Posterior condyle fractures of the femur (Hoffa fractures) are generally treated by anterior to posterior-directed screw fixation. However, such screw fixation sometimes failes because of poor bone quality. To enhance the fixation strength, posterior buttress plate was used, and the clinical results including union time, ROM of the knee joint and gait ability were estimated. Although all cases were geriatric fractures, the reduction position was maintained without any displacement. Therefore, the posterior buttress plating method appears to be advantageous in this setting.

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Calcaneal fractures in children are quite rare. We report the treatment of a calcaneal fracture in a child at our hospital. The patient, a 9-year-old boy, jumped from a height of 2.5m height and suffered right heel pain. X-ray and CT examinations revealed a calcaneal fracture, showing a tongue-type fracture pattern by the former modality and Sanders type 2B by the latter. Bohler's angle was 32°, and joint displacement was 5 mm. We attempted manual reduction under general anesthesia 4 days after injury, but the displacement could not be corrected. Therefore we employed the Westhues method. Bohler's angle was thus reduced to 40°, and the joint displacement to 1 mm. The fracture became united after 12 weeks, which included splint application for 4 weeks and non-weight-bearing for 4 weeks. Fractures of the calcaneus are rare in children, with an incidence of only 1 in 100,000 fractures, and are traditionally treated non-operatively. There is some debate regarding the patient age and the degree of displacement that would necessitate more aggressive treatment.

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Traumatic separation of the distal humeral epiphysis is rare injury in infant. We report a case in which ultrasonographic examination provided adequate diagnosis of the injury and state of the reduction. A 6-month-old boy was injured with rotary shear forces. Plain radiographs revealed that the proximal radius and ulna maintained an anatomic relationship to each other but were displaced posteriorly and medially in relation to the distal humerus. Ultrasonographic examination of both the injured elbow and the opposite uninjured elbow was carried out. The scans confirmed the epiphyseal separation and its displacement in the longitudinally along the length of the elbow from the lateral, anterior and medial side. We diagnosed his condition as separation of the distal humeral epiphysis (Salter-Harris type 1). Open reduction by using the lateral approach and the fixation with 3 percutaneous pins laterally placed was performed. Intraoperative findings were the same as ultrasonographic examination. And the state of the reduction and fixation were compared with the opposite uninjured elbow ultrasonographically. The pins were removed in 4 weeks and the cast removed 6 weeks.
Ultrasonographic examination is non-invasive and can easily be performed on an infant at outpatient. It can provide adequate diagnosis of the cartilaginous epiphysis.

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Fractures of the proximal humerus represent approximately 0.45% of all pediatric fractures and 4%-7% of all epiphyseal fractures. We report 2 children who underwent conservative treatment for fractures of the proximal humerus.
Case 1 : A 12-year-old girl fell from some playground equipment. Plain radiograph demonstrated fractures of the proximal humerus (Neer classification, 2-part surgical neck, and type II by the Salter-Harris classification, with more than 90 degrees of varus deformity and 80% limb-length discrepancy). She was treated conservatively with a fitted external fixation brace for 6 weeks.
After 4 months, plain radiograph demonstrated 60 degrees of varus deformity and 30% limb-length discrepancy. However, she had no disability with shoulder function.
Case 2 : A 15-year-old boy fell down from his bicycle and twisted his left shoulder. Plain radiograph demonstrated fractures of the proximal humerus (Neer classification, 2-part surgical neck, and type II by the Salter-Harris classification, with 30 degrees of varus deformity and less than 30% limb-length discrepancy. A large bone fragment was observed). He was treated conservatively with a fitted external fixation brace for 6 weeks. After 3 months, plain radiograph showed that the deformity had been corrected and that the third bone fragment had disappeared. The patient had no disability with shoulder function.
The proximal growth plate of the humerus is known to be the most active physis of the whole skelton. In most cases, proximal humerus fracture can be cured without residual disability or functional problems, and also cosmetic results are good. Remodeling potential is considerable, and is related to the age of the patient.
This report has described good result of conservative treatment for fractures of the proximal humerus in children.

