Out of 31 consecutive fractures of the tibial shaft in adults, 21 fractures were treated with AO plate fixation. The procedure was indicated except for the transverse or the short oblique type of the fractures in the middle third of the tibia, which were treated with intramedullary nailing. In cases of the comminuted type (15 fractures), bone grafts were used.
Although the complications included the stiffness of the knee joint in one patient and non-union led by premature weight-bearing in another patient, good anatomical restoration of the tibia was finally resulted in every case.
Operative results of the AO plate fixation were considered to be satisfactory, even though postoperative treatment required longer.

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We studied the mechanism of development of osteoarthrosis (OA) of the ankle by roentgenological measurement and compared the finding in OA with those of normal ankles.
In this study, there were two groups, an OA group and a control group. The age of the patient in the OA group ranged from 58 to 77 years (mean age 66.6 years). There were 6 males and 2 females, 5 primary and 3 secondary OA of the ankle. In the control group, the age of the subjects ranged from 9 to 81 years (mean age 26.2 years). We evaluated 242 ankles of 242 subjects. The A-P mortice angle, emprical angle, medical malleolar angle, tibial angle, fibular angle, lateral mortice angle, α-angle, and β-angle were measured in both the OA and the control group.
The A-P mortice angle of the OA and control groups were 66.33±6.62 and 88.59±2.20, respectively (p<0.01). The lateral malleolar angles of the OA and control groups were 78.00±5.79 and 82.38±3.14; these values were significantly different (p<0.05). The β-angles of the OA and control groups were 107.22±5.16 and 101.76±5.20, they were also sibnificantly different (p<0.01).
These results showed that the initial site of the OA of ankle was the anteromedical region of the talocrural joints, which facilitated varus deformity of the ankle with time.

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Usually mallet finger is treated conservatively. When the fragment includes one third or more of the articular surface or is displaced enough, operative treatment is indicated. But existing operative treatments are difficult procedures and the results are uncertain. During a two-year period, we used the extension block method. This method is as follows': Under an image intensifier, the operator reduces the fragment by flexing the DIP joint. A Kirschner wire is inserted in the middle phalanx from the dorsal side of the fragment. Finally, the DIP joint is fixed in extension by another Kirschner wire. After 6 weeks fixation, the Kirschner wire is removed and ROM exercise starts. This method follows Ishiguro's method which was presented in 1987. However two points are differrent. In Ishiguro's method, the DIP joint is fixed in flexion for 4 or 5 weeks. In the 10 cases which we treated, the result according to Nanjo's assessment was exellent in 5 cases, good in 4 cases and fair in 1 case. According to Kanie's assessment, the results were 5 exellent cases, 3 good cases, 1 fair case and 1 poor case.

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We performed 10 fusions of the first carpometacarpal (CM) joints in 10 patients (3 males and 7 females), mean age: 64 years ranging from 29 to 75 years. All patients had clinical and radiological evidences of osteoarthrosis. In the adjacent joints roentgenographic evidence of degenerative arthrosis was present in 7 cases. The mean follow-up period was 2 years and 10 months (range: 7 months to 7 years and 3 months). All patients obtained relief of pain and improvement of pinch and grip strengths and ADL. There was no pseudoarthrosis. No one had increased degenerative changes of the other joints of trapezium. We concluded that arthrodesis is a satisfactory procedure for patients who need a stable and painless thumb.

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We present a case of a 42-year-old woman with traumatic dislocation of the tibialis posterior tendon without bone injury. Her Foot was everted due to a fall from a chair. The diagnosis was comfirmed by the observation of a palpable longitudinal structure overlying the medial malleolus, tenography and computerized tomography.
During the operation, it was found that the flexor retinaculum was not torn, but partially peeled from the medial malleolus, and that the tendon was lying between the peeled retinaculum and malleolus. We performed a sliding bone graft on the medial malleolus, similar to the DuVries method. Five months after the operation, the patient was walking without pain or recurrence.

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We have reported ten cases of epiphyseal plate injury to the distal phalanx of the hand.
The majority of cases involved injuries sustained while playing ball with the middle and ring fingers being primarily effected. As per Tanabe's classification, most injuries were of the Flexion-Fracture, Salter-Harris' type 1, grade 1.
In this injury, since the flexor digitorum profundus tendon flexes the metaphysic into which it is inserted, while the extensor tendon, being inserted into the epiphysis, maintains the epiphysis in the extended position, they tend to become unstable. We selected conservative treatment to avoid damage to the epiphyseal plate, and kept the DIP joint a cotinuous reduction position with a coil splint. Active exercise resumed after three or four weeks, with no pain, no deformity and a normal range of motion being reported in all cases. We have taken these as favorable results.

