In recent years destructive spondyloarthropathy (DSA) has been recegnized in long-term hemodialysis by the occurrence of bone and joint indisposition.
DSA was reported by Kuntz in 1984 as a spine complication of long-term hemodialysis.
We report a case of the long-term hemodialysis patient with DSA who needed surgery.

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We applied hydroxyapatite (HAP) grafting clinically for 10 patients with defects produced by a curettage of benign bone tumors. The average follow up after surgery was 29 months (range 4 to 53 months). Physical and hematological findings during this period did not show any abnormalities. The radiographic evaluation of the incorporation of the implant was divided into four stages based on marginal findings and homogeneity of the grafted HAP. The margin of HAP became possibly unclear (stage II) an average of 3 months after surgery, and almost homogeneous with the surrounding bone (stage III) 11 months after surgery.

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We used magnetic resonance imaging (MRI) to evaluate 32 vertebral compression fractures in 28 patients. Fresh vertebral compression fractures exhibited low signal intensity on T1-weighted images (T1-WI) and high signal intensity on T2-weighted images (T2-WI). The alteration of the signal intensity was more apparent on T2-WI than on T1-WI. MRI was useful for diagnosis of this type of fracture and the determination of fracture level. In a few cases, the grade of the signal change was increased one month after injury compared with that on initial examination. Results of MRI 3 months after the original examination were grouped into two, depending on whether they showed signal improvement or not. That grouping would be useful in predicting the prognosis of the fractures.

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We report the results of surgical treatment in seven cases of fracturedislocation of the elbow. Dislocation of the humero-ulnar joint was associated with fracture of the medial epicondyle (N=1), and fracturer of the lateral condyle (N=1), and fracture of the coronoid process (N=3), and with fracture of the radial head or neck (N=3). We classified three types of complications of bone and soft tissue: type 1 including injuries (failures) of the medial stabilizer of the medial epicondyle and the ulnar collateral ligament. Type 2 with fracture of the coronoid process, and 3 including injuries (failures) of the latetar stabilizer of the lateral condyle, radial head, and the radial collateral ligament. According to the criteria of Wheeler et al., the results of treatment were excellent in two, good in none, fair in four., poor in one. It is our opinion that surgery is necessary to restabilize bone and soft tissue in these types of cases.

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Conservative treatment is generally selected for pubic bone fractures in children. We have reported a case of pubic bone fracture requiring surgical treatment in a child because of high grade dislocation and good clinical course.
The patient was a six-year-boy who had a traffic accident. When he came to our hospital, we recognized pain and tenderness in the right pubic bone area. On X-ray films and a CT scan, right pubic bone fractures with high grade dislocation were found. These fractures were double breaks in ramus superior ossis pubis. But there was not symphyseolysis. We classified it as typeIII-A according to the Key & Conwell classification. We treated the fracture by Kirschner-wire fixation. The patiant started full weight bearing three weeks after the surgery, because a clear callus was recognized on X-ray films.

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We investigated 22 patients older than 65 years who were diagnosed with lumbar disc herniation on surgical findings during a 14-year period. Most common preoperative symptoms were leg pain, low back pain and gait disturbance. Nine cases were unable to walk due to severe leg pain. Positive femoral nerve stretch test was found in 12 cases, positive straight leg raising test in 7 cases, sensory disturbance in 13 cases, and motor weakness in 9 cases (drop foot in 2 cases). Types of disc herniation included protrusion in 10 cases, extrusion in 9 cases, and sequestration in 3 cases. Follow up ranged from 1 month to 8 years (mean; 28 months). Seventy-seven % of patients had excellent or good results. There were no poor results and no one required additional surgery. Average recovery rate with JOA score (Hirabayashi) after surgery was 81.3% at final follow up. Clinical symptoms were markedly improved especially those involving leg pain and gait.
From these results, we concluded that lumbar disc herniation should be treated surgically even in the elderly, when conservative therapy is ineffective.

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We report a very rare case of dislocation fracture of the lumbosacral joint. The patient was a 35-year-old male who was injured at work due to forced anteflexion on knee extension.
Although invasive redressment using a posterior approach was performed one week after the injury, redislocation occurred, and laminal wiring and anterior fixation were therefore performed.
The mechanism of injury for this type of fracture may be circumflex force due to strong flexion in the lumbar region.
This fracture is unstable, and anterior and posterior fixation in addition to invasive redressment are required for its treatment.

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We reviewed treament results of 13 cases of tibial plateau fractures which underwent open operations. The operations were conducted on 13 joints on all the 13 cases in six male and seven female patients. Their ages range from 16 to 79, with the average of 53.4. Causes of the fractures include 12 cases of traffic accident and one case of a fall. Types of fractures are in accordance with the Hohl classification. The following is the breakdown: three cases of minimally displaced joints, three cases of split compression, two cases of total compression, four cases of comminuted and one case that was unclassifiable. In all the 13 cases a plate was used for fixation during an operation and a bone graft was performed in two severe depression and comminution cases. As to postoperative therapy, the patients participated in excursion training via CPM without external fixation from the early stage of the postoperative phase. The outcome of the treatment was judged based on the Hohl & Luck Treatment Outcome Evaluation Standard. The results showed “excellent”in 10 cases and “good”in 3 cases in the anatomical evaluation; “excellent”in 12 cases and “fair”in 1 case in the functional evaluation. The arthroscopy conducted four to six weeks after each operation verfied the repair status of articular cartilage, thus was helpful as an index in determining when to start weight bearing.

