In order to make the proper and effective arch support for orthopedic foot problems, we modified the UC-BL Shoe Insert and had good results. Our shoe insert is made of fiberglass reinforced laminated plastics with a detachable heel lift plate. The heel lift plate may be attached to the outer heel of the shoe insert. This made it very convenient to use the shoe insert without the shoes, as we Japanese often do so in our homes. We applied the shoe inserts to plano-valgus foot, painful heel syndrome, metatarsalgia, flattened transverse arch, the Second Köhler disease, posterior foot deformities due to calcaneus fracture, and etc. Our shoe inserts revealed following advantages; 1. Much more close to perfection for correction the deformities than the other types of arch supports. 2. Possible to wear any kind of shoes with it and also can apply the shoe insert without shoes. 3. Easy to clean the brace without giving any bad effect to its material. 4. Less expensive than corrctive shoes. There were following disadvantages; 1. Need some training to take proper negative cast. 2. Cooperation and understanding of the orthotist must be necessary.
The basic material comprised all the patients who, during the period 1951-1970, were admitted to our department for the injuries of the semilunar cartilage of the knee. The numbers of the injured menisci were 199 in which four have been discarded on account of the lack of data. In 165 patients the single meniscectomies were undergone while the remaining two had been operated on “double or dual menisci” in the same knee, and the other thirteen had the single meniscectomies in the both knees. No differences have been found in the side and sex distribution, but ratio lateral to medial 4.6:1 and ratio except discoid type 2.2:1 were represented. The mean age for the entire material was 25.9 years, and the peak was situated in the third decade as the other authors. Trauma clearly associated were proved in one third of the patients and no history of the trauma was also found in one third. Athletic activities as the causative factors tend to increase the medial semilunar injuries. Five main symptoms were snapping, muscular atrophy, tenderness at the joint space, click, and the disturbance of the motion. The predominant types of the lesions in the menisci were considered to be the degenerative change rather than the rupture or division. The detachment from the capsule in the medial menisci has the higher incidence than to be hitherto described.
The authors experienced three cases of spontaneous osteonecrosis of the knee reported by S. Ahlbäck in 1968. This lesion is characterized by the radiolucent area with circumscribed sclerosis in the medial femoral condyle and by sudden onset with persisting pain in the knee. Case 1 was 66-year-old woman who had sudden onset of persisting pain of the knee and has been treated as osteoarthritis, X-ray showed slight flattening of the medial femoral condyle two months after onset. When she admitted at 8 months after onset, complaining of severe deteriolated pain, it was revealed that the flattened area progressed to radiolucent area contained a thin calcified plate which was sorrounded by a sclerotic halo. The treatment was made by splinting and complete non-weight-bearing for two months with marked recovery of clinical symptome and x-ray finding examined 1 year and 4 months after onset, Other 2 cases, 78-year-old man and 77-year-old woman, were reported briefly,
The trimalleolar fracture is rare in the malleolar fractues of the ankle. Since 1964, we have examined 17 cases of the trimalleolar fractures. The causes of them were as follows: Traffic Accident…7 Blow…7 Fall…2 Un-known…1 Frequent complication of the tear of the tibiofibular ligament and the subluxation of the talus are shown on these type of fractures. All cases were treated under the open operation. The flagments were fixed with the screw; the repair of the tear on the tibiofibular ligaments were treated with the tibial bolt. The flagments should be lined up as well as possible. Otherwise, sooner or later with the motion and weight-bearing, the ankle develops severe traumatic arthritis.
We studied 49 fractures which have been treated by means of compression osteosynthesis in our hospital. Among them, 32 cases are fresh fractures and the others are pseudarthrosis. Twenty-four fractures were treated with A. O. compression plate, seven cases with K. U. plate and sixteen cases with Judet's compression plate. In majority cases, their consolidations of the fracture site were seen from three to five months after opeation on both fresh fractures and pseudarthrosis. We have eight complications; one of the A. O. plate and one K. U. plate were broken, in one case of the A. O. plate we have seen two broken screws as a result of early weight bearing. Two cases were infected and we observed the absorption at the end of fracture which was treated with A. O. comprssion plate after failure of intramedullary nailing. We introduced the technique of the osteosynthesis by Judet's comprssion plate, these cases were observed primary fracture healing roentgenologically.