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We reported one male case of iliac sclerosing osteitis. The case was a 24-year old man who consulted our department because of lumber pain, as a main complaint.
Plane radiograms revealed bilateral sclerosing pictures in the region of the iliac bone which forms the sacroiliac articulation. Similar findings were recognized in the CT. The ^99mTc scintigraphy demonstrated a high density at the bilateral sacroiliac articulation. An unclear low signal area was recognized in the MRI. There was no hematological findings which indicated inflammation. Since the case showed negative in the HLA and B27, no tonic spondylitis seemed to exist.

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One hundred and ninety eight cases of herniated lumbar disc, operated from May 1985 to September 1991 at our hospital, were reported here.
We selected virgin, single level operated cases only. And all cases were estimated Japanese Orthopaedic Association (JOA) score at pre- and post-operation.
All cases underwent operations utilizing the operating microscope and microsurgical technique (modified Caspar's method). The operating time using this method averaged twenty nine minutes. Three recurrences were observed in postoperative periods of five years. There were thirty seven cases impairement of neurological symptoms; lumbago after work, lower leg numbness.
The advantages of performing the procedure under the operating microscope include improved vision and lighting, precise identification of structure in a deep intracanal field, and safe control of bleeing by coagulation.

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This paper presents a case of fibrous osteitis due to parathyroid carcinoma, diagnosis and treatment of the disease are briefly discussed. A 67-year-old woman came to our hospital owing to low back pain and body weight loss. Finger and skull X-P showed typical subperiosteal resorption and granular demineralization. Laboratory data were as follows; serum calcium 14.6mg/dl serum phosphorus 1.6mg/dl serum alkaline phosphataze 2822IU/L, and HS-PTH 23000pg/ml. On physical examination, a small and firm nodule was noted on right anterior neck. Computerized tomography and magnetic resonance imaging showed a tumor at that site. Needle biopsy suggested group 4 malignancy. The tumor was resected en bloc and regional lymph nodes were dissected. The histological diagnosis was parathyroid carcinoma.
At the 7 month after operation, laboratory, radiographic, clinical findings indicated great improvement. Neither local recurrence nor metastasis have been observed.

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We report a case in which tendon transplantation was performed for femoral nerve injery cased by the excision of Schwannoma in the femoral nerve. The patient was 41-year-old man and gait disturbance started as the femoral nerve was amputated when Schwannoma in the retroperitoneal space was excised. As the symptoms were not improved, transplantation of tendons was performed according to the modified Schwartzmann method in which semitendinosus and biceps femoris tendons were attached to the patella by suture. Since one year postoperation, extension of the knee joint became possible enabling the patient to walk by himself.

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A retrospective study of ten patients after ankle arthrodesis for osteoarthritis and rheumatoid arthritis was carried out means of clinical evaluation and roentgenograms after an average follow-up of 7.5 years. The roentgenograms showed that the position after arthrodesis was on average at the right angle. And compensatory hypermobility of midtarsal joint was parallel to the ankle motion.
Five patients had good or excellent result. Although two patients had poor result, in whom arthrodesis had been performed for rheumatoid arthritis. But they confused pain of ankle with the other joints. Our findings suggest that ankle arthrodesis is a good treatment at least for osteoarthritis.

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This paper presents a case of peroneal nerve palsy due to fabella. The patient was a 67-year-old woman with right drop foot. She came to our hospital because of increasing pain and numbness in the left great toe and dorsum of the left foot. Conservative treatment was ineffective. MMT was as follows; tibialis anterior muscle 3 extensor hallucis longus 3+Tinel's sign was detected over the peroneal nerve at the level of the fabella. Motor conduction velocity of the left peroneal nerve across the fabella was 36.6 meters per second. The peroneal nerve was explored surgically and found to stretch over the lateral head of the gastrocnemius muscle bulging with a large fabella.
Two months after extirpation of the fabella and peroneal neurolysis, peroneal nerve palsy was completely cured.

