We followed up 36 cases, 49 hip joints that were left femoral heads lateralized after conservative treatment in congenital dislocation of the hip joint. And next results were obtained. 1. Frequency of lateralization of the femoral head reduced by Pavlik's method was more that by other method. Pavlik's method 16.2% other methods 10.9% 2. Prognosis of the lateralization of the femoral head not combined the change of the epiphyseal center of the head was as follows. Only 5 cases of these 36 joints were poor results. Acetabular angle of 4 joints of these 5 was over 30 degrees. 11 joints treated by Pavlik's method showed all good results. 3. In 13 joints the lateralization of the femoral head combined the aseptic changes of the epiphyseal center of the head. 10 joints of these 13 showed poor results. 4. The evidence was not obtaind that the grade of dislocation and excessive antetorsion caused lateralization of the head and influenced prognosis. 5. Arthrography was done in 9 cases, these cases showed lateralization of the femoral head. 6 joints of these 9 had some obstacles in the joints.
57 cases with congenital dislocation of the hip joint after varusosteotomy were reviewed from the following points as below: 1) acetabular angle 2) CE angle of Wiberg 3) neck shaft angle and revalgisation 4) hypertrophy of the femoral shaft and its inner coricalis after surgery 5) complications of the knee joint 6) length of the legs 7) contour of the spinal column 8) manner of walking 9) contracture of the hip joint 10) deformity of the hip The attempt was made to determine the accuracy of the measurements on the roentogenogram.
Intra-osseous venography of the femoral head of the Perthes' disease was carried out to clarify the pathological condition of blood circulation every six months in the same case. Investigated veins in this study were V. retinacularis superior, V. retinacularis inferior and V. capitis femoris, which were considered to play an important part on nutrition of the femoral head. Twenty Perthes' disease hips (male 18, female 2), aged from three years to twelve years, were investigated. The results have been summarised as follows. (1) Within six months from onset of disease, venous pattrn is changeable in the same case, but after seven months from onset of disease, it is stationary and continues up to healing time. (2) It is considered that V. retinacularis superior plays a principal role in the venous circulation of the femoral head and prognosis of the Perthes' disease depends upon whether it appears or not.
Seven cases of traumatic fracture dislocation of the hip treated by open reduction were reported. The most frequent complications were avascular necrosis and osteoarthritis. The treatment should be indicated to avoid these complications, for this reason weight-bearing should be avoided for 3 or 4 months after the operation.
We had experienced 42 cases of the femoralneck fractures of the aged for this 12 year duration. Of these cases, medial fractures were twenty-eight. As therapy, we uesed Whitman's plaster cast, a traction and operative methods, as well as, Smith-Peterson nail, Mclaughlin nail, multiple wire, Y screw and prosthetic replacement. In these methods, internal fixation of Y screw was excellent. In future, we will make use of it and hope use of a prsthesis for many cases.
The patient is a male of 52 year old and holds managerial position. He suddenly devloped left leg pain and low back pain seven years ago, which were followed by similar pain on his right leg and visited this hospital one year later. On X-ray examination, his right femoral head showed an image of spotty sclerosis and his left femoral head showed a punched-out image of sclerosis and spurs in its inside. As time went by, his symptoms were aggravated, and deformities of femoral heads and bone sclerosis progressed. However, owing to conservative treatment, his clinical symptoms have been alleviated and he walks quite normally now, but with a moderate limitation on internal rotation of hip joints. On X-ray, defor mities of both femoral heads are moderate, but bone sclerosis appears to have become less conspicuous and to be remedied. It would be necessary to follow up this case for an extended period of time.
A muscle pedicle bone-graft was devised with the intention of arresting or delaying progress of the necrosis in this disease. Its procedures were as follows: 1. a rectangular bone-block with a pedicle of the M. glut. med. was shaped from the great trochanter 2. after removal of the necrotic tissue from the femoral head, bone-chips were tightly packed 3. the bone-block aboved mentioned was inserted from the great trochanter into a part of the grafted bone-chips in the femoral head. Two cases (32 years, male: bilateral; 67 years, male: left) were operated by this method. After about two years in the former, after a year and five months in the latter, satisfactory results were obtained roentgenologically and clinically.
