(1) We made radiographic researches of the spine in 100 children with cerebral palsy, and found 83 cases of scoliosis in them. (2) Most of these cases are throught to be functional scoliosis, and only 6 cases are true structual scoliosis. (3) In this series, it is suggested that the incidence of structual scoliosis in athetotic type is higher than in spastic type, and then its incidence in children incapable of walking is higher than the capable. (4) It may be that the functional disturbance of the spine in cerebral palsy causes scoliosis, therefore the functional training prevent these scoliosis.
Six patients with scoliosis have been treated with Harrington instrumentation and spine fusion in our clinic. Five cases were followed up at least one year. Rate of correction immediately after operation revealed 69 to 20 percent. Loss of correction one year after operation had 17 to 58% (average 32.5%). As three cases had metal comlications (rod breakage and hook turned out), they were re-operated. In one case, vertebral osteotomy following skeletal traction was applied with a good result. With proper use and in experienced hands Harrington rods are a safe and effective addition to the surgical treatment of scoliosis, as Moe and Scheier reported.
The patient, eight-year-old boy, was admitted with the deformity and restriction of the left shoulder. The deformity was at first noticed at the age of two months. He had been left untreated. Clinically, the left shoulder were elevated 4.5cm higher than the right. The flected scapula and the other malformations were not associated. Maximal flexion of the left shoulder joint was 130 degrees. Roentgenographically, the upper margin of the left scapula was found at the lower margin of the 5th cervical vertebra. The scapula index was 77 on the left side, 56 on the right side. The omovertebral bone was present on the left laminae and transeverse processes, extending from the 6th to the 7th cervical vertebrae. Electromyographical investigations revealed very weak voluntary activities without resting potentials on the left rhomboids and levator scapulae muscles. Woodward's operation was performed. After the surgery, a Velpeau bandage was applied for two weeks. The brachial nerve palsy did not develope. Three months after the operation, a increase of ca. 30 degrees in flexion was obtained. The upper margin of the scapula was lowered at the upper margin of the 7th cervical vertebra. This case was too short for a evaluation of this method. It, however, could be said that there were improved function and appearance, and that the procedure was believed to offer the advantage of relative simplicity. The earlier surgery had been performed, the better might be the results.
Experimental osteolathyrism was produced by Aminoacetonitrile (AAN) in hypophysectomized rats. This experiment could reveal the effect of lathyrogen on the epiphseal growth plate under the condition, in which proliferation and maturation of the cartilage cells were ceased. Young rats of Wistar strain, weighing about 50gm, were hypophysectomized. The rats were daily treated with subcutaneous injection of Aminoacetonitrile hydrogen sulfate 0.2-0.25mg/gm. The proximal part of the tibia was sectioned for histological study of the plate. Histologically the cells in cartilage column of the plate were enlarged, vacuolated, irregularly arranged and intercellular spaces were widened. These findings means that AAN accelerate maturation and degeneration of the chondrocytes. The cartilage matrix in the plate showed a considerable degree of edema, but was not enough resorbed in the layer of provisional calcification if the cells were fully degenerated. These findings indicated that the maturation and resorption of the cartilage matrix were disturbed by AAN. In the osteolathyrism of hypophysectomized rats prolifetation of the cells was not observed. The increasing in width of the plate in osteolathyrism was not owing to hyperplasia of the cells, but owing to the disturbed resorption of the cartilage matrix. Our observations indicated that AAN delayed the maturation of the cartilage matrix, but had no effcet on the proliferation of the chondrocytes.
We are reporting two cases of osteomalacia. Case I. Twenty-eight years old a female. She complained of dullness of her both legs from 13 years ago. This symtome has increased, recently she complained of disturbance of gait and of pain in her trunks and extremities. The roentogenograms of her bones showed demineralization and lots of fractures. The serum calcium was 4.0mEq/l, the serum phosphorus was 1.4mg/dl and serum alkaline phoshatase was 21.4K. A unit. Case 2. Seventy-six years old a female. She complained of pain her both calcaneus in the walking. The raentogenogram of her feet showed porosis, the serum calcium was 4, 4mEq/dl, and serum alkaline phosphatase was 38.8K. A unit. Two cases have been given Vitamin -D 2.5-5.0 miligram for two or three months. There has been improved on the biochemical examination and raentogenographic views.