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Percutaneous lumbar posterior medial branch neurotomy is a technique for the treatment of lumbago which is caused by irritation of the posterior medial branch. The needle electrode was located in the groove between mamillary process and accessory process by anteroposterior fluoroscopy. To destroy the nerve a lesion was made with a radio-frequency generator (10W, 20sec, 2times). 32 patients of lumbar facet syndrome and one patient of lumbar spondylolysis were treated with this technique. 20 cases had good clinical course. The cases of multiple facet pain and psychogenic low back pain had poor result.

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Squamous cell carcinoma secondary to osteomyelitis is uncommon, although well documented. The accurate incidence of this complication is difficult to assess, but in patients with chronic osteomyelitis it has been estimated to range from 0.2% to 1.7%. Most patients have a 20- to 30-year history of osteomyelitis with an intermittently draining sinus prior to the development of malignancy. More than 85% occur in the lower extremities, with 50% involving the tibia. Involvement of the hand is relatively rare.
Since metastasis way result in death, amputation proximally to the tumor is a current treatment modality.
We encountered two cases of squamous cell cacrinoma secondary to osteomyelitis. One was a typical case in which the affected extremity was preserved. The other was a female who developed squamous cell carinoma in her finger at three months after the onset of osteomyelitis.

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Abduction and external rotation of the shoulder are often limited in birth palsy. The most consistent deformities of the shoulder are contracture of internal rotation and abduction, we have performed rotational osteotomy of the humerus on seventeen-year-old male with internal rotational contracture of the shoulder. A limitation of external rotation made it impossible for the hand to reach the mouth without awkward abduction and flexion of the shoulder. The follow-up period is 5 months. Bugler position almost disappeared after surgery. He gained good abduction, of 180 degrees and 10 degrees of external rotation. Function of the arm, the hand have been improved.

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From 1977 to 1992, twenty three arthrodesis of the ankle in twenty one patients were performed by means of a transfibular approach in National Misasa Onsen Hospital.
The subjects were twelve patients with osteoarthritis, seven with rheumatoid arthritis, one avascular necrosis of talus, and the other suppurative arthritis.
Union was obtained in twenty of twenty three ankles (87%). The clinical results of nineteen ankles except three ankles of nonunion and one of suppurative arthritis with paraplegia were evaluated by Takebe's method.
Exellent result was gained in six ankles, good in six ankles, fair in six, and poor in one. The patients who gained the good result in activities of daily living had been arthrodesed from five to thirteen degree of equinus. Subtalar bony change was radiographically demonstrated in almost cases but not correlated with the pain.

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Pseudoachondroplasia is a rare skeletal dysplasia resulting in short-limbed dwarfism. It involves the spine, metaphysis and epiphysis of the long bones but not the skull. Dwarfism is not recognized until after the second year of life and the body proportion resembles achondroplasia. However, the head and face remain normal. Some patients develop cervical myelopathy due to atlantoaxial dislocation.
This paper presents a 22-year-old woman with pseudoachondroplasia associated with cervical cord myeloradiculopathy caused by traffic accident. Roentgenography revealed os odontoideum with atlantoaxial subluxation. The subluxation was managed by surgery (McGraw's method), and this improved the neurological signs.
This report demonstrates the importance of early diagnosis and treatment for atlantoaxial dislocation in skeletal dysplasia.

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For 10 years since the opening of our hospital in 1981, hip replacements have been performed in 89 joints. In this study, clinical and roentgenological investigations were periodically performed in 37 joints of 30 cases in which more than 5 years have passed. The subjects were 3 males (5 joints) and 27 females (32 joints). The period of the observation ranged from 5 years to 10.5 years and average period was 6.9 years.
The mean scores according to the judgement by the Japanese Orthopedic Association were 49 points before operation and improved to 84 points at the final investigation. However, in the evaluation of the radiolucent line, stage 3 and 4 (Nagaya's classification) were observed 25% in the cup side and 31% in the stem side. Re-replacement was performed in 2 cases (3 joints, 8%). Therefore, careful follow up will be necessary, because new appearance of the clear zone will increase every year.