Japanese winter sports fair was held at Daisen skiing ground from February 17 to February 23, 1972. 154 patients were treated in the emergency room because of skiing injuries. On the rate of the injuries, the jump accounted for 7.0 per cent, the descent for 2.3 per cent, the Langlauf for 0.8 per cent and avarage for 2.5 per cent of the skiers. The principal causes of injury were falls and collisions.
Boyes described two patients with traumatic dislocation of the extensor tendons of the hand. Our case is the traumatic dislocation of the left litte finger. It is a rare clinical entity. Patient was referred because of the complaint of pain and snapping of her extensor tendons. The Operation was carried out and full function was regained.
We have experienced 33 cases of acromioclavicular dislocation during past 15 years. Good therapeutic results were not always obtained in those cases who received operative procedure. From the results described above, closed reduction using Spigelman's Harness were performed in 8 cases, and good reduction and fixation were obtained in 6 cases of them.
Fifty patients with pathological fractures treated in our orthopaedic clinic from 1957 to 1971 were analyzed. Vertebral fracture and epiphysiolysis were excluded because it was thought that they would confuse the analysis. Twenty-three of the patients were male, and twenty-seven were female. Twenty-three fractures associated with bone tumors and tumorous conditions had been seen in the humerus, metaphysis of the femur and around the knee joint etc.. Each benign tumor of bone had been curetted, and the cavity had been packed with cortical and cancellous bone grafts. Sixteen fractures associated with bony metastasis of miscellaneous cancer had been seen in the metaphysis of the femur and rib etc.. There were seven fractures occurred in the patients with osteomyelitis which located at the diaphysis of humerus and tibia etc..
The authors presented experiences of 8 figure wire fixation for 21 cases of fracture of bone end and small bone, 2 cases of acromioclavicular dislocation and 21 cases of orthopedic operation such as fixation of greater trochanter at artificial hip operation, supracondylar and supramalleolar correcting osteotomy. The procedure could be carried out simply without any special implants and firm fixation of the fragments were obtained.
We have been treated the shaft fracture of lones, especially the femoral shaft fractures, by the closed intramedullary nailing, for one and a half years. From our twenty three cases of the fresh fractures treated by this method, We discussed, in this paper, about the following factors for the successful performance of the closed intramedullary nail; 1) reduction of the shortening, 2) reduction of the lateral and rotatory displacement, 3) minimization of the exposure to X-rays, 4) use a nail of sufficient width. Particularly, in the case of femaral shaft frcatures, we emphasized the necessity for the overdistraction of fragments by the use of skeltal traction, in the pre-operative periods.
The desirable conditions for adequate immobilization of fracture-site by the method of osteosynthesis are as follows: trauma of the soft tissue on operation should be minimized as littie as possible, fixation of the fracture should be strong enough for as early exercise and weight-bearing, and it results in solid union and no deficit in the strength of the bone. Television image intensifier faciliates us the closed intramedullary nailing. Our several trials could conquer the weak-points of it. These are: (1) use of two television image intensifiers for reduction of the fracture, (2) employment of the apparatus for dynamic compression of the fracture, exercise of the fracture-site under compressive traction, and transverse fixation of the intramedullary nail with two screws which hold back rotation of the nail in marrow cavity, (3) compressive intramedullary nailing was devised using modified clover-nail with a special bolt for compression at the one-end. Compressive intramedullary nailing could satisfy the desirable conditions for the adequate immobilization of the fracture-site.
In the operative treatment for fracture, operation without cast immobilization after surgery has been carried out. However, there were only few description of starting time and its concrete method for post-operative exercise. Though, operative technique varies in choice according to location and type of fracture, we obtained good result by carring postoperative therapy as follows. About 10 days after surgery, patient was put into pool bath up to the neck, and water is controlled at 39°C in temperature, therefore 10% of weight of the body bear on feet and carried on slow reciprocal motion of lower limbs. After identification of entirly free from pain at weight bearing, gradually submerged level was lowered, accordingly from about 3 weeks after surgery submerged level is processus xiphoideus, and at 4 weeks after surgery level is the navel, therefore 50% of body weight bear on feet. Further after 4 weeks submerged level is the greater trochanter, then 2/3 body weight bear on feet. At a time like this, patient is carried out additional muscle exercise, in addition to resistance by means of rather swift movement, after 5 weeks gait with one cane is carried out.