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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are invariably associated with substantial blood loss during or after surgery. To avoid allogeneic blood transfusion, autologous blood is obtained preoperatively when THA or TKA is scheduled. To determine the appropriate amount of autologous blood to be taken before surgery, we investigated the extent of intraoperative and postoperative blood loss, and the proportion of cases requiring allogeneic transfusion.
Eighty-eight primary THAs and 92 primary TKAs were included in this study. For 65 of the THAs (73.9%) and 67 of the TKAs (72.8%), autologous blood was donated according to the guidelines of the Japanese Society of Autologous Blood Transfusion. The mean volume of total blood loss was 1,120ml in the THA group and 460ml in the TKA group. Allogeneic transfusion was performed in 28 of the THAs (31.8%) and 21 of the TKAs (22.8%). The rate of usage of postoperative allogeneic transfusion decreased in accordance with the increase of the amount of autologous blood that had been stored.
Storage of more than 600ml and 400ml of autologous blood for THA and TKA, respectively, is sufficient for avoiding allogeneic blood transfusion. Further effort is required to reduce intra- and postoperative blood loss in patients who cannot donate a sufficient amount of autologous blood.

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We reported a case of subtrochanteric femoral shortening osteotomy in coxa breva with total hip arthroplasty (THA). A 73-year-old woman suffering from hip dislocation (Crowe type III) had significantly limited excursion with a leg length discrepancy of approximately 60mm. We performed subtrochanteric femoral shortening osteotomy with THA, and leg lengthening by 36mm was confirmed postoperatively by X-ray examination. Bone union was achieved in the osteotomy area at 4 months after THA, and the JOA score was improved from 51 points to 76 points, without nerve paralysis. However, this procedure has some associated problems such as a complex surgical maneuver, non-union and delayed rehabilitation. Subtrochanteric femoral shortening osteotomy with THA is useful for osteoarthritis of the hip with severe contracture, high dislocation, and coxa breva.

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We report seven cases of spontaneous spinal epidural hematoma (SSEH). The patients comprised 2 males and 5 females with an age range of 4 to 88 years (average, 63 years). The SSEH was located in the cervical and thoracic region in 4 and 3 cases, respectively. Three patients recovered without surgical intervention, but three required posterior decompression. One patient who suffered complete paralysis was treated conservatively because of liver cirrhosis and pulmonary hypertension, and there was no neurological recovery. Our experience suggests that thoracic hematoma likely has a poor prognosis.

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Cervical vertebral fracture with spinal cord injury is a potentially lethal form of trauma. However, in cases of polytrauma, a cervical vertebral fracture might be missed, or diagnosed only later. Here, using postmortem computed tomography (PMCT), we investigated the possible presence of cervical vertebral fractures in patients transferred to us because of traumatic cardiopulmonary arrest. Radiological investigation was performed on 74 such patients between March 2005 and March 2012. PMCT was done in 68 of the 74 patients (51 males and 17 females; average age 55.8 years). Parameters investigated included the mechanism of injury, cause of death, use or non-use of cervical spine CT, use or non-use of cervical multi planar reconstruction (MPR), and presence of cervical spine injury. The most common cause of injury was traffic accidents, followed by falls. Cause of death was obtained from the death certificate diagnosis; traumatic shock accounted for the majority of cases. Cervical MPR was performed in 37 cases; only axial in 15 cases. Cervical CT was not available in 16 cases. Cervical spine injury was apparent in 11 cases, and in 7 cases there was a possibility that cervical spine trauma was involved in the cause of death. In traumatic CPA, as cervical spinal injury may not be properly diagnosed, further investigation is considered necessary.

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We experienced 6 cases of lumbar spinal canal stenosis after compression fracture, for which we performed microendoscopic laminectomy. We examined the usefulness of this approach.
Materials and Methods: We assessed 6 patients who underwent microendoscopic laminectomy between April 2009 and April 2012. The operation was a single-sided approach with bilateral decompression under the METRx system. The parameters examined were the JOA score, Face Rating Score (FRS), the angle and the degree of intervertebral motion before and after the operation, and at the time of the last investigation.
Results: The average JOA score was improved by 8.3 points to 21 points and the average FRS was improved by 5.7 points to 3.0 points. All cases thus showed improvement. The angle of intervertebral motion was 4.8-4.6 degrees, and the degree of intervertebral motion was 0.75-0.98mm. There was no evidence of aggravated instability causing lumbago.
Conclusion: This series revealed neither aggravation of instability nor aggravation of lumbago after surgery.