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A new surgical procedure, cyst-subarachnaid shunt, was applied to an anterior cervical intradural arachnoid cyst extending from C₂ to C₄ in a 44-year-old woman. Although symptoms were only vague numbness and pain of both upper limbs, MRI demonstrated marked displacement and flattening of the cord due to a large anterior mass which was similar in signal intenisty to CSF on both T₁ and T₂ weighted images. The diagnosis of uncomunicated intradural arachnoid cyst was suspected, because the water-soluble contrast medium did not enter the cyst not only during myelography but also on delayed CT films taken at 12 and 24 hours. Surgical exploration with hemiopen laminoplasty and opening the dura mater from C₃ to C₆ was followed by a cyst-subarachnoid shunt using a silicone tube with plenty of small holes at both ends. The procedure resulted in complete disappearance of symptoms accompanied by morphological restoration of spinal cord on MRI. The shunt procedure could be a choice of treatment when complete removal of the spinal arachnoid cyst is not considered to be easy because of its size and/or site.

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Fracture of the Trapezium is relatively rare. It is reported to account for 3.5-5% of all fractures of the carpal bones. We have experienced to treat 5 cases of fracture dislocation of the carpometacarpal joint, accompanied with vertical type fracture of the trapezium. The treatment was open reduction and Kirschner wire fixation in every case.
Clinical results in 3 cases of the trapezium fracture alone were exellent. However, the result of two elderly women with trapezium fracture accompanied by Bennett's fracture dislocation were unsatisfactory, because they had pain, restricted range of motion and arthritic changes on X-ray films.

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Thirtythree cases with tibial condylar fractures treated in our hospital between 1983 and 1992 were studied. An average follow-up period was 30.2 months. Each fracture was deviled into 6 types according to the classification of Hohl & Luck. Clinical end results were evaluated by functional grade of Hohl & Luck and JOA score. The functional results were acceptable in 90 percent of the cases and an average JOA score was 88.3. The relationship between end results and factors such as age, type of fractures, depression depth, residual depression, therapeutic approach, duration of immobilization and alignment of lower extremity was also evaluated.
The factors providing poor results were aging, inadequate reduction of articular surface and prolonged immobilization. Based on this clinical study, anatomical reduction and rigid internal fixation permiting early knee motion are most important in obtaining acceptable results in tibial condylar fractures.

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We have experienced a case of a relatively rare traumatic dislocation of the extensor tendon of the hand. The injury was caused by worm-flipping motion.
We performed an operation on the next day of the injury occurrence. The operation method we adopted was the knotted suture of the intertendinous fascia and the sagittal band as a lump. In terms of reinforcement, we everted and sutured a part of the extensor tendon to the interosseous tendon. We did not observe recurrence of dislocation at the postoperative 6th month.

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The patient was a 60-year-old man who was admitted to the hospital in August, 1991 because of pain and weakness in his right arm, after it had been injuried. There was a sharply convex bulge near the upper part of the right arm with local tenderness and weakness of flexion of the elbow and supination of the forearm as compaired to the left side. With the patient under axillary block anesthesia, the distal tendon of the right biceps brachii muscle was attached into the right radial tuberosity according to the Boyd and Anderson's procedure. The result has been satisfactory. About three months after the operation, the patient had regained almost complete function of his right arm.

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As total hip arthroplasty for coxarthrosis, recently bipolar hemiarthroplasty or cementless hip prosthesis are mostly coming to be of use though their painelimination does not seem to take effect distinctly. We've been adopting medullary cavity supporting type stem with cement. Since 1988 MX-1 hip prosthesis has been used, which fits well to the medullary cavity of proximal femur of Japanese coxarthrosis. We have this MX-1 type adopted to 91 joints of 81 cases for these 4 and a half years. The average age of the operated patients is 67.7, which is cemparatively high age. After operational develpment condition is good, though it is still short a period. We have not seen the loosening cases, while pain-elimination effect being stable so far.

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Since 1991 automated percutaneous nucleotomy was employed as a treatment for lumbar disk herniation in Ehime University Hospital in limited cases.
All patients were eligible for this procedure if they met the following criteria: (1) the presence of a sciatica that was resistant to conservative treatment over the period of 2 months (2) no sequestrated herniation, no migrated herniation and no spinal stenosis (3) no cauda equina syndrome.
25 patients were available for follow-up examinations over a 2 month period. 18 patients had either excellent or good results, but in 7 patient, this procedure was ineffective.

