The outcome of conservative treatment of distal radius was evaluated using clinical and radiographic findings in patients treated at our hospital during the past 5 years. Non-comminuted fractures such as chauffeur's fracture and Barton's fracture were excluded from the study. The subjects of this follow-up study were 45 patients, 10 men and 35 women. Of the 45 patients, 39 were treated by immobilization in a cast alone after reduction. Percutaneous pinning was added to the immobilization in 6. Saito's scale was used to rate clinical findings. Radiographic findings of the length, radial angle and volar angle measured on radiograms obtained after removal of the cast were rated with Scheck's rating system. The dislocation of radiocarpal joint surface of the radius was assessed by measuring the degrees of separation and step-off while in the case after reduction. The therapeutic outcome was excellent in 18, good in 19, fair in 7 and poor in 1. The involvement of the distal radioulnar joint coupled with a step-off of 1mm or greater tended to indicate poor or fair prognosis. The clinical score was not associated with age, Scheck's radiographic score, nor the extent of separation.

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We reviewed 9 patients (10 hips) who had undergone a revision total hip replacement (revision THR) during the period from 1988 to 1992. Age at revision THR ranged from 64 to 75 years (average, 70 years).
In this follow-up study, the average pre-revisional and post-revisional JOA scores were 38 and 63 points respectively.
We evaluated the acetabular defects according to Hedley. We had 3 hips to be contained defect, and 5 hips to be noncontained defect. Of them all, 8 hips required additional acetabuloplasty with bone graft to provide bone stock. In 4 hips, revision surgery was performed by cemented acetabular cup.

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The vertebral hemangioma is found in about 10% of general autopsy series They are usually asymptomatic. Clinical problems caused by hemangioma are extremely rare. We reported a case who had hemangioma in her thoracic spine showing the gait disturbance. Her fourth thoracic vertebral body was removed and an auto-bone graft was performed in December, 1987. She was asymptomatic in spring, 1992. In literature, the hemangioma in the vertebra with symptoms is difficult to remove due to severe bleeding during surgery. Recently, the techniques of anesthesia and surgery are advanced. Therefore we recommend the radical surgery for this lesion.

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To determine the pathological structure of herniated intervertebral disc which was enhanced on MRI by using Gd-DTPA, the relation between preoperative Gd-DTPA enhanced MR and histological findings of seven herniated lumbar intervertebral discs (six sequestrated and one extruded) were examined. All of herniated disc materials were enhanced marginally on early postcontrast T1-weighted images. The enhanced area of the disc materials herniated long duration was larger than that herniated short duration. Histologically, there were fibrous granulation tissues with abundant blood vessels around the all of disc materials. The longer the period from the onset to the operation was, the larger the granulation tissue on histologically as well as the enhanced area on Gd-DTPA enhanced MRI findings existed. In conclusion, the tissue enhanced by using Gd-DTPA was granulation around the disc materials.

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External fixation of unstable fractures of the distal radius has produced satisfactory results but has some problems. We studied the indication and the limitation of the external fixation in 33 fractures of the 32 patients.
The dorso-medial fragment (so called “die pumch fragment”) was not often reduced with external fixation technique. Because the dorsal wrist ligaments are not adequate for reduction by ligamentotaxis. Percutaneous pinning or open surgical treatment are necessary for this fragment.
The failure to restore palmar tilt and ulnar variance was concerned with the prognosis. Accurate anatomical reduction is neceesary to provide the good results.
The results appeared to be independent of the type of external fixation apparatus employed (Hoffman, Ace, Clyburn).

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We experienced eight fractures of the coracoid process during the period from 1984 to 1992. Seven cases of them were basal fractures and one case was apical one. Two cases were isolated, being in the other six cases combined with acromioclavicular dislocation or clavicular fracture. One patient with minimally displaced fracture of the coracoid process was treated conservatively. But the others were treated by internal fixation with a cannulated malleolar screw, one of which was inserted percutaneously. Postoperatively, Kenny-Howard type harness was worn in each case for four weeks. The result was satisfactory and all surgical cases were united. Neither infection nor loss of function was observed. These fracutures were assessed regarding the cause of injury, region of contusion, and complicated osseous-articular injuries around the shoulder. From the mechanism of injury, they were classified into two major groups: Group I; direct fracture, group II; indirect fracture. The direct fractures were subdivided into two types: Type I; by force from outside, type II; by force from inside. The indirect fractures were further divided into two types; Type I; by ligamentous traction, type II; by muscular traction. It is recommended to treat operatively if a gap of indirect fracture is five millimeter or more on roentgenograms.

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Since 1986 we have performed arthroscopy of the ankle. Selected patients have undergone operative procedures under arthroscopic technique. A total of 40 patients (14 males, 26 females), 41 joints were studied. The most common diagnosis was old lateral ligament injury of the ankle (14 patients), followed by degenerative joint disease of the ankle, fresh lateral ligament injury of the ankle and fracture of the talus and its cartilage. Tuberculous disease and PVS were definitively diagnosed by synovial biopsy performed during arthroscopy. Eighteen joints have undergone surgical procedure under arthroscopic technique.
The main procedures were partial synovectomy, curettage of the bone and cartilage, drilling and adhesiotomy. The mean post-operative follow up period was 2 years 6 months.
There was distinct improvement in pain. Walking ability and ADL also improved, but there was no appreciable improvement in range of motion. By carefully selecting the insertion site according to the region targeted for examination, arthroscopy was useful in patients requiring an accurate diagnosis and detailed understanding of the involved pathology. Although we have only performed limited surgical procedures under arthroscopic technique as of the present, the distinct improvement in pain post-operatively and the low degree of surgical stress make arthroscopic surgery of the ankle a very useful procedure for selected patients such as athletes who desire the minimal period for treatment.