Congenital angulation of low leg is relatively rare and occurs uniformly in the distal portion of the central third of the tibia with anterior or posterior convexity. It is the purpose of this paper to present two cases of congenital anterior angulation that we experienced and treated with wedge osteotomy. In these cases, many cáfe au lait spots were presented, and relationship to von Recklinghausen's neurofibromatosis is discussed but not clear.
1. The sibling cases of congenital defect of tibia who were born from the inter-marriaged parents were reported. 2. For one of them, the disarticulation of both knee was performed after a gait exercise by the specially deviced prosthesis and afterward the skeletal typed prosthesis was prescribed. 3. The patho-anatomical findings were as follows. The tibia, 1st cuneiforme and 1st metatalsus bones were in defect. The tibialis anterior, flexor hallucis longs, extensor hallucis longs and brevis muscles were abnormal. 4. By our treatment, the patient who were staying at home without any educational services acquired not only the ability of walking but also the chance of attending school and social intercourse.
We treated deformities of 10 feet in 5 children with Spina Bifida in 1971. Most common deformity was Equino-varus. We confirmed that the resistance to conservative treatment of the foot deformity with Spina bifida was best explained on the basis of the muscular imbalance. We reported our experience about 8 feet we treated operatively.
In order to make an appropriate orthosis to the patient, mutual understanding to the prescribed orthosis between the prescribed doctor and the orthotist are necessary. For this purpose we made the unique orthotic prescription form. The form adopted the check system for complete the prescription and it also included the space for free writing and the illustrations of human body shape for convenience. We usually make three carbon paper copies when prescribe, and deliver them to the doctor in charge, the orthotist, and prescribed doctor. We have been using this prescription sheet since two and a half years ago and had satisfactory results. We found that this prescription form was useful for education of the young doctors and the orthotists.
Plastc shoe insert was described by the University of California Biomechanics Laboratory (UC-BL) in 1964. New Yorke University (NYU) has derived a technique for the attachment of the shoe insert to standard below-knee up-right and ankle joint. We applied to the twenty patients at the Kumamoto Rosai Hospital ower the year 1971 to 1972. 1) combine in a single appliance of foot alignment with functions of a connextional below-knee brace. 2) permit interchange of shoes without disassembling the brace. 3) improve cosmesis.
The unigre electric artificial arms which were controled by the teeth clicking sounds for amelia patient were successfully made by Kumamoto University Artificial Arm Aeserch Group. This time an electric driven upper extremity orthosis was controled by same method was made. This orthosis has three foundamental movement; flexion and extension of elbowjoint, dorsi-flexion and palmar flexion of wrist joint and three jaw chuck movement of fingers. This orthosis was applied to the patient with muscular dystroply who was wheel chair bound and had no muscle power on his whole extremities. The patient could easily managed this new power orthosis. The teeth clicking sounds are excellent control signal to this electric driven orthosis. Several types of self-help devices for increased the A D L of severe handicapped patients also were made and might used with our powered orthosis.
Fine Structure of the epiphyseal growth plate was studied by means of scanning electron microscopy, using Tanaka's resin cracking method. Four layers were recognized in the growth plate, that is to say resting, proliferating, hypertrophic and degenerating layers. The structure of the intracellular components and matrix was observed and it was almost similar to that which had been observed by transmision electron microscopy. However a few different views were found which are described as follows. 1. The numerous cytoplasmic processes were found around the chondrocytes of the proliferating cell layer. These were coralliform in appearance and considered to be combinded with the collagen fibrils in the matrix. 2. Calcified matrix was increased in the part adjacent to metaphysis. In this layer the clusters of hydroxy apatite crystals were spherical (about 0.5-1.0μ in diameter). They were scattered uniformly, and attached to netlike collagen fibrils. On these fibrils the characteristic cross striations were found first by us by means of scanning electron microscopy.