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We report three cases of interpositional arthroplasty of the metacarpophalangeal (MP) joint of the hand.
Case 1. Fifty two-year-old woman sustained giant cell tumor of the head of the left third metacarpal, and underwent en-bloc resection, iliac bone graft, and interpositional arthroplasty using the fascia of the external oblique muscle. Four years and two months after surgery, she complains minimal pain and the motion of the MP joint is 25°/65°.
Case 2 & 3. Sixty three-year-old man sustained aseptic necrosis of the bilateral metacarpals, and underwent interpositional arthroplasty using the fascia lata. Three years after surgery, he complains no pain and the motion of the MP joints are 25°/50° at the right side and 25°/55° at the left side.
Interpositional arthroplasty using the fascia should be considered as one option of arthroplasty of the MP joint.

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We reported eleven cases of giant cell tumors of bone which were treated by marginal extracapsular curettage and cementation. There was no local recurrence or no infection. Functional results were evaluated accoring to a modified Enneking's functional evaluation system. Six cases were rated as excellent, four were as good and one was as fair. A postoperative pathologic fracture occurred in one case healed by conservative treatment. We recommend the marginal extracapsular curettage and cementation as the first treatment for giant cell tumors of bone with stages 1 and 2.

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Thirtyone patients on chronic hemodialysis developed carpal tunnel syndrome were reported. This syndrome was found in the side of the arterio-venus fistula in 24 hands and the opposite side in 20 hands. All patients complained paresthesia, dysesthesia, nocturnal pain in the hand.
The duration of hemodialysis at the time of the operation was 12 years on an average, ranging from 7 years to 22 years. At surgery, the median nerve was found to be compressed under the thicked transverse carpal ligament in all cases.
The histological examination of synovia and transverse carpal ligaments obtained at the time of operation revealed pale eosin stained fibrous degenerative material (H-E stain) among the fibrous connective tissue. Congo-red stain was positive. It's regarded as an amyloid material.
Surgical decompression of the median nerve at the wrist resulted in the immediate relief of the symptom.

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Intra-articular fractures of the distal radius in adults can be classified into three groups according to the mechanism of injury; 1) Barton type produced by shearing force, 2) bursting type produced by axial compression to the radius, and 3) Colles type produced by oblique force transmitted from the palm. Most intra-articular fractures can be classified as Colles type. In this group, the traction force produces a transverse fracture on the volar side. The compression force produces dorsal tilting on the joint surface with split shell fragment resulting on the dorsal side. Further intra-articular comminutions may also occur. If anatomical reduction is necessary, we think it is, then open reduction is recommended as follows. Firstly, the volar displacement is corrected through a transverse skin incision. Secondary, through a dorsal lazy S skin incision, split fragment is removed. Finally, the dorsal tilting should be elevated carefully and the defect caused by reposition packed with chip bone. From a sample of eight cases the prognosis of this operation is favorable.

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Our hospital reported 11 cases treated with Chiari pelvic osteotomy during 1987-1991. The following are the results: There were 2 male patients and 9 female patient. The average age of the patients at operation was 30.7 years. The average period of follow up study after operation was 3 years and 2 months.
The clinical results were assessed by the JOA score, X-ray and the muscle power of the hip joint measured by Cybex 350.
The average JOA score improved to 90.9 from 71.0; Sharp angle to 44.0°from 51.6°; CE angle to 24.0°from -7.5°; acetabular head index to 78.5% from 46.6% and lever arm ratio to 2.71 from 2.96. The muscle power of the operative hip joint was almost equal to the opposite side.
The result was found to correlate with the JOA score and lever arm ratio, but not with the muscle power of the hip joint.

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Deformity of the forearm is common in patients with multiple osteochondromas, producing cosmetic and functional impairment in which shortening of the ulna is a significant factor. The results of ulnar lengthening with excision of the osteochondromas in three forearms of three patients are reported. In all patients, the cosmetic appearance was improved. In one patient without dislocation of the radial head, clinical result was excellent. But in two patients with dislocation of the radial head, they got deterioration of the forearm movement and pain in the wrist joints after surgery. We propose the new method for reduction of the radial head with ulnar lengthening. Deformities of the forearm should be treated before dislocation of the radial head to prevent disability.

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We performed total knee replacement with Z-plasty of quadriceps for the ankylosing knee in rheumatoid arthritis. The range of motion achieved -5°-85°postoperatively while it was -25°-35°preoperatively. RA knee function score improved significantly from 32 points to 79 points. Though about 10 degrees of extension lag remained, the patients could walk freely with no pain as the muscles recovered. And now they were satisfied without problems in activities of daily living. It may be necessary to have continuous rehabilitation after surgery.