Patient: 51 years old female. Chief complaints are polyarthralgies and pathological fracture of right upper extremity. Family history: non contributely. Past history: duodenal ulcer, bronchial asthoma. Present history: She developed the pain and swelling of both hands, knees and elbows in Jan. 1971. At that time she noticed a loss of appetite and general weakness which were followed difficulty in walking and was hospitalized on Apr. 18, 1971. On that day she developed a pathological fracture in her right humerus and was transferred to our hospital. On X-Ray examination, right upper extremity showed abnormal findings which were polycystic and localized osteolytic changes. On biopsy from her tibia, it was revealed histologically to be like a hyperparathyroidism. There may be some doubt to diagnose definitely as laboratory and physical examinations did not reveal typical findings related to hyperparathyroidism, however, this is a interesting case could be diagnosed as hyperparathyroidism.
Primary hyperparathyroydism in childhood is a rare occurence. The present report is of a 13-year-old girl who explained of pain and varus deformity of the hip joint for 2 years. On the laboratory examinations, hypercalcemia, hypophosphatemia, hypercalciuria, hyperposphaturia and increased serum alkaline phosphatase were found. Parathyroid gland function tests were of its hyperfunction. On the radiographic examination of long bones, skull and fingers, diffuse resorption and cystic areas wewe seen. A small tumor was found at the right lower pole of the thyroid. A diagnosis of primary hyperparathyroidism was made and surgical exstirpation was performed. The histological diagnosis was a chief cell adenoma of parathyroid gland. After exstirpation, serum calcium and phosphorous concentration gradually become within normal limmits and hip pain was diminished. Lately we performed valgus osteotomy of the Femur, for its varus deformity.
1. Radiological examinations were described in two cases of chondrodysplasia punctata. 2. Case 1. A girl, aged 8 months, showed only a slight shortening of the right lower extremity. 3. Case 2. A girl, aged 2 years and 9 months, had unilateral shortening of the left extremities. The left elbow joint showed a slightly limited range of movement.
The realignment osteotomy and rodding fixation is the most popular procedure for straightening the deformity of the femur in patient with osteogenesis imperfecta. We have been applying this procedure in most cases with osteogenesis imperfecta, and have applied long leg braces to them after operation. But, insufficient immobilization by long leg brace leads to bowing of the leg recurrently. We designed ischial weight-bearing braces in these cases. A quadrilatieral socket with an ischial seat is used for thigh shell, and a free off-set knee joint promotes the knee stability, and ankle joint is allowed to move 15 degrees forward as well as backward. We have applied these braces in four cases. This design provides a better gait pattern, and prevents the formation of recurrent deformity.
In a period of recent three years, a group of small fibrous tumors, occurred in the fingers and toes in children, have been treated in our hospital. All of them have been located in the dorsal subdermal tissues of the terminal phalanges and showed a tendency to recur locally after simple excision. On the basis of their age distribution, anatomic site, and histological feature, they were classified as Infantile Dermal Fibromatosis (Enzinger, 1965). None of them have been metastasized in any parts.
The patient, a 21 years old female, noted a painless mass in the medial aspect of her left knee in October 1970. As the mass gradually increased its volume, she consulted with an orthopedist, who diagnosed it to be a aneurysma at the knee. She visited our clinic on March 22, 1971. We palpated a remarkably pulsate mass as great as hen's egg and noticed the vascular noise by auscultation. The angiogram showed a characteristic figure which the contrast medium pooled closely in the mass. A well circumscribed and thin encapsulated tumor, 3×3×4.5cm., was removed from the left m. vastus medialis on April 30, 1971. The outer surface was dark red and slightly nodular, the cut surface was yellow gray with mottled hemorrhage areas. Fine trabeculaes transversed the surface forming small lobules of homogeneous tissue. Microscopic diagnosis was alveolar soft part sarcoma. After the exsirpation, irradiation therapy was given. A dose of 8, 000 rads was delivered to the operated site. She is now in good health without recurrence or metastasis.
