 66-year-old man who developed lateral lumbar disc hernia at the L5/S level 6 months after L4/5 level PLIF. He recovered after several sessions of nerve root block treatment.
The third patient was a 68-year-old man, who also developed lateral lumbar disc hernia at the L5/S level 3 months after L3/4 4/5 level PLIF. Nerve root block was ineffective, so he was treated surgically with lateral foraminotomy at the L5 level. However, 3 months after the second operation, the same symptom occurred, and therefore he finally underwent surgery with PLIF at the L5/S level.
Our experience suggests that considerable attention should be paid to the adjacent segment when performing PLIF if the patient has disc degeneration at the adjacent segment, and that the surgical method may need to be changed in such a case.

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A 61-years-old woman who had been receiving hemodialysis for diabetic nephropathy developed sensory disturbance in her lower leg.
Her right plantar area had been burned by a heater two years previously. She has been treated for the wound at a local clinic for two years, but as healing had been unsuccessful, she consulted us. Destruction of the MP-joint of the big toe was observed on X-ray examination. Curettage of arthritis purulenta was performed. After surgery, the patient wore a decompression brace and the ulcer was sprayed with trafermin.
The intractable plantar ulcer was healed 7 months after surgery.

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We report the treatment of two infants with tuberculous osteomyelitis.
Case 1
An 11-month-old girl was admitted because of swelling of the left shoulder and left knee. She had not been vaccinated with BCG. Her uncle, who had lived with her in the Philippines, had developed tuberculosis. MRI revealed a large abscess in the right shoulder.
Case 2
A 2-year-old boy, who had been vaccinated with BCG (Tokyo stain) at 5 months of age, developed swelling of the left hand. The patient had not been in contact with any individuals affected by tuberculosis. Radiography demonstrated an osteolytic lesion and periosteal reaction in the left second metacarpal.
Both patients were diagnosed as having tuberculous osteomyelitis by real-time polymerase chain reaction and received antituberculous chemotherapy after surgery. Case 2 was diagnosed as BCG osteomyelitis.
Tuberculous osteomyelitis should be considered in the differential diagnosis of pyogenic osteomyelitis or bone tumor.

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