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For 7 years since 1983, 21 male and 17 female patients were treated for pelvic fracture in Onomichi Municipal Hospital and Okujima Hospital. Causes of injury were most frequently in traffic accidents (23 cases), and secondarily in labor accidents (8 cases). The youngest patient was 2 years old while the oldest one was 84 years old. The average age of males was 37.0 years old, and that of females 42.6 yeas old. The follow up period ranged from 6 months to 24 months, with an average of 7.2 months.
According to Connolly's classification, 12 patients were classified as major fractures and 26 patients as minor fractures. Fractures of the extremities were accompanied in 17 patients, and injury of abdominal organs in 6 patients. Hematuria were found in 18 patients. In 12 cases of 38 patients, 200ml to 4800ml of blood was transfused and the average voluml of blood transfusion was 1933ml. In 26 patients with miner fractures, one case was treated operatively but only rest with care was made in 25 patients.
A good clinical result was achieved in all cases with miner fractures. In 12 patients with major fractures, one case was died by hemorrhagic shock. Eight patients were treated by traction and 3 patients were treated by rest care. Eleven patients with major fractures were good in result.

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Since 1981, the compression hip screw technique was used for 116 patients (35 male, 81 female) with intertrochanteric fracture. Average age of the patient at the time of surgery was 76.7 years old (range, 42-95). Average follow up after surgery was 8.0 months (range, 3-47).
In 11 cases, the screw migrated more than 15mm and 6 cases had posterior fragments. Twenty-nine cases had posterior fragments on lateral X-ray view. Twelve cases were treated by setting the anterior cortex in apposition to each other so that the proximal fragment was anterior and migrated 5mm on average, the others migrated 17mm.
It is necessary to set the anterior cortex in apposition to each other for unstable intertrochanteric fractures which have posterior fragments.

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Fibrous dysplasia is known as a benign bone tumor. Mostly it involves in long bones, but rare cases were reported in the spine.
The patient was a 14 years old boy. He had been suffering from low back pain during a period of 15 months. Radiography of his lumbar spine displayed the deformity of L₃ body, and large lytic lesion without marginal sclerosis was found on CT scanning. Technetium scintigraphy showed high uptake of single lesion in the L₃ body. The vertebral body was removed and reconstructive surgery of spinal column was performed in July 1987. Histological diagnosis was typical fibrous dysplasia. Three years and eight months after the surgery, he was asymptomatic.
Thirty seven cases of fibrous dysplasia involving the spine have been reported until now. According to the description, back pain and reffered pain are the main clinical symptoms in monostotic fibrous dysplasia, and spinal deformities and paralysis are major symptoms in the polyostotic type. Histological study is essential to get a final diagnosis. In this lesion, if the structual failure of the spinal column and paralysis occur, surgical reconstruction is needed.

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We reported three cases of large soft tissue tumors of the extremities; a 93-year-old female with malignant neurinoma (941g, 20cm×13cm×14cm) excised after 11 years of tumor formation, a 64-year-old male with malignant fibrous histiocytoma misdiagnosed as hematoma by radiologist 10 months before surgery, and a 56-year-old male with liposarcoma recommended operation 2 years ago.
Leaving these large malignant tumors for a long time is caused by responsibility of doctors and/or patients themselves.

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Three fresh ruptures of the patellar ligament were surgically treated by the modified McLaughlin's procedure. One rupture was open, and the others were closed.
The authors inserted two AO cortical screws into the patella and tibial tubercle, attached to the screws with dual figure-of-eight wire, and pulled down the patella to its original position. The patients started active motion of the knee from one to 15 days after surgery, and bore partial weight from four to six weeks, when extension lag of the knee had disappeared.
In one patient with chronic renal failure, his repaired ligament slightly elongated. In two, their wire broke. But in all, the clinical result was excellent according to the Siwek and Rao's evaluation system at the follow-up, averaged one and one-half year.
The fresh rupture of the patellar ligament may necessitate supplimental fixation between the patella and tibia in addition to ligament repair. Our method could provide more rigid fixation. All patients restored motion of the knee and muscle strength of the quadriceps in their earlier stages.

