An evaluation of 39 patients with acute injury of anterior cruciate ligament was carried out with associated meniscal tears. Lateral meniscus tears and medial meniscus tears were seen in 38% and 18% of the patients, respectively. Lateral menisscus tear was frequently a vertical one of the posterior horn in its midsubstance and was left it alone because of small size tear. On the other hand, medial meniscus was torn in the middle section and frequently was operated arthroscopically.

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We carried out arthroscopic surgeries in 31 knees of 29 patients with osteoarthritis who did not respond to conservative therapy.
Satisfactory results were obtained in 23 of 31 knees with a mean follow-up period of 20 months.
The outcome was better in the 18 knees with meniscal tears than the 13 knees without them.
Four knees of the 9 knees with femoro-tibial angles which were more than 180°, had poor results and subsequently high tibial osteotomy or total knee arthroplasty. Of the knees without varus deformity, only one knee had total knee arthroplasty. particularly effective for the patients with meniscal tears or normally aligned knees.

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Three patients (four knees) with total knee replacement (TKR) following high tibial osteotomy (HTO) are reported. Mean age was 67 years and average period between HTO and TKR, 75 months.
Eversion of the patellar mechanism at operation had been diffcult, the primary reason being that the patellar tendon was abnormally short. Radiography indicated the average patellar index to be 0.91 (range, 0.84 to 1.09), as measured by the Insall-Salvati index. In two knees, lateral retinacular release was early required to facilitate eversion of the patella and patellar tendon.

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Thirty-seven patients with a total of 39 hips affected by Legg-Calvé-Perthes' disease were treated in conservative fashion. The follow-up period ranged from 5 to 18 years and 7 months, and averaged 9 years and 2 months. The average age at first visit was 6 years and 5 months.
We determined the number of head-at-risk signs and the Catterall classification using a radiograph obtained during the initial period of treatment. The CE angle, articulo-trochanteric distance, acetabular head index and epiphyseal index were measured on the final radiograph, and assessment was made using Stulberg's criteria. Five hips were in Catterall group 2, 25 in group 3, and 9 in group 4. Twenty-one of the 39 hips (53.8%) were in Stulberg class 1 and 2 at final follow-up. Of 5 hips initially in Catterall group 2, good results were obtained for 4 (80.0%), however, only one from 9 hips in group 4 (11.1%) showed good in results and other 8 hips in poor. Of 25 hips in group 3, good results were obtained for 16 (64.0%) and poor results for nine. The number of head-at-risk signs was also determined. If two or more head-at-risk signs were found, the result of treatment tended to be poor. Of 18 hips in patients under 6 years of age at first visit, good results were obtained for 11 (61.1%), and other 3 hips had final assignments to Stulberg group 4 or 5. Significant correlations were found between Stulberg radiographic classes and each of Catterall group assignment, the number of head-at risk signs and the age at fist visit.
Nineteen hips treated with the Snyder sling was compared with another group of 15 hips treated with the Pogo stick. Good results were obtained for 11 hips (57.9%) of the former group and 8 (53.3%) of the latter. The difference between the two groups was not significant. But if only cases in group 3 are considered, treatment with the Pogo stick yielded better results.
These findings indicated that it is necessary for this disease to follow carefully even in patients under 6 years of age at first visit.

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The results of Chiari pelvic osteotomy have been examined in a group of patients with persisting acetabular dysplasia.
The age of the patients at the time of operations ranged from 9 to 15 years, and the length of follow-up ranged from 2 to 11 years.
Clinical results were excellent in one case, fair in 2 cases and good in 4 cases according to Colton's criteria.
The average CE angle improved to 48° from 9°, and the Sharp angle to 35° from 46°. Our results show that Chiari pelvic osteotomy is effective in relief of pain.

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Serum and urinary Mo, Cr, Ni and Co concentration was examined in patients with total hip replacement (THR) by a method using a flameless atomic absorption spectrometer. This method is highly sensitive to allow measurement at the ppb level. The subjects were consisted of 28 patients; 11 patients with Müller type, and 17 patients with Charnley type. Mechanical loosening was observed in 7 patients but not in the other 21. The mean postoperative period was 9.3 years. On the other hand, 19 healthy controls without any implants were also examined.
The serum and urinary Mo, Cr, Ni and Co concentration in the group without mechanical loosening were similar to those in the healthy control group. However, the urinary Ni concentrasion in the group showing severe loosening of the prosthesis was significantly higher than in the group without loosening and control. Therefore, high Ni accumulation seemed to be dangerous for patients with decreased renal function.