A 34 year old female suffering from Rbeumatoid arthritis since her 20th year of age. She has been noticed tumorous swelling of medial condyle of bilateral humerus since December, 1969. These tumors enlarged gradually and then developed claw hand with sensory disturbance of 4th and 5th fingers. In x-ray findings of bilateral elbow joints, humerus, radius and ulna were all remarkably destructive and absorptive, that is classical Arthritis mutilans. Synovectomy in right elbow-joint was carried out in April, 1971. There were numerous cartilainous loose bodies in the capsule and respectively semitransparent substances from ant-egg to the head of little finger in size. In histological study, cartilaginous loose bodie were constituted with fibrinoid lucid substances and Synovial membrane thickened and infiltrated with chronic iuflammatory cells. Synovectomy in left elbow-joint was carried out in october 1971. Abundant free bodies were detected similary.
Tenosynovitis is very common in rheumatoid arthritis. It has been said, particularly in previous literatures that over half of all patients with rheumatoid arthritis have tendon disease. The extensor tendons are frequently involved, but tenosynovitis of the flexor tendons is often not diagnosed. In a consecutive series of 243 patients attending three hospitals, the cases suffering from rheumatoid tenosynovitis comprised 79 hands. The incidence was 2.5 times higher in the flexor tendons of the hand than in the extensor tendons. There were lesions in the extensor tendons in 26 hands with rupture as a result in 6, and most of them were caused by so-called “Caput ulnae syndrome”, in which the caput ulnae forms a prominent lump on the dorsal aspect of the wrist. As for flexor tenosynovitis, we often palpated the nodules at the level of the metacarpophaangeal joint of the fingers, associated with “Snapping” or “Locking” at flexion. We have operated 18 cases with rheumatoid tenosynovitis, including 2 cases by procedure of tendon transfer to ruptured extensors. The purpose of this paper is to introduce some cases, and to emphasize usefulness of early synovectomy in the tendon and the tendon sheath.
We operated for functional disorders of R. A. joints. These operations were: Synovectomy (including Debridment) 17 cases, Arthroplasty 20 cases, Tendon-cutting or Tendonprolongation 4cases, Osteotomy 2 cases, Arthrodesis 1 cases, and Bone-grafting 1 cases. In arthroplasty, we chose the methods: Total hip replacement, (McKee-Farrar), Femoral head prosthesis (Austin-Moore), Cup for the hip joint, Tibial plateau prosthesis, Silastic implant for mp & pip joints, J-K membrane interposed. In general, these operations relieved the local inflammation and restored function to these joints. But, if many joints were destroyed, it was necessary to draw up a special regimen of postoperative care before operation was performed.
A girl aged 14 came to our hospital with a three month's history of pain and instability at her right Knee. She felt pain and instability in walking. There had been no history of injury of her knee. Present illness was follows; She began to play tennis at 13-years-old. after three month's she noticed these symptomes. In spite of the articular injection with corticosteroids and physical therapy, her pain increased gradually. Therefore she admitted to our ward in march 1972. Physical examination showed the muscle atrophy on her right thigh and snapping in movement. Positive Mc-Murray's test and Alpey's test were found without tenderness. X-Ray examination suggested a medial discoid meniscus. We confirmed the diagnosis by Operation.
Questionnaires were sent to those who were treated in our department during 1951-1970. The questionnaire was designed to determine the patient's current symptoms, the level of his physical activity and the presence of any disability related to his knee. Of the questionnaires which were sent to the patients in our previous report, 51 were completed and returned; 26 of these patients returned to our clinic for examination. The results were as follows: 1. 89.4% of patients in our series had satisfactory clinical results in their daily activity and occupation, but five cases were graded poor. 2. In any cases the post-operative osteoarthritis was so apparent that we could identify the site of meniscectomy. It was, however, independent of the symptoms. 3. The problems pertinent to our series were: (i) persistent dysesthesia and pain due to the injury to the infrapatellar branch of the saphenous nerve in the medial meniscectomy, (ii) few recovery of the quadricipital atrophy even twenty years after the procedure, (iii) slow recovery of ability to sit in Japanese form (Seiza) ranging from four months to two years, (iv) occasional difficulty for active younger patients eager to sports and to a full power run, (v) necessity of the meticulous consideration to the associated injuries or diseases.