Although intramedullary nailing and plating are excellent methods for femoral shaft fractures, failures of healing can not be always avoidable with these methods. The authors carried out intramedullary nailing combined with plating for 12 cases of the femoral fracture, including 2 old fractures and 10 delayed or/and non-unions. After the fractures were fixed with intramedullary nail, platings with or without compression were performed with short screws. One week after the operation, the patients were usually allowed to walk and excellent results were obtained.
This study is based on a series of 79 patients with 80 intracapsular fractures of the femoral neck, who were treated in our clinic from 1955 to June 1970. The review was carried out by direct attendance or questionnaire, and 53 hips were followed nore than 1 year after their admission. The avarage of follow-up term was 4 years and 7 months. The following results were obtained: 1) It is able to manifest that prosthetic replacements are not always acquired good results. 2) Collapse of femural head which was occured after internal fixation, concerned presumably with reposition of the fragments. 3) If secured fixation was obtained, results would not be concerned about method of inernal fixation. Recently, we have adopted cross-screw fixation with large 3 screws to the intracapsular fracture of the femoral neck, unless prosthetic replacement has not employed. The advantages and the essential of this technique was mentioned.
We analysed sixty-six cases of extracapsular fracture of the hip which had been treated during past thirteen years. The years of age at injury were 65 on an average and female were much more cases than male. Twenty three cases were treated conservatively and 43 by internal fixation. An average follow-up periood was 1 year and 3 months. According to Evans's classification, they fell into 54.3% on the unstable fracture and 45.7% on the stable fracture. The unstable fracture were treated conservatively and operatively occurred respectively varus deformity in 50%. There were 13 cases, in 20% of them, without walking before discharge, because the fracture occurred frequently in elderly patients with some complications. We disccussed especially the unstable type of extracapsular fracture of the hip and consider that Sarmiento technique was excerllent therapeutic method, although we were experienced in only some cases.
This paper reports a study of 160 fractures of the shaft of long bones seen at Fukuoka National Central Hospital, Fukuoka, during the nine years from 1963 to 1971. In 111 Patients (69per cent) of these cases the patients were treated by open methods. Of these cases, fifty-six (50per cent) were reoperative cases due to delayed union or nonunon of fractues and malunited fractures. The causes of these fractures needed re-operation were analysed as follows; 1. technical errors of the operation 2. post-operative infections 3. breakages of internal fixation materials 4. re-fractures after removal of the internal fixation materials 5. ineffective immobilizations.
The purpose of the presentation is to review treatment of 72 cases with delayed union and non union of the shaft of the femur, treated between 1966 and 1971. Intramedullary nailings were used mainly, and Jewett's nails or AO plates at level of proximal and distal level. We reached the following conclusions. I] Strong and large intramedullary nailing for delayed union and union on the femur serve as an excellent salvage procedure. 1) The reaming of the canal provides autogeuous grafts of marrow and bone. 2) In this method, early knee exercise is done. II] Jewett's nails and AO peritrochanteric plates were used in the proximal level. III] In the distal level, AO condyl plates, Blade plates or intramedullary nailing were used.
Case I. Malformation of the atlas and axis with atlanto-axial dislocation. Clinical findings…Brown-Sequard type. X-ray examination…i) occipitalisation of the posterior arch of the atlas ii) aplasia of the odontoid process iii) spondylolysis between anterior and posterior arch of the atlas iv) atlantoaxial dislocation. Treatment…occipito-axial fusion. Case II. Traumatic spondylolisthesis of the axis. Clinical findings…i) neuralgia of the right greater and lesser occipital nerves ii) paresthesia and tenderness of the left arm. X-ray findings…i) fracture between superior and inferior articular process of the axis ii) large gap between the fragmets iii) dislocation of the axis. Treatment…C2-3 anterior spondylodesis.