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An autologous blood transfusion is very useful for decreasing problems associated with homologous blood transfusion in elective orthopedic surgery. In this study, we evaluated methods of preoperative transfusion with autologous blood stored as liquid blood in patients undergoing elective hip surgery. Thirty-nine patients (44 hips: ALB group) aged 36-79 years (mean 58.6 years) received autologous transfusion, 21 patients (21 hips: HLB group) aged 35-80 years (mean 64.5 years) did not receive preoperative transfusion of autologous blood. In 27 of the ALB group, and 2 of the HLB group, homologous transfusions were avoided.
We conclude that preoperative transfusion of autologous blood is useful in elective hip surgery.

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Since 1990, we have used the predeposited autologous blood transfusions for elective orthopaedic surgery. This series consisted of 63 patients, 29 men and 34 women, who suffered from various diseases (19 with spinal canal stenosis, 17 with aseptic necrosis of femoral head, 10 with osteoarthrosis of hip or knee joint, 17 with other orthopaedic conditions). The average age was 55 years (range, 12 to 88 years). The operations included 29 implant arthroplasties, 23 laminectomies, and 11 other procedures. All patients who had a hemoglobin of more than 11mg/dl without any infection and tumors deposited blood for autologous transfusion. An average of 392ml of blood was obtained. In 43 patients (68 percent), only autologous blood was required for transfusion. No complications were encountered in this study except one patient with transient vertigo.
We conclude that the autologous blood transfusion is a simple, safe and useful method for orthopaedic procedures in which homologous blood may be needed.

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A case of thoracic outlet syndrome with abnormal first rib and thrombosis in the subclavian artery was treated by removal of the first rib and thrombectomy of the subclavian artery. A 54-year-old man complained of a swelling in the left supraclavicular region. X-ray examination revealed abnormal first rib, which formed a non-union between the first and the second rib. Angiography showed complete obstruction of the subclavian artery with collateral circulation. Based on clinical symptoms and X-ray examination he was diagnosed to have thoracic outlet syndrome. Resection of the abnormal first rib, thromboendarterectomy of the subclavian artery and thrombectomy of the brachial artery were performed. During the operation, abnormal shape of the first rib, pseudoarthrosis between the first and the second rib and fibrous band overlaying subclavian artery were found. From pathological findings of the thrombus, the thrombosis of the subclavian artery had grown for about one year. About one year ago, the patient had sustained a traumatic thumb amputation which was treated with pediculed flap. Following the surgery his shoulder was immobilized for 3 weeks. It is suspected that the shoulder immobilization was a trigger of thrombosis in the subclavian artery.

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We report a case of spinal cord infarction with acute onset of right scapular pain radiating to the sternum. Serial magnetic resonance imaging (MRI) revealed an abnormal signal intensity in the cord at the levels corresponding to the neurologic deficits in the patient, whereas CT-myelography failed to demonstrate any abnormalities. Ten days after admission, the T2-weighted images (T2WI) demonstrated an abnormally increased signal in the anterior aspect of the cord at the same level. Gadolinium-DTPA enhanced T1WI revealed cord enhancement at a level of Th1/2 intervetebral disc and Th2 vertebral body. One hundred and twenty-eight days following admission, T1WI revealed decreased signal in the anterior aspect of the cord from the Th1 to the Th2 vertebral bodies. The T2WI showed reduction of the increased signal intensity area compared with the T2WI taken on the 10th admission day. Axial T1WI showed decreased signal in the anterior portion of the cord at the level of Th1/2 intervertebral disc and Th2 thoracic spine. In consideration of the neurologic examination and MRI findings in this case, the patients was diagnosed with a spinal cord infarction of Th4.

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We have treated 6 cases of unilateral facet dislocation and fracture-dislocation of the cervical spine.
Operative treatment were performed in 2 cases, and the other 4 cases were treated conservatively. Clinical results were almost identical for both treatments, but radiographically, the operative treatments produced better results. We have also seen some unusual movements and/or subluxations in patients treated conservatively.
We conclude that it is difficult to maintain anatomical integrity in a patient with such injuries using a Halo-vest.

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We examined the upper cervical spine of three patients with RA by MRI before and after operation. The posterior atlanto-axial fixation was performed in one case, and occipito-cervical fusion was performed in two cases. Anterior atlanto-axial subluxation and mild compression of the spinal cord by inflammatory lesions behind odontoid process were observed in all cases before operation. However, post operative MRI showed inflammatory lesions were decreased or almost disappeared and no compression of the spinal cord was seen. We suspected the effect of the upper cervical fusion on reduction of the inflammatory lesions. These findings suggest that some RA patients with reductive atlanto-avial subluxation can be operated only by atlanto-axial fixation without laminectomy of the first cervical spine, even if preoperative MRI showed mild spinal cord compression by inflammatory lesions.