1. With the use of disc electrophoresis on polyacrylamide gel, acid phosphatase isoenzymes were investigated in homogenates of giant cell tumors, osteosarcomas, bone metastasis, cortical bone (new born), prostate, and placenta. 2. Five isoenzymes were found in tissue homogenates and were called acid phosphatase A, B, C, D, and E in order of increasing cathodal mobility. 3. Different ratios of isoenzymes in each tissue homogenate above mentioned were observed. As one of the most characteristic features in the giant cell tumors, three isoenzmes (B, D, E) were found and strong enzymatic activity was concentrated in band E. 4. These preliminary results indicate that the acid phosphatase isoenzymes may be valuable markers in differential diagnosis of the bone tumors.
The authors experienced three cases of pigmented villonodular synovitis of the knee, which were diagnosed histologically. One of them, 18-year-old female, was complicated with haemangioma in the ankle joint, suggesting that the lesion would be better named as “angiodysplastic synovial hamartoma”. All patients were operated successfully with synovectomy, and there are no evidences of local recurrence.
In a period of the last twelve years, two cases of Osteo-periostitis (De Lorimier) have been treated in our hospital. They were a twenty-five-year-old and a seventeen-year-old man. Their primary site of affections were limited within the cortex of femurs. It was presumed that their focuses would be caused by the bacillemia in the intracortical blood vessels or in the periosteal ring arteries, and staphylococcus aureus would be assemed to be their pathogenic microorganism.
We investigated for 152 patients (159 joints) who received conservative treatment for frozen shoulder at the Orthopedic clinic in the Red Cross Hospital of Hiroshima, for three years, from January 1968 to December 1970. The follow up are: Excellent 43 cases (28%) Good 72 cases (47%) Fair 32 cases (21%) Poor 0 Unknown 5 cases (4%) Manipulation for frozen shoulder has been done for 22 cases for last 10 years. 10 cases who has got follow up are: Excellent 4 Good 4 Fair 2 Poor 0 Cases who has been treatment between 3-6 months after the begining of complain, had good results.
Patients, that complaint pain and swelling of their knees, have been receiving random treatment like Steroid hormone. But, in most of such cases, pain, swelling and dropsy continue in spite of these treatments. In these cases we find some tuberculosis of the knee frequently. We have experienced seven tuberculosis of the knee for the last 4 months and performed arthrodesis and synovectomy of these five tuberculous knees. One of them has received treatment as Rheumatoid arthritis for about a year. It is very difficult to make an early diagnosis of tuberculosis. But in doubtful cases, biopsy is the best method of diagnosis. Our method is to tear off a part of synovial membrane by herniation forceps. We report the above cases adding to the transition of bone and joint tuberculosis of the latest 5 years in our hospital and review of the riterature.
We had twenty and two children which are difficult in the treatment of congenital dislocation of the hip by Davlik method. Fourteen cases could not be reduced. Five cases had pseudo-reduction or repeated dislocation. On three cases, femoral heads were damaged. Eleven cases of those were undernorished. In the undernourished children, lower extremities was so flexed that kicking was not observed and the reduction was not succeeded by Pavlik method. When hip joint was in this position during long time, the femoral head was damaged markedly. Therefore, for these children there are little indication of Pavlik method, the treatment should be delayed until they are well-nourished and their physical strength increase. We emphasize that nourish is an impartant factor for the treatment of congenital dislocation of the hip under one year.
Recently, functional treatment with Pavlik's bandage in younger case of C. H. D has been popularized and the results with this method are increasingly improved. But, still there are considerable number of cases which remained untreated until about one year old. Since January. 1970, 12 dislocated hips of such older cases were treated with Pavlik's bandage. 3 of them were reduced with Pavlik's bandage only. 4 of them were reduced by manual reduction under awake condition after application of Pavlik's bandage for 3-4 weeks. 4 of them which were unable to reduce manually under awake condition were reduced under general anesthesia. Only one of them was unable to reduce under general anesthesia. In this one hip, intervening limbus and lig. teres was found.