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In this report, we describe a long term clinical and radiological study on 14 Charnley total hip replacements in 13 patients with osteoarthritis of the hip. Twelve replacements were performed in women while two were in men. The average age at the time of operation was 53.6 years. The average follow-up term was 12.6 years (a period from 10 to 15 years). The average of JOA hip score was 51.5 points preoperatively and 70.4 points postoperatively at the time of follow-up. Radiological studies showed mechanical loosening in 5 sockets (35.7%) and 2 stems (14.3%). The average socket wear was 0.13mm by a year. The rate of mechanical socket loosening was high. Postoperative radiography of 5 sockets which were migrated at the time of follow-up showed incorrect position or unsatisfied cementing of the socket. There were 2 cases in which the socket migrations were difficult to be recognized. So, careful observation is indispensable in radiological assessment of the socket.

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Twenty-seven cases (23 males and 4 females) with rib fatigue fractures after continuous stress were experienced.
The fractures occurred during playing golf in 14 cases, baseball in 4 cases and heavy work in 2 cases. In golfing, 72 percent (11 out of 14) of the cases had fractures within 3 months after they started playing. The lesions were found on the opposite side of their handedness in all cases. The 5th and 6th ribs were most commonly affected. Most of the cases threw more than 200 balls a day. In baseball, fractures occurred on the same side of their handedness during sidethrow in most cases.
Doctor's questions, clinical symptoms, X-ray films, and bone scintigram were useful for the diagnosis, but patient history is most valuable.

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Eight knees of four female cases, with aseptic necrosis in bilateral femoral condyles were reported. Three cases were received steroid therapy for previous diseases. We classfied Magnetic Resonance images (MR images) by the necrosis size and pattern. We compared MR image with the roentgenograms and the clinical symptoms.
Necrosis size in four knees was classified as localized type, and the other four as broad type. And we classified MR images into three patterns.
Five knees were typical band pattern, and two were homogeneous pattern, and the another was inhomogeneous pattern.
No collapse was recognized in cases of the localized type and band pattern type in our cases.

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One case of giant cell tumor of the bone at proximal epiphysis of the tibia was reported. The case was a fifty five-year-old male, who was a blue collar worker. When the diagnosis was made, three months had passed since the onset of pain caused by the tumor. Open biopsy revealed that a giant cell tumor was the most likely diagnosis. Both CT and MRI were helpful to determine surgical margin of the tumor. The tumor was resected as en bloc, that was 8^*8^*8cm in size. The proximal end of the tumor invaded up to subchondral bone of the tibia, and the tibial tubercle had been thinned and elevated. After resection, as well as a large amount of the iliac autografted bone, hydroxyapatite was needed into the bone defect to fill up the space for the substitute. Although no reccurrence was demonstrated at nine months after the operation, follow-up examinations are essential for at least five years.

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In a series of 75 patients with intertrochanteric fractures of the femur, 51 patients were treated by the compression hip screw (CHS) fixation and 24 patients of them were treated by the Ender nailing.
Ender's procedure required less operative time and blood loss than CHS. However, the incidence of failure of fracture fixation was higher, especially with the unstable types of the fracture, in the group treated by the Ender nail. On the other hand, we obtained successful results even with the unstable types in the group treated by the CHS fixation.
It is our opinion that the CHS is preferable in both the stable and the unstable intertrochanteric fractures, although the Ender nail can be indicated for elderly patients of poor risk with stable fractures and is also applicable to elderly patients with unstable fractures who do not necessarily have to gain high activity.

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A survey with questionnaires was made on aged persons at age of 65 or older with 207 returns (average age: 75.3) to find out the cause of falls.
As to the relationship between the kind of cases and the direction of falls such tendency was noted as many sideways falls causing fracture of the femoral neck while many rearward falls causing compression fracture of the spine. It was also noted that when one falls on his/her knee at the time of the falls little fracture of the femoral neck took place.
As one reaches to the age of 75, his/her stability in standing becomes worse and he/she has more possibility of falls. As the cause of the instability in standing, not only knee OA but neurosurgical aspects shoud be taken into consideration.

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From 1976 to 1990, 19 patients (21 knees) under 15 years old received open total lateral meniscectomy in our department. Nine patients (10 knees) directly examined by us were reviewed retrospectively. The mean age of the patients (3 males and 6 females) at operation was 10.1 years (ranging from 4 to 15 years). Meniscus disorders mainly with flexion contracture of the knee included 6 complete discoid, 3 incomplete discoid and 1 semilunar type. Three of them had tear.
The mean follow-up period was 5 years and 7 months. The results were assessed by Kurosawa's clinical score and Appel's roentgenographic grading. The clinical score was 9.7 points on the affected knees and 9.8 points on the opposite knees. Preoperative roentgenographies showed grade 0 in all cases, and postoperatively 7 affected knees were grade I and other 3 knees were grade 0. On the other hand, one was grade I on the opposite side. Postoperative clinical results were satisfactory, but roentgenographically OA changes appeared from an early postoperative period.