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From our recent experience, we report a case of spinal extradural angiolipoma, which is an extremely rare spinal tumor.
The case was a 67-year-old man presenting spastic gait, numbness of both lower extremities and dysuria. Physical findings in the first examination were hypalgesia and vibratory hyposensitibity below thoracic myelomere 8 level, hyperreflexia and pathologic reflex of lower extremities as well as muscular weakness of right lower extremity. High signal spindle-type occupying lesions at the Th₅∼Th₆ level was found in sagittal plane of simple MRI and in T1-weighed images. These findings were more clearly revealed by enhanced-MRI. Forward-shift of dura matter by pressing from behind was also noted by CTM.
From the above, the case was diagnosed as spinal extradural tumor at the Th₅∼Th₆ level and was put on tumorectomy. Pathohistologically, diagnosis was made as angiolipoma, and these MRI·CTM findings in the present case are thought characteristic of the present disease.

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Osteoporotic thoracolumbar burst fractures are rarely complicated by neurological deficits. Recently the treatment of these fractures has been controversial. A 69-year-old woman developed paraparesis in June 1991 with no previous history of trauma. Radiograph demonstrated a burst fracture of the 11th thoracic vertebra and myelography disclosed incomplete blockage of contrast column at this level. The CT scan demonstrated retropulsion of vertbral fragment into the spinal canal. The patient had a past medical history of chronic viral hepatitis type C. If the patient's general condition permited, anterior decompression and stabilization seemed to be the most reasonable treatment at that time. However, we had to chose a minor invasive surgery because of the complications. We planned and carried out a modified decompression surgery without spinal instrumentation. Two years and five months after the surgery she recovered from Frankel grade C to D despite her kyphosis not being corrected nor stabilized. The kyphosis was assessed using the Cobb method on the lateral radiograph. Her preoperative kyphotic angulation was 16° and progressed to 21° at the time of the follow-up. Anterior decompression is an essential factor for neurological recovery, however, in exceptional cases stabilization is omissible.

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We treated surgically 4 cases of thoracic myelopathy caused by ossification of yellow ligament and 1 case by calcification.
There were 2 males and 3 females. The duration between the occurrence of symptoms and the operation ranged from 2 months to 10 years (average, 32 months). The average age at surgery was 63.6 years.
The method of operation was a simultaneous decompressive wide laminectomy by Kirita.
The average JOA score of preoperation was 5 points and that of postoperation was 8.8 points: the meas recovery rate was 63.4%.
This operation for these thoracic myelopathy treated by wide laminectory achieved successful results, however, they were influenced by duration of the history rather than severity of preoperative clinical symptoms.

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Fractures of the femoral neck in children are much rarer than those in adults, and usually the results are not so good. We treated a transepiphyseal fracture of the proximal femur of a child.
The patient, a supposedly battered child, was 8 months old. She had many ecchymosis on her face and ears and her right hip was swollen. She cried when her right lower extremity was moved. Radiographs and arthrgraphy of right hip showed a displaced transepihyseal fracture of the capital femoral epiphysis. The patient underwent closed reduction and internal fixtion with three Kirschner wires, and a semidouble hip spica was applied. The cast was removed from the her 4 weeks after the operation, and the wires in 7 months. After 15 months she had almost full range of motion.
The incidence of the complications, such as avascular necrosis, coxa vara, premature epiphyseal closure and non-uninon was high in chidren. Avascular necrosis caused most of the poor results. For these reasons we must follow up on the patient but at present she is doing well.

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A follow-up study of osteosynthesis was conducted in 15 patients (5 men and 10 women) who had a intracapsular femoral neck fracture. At surgery, the mean age was 57 years (range: 20 to 75 years). The average follow-up period was 4 years and 2 months (range: 3 months to 15 years and 8 months).
According to Garden's classification, 3 cases were in stage I, 5 in stage II, 4 in stage III and 3 in stage IV. Three kinds of osteosythesis devices were used: cannulated hip screw for 8 cases, compresssion hip screw for 4 and cancellous screw for 3.
There was no case of non-union of the intracapsular fracture of the femoral neck and 2 cases of valgus deformity of the femoral neck: one in stage III and the other in stage IV. Late segmental collapse of the femoral head was observed in only one case in stage IV. Evaluation of hip joint function by J. O. A. score showed 88 points on average.
It was concluded that anatomical reduction of the displacement and solid fixation were required and that the fixation device should be removed more than 2 years after osteosynthesis, if possible.