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A girl 9 years and eight months old was seen first on March 3, 1994. She had complained of a left hip pain and had been limping for about 3 months. Roentogenograms showed that the lateral head-shaft angle of the hip was 17 degrees on the left and 8 degrees on the right, and she was diagnosed as a slipped capital femoral epiphysis. After 6 days, she tumbled and complained of a severe hip pain. The lateral head-shaft angle of the left hip increased to 28 degrees. She was admitted and treated by skin traction with internal rotation. On the third day of hospitalization, we gently manipulated her left hip under general anaethesia and fixed both hips by the method of multiple pinning with cannulated screws. The patient followed a good postoperative course at 6 months after the operation.
We suppose if an earlier manipulation is attempted in the acute slip, safer and gentler anatomical reduction of the hip can be achieved.

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Recently, tuberculosis of bones and joints has decreased. But, difficulties remain in diagnosis and treatment. Since 1992 we have experienced 16 cases of tuberculosis of bones and joints. Nine were males and seven were females, ranging from 42 to 81 years old. There were 12 cases of tuberculous spondylitis, and 8 cases out of the 12 underwent an operation at the anterior fusion by curretage and bone graft, and almost of all exhibited union on roentgenogram, and almost all could walk. We conclude that the early stage operation is effective for tuberculosis of bones and joints under the chemotherapy, because we experienced reduced recovery times using this method.

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We present our surgical procedure for arthroscopic anterior cruciate ligament (ACL) reconstruction using a new substitute composed of doubled autogenous semitendinosus/gracilis tendons and Leeds-Keio (L-K) artificial ligament tape.
Ninety-one patients were followed up from 12 to 48 months (mean, 23.5) postoperatively. The outcome of this procedure was evaluated by subjective assessment using Noyes' scoring system and physical examination such as stress X-P, KT-2000 arthrometer testing, Lachman's testing, Pivot's shift testing and range of motion testing.
The results appeared satisfactory to both subjective and physical assessment. However, the follow-up period in this study was not sufficient to make a definitive conclusion regarding this new surgical procedure. Therefore, we will continue to follow-up these patients carefully.

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We report the use of intramedurally nailing in the treatment of 37 fractures of femoral or tibial shaft. In 1988-1993, 25 femoral shaft and 12 tibial shaft fractures in 33 patients were treated with intramedurally nailing. Of 37 fractures, 9 were open fractures and 4 were delayed unions. Interlocking nailing was used and dynamization was performed for 24 fractures.
At follow up, 35 of 37 fractures had healed. Two fractures in one patient with renal failure failed to consolidate. These 2 fractures were in one patient, who needed dialysis and had not followed enough aftertreatment. Three nails were broken at the distal interlocking screw hole.
In order to get anatomical reduction and to reduce irradiation time, we used an open reduction and nailing method in 26 fractures. In these cases, no infection or no deformity developed but longer period were needed for radiographic consolidation than the closed nailing.
In 20 fractures, out of 24 fractures for which the dynalization technique was used, the fracture-healing processes seemed normal, but not apparently proceeded. In 2 fractures, apparent proceeding in fracture healing were observed after removal of the interlocking screws.

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Radiological natural course of the cervical lesions in Reumatoid Arthritis (RA) were evaluated, based on a follow-up period ranged from 2 to 23 years, average 10.5 years. Severity of RA was classified according to three subsets by Ochi: the least erosive subsets (LES n=3), the more erosive subsets (MES n=4), the mutilating disease (MUD n=4).
Radiological deterioration in LES patients progressed to only atlanto-axial subluxation (AAS), but not to AAS with vertical subluxation (VS).
Radiological deterioration in MES patients progressed to various stages; AAS, AAS+VS, VS and subaxial subluxation. In MUD patients, progressed VS lesions and subaxial lesions were observed at follow up time.

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We examined the clinical significance of 23 patients who underwent partial meniscectomy of the lateral meniscus, aged 40 or older. The average age at the time of surgery was 59.2 years (range 45 to 72 years). The average duration of symptoms before meniscectomy was 40.3 months. Only 3 cases had history of trauma for the onset of symptoms. Twelve cases experienced“locking”before meniscectomy. Joint effusion was recognized in 15 cases and meniscal signs in 17 cases. Meniscal tears were localized at anterior segment and middle segment in each 2 cases and at posterior segment in 19 cases. The types of tears included 11 peripheral, 4 degenerative, 3 bucket-handle, 3 transverse and 2 longitudinal tears. Almost all cases had only minor osteoarthrotic changes in their knees on plain radiographs.

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Surgery for malignant spinal tumor has not well established. I have advocated the necessity of introducing oncological concept for surgery on malignant spinal tumor. Our surgical classification and the surgical staging of malignant spinal tumor is presented. The surgical indication based on this concept is discussed and the surgical technique of total en bloc spondylectomy, which I established was introduced.

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