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Four cases of cervical myelopathy due to calcification of ligamentum flavum were reviewed. There were three females and one male, and the age at the time of operations ranged from 71 to 77 years old. Gait disturbance had be seen severely in all cases. Minimum antero-posterior diameters of the cervical spinal canal on plain X-ray ranged from 10mm to 13mm. CT scan detected calcified masses apparently, and magnetic resonance image (MRI) showed no-signal or low-signal area in the calcification of ligamentum flavum. All cases underwent en block laminectomy for the purpose of complete decompression, and their clinical symptomes improved well. Histologically, degenerative changes of elastic fibers and massive calcification in the ligamentum flavum were observed. The substances of the calcificated tissues were analyzed in three cases and were proven to be calcium phosphate.

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Five cases of Paget's disease were anaylyzed clinically and histopathologically in this study.
Plain X-rays revealed signs of a combined phase in all cases. Bone scintigraphy, performed in 3 cases, disclosed abnormal accumulation in the affected bone. A histopathological examinations, which was performed in all cases revealed a specific mosaic pattern for diagnosis of Paget's disease. However, a typical combined phase was observed in only one case. Two cases were treated by calcitonin and one case by calcitonin and EHDP. Although ALP rose again during long-term drug therapy or after discontinuation of drugs, pain could be controlled well by these drugs. Therefore, these drugs seem to provide an effective means for controlling pain associated with Paget's disease.

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Three cases of polyostotic fibrous dysplasia were reported. A nineteen-year-old male with fibrous dysplasia in the ribs, was treated with curettage only.
Other two cases, twenty one and thirty-year-old females with fibrous dysplasia in the long bones, were treated with curettage followed by the implantation of hydroxyapatite with autonomous bone graft. Clinical results were excellent in all cases and no local recurrence of tumor was seen. Generally, it is difficult to treat polyostotic fibrous dysplasia because of its expanded lesion and its high histological activity.
However, the implantation of hydroxyapatite with autonomous bone graft useful to the expanded lesion of the polyostotic fibrous dysplasia.

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Fifteen patients with lumber spinal stenosis were treated with Cirostazol, a vasodilator, orally administrated at a dosage of 200mg/day for 4 weeks. Clinical effects were evaluated by scoring of low back pain, leg pain, numbness, cold sensation, sensory disturbance, muscle weakness, gait disturbance and total JOA score. The hemodynamic effects on the legs were studied using thermography. Circulatory improvement was noted in 13 patients (86.7%) and neurological improvement in 12 patients (80.0%). Clinical effects were found to be correlated with hemodynamic effects which were characterized by increase of temperature in the leg principally within the foot. Clinical improvement obtained by Cirostazol for the patients with lumbar spinal stenosis was considered to be provied by vasodilatative hemodynamic effects on nerve lesions and the secondary circulatory disturbance in the legs.

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During the last 5 years, we have performed the operation for the torn lateral ligament in 58 ankles of fresh cases. According to Mure's classification, type of the tear of the anterior talo-fibular ligament during the operation could be classified into 7 groups. We compared the findings of our observation between each group according to talar tilt angle measured radiologically. Furthermore, in the cases that talar tilt angles were more than 15 degrees when they were injured, we compared the improvement of talar tilt angle between groups with the calcaneo-fibular ligament repaired and not repaired.
Radiological results of the transverse tear of the anterior talo-fibular ligament (type c) were not good.
In addition to the repair of the anterior talo-fibular ligament, the cases which received treatment of the torn calcaneo-fibular ligament indicated better improvement than those which were not treated for the ligament.
Hence, it is considered from these findings, that if a transverse tear of the anterior talo-fibular ligament with more than 15 degrees of talar tilt is observed, further examination would indicate a calcaneo-fibular ligament problem. These data suggest that it will be better for the patient's long term stability to provide treatment of the calcaneo-fibular ligament as well an talo-fibular ligament.

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Sixty-five patients with birth palsies were retrospectively reviewed in a 35-year period from 1956 to 1991. Patients with birth palsies who had visited our institute did not decrease even in recent years. The distribution of palsies included 50 upper-type palsies, 15 whole-type palsies, and no lower-type palsies. High incidences of upper-type palsy were demonstrated in patients of breech deliveries. Major risk factors of birth palsies seemed to be breech deliveries and large infants.
Reconstructive surgery was performed in three cases, aged 5 to 6 years, with upper-type palsies who had shown no recovery. Stability of shoulder and useful function of shoulder abduction were obtained by Bateman's trapezius transfer, though the transferred sites migrated far distally with growth of the humerus. Excellent function of elbow flexion were reconstructed by modified Steindler's flexorplasty.

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Severe spondylolisthesis induces various nerve symptoms, and frequently requires surgical procedures. Surgery was done by two methods, one-stage operation and two-stage operation.
The Roy-Camille plate reduction by the posterior approach and PLIF and PLF were carried out on a 6-year-old female because of spondylolisthesis in Meyerding grade IV at the L 5.
An 11-year-old female with Meyerding grade IV at the L 5 underwent anteriorfusion after slow reduction by means of halo-pelvic traction and Ohki wire reduction.
We comparatively studied both surgical methods.

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