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Avulsion fractures of the tibial tuberosity are uncommon fractures observed most frequently in adolescents. Over the past twenty-six years, we have treated eight of these fractures in eight patients, and reviewed seven of these cases in this paper.
All were boys; ages at the time of the fracture ranged from fourteen to sixteen years. All sustained fractures during sports activities. By Watson-Jones classification, four patients had Type-I, one Type-II, and three Type-III fracture. All of them were treated with open reduction and fixation with a screw or Kirscner-wires.
At 11 years follow-up, two patients had a loss of range of motion of less than 10°, but had no limitations in sports activities. The others had no limitations in various daily life and sports.
All patients had equal leg lengths and none had roentogenographic evidence of premature closure or overgrowth of the tibial epiphysis. In two patients with a full range of motion, however, a tendency toward patella baja was noted.

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Fourteen patients with tibial condylar fracture were assessed by magnetic resonance (MR) imaging. MR imaging demonstrated meniscal disruptions or ligamentous tears acompanied with fractures as well as the site and the extent of the fracture depression or displacement. Lateral meniscal disruptions were detected in six of fourteen patients and tears from peripheral attachment at the anterior portion were most common. Lateral meniscal disruption was frequently acompanied with split depression of laretal condyle. Ligamentous tears were detected in three fractures. In cases remaining condylar depression, ariticular surface has become smooth more than a year after the operation, which suggests fibrocarilage repair.

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We evaluated the methods and the results of surgical treatment in nine patients with tibial plateau fractures. The average follow-up period after surgery was 13.2 months (range, six to 27 months). All fractures were treated by anatomical reduction and internal fixation. The resultant metaphyseal bone defects following open reduction of the articular fracture fragments were filled with autogenous bone graft and/or interporous hydroxyapatite in four patients. Two patients had concomitant ACL injuries (avulsion fracture of the tibia), primary repair was performed. Four patients had concomitant lateral meniscal tears, treated by partial meniscectomy in three patients and meniscal suture in one patient. The average duration of cast immobilization after surgery was 3.3 weeks, (range 1-5 weeks). The clinical results were evaluated using the criteria proposed by Hohl and Luck. In the anatomic grade, all patients had excellent results. In the functional grade, there were seven excellent, one good, one fair, and no poor results.

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Extraskeletal Ewing's sarcoma is a rare soft tissue tumor composed of small round cells. We report a case of extraskeletal Ewing's sarcoma in the left thigh.
Chemotherapy, radiation therapy and hyperthermic therapy were performed preoperatively. On MRI taken after preoperative treatment, the tumor was decreased in size and was not enhanced by Gd-DTPA. These findings suggest that the tumor was necrosed by the preoperative treatments. MRI was very useful for showing the tumor area and for assessing the preoperative therapeutic effects.

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We examined twenty-nine patients (18 males; 11 females) with soft tissue tumors by needle biopsy and analyzed its usefulness and problems. Fiftenn patients had benign tumors, six had benign tumorous lesions and eight had malignant tumors. In twenty-six cases (89.7%), it was possible to obtain enough tissue mass by needle biopsy for diagnosis but impossible in three cases which had cystic or necrotic lesions. Of the twenty-six cases in which enough tissue was obtained, in twenty-three cases (88.5%) a distinction could be made between benignity and malignancy. It was impossible to establish distinction of malignancy in three cases including those of fibrosarcoma, and of desmoid and myxoid liposarcoma. In twenty-three cases with determined beignity or malignancy, nineteen cases (82.6%) achieved final diagnosis but in four cases open biopsy was necessary. (for diagnosis). There were no major errors in diagnosis of benignity or malignancy. In conclusion, needle biopsy is convenient and a useful method to make histological diagnosis of soft tissue tumors.

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The following is a report on the exceptional results achieved in a case of interosseous ganglion of the talus when Hydroxyapatite was used after removal of the lesion.
The patient was a 30 years old female, whose chief complaint was pain in the right ankle. The X-rays taken at her local hospital revealed unusual shading in the interosseous region, so the patient was readmitted. Further X-rays revealed sclerotic change accompanied by a cyst shadow with a clear boundary in the lower cartilage of the interosseous region, roughly circular, and of diameter approximately 1cm.
Operative, treatment commenced after referral bone scintigram, CT and MRI. Upon operation, it was confirmed that a gelatin-like substance was issuing from the focus. The lesion was dignosed the interosseous ganglion through histological examination. The patient returned to the job of the teacher without the ankle pain, at the present of postoperative 7 months.

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Ganglions is a soft mucin-filled cyst, which is usually attached to the adjacent underlying joint capsule, tendon or tendon sheath. A rare case of a forty-six-year old female with intraosseous ganglions of the bilateral lunates was reported.