Eight cases of traumatic cervical spinal cord injuries were treated by anterior spinal fusion. All cases were male from fifteen to sixtyseven years old. Acute and chronic injuries were each four cases. All cases except one showed incomplete paralysis at the operation. Roentgenologic findings showed luxation in two cases, subluxation and insupportability in three cases, compression fracture in one case, and in two cases no significant changes. In the large majority of the patients considerable improvement of neurological signs and symptoms were obtained after surgery, but one with complete quadriplegia showed no improvement in motor and sensory function. So it shows that the anterior decompression by disc and spur excision gives far better results and higher salvage rate in these serious injuries than we have been able to accomplish by therapeutic program employed in the past.
A follow-up study of nineteen patients early treated for traumatic lesions of the cervical spine with associated neural deficits is presented. Mannitol, predonin, cytochrome C, neurotropic vitamins, etc. were administrated. Operation was performed in thirteen patients on one day to fourty days after injury. The objectives of these procedures were to reduce the dislocation by Roger's technique and wiring of the spinous processes or to stabilize the cervical spine by interbody fusion. Two of the nineteen patients died after acute complete transverse cord lesions. Three died in five months to one year after injury. Five cases of postmortem examination on spinal cord are reported. Four cases were studied the patterns of the spinal vasculature by mean of injection of micropaque solution through the vertebral arteries. In all cord injuries there were combinations of both of vascular and direct damage. Four cases showed a longer segment of the cord involved than was expected by vascular disturbances or by compression and crushing alone. In one case with the syndrome of acute anterior spinal cord injury the damage which involved the posterior, lateral and central portion of the cord was observed.
1) In twenty-three cases, disabling and persistent symptom (Barré-Lieon), was operated upon to excision of one or two cervical discs and interbody fusion through an anterior approach. It was possible to evaluate the late results, in eighteen of twenty-three patients operated on. 2) Nine had fusion carried out at a single level, and nine other patients had two levels fused. The greatest number of interbody fusion at one level was performed between the fourth and fifth cervical vertebrae, at two levels fused had fusion between the third and fourth and between the fourth and fifth cervical vertebrae. 3) The longest follow-up was fourty months and the shortest six months. 4) In evaluation of the postoperative results, occipital headache, neck pain, persistent spasm of the trapezius, power weakness and paresthesia of arm were improved to good after operation. In many cases, but, in the patients who had been nausea and tinnitus frequently had poorly. 5) It was suggested, a slight but definite correlation was obtained between the discectomy with the charted level of pain reproduction by the discogram and results of surgery.
We examined 450 patients of cervical Oateochondrosis for establischment of the diagnosis of cervico-omo-brachial syndrome in our clinic. These patients were classified into 345 patients of radiculopathy and 105 patients of myelopathy. We discussed symptoms, clinical findings and plain, functional radiograms of each group. Results: 1. Pain presents most frequently in radiculopathy and numbness in myelopathy. 2. Tenderness are noticed more frequently in radiculopathy than myelopathy. Mobility disturbance and sensory disturbance are noticed more frequently in myelopathy than radiculopathy. 3. In radiological changes, sagittal diameter of cervical spinal canals are more shorter in myelopathy than radiculopathy. 4. Occurrence of posterior spur formation shows more high percentage and it degree are more severe in myelopathy than radiculopathy.
In the last II years, 1598 patients were diagnosed as cervico-omo-brachial symdrome in our clinic. We could classify the various disorders considered as a cause of the cervico-omo-brachial symdrome on the basis of the symdomes, clinical findings and radiograms. In these disorders, there are 450 cases of cervical osteochondrosis (105 cases of myelopathy and 346 cases of radiculopathy), 980 cases of so-called idiopathic cervico-omo-brachial symdrome, 45 cases of thoracic outlet symdrome, 10 cases of spinal cord tumor, 7 cases of spinal tumor, 10 cases of perpheral nerve disorder and one case of Pancoast's symdrome, We discussed radiculopathy and so-called idiopathic cervico-omo-brachial symdrome according to age, sex, occuation, cause, sign and symptoms. By the follow-up studies on those socalled idiopathic cervico-omo-brachial symdromes, we obtained that the symdromes and clinical signs became better in most cases (75 percent) but these were unchanged or became worse in few cases (15 percent).