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We carried out an epidemiological survey of acute traumatic spinal cord injury sequentially from 2009 to 2011. Data were obtained from 37 hospitals where orthopedic surgeons were working. The mean collection rate was 83.8%, and a total of 297 patients (mean age 64.0 years) with traumatic spinal cord injury were identified. The peak frequency of spinal cord injuries occurred in the 70-79-year age group. On the basis of the Frankel grading for classification of palsy, 41 patients(14%) were classified as Frankel grade A, 27 (9%) as grade B, 88 (29%) as grade C and 142 (48%) as grade D. Traffic accidents, falls, and falls from height were the most common causes. Cervical level injuries were found in 239 patients (80.5%) among whom 155 (64.8%) had no bone injuries in the cervical spine. On the other hand, 58 patients had thoracolumbar injuries and all of them had fractures or dislocations. The annual incidence of spinal cord injury in Kochi prefecture was 124.7 per million. These results indicate that spinal cord injuries in the elderly will likely increase in Japan because the aging of the population in Kochi is progressing much more rapidly than in Japanese as a whole.

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Spinal fixation surgery can be associated with postoperative hematoma and excessive bleeding, often requiring allogeneic blood transfusion. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that prevents the breakdown of fibrin, thereby stabilizing blood clots and reducing blood loss in conditions that promote fibrinolysis. It has been demonstrated that administration of prophylactic TXA in cardiac surgery, total knee arthroplasty, and scoliosis correction reduces perioperative blood loss and transfusion requirements. However, clinical data for the efficacy of TXA in spinal surgery are limited. Therefore, the objective of this study was to evaluate the effect of TXA on perioperative blood loss and the requirement for transfusion of blood products in spinal fixation surgery. Thirty-one patients were allocated randomly to either a TXA group (1,000 mg infused before surgery) or a non-TXA group. Intraoperative and postoperative blood loss was not significantly reduced in the TXA group relative to the non-TXA group. In the TXA group, however, no patient required blood transfusion. There were no complications related to the use of TXA in either group. Although TXA did not have a significant impact on the management of intraoperative and postoperative blood loss in patients undergoing spinal fixation surgery, a large comparative trial is needed to further assess the relative efficacy of TXA in spinal fixation surgery.

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We investigated the therapeutic results of posterior fusion (fixation) surgery and video-assisted thoracoscopic surgery (VATS) for thoracolumbar spine transitional burst fractures with anterior and posterior elements.
The subjects were 12 patients who each underwent surgery on one vertebral body (T11: 1 case: T12: 7 cases; L1: 4 cases) at our hospital between 2004 and 2012. Ten patients were males and two were female; the mean age was 49 (18-69) years. In each cases, the parameters investigated were operation time, intraoperative blood loss, number of days until ambulation, postoperative complications, and period until bone-union.
The mean operation time for posterior surgery was 140 minutes, and mean blood loss was 250 ml. For anterior fusion via VATS, the mean operation time was 246 minutes, mean blood loss was 779 ml, and the mean period until ambulation was 3 days.
While sufficient training is required for VATS, our results suggest that it is a useful and minimally invasive form of surgery.

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We evaluated the clinical results of treatment for distal radius fracture (AO classification C3) with a volar locking plate. Twenty-seven patients (10 men and 17 women, mean age 61.4 years) were treated with a volar locking plate between October 2008 and October 2011. The mean follow-up period was 11.2 months. We used a SmartLock in 15 cases, VariAx in 7 cases, VA-TCP in 4 cases, and AcuLock in one case. K-wire additional fixation was undertaken in 2 cases, and artificial bone grafting in 6. An external fixator was used temporarily and eliminated after internal fixation in 7 cases.
All cases showed good bone union. The clinical evaluation according to the Mayo wrist score was excellent in 4, good in 20, and satisfactory in 3. All the satisfactory cases had resulted from high-energy trauma, traffic accidents, or falls. These cases lost 5-12 degrees of radial inclination and 4-20 degrees of volar tilt.
We consider that volar locking plate fixation might be a good method for C3, although in some cases of high-energy trauma, the clinical results tend to be less favorable.