The material consisted of 298 cases (428 hips). In this series 140 hips had no changes and other hips had presented various changes. These changes were classified in atrophy, partial defect, irregular margin, cloudy figure, condensation, and overlapping of the head on the metaphysis, and each of them were examined according to the reduced age, grade of dislocation and the method of treatment. The earliest change is the atrophy and this change becomes to normal figure or varies to other changes. In these various changes, condensation, fragmentation and overlapping figure are presented relatively in late stadium and their late results are worse than the other changes.
One hundred twenty-three patients from primary osteoarthritis of the hip joint were reviewed radiologically and clinically. Three basically different types of primary osteoarthitis were described radiologically for the cases at the advanced stage in combination with the severity index as semiquantative evaluation for deterioration of the disease. Three different types are lateral displacement of the head or subluxation type, deformed or destructive head type, and concentric or protrusion type. The correlation was studied between clinical observation and radiological type and severity as well. It has been discussed on etiological factor such as anatomical, vascular, and metabolic factor in relation to aging and pressure imbalance in the hip joint. It was suggested that treament of primary osteoarthritis, especially the operative method should be properly chosen after more accurate of clinical and radiological evaluation.
We invented the K-U Compression Blade Plate for hip fusion, and tried to 13 cases with very good result. This plate was put on the anterior surface of the hip joint and had excellent immobilizing strength to the joint. Therefore the patient may ambulate earlier with this plate than other methods. The skin incision of this procedure was followed by the Smith-Petersens method. Underlying sartorius and rectus femoris muscles were retracted medially, and tensor fasciae latae and vastus lateraliy muscles were retractcd laterally. The origins of the tensor fasciae latae and the gluteus medius and minimus muscles were separated from the crest of the ilium subperiosteally. Then incised the capsule followed by artificial dislocation of the head of femur. After the cartilages of both acetabulum and head of femur were removed, the orgin of vastus intermedius muscle were separated partially for the purpose to put the blade plate anteriolly. The blade was inserted at the point of antero-inferior iliac spine and directed to posteromedially in order to use most thick part of the iliac crest for better immobilization.
Fusion of Charcot's joints has been a relatively difficult problem to the orthopaedic surgeon. We attempted to fuse a tabetic knee of a woman aged 64 by compression osteosynthesis using two A-O plates, and succeeded to obtain a complete fusion of the knee. The plates used were long straight ones each having 10 screw holes. The period of immobilization in a plaster cast was about two months. In serial roentgenograms we could find how the bone trabeculae gradually passed through the compression surface. The roentgenograms taken after fourteen months suggested the complete successful union, so we removed the plates and screws. The union was complete and solid on the time of removal operation. We were able to find the compression surface neither in gross findings nor histological findings. The continuity of lamellar bone through the fused surface was proven by both histological and micro-radiographical techniques.
31 cases of the hiparthrodesis, operated in our clinic, were examined by means of questionnaire. 18 cases of which were examined clinically and radiogically with paticular emphasis on the changes in the lumbar spine, in the other hip and in the knee of operated side. It was suspected from the results that the fixation of the hip in neutral abduction-adduction and slight flexion is desirable from the effect on lumbar spine.
Results after 25 intertrochanteric ostestomies in 22 patients (15 females and 7 males) were reported. The average length of follow-up was 316 years. The longest observation period was 612 years and the shortest 116 years. Operativemethods were varus ostestomy in 18 hips, valgus osteotomy in 7 hips. Results *Non-Union occurred in 6 hips (24%). *13 cases (63.6%) were satisfied with the results of the operation. 5 cases were unsatisfied. *In 18 cases (81.8%), pain disappeared or diminished. However in 1 case, result according to patient's assessment was poor for the decrease of hip motion, inspite of pain relief. *In movility of hip joint, no significant differences were found after operations except 1. *In radiological findings, widening of the joint interval occurred in 11 hips (44%), narrowing in 3 hips.
Pain from osteoarthritis of the hip is usually relieved by intertrochanteric osteotomy. Pain due to osteoarthritis of the knee is also relieved well by tibial osteotomy. The ideal indication at the present time appears showing narrowing of the joint with resultant valgus or varus deformity but minimum degenerative change. Indications, contraindications, sites of the osteotomy etc. were discussed here. A new method for conservative treatment of gonarthrosis was described.