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Three cases of eosinophilic granuloma were reported in this study. The patients were 5-year-old girl who presented with pain in the left buttock, 5-year-old boy with pain in the right thigh, and 4-year-old boy with pain in the right hip joint. X-ray films and computed tomographic scans revealed lytic lesions in the left ilium, in the right femur, and in the right ischium, respectively. Technetium scan demonstrated abnormal accumulations in these lytic lesions. Curettages were performed and all patients were diagnosed as having eosinophilic granuloma. No additional treatment was performed since the lesion was considered to be solitary. These patients have been disease-free more than 12 years, 6 years, and 1 year, respectively.

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Background
Enchondroma is a benign bone tumor having a predilection to develop in the bones of the hand. A total of 27 cases of solitary enchondroma was diagnosed at our department and as operative method in all the cases bone grafting was made following curretage of enchondroma. Of thease cases, study was made on 11 cases on whom follow-up observation could be made.
Methods
The subjects of the present study were 27 cases whose age at time of surgery ranged from 6 to 72 with a mean of 35.9. Pathological fracture was observed in 12 cases. The 11 cases on whom follow-up could be made were evaluated in accordance with Takigawa's criterion having five items, that is, pain, deformity, R.O.M., grip power, and radiologic change.
Results
Evaluation of excellent was made in 5 cases, good in 4 cases, fair in 2 cases, and poor in none of the cases. No cases of recurrence or malignant transformation has been observed, but in 2 cases enchondroma was observed in other bones of the hand.
Conclusion
Bone grafting following curretage is an effective and extensively utilized method of treating enchondroma. Long term postoperative follow-up observation is necessary for enchondroma.

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Limb salvage surgery was performed for 27 patients with locally aggressive or malignant tumors of the extremities or limb girdles. The average follow-up time was 28 months in 5 bone sarcomas, 31 months in 2 giant cell tumors, 23 months in 5 patients that died and 20 months in 11 patients still alive after resection of soft tissue sarcoma, and 11 months in 5 metastatic bone tumors. The initial limb salvage rate was 81.5% excluding patients with metastatic bone tumor. Complications related to the therapy occurred in 50% of the patients during the early phase after surgery and 28.6% during the late phase. Additional surgical procedures were required in 26.7% of the patients in the early phase and 14.3% in the late phase. Skin problems in the early phase and infection in the late phase were the most frequent complications. Only one patient required amputation for infection occurring in the early phase. Local control was unsuccessful in 14.8% of patients. Distant relapse was observed in 19% of the patients except for one patient with stage III B soft tissue sarcoma and 5 patients with metastatic bone tumor. Eighteen patients have survived without sign of the disease.

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Using the posterolateral approach (Tsuge's method), we can obtain wide exposure for arthroplasty of the elbow joint.
We performed this surgery for 4 cases of osteoarthrosis (OA) and 5 cases of rheumatoid arthritis (RA), and evaluated post-operative clinical results by Japanese Orthopaedic Association score (JOA score). The average duration of follow-up was 11.8 months.
The average JOA score improved from 49.0 to 69.5 in the OA cases and from 44.0 to 69.4 in the RA cases. There were a few unsatisfactory results among the OA cases due to instability secondary to splitting of the lateral collateral ligament and overuse after returning to work. In the series, all RA cases were late stage and relief of pain allowed improvement in refine. We considered arthroplasty effective for late stage RA.

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The fresh cases of the buttonhole deformity have been treated conservatively, but the results were not always satisfactory. We operated on two cases and were satisfied with the results. We also studied the extensor apparatus at the proximal interphalangeal joint (PIPJ) by using specimens obtained from amputated hands and five hands of cadavers. The study confirmed that the dorsal plate consisted of the dense connective tissue and was thicker than the extensor tendon at the PIPJ. Considering the clinical results and the structure of the extensor apparatus at the PIPJ, surgical repairment of the ruptured dorsal plate would be a choice for the buttonhole deformity.

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We report three cases of the second metacarpal flap for treatment of the skin defect of the hand. The second metacarpal artery can be identified intraoperatively and the flap survied without any trouble. The procedure is not technically demanding and the reverse flap can be raised to cover the distal skin defects. The flap can be mobilized to the proximal interphalangeal joint of the index and middle fingers. We conclude the second metacarpal flap is the reliable flap for treatment of the skin defects of the hand.

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Tuberculous tenosynovitis of the hand is uncommon in comparison with other parts of the body. The authors have encountered six cases of the last seven years.
Three were males and three were females, ranging from 43 to 76 years old. The duration of symptoms varied from two months to four years. Two cases were bacteriologically, but four cases were diagnosed only by pathological examination. In one case, only anti-tuberculous chemotherapy was done, and only synovectomy was done in two cases. The other three were treated by synovectomy and chemotherapy.
One of two cases treated only synovectomy recurred three months after the surgery, and underwent radical tenosynovectomy and anti-tuberculous chemotherapy.
Tuberculous tenosynovitis is difficult to diagnosed in earlier stage. Whenever tuberculous tenosynovitis is suspected, radical synovectomy should be carried out and the resected specimen should be examined bacteriologically and pathologically. The decision to begin the chemotherapy should be made earlier on the histopathological basis.