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We report a 62-year-old man who was pierced by buttons and rivets through his middle finger tip. There have been no previously reported cases of piercing by metal buttons and rivets attaching to jeans. The rivet is fixed to the shape by the same crushed after that the other side has a slightly larger diameter head on one side of the cylindrical body, through the hole in the object. Be integrated with jeans buttons and rivets join, remove easily, I will not be able to. I found that the diameter is sandwiched between the teeth of the pliers to the skin surface of the button is larger than the rivet can be removed easily and knead.
Finger block anesthesia should be performed for reducing the pain associated with surgical removal. The wound should be washed thoroughly after removal and tetanus toxoid injection administered, leaving the wound open.

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We compared and analyzed the operative results of compression hip screw (CHS) with those of peri-trochanteric nail (PTN) in treatment of unstable trochanteric fractures of the femur. We performed retrospective analysis of unstable trochanteric fractures of the femur using CHS on 9 cases and compared the results with those of 13 cases of PTN fixation. All cases were operated between April 2007 and March 2012 and followed for minimal 2 months. All cases were classified using the Jensen classification. The mean period of follow up were 6.3 months (2 to 12) and 5.8 months (2 to 19), respectively.
We are aiming at trying for the anatomical reduction of anterior cortical bone. We evaluated the cephalic position of the femoral head screw, the tip-apex distance (TAD), the degree of postoperative sliding, the operation time, and bleeding amount, postoperative mobility, postoperative C-reactive protein (CRP), and complications.
The average operation time was significantly shorter in the PTN group than in the CHS group. The average amount of bleeding, TAD, and postoperative sliding were significantly lesser in the PTN group than in the CHS group. However, there was no significant difference in the postoperative mobility and CRP between two groups. All cases got bone union. And there was no case of cutting out of lag screw in the two groups.
There was no statistically significant difference in the clinical results between two groups. If there was got the good anatomical reduction, there was no statistically significant difference in the clinical results in the treatment of unstable trochanteric fractures with both implants.

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The purpose of this study was to identify the risk factors for non-infected non-union after femoral nailing. A case-control study of 18 fractures was conducted. There were 5 fractures in the non-union group and 13 in the control group.
All the fractures were type A2 or A3 by the AO classification. Mechanism of injury, whether the fracture was located in the most narrow portion, smoking, contact of the cortex, length or diameter of the intramedullary nail, timing for loading, any episode of dynamization, and the time until final fixation were examined retrospectively.
The results confirmed the importance of making a conscious inner fixed bony contact at the initial operation. As a result, the transverse screw has been removed in the early postoperative period, and a case that may have led to non-union of the fracture stability is compromised, and that the definition of dynamization adaptation should be discussed.
conclusion: Be carried out within a fixed to obtain a bony contact for the first time of surgery is important.
For example, inserting a transverse locking of a sufficient number, to increase the stability of the fracture.
We believe that there is room for reconsideration for the adaptation of dynamization.

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A 53-years-old man injured his left foot while walking, and the great toe was forced into dorsiflexion and varus. Radiographs showed dorsal-medial dislocation of the great toe distal phalanx. Several attempts at closed reduction were unsuccessful. An open reduction was therefore carried out via the dorsal approach. The capsule was ruptured and dislocation of the interphalangeal (IP) joint was observed. The sesamoid bone was found to be displaced over the proximal phalangeal head. A curved spatula was inserted between the proximal phalangeal head and the sesamoid. The flexed IP joint allowed reduction. After the reduction, the joint was unstable in the varus direction, and therefore lateral collateral ligament injury was suspected. A Kirschner wire was placed longitudinally across the IP joint for three weeks post operatively to help hold the reduction. At six weeks of follow-up radiography showed no varus instability. Three months after surgery, the patient has no complaints with almost normal function.