We made a report on sixteen cases with ossification of the posterior longitudinal ligament of the cervical spine. The age ranged from twenty to sixty-eight; twelve were male and four were female. Radiculopathy was found in six cases and myelopathy in ten cases. The pathogenesis of this condition could not be clarified. Four cases with radiculopathy and myelopathy were applied to anterior spinal fusion by Cloward's or Robinson's method. Their postoperative courses were quite satisfactory.
One hundred forty nine cases of low back pain and sciatica have been examined by peridurography, using Conray 60% as contrast medium. Stereoscopic observation was performed on 89 cases of the patients. By this method, more accurate diagnosis were obtained than the ordinary. 17 cases of lumbar disc herniations were determined by this method, and all cases were confirmed by the operation. Severity of the pain during the procedure was variable, and patients with protruded disc were liable to complain more pain and often reappeared as usual. In the cases with seiatica there were observed more abnormal filling defects. Considerable cases frequently of spondylolysis, spondylolisthesis and low back pain showed abnormal findings in this examination.
Of the patients with Love's operation for the lumbar disc lesion, eight patients have experienced a postoperative relapse of low back pain several years later. These patients show all a great amount of abnormal instability on the resected disc itself or its near disc level. While two patients have showed already a slight change on the near disc even at the preoperative stage, six patients give a mere suggestion of having some relation to the removed quantity from the disc. We treat six patients conservatively and undertake one patient the anterior fusion. One patient is now in hospital.
The object of this paper is to show the result of clinical and mainly radiographic examination on un-treated about 50 patients with spondylolysis and spondylolisthesis who have had long history of several years (average 7-10 years) of chronic low back pain. The following resulte were obtained. 1. Onset (complaining of low back pain) Spondylolysis (Group I); at the age of 30 years (average) Spondylolytic Spondylolisthesis, (Group II); at the age of 40 years. (average) Degenerative Spondylisthesis, (Group III); at the age of 47.8 years. (average) 2. Anterior displacement of L4 vertebra on L5; Average extension-flexion motion of L4 had expressed the maximum movement in Group III, while it has done the minimum movement in Group II. 3. The degree of anterior-posterior sliding in Group II is more than Group III. 4. In 9 cases (64%) of Group I, anterior-posterior sliding over than 3mm has been found by functional radiographic lateral view. It is suggested that these sliding might be one factor of the indications for operation about Group I (Spondylolysis).
Three patients aged fourteen and fifteen, were admitted to our hospital with the chief complaint of low back pain after accident, during recent six years. On examination, two of them had clinical signs of radicular sciatica and another, of flaccid paralysis of bilateral lower extremities. In each case, a bony fragment at the posterior lower margin of the lumbar vertebral body was verified in plain radiographs and surgical exploration, as a cause of the narrowing of the vertebral canal. After the removal of the fragment or the decompression by means of laminectomy, three patients are completely free from complaints. At first we had diagnosed the fracture at the site of the lumbar vertebral body, but according to the histological findings, we thought fit to regard it as so called “persistent apophysis”. The purpose of this paper is to introduce these cases and, to discuss a concept of “persistent apophysis”, including a peculiarity of age, site and of its onset.
This study is based on an analysis of the results of 69 peripheral nerve injuries in the upper and lower extremities treated conservatively or operatively. The assessment of recovery was made according to the British (Highet) method. The following results were obtained. 1) The type of injury was classified into three types-non-degeneration type, partial degeneration type and complete degeneration type—according to the results of motor and sensory functional examinations, nerve conduction test and electromyography. 2) In the cases with complete degeneration type regardless of the cause of nerve injuries and with partial degeneration type due to open wounds, we shall explorate the lesion of injured nerves surgically to decide the indications for neurolysis or nerve repair. 3) In some patients, with peripheral nerve lesions in continuity and moreover complete degeneration type, no-recovery was obtained. 4) The following peripheral nerve lesions in continuity, that is, the nerve action potentials could not be evoked through the peripheral segment of injured nerve, and furthermore the contrast media in neurography could not be flowed through the lesion, should be performed the nerve repair.