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Since 1990, we have treated hallux valgus by corrective osteotomy, according to the Hammond procedure (modified Mitchell procedure). The results of this surgery were recently analyzed. The subjects of this study were 9 patients (for a total of 12 feet receiving surgery), including 2 males (2 feet receiving surgery) and 7 females (10 feet). The ages at the time of surgery ranged from 16 to 66 years (mean: 36.5 years). The postoperative follow-up periods ranged from 2 months to 3 years and 6 months (mean: 1 year and 11 months). In these subjects, we examined postoperative changes in the hallux valgus angle and the intermetatarsal angle (M1-M2) in comparison to their preoperative values. Taking into account the presence/absence and severity of pain and complaints pertaining to the use of shoes, an overall assessment of surgical results was made, using the Glynn's criteria.
The mean hallux valgus angle was 35.4 degrees before surgery and 19.8 degrees after surgery. The intermetatarsal angle was 15.3 degrees before surgery and 10.1 degrees after surgery. No patient developed non-union. According to Glynn's criteria, 7 feet were rated as excellent, 5 feet as good and no feet were rated as unsatisfactory.
The modified Mitchell procedure is recommended for surgical treatment of hallux valgus on the grounds that its results are stable and satisfactory.

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We reported a case of ossification at the insertion of both Achilles tendons which is reportedly rare condition.
The patient, forty-seven years old, suffered from severe pain at the insertion of bilateral Achilles tendons. He had no systemic, metabolic, or inflammatory disease and there was no history of trauma or surgery. He was successfully treated by excision of ossified mass in both Achilles tendons.
In this case, the etiology of ossification may be secondary to minor trauma at the insertion of Achilles tendon. The ossified mass is usually asymptomatic and needs no treatment, but if it becomes painful, the excision of it should be considered. The recurrence of ossification is rare, but the careful course observation of this condition should be required.

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In the last five years, we have treated three cases of traumatic dislocation of the peroneal tendon due to sports.
Two were surgically treated by the Hirota's procedure, which used the plantaris tendon to reconstruct the peroneal tendon.
In the third case, displasia of the plantalis tendon, both the achilles tendon and the plantaris tendon were used in the reconstruction.
In this case, the wating period between the operation and renewed sports activity was longer than that of the other cases.

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10 patients treated surgically with acute ruptures of the lateral ligaments of the ankle are reported. At an average of 30.3 months after sugical treatment, clinical and roentgraphic examination were undertaken. The results were satisfactory but there were some minor symptoms such as, occasional slight pain, functional instability, loss of range of motion, and some tenderness.
There was some relation between minor symptoms and stress roentgraphic findings.

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The results of operative treatment for 78 fracture-dislocations of the ankle joint were assessed. According to Lauge-Hansen classification of ankle fracture, 25 (32%) were SER type, 33 (42%) were PER type, 6 (7.7%) were SA type, 10 (12.8%) were PA type, and 3 (3.8%) were PD type.
Noncomminuted spiral fractures of the fibula were fixed with an intramedullary K-wire combined with half circular wire fixation, while fractures of the medial malleolus were fixed using the tension band technique. Immobilization with a plaster cast was maintained for 4-5 weeks postoperatively.
More than 85% of the patients showed a good result by radiographic and objective assessment.
We conclude that satisfactory results can be obtained by anatomical reduction of the fibular and medial malleolar fractures, and that delayed mobilization is not an adverse factor as long as satisfactory anatomical reduction is maintained.

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We report 21 cases of stress fractures which were treated at our department during 1990-1993. There were 16 male and 5 female patients. The average age of the patients was 15.7 years.
Causes of fractures were most frequently running (males) and basketball (females). The tibial bone were most commonly affected. In one of the cases, we report a rare stress fracture of the femoral neck in a 15 year old boy.
This was a compression fracture.
The importance of the early diagnosis is emphasised in order to prevent several complications.

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High tibial osteotomy is a reliable method for relieving pain in the varus osteoarthritic knees. The success of the operation depends in large part on obtaining satisfactory postoperative alignment. Many studies emphasized excellent stability and alignment achieved by an external fixator. We used the Orthofix external fixator which was a unilateral device containing a ball and socket joint, and used half pins. The Orthofix external fixator was found to be useful in maintaining alignment as well as in diminishing the complication of peroneal nerve palsy et al.