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Negative pressure wound therapy (NPWT) has been used until definitive coverage of wounds becomes possible.
We employed NPWT for management of soft tissue injury associated with open fractures, degloving wounds, compartment syndrome and soft tissue necrosis after surgery for trauma. NPWT was used for 22 patients (14 men, 8 women) including three who had infection after surgery. All of the patients achieved wounds healing, and NPWT was used for 16.6 days until definitive wound coverage or epithelization. NPWT is thus effective for treatment of soft tissue trauma.

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Lipoma arborescens is a rare lesion, typically arising in the knee. It shows a predilection for the supra-patellar pouch of the knee joint, but can also occur in any area of the knee joint and other joints. Lipoma arborescens is widely recognized to have a pathognomonic appearance on MR imaging. This includes a frond-like synovial mass that is iso-intense relative to fat with all sequences (including fat-suppression sequences), and joint effusion. MRI also often reveals subchondral bone cyst and/or bone erosions, and there may be a correlation between lipoma arborescens and chronic inflammation or degenerative change, for example that in osteoarthritis. However, no correlation with rheumatoid arthritis have yet been reported. We described a case of histologically proven lipoma arborescens in the supra-patellar pouch and infra-patellar area of the knee with severe synovitis characterized by CD 68 reactivity of sub-synovial giant cells. During follow-up, bilateral carpal and inter-phalangeal joint swelling appeared, and ACR/EULAR RA score jumped from 3 to 7 points. Therefore, methotrexate treatment was started, and the patient's symptoms improved gradually. Although there have been few reports of lipoma arborescens, the evidence suggests that if severe inflammation is proven histologically, clinicians should be mindful of the possibility of RA.

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Coxitis knee refers to knee osteoarthritis caused by ipsilateral or contralateral hip joint disease, while long leg arthropathy (LLA) occurs contralateral to the affected hip joint and requires treatment that takes into consideration the alignment of both lower limbs. Here we report a case of rheumatoid arthritis with valgus deformity and severe knee flexion contracture caused by LLA.
A 68-year-old woman consulted us in 2011 because of right gonalgia accompanied by impaired motor function. On examination, severe pelvic inclination due to terminal-stage coxarthrosis on the left was observed. Consequently, valgus knee deformity with a femorotibial angle of 162 degrees, and flexion contracture of 50 degrees were observed.
In order to achieve support in the lower limbs, the patient was informed that total knee arthroplasty (TKA) followed by total hip arthroplasty (THA) would compensate for the limb length discrepancy. Left THA was performed two months after completing posterior-stabilized type TKA on the right knee. As a result, the patient had good limb function. With regard to the treatment of LLA, even when the chief complaint indicates a knee joint disorder, the need for simultaneous treatment of the hip joint disease for correction of the bilateral lower limb alignment should be considered and explained to the patient.

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The clinical practice guideline by the Japanese Society of Nephrology in 2012 has recently recommended that patients with chronic kidney disease (CKD) should avoid non-steroidal anti-inflammatory drugs (NSAIDs) whenever possible. The purpose of this study was to investigate the prevalence of impaired kidney function and NSAID prescriptions in patients undergoing elective orthopaedic surgery in a university hospital.
A total of 241 adult patients (mean age 67 yr；range 24-92 yr) were included in the study. Impaired kidney function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m². NSAIDs were prescribed mainly by orthopaedic residents and fellows for postoperative pain management.
Sixty-five patients (27%) had impaired kidney function preoperatively, and its prevalence increased significantly with age. In 39 (60%) of the 65 patients with impaired kidney function, NSAIDs were prescribed regularly for more than 5 days after surgery.
CKD is now recognized as a growing global public health problem. This study showed that a considerable number of patients undergoing elective orthopaedic surgery used NSAIDs regularly afterwards. Orthopaedic surgeons should be more aware of the potential risks associated with regular use of NSAIDs in patients with CKD.

