During a half year period from December 1991 to July 1992, four cases of combined shaft and basal neck fractures of the same femur were admitted to our hospital. Three of them were male and all of them suffered multiple injuries due to high energy trauma. In all cases, the fractures at the shaft were typical transverse midshaft ones and the neck fractures were non or minimally displaced. In the earlier two cases, neck fractures were nondisplaced and in the first case, had not been detected until the union and removal of the medullary nail of the femoral shaft fracture. At that time, malunited neck fracture in varus was found and corrected by subtrochanteric osteotomy. In the second case, nondisplaced neck fracture was detected fortunately during medullary nailing of the shaft fracture and fixed with a proximal diagonal locking screw of the medullary nail. In the later two cases, minimally displaced neck fractures were diagnosed at the initial X-ray examination and the internal fixation of the neck and shaft fractures were performed with canulated cancellous screws and Ender nails, inserted percutaneously under fluoroscopy. In the case with a transverse midshaft fracture of the femur due to high energy injury, in addition to routine X-ray of the hip and Knee joint adjucent to fracture, correct two plane X-ray of femoral neck during operation is neccessary to exclude the presence of the nondisplaced neck fracture.

View full abstract

We have reported five cases of Jeffery's type fracture of the elbow. The average age of the patients was 7 years, ranging from 4 to 11 years.
This fracture is caused by valgus stress due to physiological valgus of the elbow where by the axial pressure is inflicted on the extended elbow. At the moment of injury, we find that compression force on the radial side leads to radial neck fracture. While traction force to the ulnar side causes two types of injury: one is avulsion fracture of the medial epicondyle or rupture of the medial collateral ligament and fracture of the olecranon the other is fracture of the proximal ulnar shaft.
As for treatment of Jeffery's type fracture, accurate reduction of the radial neck is necessary for the rotational limitation of the forearm. Further correct reduction of the olecranon and repair of the medial collateral ligament are also important so as to not cause instability of the elbow.
We selected operative care for all cases. We have found good results.

View full abstract

Twenty acute ruputures of the lateral collateral ligaments of the ankle in 19 patients were surgically treated. The patients were diagnosed and evaluated by the talar tilt angle measured before the operation and two months later using stress radiography without regional analgesia.
Every patient except one showed the angle of 5 degrees or less after the operation, which could guarantee the good clinical results.
We recommend surgical repair rather than conservative treatment for acute injuries of the lateral collateral ligaments of the ankle.

View full abstract

We investigated 30 planovalgus feet in 20 cases where extra-acticular arthrodesis of the subtalar joint was performed.
All the 20 cases consisted of 12 cases of cerebral palsy, 3 cases of myelomeningocele, 2 cases of aftereffects of a brain injury, 1 case of prader-willi syndrome, 1 case of poliomyelitis, and 1 case of microcephaly.
The period of follow-up averaged 8 years and 4 months.
Changes in the talo-calcaneal index were examined in all the cases preoperatively, as soon as postoperatively, and at the final follow-up. All the cases were classified according to the time of body weight bearing, the paraoperative age, and the kind of the transplanted bone. Then, the comparative study of the changes in the index was made.
As a result, it was found that the time of weight bearing didn't influence the talo-calcaneal index approximately 12 weeks later.
The results were better in the group of fibula grafting than in the group of tibia grafting.

View full abstract

Two cases of tetraplegia due to traumatic brain injury were operated and reported. Successful surgical correction of the equinovarus foot deformity resulted in remarkably improved Barthel index scores. In particular, transfer and gait improvements allowed for increased mobility.
If adequate psychological and physical evaluation approves the surgery, the correction of the foot deformity which disables the patients' mobility would provide a good chance for improvement not only for post cerebrovascular accident hemiplegics but for post brain injury tetraplegics also.

View full abstract

Traumatic posterior dislocation of the sternoclavicular joint is extremely rare, and special consideration should be taken since complications involving major viscera, including tracheal laceration, hemorrhage from insult to great vessels, and hemopneumothorax, are not uncommon and catastrophic potential.
However radiologic diagnosis and management are frequently difficult in this disorder.
We have reported a case of the dislocation of 15 year-old female, in whom we treated succesfully with closed reduction under general anesthesia.

View full abstract

Although high tibial osteotomy for osteoarthrosis of the medial compartment of the knee joint is well recognized, the correctional angle in the management of this osteotomy is much less well established. Sixty-eight out of 92 joints were reviewed 1 to 14 years following tibial osteotomy.
The femorotibial angle (FTA) and the Mikulicz line (M line) were measured on anteroposterior radiographs of the lower extremities in standing position postoperatively. The region of the M line on the tibial joint surface was determined by the % M value described by Ogata. Clinical results were evaluated using the recovery rate of the Japan Orthopaedic Association score by Hirabayashi.
There was no significant correlation between either %M and the recovery rate or FTA and the recovery rate. A comparison of FTA and %M showed a correlation of R=0.446, but this was not statistically significant.
In the patients in whom the M line passed through the middle one-third of the lateral tibial plateau; that is, the %M (the portion from 66.67% to 83.33%), the postoperative recovery rate was much better than in other patients. Therefore, it was suggested that in performing a high tibial osteotomy, it is essential to choose the degree of axial correction in such a way that the postoperative M line passes through the middle one-third of the external tibial plateau.

View full abstract