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Charnley compression arthrodesis was carried out in 19 patients because of osteoarthritis, rheumatoid arthritis, pyogenic arthritis and tuberculos arthritis of 11 knees and eight ankles. Charnley clamp was kept for an average of eight weeks and plaster cast was used for additinal three or four weeks in 16 patients in whom solid fusion were seen. Another three patients had delayed union and received radical debridement, bone graft and/or muscle flap operation. 27 weeks later, complete union was obtained.
Pyogenic or tuberculos arthritis were in 11 patients. One-stage arthrodesis was carreid out in six patients and two-stage procedure in five and re-operation such as radical debridement was performed in two and one, respectively. In one case of failed total knee replacement by infection, time to complete fusion was 14 weeks.
We concluded that Charnley compression arthrodesis is the most reliable for arthrodesis of the knee ane ankle, and is useful as a salvage procedure after failed total knee replacement.

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Selective nerve root blocks and radiculographies of 59 nerve roots were performed for lumber radiculopathies between October 1989 and August 1993.
The age of these patients ranged from 15 to 81 years old (average age, 55.1 years).
This method was effective for 41 cases in whom 23 cases were treated by nerve root decompressive surgery and 18 cases conservatively.
Diagnoses of the operation group were lumbar disc herniation (n=14), lumbar canal stenosis (n=9).
Diagnoses of the conservative treatment group were lumbar canal stenosis (n=17), lumbar disc herniation (n=1).
This method was useful for diagnosis of the pathological level in 41 cases and for treatment in lumbar canal stenosis.

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Meralgia paresthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve, clinically characterized by burning, stinging and tingling sensation of the outer side of the thigh.
We have studied SNAP (sensory nerve action potential) of 6 patients (three females, three males). The ages of these patients ranged from 16 to 65 years old (averaging 36.5 years). These patients had tenderness or Tinel sign at the Inguinal Ligament. We stimulated the nerve at the proximal and distal sides of the Inguinal Ligament and recorded the findings. These recordings were taken at points 10∼15cm from the anterior superior iliac spine.
On the affected proximal side, the amplitude of SNAP were lower than the unaffected side. In conduction velosity, there was no significant difference between the two stimulation points.
Recording of SNAP (especially the difference of the amplitudes) were useful in the diagnosis of Meralgia Paresthetica.

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This paper describes the clinical results of percutaneous electrical cauterization of the postero-medial branch of the spinal nerve root for lumbar facet joint pain. Between 1990 and 1993, we treated 31 patients using this procedures. There were 21 males and 10 females with an average age of 63.1 years. The mean follow-up period is 15 months.
The clinical results were evaluated by Japanese Orthopaedic Association score excluding neuroogical signs and subjective leg symptoms. This score has 20 full points. At the time of admission, mean score is 7.2 points. At the time of discharge and follow-up, the mean score is 15.6 and 14.8 points respectively. A favorable clinical response was achieved in most of cases. Although 8 patients had lower points 5 months after the procedure compared with that at the time of discharge, the degree was not as much as before the treatment. The results show that this treatment is not invasive procedure and effective for lumbar facet joint pain.

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The following is a report on operative treatment performed in our hospital in the last 5 years on 5 patients undar 15 years old, all suffering lumbar disc herniation. Four of 5 cases had some cause of onset. Strong tension signs were present in the cases. The average recovery rate was a very pleasing 93.3%, and all 5 patients are currently attending school, suffering no difficulties in their daily lives.

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The following is a report on operative treatment performed on 3 patients suffering posterior separation ring apophysis of the lumbar spine. Two cases were of a chronic nature, and the other, an acute onset. The condition occurred due to, in the chronic cases, repeated minor trauma during growth to the end plate of the vertebra, an anatomical weak point, and in the acute case, was the result of application of sudden external force to this same point.

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Nine patients with idiopathic thoracolumbar and lumbar scoliosis were treated with Zielke instrumentations and additional posterior fusions. The average age of patients was 14.0 years old. The mean follow-up period was 32.4 months. Their curves before operation averaged 54.6 degrees, and at follow-up 11.8 degrees. The correction rate was 76.8%. The average rotation of apical vertebrae (according to Nash and Moe's method) was 40.1% before operation and at follow-up 19.0%. The mean tilt angle of lower end vertebrae was corrected from 26.1 to 7.3 degrees.
With this method, we had good results in terms of correction of scoliosis. The rotation of the apical vertebrae and tilt angle of lower end vertebrae was corrected to some extent, but not satisfactory. Zielke instrumentation seems to have advantages in the correction of scoliosis, lordosis, rotation of apical vertebra, and tilt angle of lower end vertebra with minimal fusion. The problem is, however, how to decide the range of fusion. The question must be posed whether is is better to correct the alignment of vertebral columns more accurately or to keep more motion segments unfused.