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Between April 2003 and December 2011, 78 of 865 patients with proximal femoral fracture were given conservative treatment at our institution. We were able to follow-up 76 of these 78 patients (23 males and 53 females).
In-hospital death occurred in 19 patients (25% of the total patients). The average hospital stay was 41.6 days for survivors who were eventually discharged, and it was 19.7 days for those who died in-hospital. The six-month survival rate was 57.9%. For 44 patients who were still alive at six months after their injury, activities of daily living (ADL) was reduced in 29 patients (65.9%). The survival rate decreased as ASA classification severity increased.
When dealing with patients with inoperable proximal femoral fractures, life-saving treatment and general care should be the primary concern. In addition, cooperation with other departments is essential.

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After internal fixation of the femoral trochanteric fracture using short femoral nail, shortening of fracture site induced lateral projection of the lag screw, thus developing a risk of decubitus. Removal of nail may therefore become necessary, but in patients whose condition is worsening, any additional operative invasion may pose a problem.
The Inter Blade Nail System (IBN, Nakashima Medical Co., Ltd., Japan) is a medullary nail for the femoral trochanteric fracture enabling shortening of the lag screw. Here we report two cases for which lag screw shortening was performed to avoid excessive telescoping after the operation.
The first patient was a 73-year-old woman who underwent the procedure 14 months after the operation. Lateral projection of the screw was reduced from 23mm to 12mm, and the operation time was 20 minutes. The other patient was a 93-year-old woman who underwent the procedure 15 months after the first operation. Projection of the screw was reduced from 27mm to 16mm, and the operation time was 15 minutes.
Both procedures were accomplished easily, and the implant useful was considered useful for these elderly patients who had a high risk of developing decubitus.

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The purpose of this study was to investigate the sinking distance of the intramedullary nail in case of femoral trochanteric fracture. Since January 2009, intramedullary nails have been used to treat femoral trochanteric fracture in 38 patients. There were 34 females and 4 males with a mean age of 83 years at surgery. Gamma 3 systems (Stryker) with a U-lag screw implant were employed in all cases. Fracture stability was assessed in terms of medial bone contact evident on 3D-CT, and the reduction was assessed by radiographic evaluation in lateral view (Ikuta's classification). Patients were classified into four groups according to whether or not medial bone contact was evident in the lateral view classification. The nail sinking distance and the filling ratio of the stem in the femoral canal were examined at four weeks after the operation, and statistical analysis of inter-group differences was conducted. The mean nail sinking distance was significantly shortest in the group with medial bone contact and the A+N subtype. There were no significant differences among the four groups in the stem filling ratio. The group without medial bone contact and the subtype P group were each classified into two groups on the basis of the stem filling ratio (80%). The filling ratio was related to the sinking distance in these two groups. The present findings suggest that the stem filling ratio plays an important role in nail sinking, specifically in patients without medial bone contact and the subtype P group.

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To clarify the clinical results obtained with the use of short femoral nails for femoral trochanteric fracture, we investigated the relationship between the type of reduction and the amount of lag screw telescoping in 47 hips (7 men and 40 women). The average patient age at the time of surgery was 85.3 years (range 74-95 years). Nine types of reduction were classified on the basis of the antero-posterior (AP) and lateral views on X-ray films. The amount of telescoping was significantly increased when the proximal fragment was found to be displaced posteriorly in the lateral view. In the AP view, there were no significant differences among the groups. The present results suggest that prevention of posterior displacement of the proximal fragment at the time of reduction is important for minimizing the amount of telescoping.

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Extension contracture of the metacarpophalangeal (MP) joint can impede grasping and pinching function. When non-operative measures fail to gain flexion of the joint, surgical intervention is sometimes required. We report two cases for which capsulectomy of the MP joint was performed because hand therapy and splinting for over six months had not been sufficiently effective. A dorsal approach was applied in both cases. We resected the dorsal capsule and released the bilateral collateral ligaments of the MP joint and volar pouch. Transient pin fixation of the MP joint was applied for one week, and after removal of the pin, hand therapy was initiated. Reacquisition of flexion was satisfactory, but there was slight residual extension lag. Grasping and pinching function in both patients was improved adequately, and they were satisfied with the outcome.