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Ganglion cyst is a common cause of wrist pain, but it almost always occurs from a capsule of a joint or tendon sheath, whereas intraosseous ganglion of the lunate is a relatively rare lesion.
Two cases are reported and each of them was a penetrating type ganglion.
In follow-up of the two cases, the operation resulted in relief of pain and return to full function for the duration.

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Almost cases of lumber vertebra fracture-dislocation are frontward, but is rare in backward.
We present a case of a man aged fifty eight, who fell 3 meters to the ground and was imcompletely paralized on the legs. We could recognized a backward dislocation of L2/3 and a burst fracture of L3 vertebral body by an X-ray examinations. We immediately practised hyperextension traction therapy upon him, and it brought about a good reposition after ten days. A dicompression and reconstractive operation was performed after ten weeks due to neurological disorders. After about two years complete recovery was successful. We suggest that hyperextension traction therapy should be a useful treatment for backward fracture-dislocation of the lubmer vertebra.

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Avulsion fractures are relatively rare. We have treated 5 cases of avulsion fracture of the calcaneus during the last 7 years. Of these 5 patients, 1 was male and 4 were female. Their mean age was 74 years. The fracture was caused by falls in 2 cases, falls from a height in 2 cases and another accident while walking in 1 case. In all cases, the fracture was classified as type. In according to the Boehler's classfication. One case was treated by wire fixation and the other cases were treated by internal fixation. Bone fusion was achieved in all cases.
Three cases were examined for osteoporosis based on the X-ray findings and bone mineral contents, using the diagnostic criteria of the Ministry of Health and Welfare. This assessment revealed ostetporosis in all three of these cases. Avulsion fractures of the calcaneus seem to be etiologically associated with the fragility of the bone due to osteoporosis and with the indirect extrinsic force created by a sudden sharp pull exereted by the triceps muscle of the calf.

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We reviewed 20 elbow synovectomies in 15 patients (2 males and 13 females) with rheumatoid arthritis, those follow-up period varied from 2.5 to 11 years (mean 6.2 years). The average age at the time of the operation was 50 years, ranging from 24 to 64. According to the classification of Steinbrocker, two elbow joints were stage I, four were stage II, and 14 were stage III.
Postoperatively pain was diminished in 18 elbow joints (90%) and swelling was reduced in 14 (70%). The mean range of motion was increased in all directions. There was no difference between the results of early and late synovectomies, however, the recurrence of swelling was observed in 6 patients among the late synovectomized group with uncontrolled high rheumatoid activity.
We concluded that synovectomy of the elbow is useful to relieve joint pain and gain the range of motion even for the elbow which have been destroyed. The results of synovectomy seem to depend on not only operative technique but also postoperative rheumatoid activity.

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A case of irreducible dislocation of the metacarpophalangeal joint of the thumb is reported. A 51-year-old woman was involved in a motorcycle accident, recieving a bruise on her left hand. Examination showed that the thumb was swollen and positioned in slight flexion and abduction at the metacarpophalangeal joint. Radiographs showed radial dislocation of the metacarpophalangeal joint of the thumb. Because closed reduction was unsuccessful, open reduction was required. The adductor apponeurosis was interposed between the metacarpal and proximal phalanx, which blocked reduction. The ulnar collateral ligament was avulsed from the proximal phalangeal attachment and folded. The dorsal capsule was also teared extensively. The thumb was immobilized for 6 weeks, and range of motion exercise was begun. A review of literature indicates that this pathologic anatomy has been described only by Stener.

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We treated fourteen distal radius fractures by Kapandji's method from Jan. 1991 to Sep. 1992. The result was compared with that of conservative treatment (manual reduction and plaster immobilization). Clinical assessment included range of motion of the wrist joint, grip strength and the demerit point system proposed by Sarmiento. Assessment of roentgenograms consisted of dorsal tilt, radial inclination and shortening of the surface of the radial end. The clinical result of Kapandji's method was significantly better than that of conservative treatment. In spite of satisfactly initial reduction in both group, the position became gradually displaced in the conservative treated patients, but not in these treated by Kapandji's method.

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