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We reviewed 20 cases of lumbar canal stenosis that required reoperation in our hospital during the past 12 years. There were 11 men and 9 women whose ages ranged from 43 to 76 years at the time of the first decompression surgery (average, 60.9). Secondary surgery had been performed on an average 3 years 2 months after first decompression (range, from 4 months to 13 years). The stenoses had been classified as degenerative stenosis, degenerative spondylo-listhesis or post-operative stenosis. Initially, fenestration had been performed in 9 patients and laminectomy in 11 patients. Laminectomy (with or without diskectomy) was performed as the secondary surgery in all patients. The causes of recurrence were recurrent stenosis (n=9), insufficient decompression (n=5), stenosis at other vertebral levels or on the opposit side at the same level (n=3) and lumbar disc herniation at the laminectomy site (n=3). Of the 9 patients with recurrent stenosis, 7 patients showed bone regrowth at the site of decompression. Bone regrowth of the laminal arch may cause recurrent stenosis.

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The exceptional results obtained when treating multiply operated backs with the transpedicular fixation system were reported.
Since 1991, 12 cases have been treated at our hospital; 9 males and 3 females, ranging in age from 20 to 72, with an average age of 45.6. Initial operative diagnosis consisted of 8 lumbar disc herniations, 3 cases of lumbar canal stenosis and 1 spondylolysis. The Steffee VSP implant system was used in 5 cases, the Dynalok fixation system in 6, and PLF was used in all cases. The follow-up periods ranged in duration from 2 months to 2 years and 7 months, with an average of 1 year and 1 month. The results were based on the assessment criteria of the Japanese Orthopedic Association. According to this scoring, there was an average improvement from a pre-operative 13.6 to a post-operative 25.0, giving an overall average improvement rate of 72.7%. Two of the 12 cases incured post-operative infection, but they have been improved by sustained lavage and removal of the lesion.

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The lumbar disc herniation in the elderly has been said to be relatively rare, compared with the younger. Lower activity of the lumbar spine and lower liquidity of the nucleus pulposus of them are given for the reason.
On the other hand, in most of these cases of lumbar disc herniation in the elderly, the less spondylotic changes has been said to be seen and the height of lumbar disc to be kept in proportion to their age.
Our report shows the lumbar spondylotic changes as a phenomenon of aging in the cases of sixty or over of lumbar disc herniation.

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We performed corrective multiple osteotomy and intramedullary rod fixation on the bilateral femora and tibiae of a 4-year-old boy with osteogenesis imperfecta (OI) who had marked locomotive disturbance resulting from fragility and deformity of the lower limbs. Nailing was performed with a 3.2mm diameter telescoping rod for the right femur, and with a 3mm diameter Kirschner's wire for the left femur and both tibiae. Forward flexure of the right tibia subsequently recurred, resulting in cutting of the tibia by the Kirschner's wire. Reoperation was thus required. One year and 8 months after the reoperation, the patient is able to maintain a standing position and has acquired some locomotive capability.
Children with OI who often have a history of fractures, tend to limit their movement in order to reduce the possibility of sustaining additional fractures. This results in disuse atrophy and fragility of the extremities, and ultimately severe locomotive disturbance. In the present case, invasive treatment reduced the risk of francture. The patient can now perform exercises including kneeling, and these exercises can be expected to further improve his clinical condition.

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A clinical trial was made by a single energy X-ray absorptiometry (DTX-100 X-ray Bone Densitometer, Hologic Ltd.) to analyze bone mineral density (BMD) of four parts of the distal part of the forearm: radius, ulna, distal (radius+ulna) and ultra distal. These four areas are found by detecting the point where the distance between the radius and ulna is precisely 8mm.
We measured BMD of the distal forearm of 110 women, who did not have diseases influencing the bone metabolism, in their non-dominant side. We also measured the BMD of the whole body, the anteroposterior (A-P) view of L1-L4 spines and lateral view of L2-L4 spines, using QDR-2000 (Hologic Ltd.), at the same time.
The BMD of the distal forearm measured by the DTX-100 was compared with the BMD of the whole body, the A-P view of L1-L4 spines and lateral view of L2-L4 spines measured by the QDR-2000.
This data revealed a significant correlation between both the BMD of the distal forearm by the DTX-100 and of the whole body, the A-P view of L1-L4 spines and lateral view of L2-L4 spines by the QDR-2000.
The results confirmed that the DTX-100 is a useful diagnostic tool for osteoporosis.

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