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The present study was conducted to evaluate the natural history of rotator cuff tears monitored by MRI. Thirty-eight shoulders diagnosed as having rotator cuff tears by MRI were treated conservatively. More than six months after diagnosis, we performed MRI again. The oblique coronal view showed that 31.6% of the tears increased in size by more than 5mm/year. Shoulders that had 1～3-cm tears initially showed a significant increase in the mediolateral dimension compared with ～1-cm tears (P<0.05) and>3-cm tears (P<0.01). Tears that measured 1～3-cm initially showed a significant increase in the anteroposterior dimension compared with>3-cm tears (P<0.05). Furthermore, localized tears in the posterior part of the superior facet showed a significant increase in the mediolateral dimension compared with tears localized in the anterior part of the superior facet (P<0.05) and widespread tears in the superior facet and middle facet (P<0.05). Tears localized in the posterior part of the superior facet showed a significant increase in the anteroposterior dimension compared with widespread tears located in the superior facet and middle facet (P<0.05). These results may be useful for determining the indications for conservative treatment or operative treatment.

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In this study we compared the effectiveness of perioperative axillary brachial plexus blocks performed using either a landmarked-based (LM group, n=20) or an ultrasound-guided approach (US group, n=20). Patients in the LM group received 28ml of 1% mepivacaine around the circumference of the axillary artery located by palpation of the pulse.
In the US group, nerve location was performed using ultrasound. The ulnar, median, radial, and musculocutaneous nerves were each blocked separately with 7ml of 1% mepivacaine.
At the start of surgery, 14 patients in the LM group needed an injection of local anesthetic at the incision point, compared with 11 patients in the US group. Furthermore, 6 patients in the LM group needed intravenous pentazocin anesthesia, compared with 2 patients in the US group. The numbers of patients needing general anesthesia in order to complete the surgery were 3 in the LM group and 1 in the US group.
Ultrasound-guided axillary brachial plexus block may be more effective than a landmarked-based approach.

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Cervical pedicle screws (CPS) have superior strength to other approaches, but have a potential risk of neurovascular trauma. A navigation system is able to aid correct CPS insertion, but does not control final screw insertion. We inserted CPSs via a guide wire under navigation system control in 15 patients using cannulated screw system, and 56 CPSs were inserted. Postoperative CT scan was used to analyze the screw displacement, and Neo's classification was applied. Grade 2 and Grade 3 screw displacement was defined as mal-insertion, but no screw was found to be displaced. One screw was broken 3 months after the operation in a patient with athetoid cerebral palsy. Breakage of the guide pin did not occur. The advantage of a cannulated screw system is to reduce the probability of deviation of the CPS. However, it is necessary to be aware that the strength of the screw itself is weakened.

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Recently, the percutaneous pedicle screw (PPS) has been introduced. We performed thoracolumbar posterior spinal fusion using the PPS under navigation based on minimally invasive surgery. During 12 months from March 2011 through February 2012 we performed thoracolumbar posterior spinal fusion using the PPS for 14 thoracolumbar vertebral fractures resulting from trauma. We analyzed the outcome of these cases in terms of the period until surgery, the injury severity score (ISS), operation time, bleeding volume, range of fixation, and presence or absence of vertebroplasty. With regard to the period until surgery, the day of injury accounted for the most cases (n=4), and 60% of cases were treated surgically within 3 days. The average ISS was 24, and the average operation time was 143 (86-264) min. The average blood loss was 92 (10-296) ml. Range of fixation of 2 intervertebral level was accounted for the most cases (n=5). Seven cases were treated by vertebroplasty. We conclude that the PPS is useful for treatment of thoracolumbar vertebral fractures in cases of trauma because of its minimal invasiveness, minimal associated bleeding, and short surgery time.

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The purpose of this study was to clarify the outcomes of balloon kyphoplasty (BKP) for patients with osteoporotic vertebral compression fractures. Two males and eight females (mean age 75 years) underwent BKP at our hospital between January 2011 and September 2012. Non-union was observed in all patients at initial consultation. The preoperative and postoperative VAS scores were 6.6 and 3.2, respectively. The JOABPEQ was improved after surgery. Cement leakages were found in six patients, and six new vertebral fractures occurred after BKP at adjacent vertebrae. Patients with and without new fractures were compared in terms of age, pre- and postoperative VAS, bone mineral density, and local spine kyphosis angle. However, there was no significant difference between the two groups.

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