The regular medical examination for the atomic bomb survivals in October 1971 revealed the excavation on the 8th thoracic spineof a 41 years old house wife. For 5 months since then, she was suffered from the severe paroxysmal intercostal neuralgia. Admitted in April 1972, her physical examination did not reveal any abnormality, except for the pain the processus sponrosis of the 8th thoracic vertebra and the 8th intercostal space on the left side. Radiographic findings revealed some bone changes; widening of the spinal canal and of the interpediculate distance, increased depth of the concave posterior surface of the 8th verteral body, ersion of the vertebral pedicle and arch and enlargement of the intervertebral foramen, but there was no calcification of the tumor, paravertebral soft-tissue masses and abnormal spinal curvature. We removed the tumor completely, which grew from the 8th thoracic spinal nerve at the intervertebral foramen. This case was fortunately operated before the advent of the myelopathy, thanks to the regular medical examination for the atomic bomb survivals.
Recently we experienced 4 patients with hard scoliosis, 3 cases were herniated lumbar intervertebral disc, one lumbar spinal canal stenosis. We analysed these patients. Results 1. The patients inclined their trunks foreward with the slight flexion of knee joint on the side of sciatica. So, the center line of body gravity was transferred foreward and lumbar lordosis was decreased. We considered this posture were decompression of posterior element of lumpar spine. 2. As the lateral curvature on the trouble side was established rapidly, the center line of body gravity was transferred toward the opposite side. 3. Radical treatment for sciatica was the only corrective method for hard scoliosis. 4. In all cases, convex side of primary lumbar curves were bile on the trouble side, the numbers of the affected intervertebral spaces were multiple, the lowest level was the 4th lumbar intervertebral space, and all of them were muscular type and male. We couldn't confirm any regularity for the relation between the convex side of the lumbar scoliosis and the position of stimulus to the nerve root.
Nine cases with intermittent claudication due to compression of the cauda equina in the presence of lumbar spinal canal canal stenosis are described. Male are 6. Female are 3. All cases are over forty years old and were performed decompression laminectomy. The cause of two cases was from developmental spinal stenosis and four from degenerative, two from spondylolisthesis.
One case was diagnosed as osteomyelitis because of severe lumbago, conspicuous inflamatory findings and X-ray findings showing the remarkable excessive formation of osteophyte of the first vertebral body through fifth lumbal vertebre and the bone destruction likelesion on the anterior potion of the forth and fifth lumbar vertebral bodies. Although the antibiotics therapy had no responsive effect upon, the cortcosteroid and the anti-inflamatory antalgic agents therapy had dramatically effect upon the disapperance of symptome of this case. Comparing with the criteria of ankylosing spondylitis, the X-ray film of this case did not show the changes of apophyseal and iliosacral joints which thought to be recognized as the very important point. Othercase showed the lumbago and the conspicuous inflamatory findings, also the X-ray findings showed only slight formation of osteophyte of the anterior portion of vertebral body of the third and forth lumbar vertebra but the narrow of intervertebral space and the destruction-figur of bone. Now we have been taking care of this patient using the therapy of anti-inflamatory antalgic agents, and he is getting a good clinical couse. In this case, also the pathological change was not found atapophyseal and iliosacral joints. Two cases were simlar to the rheumatic disease rather than the infectious disease on the therapeutics. But these cases showed buiet different from the ankylosing spondylitis.
The 41 cases treated with anterior interbody disc excision and bone-grafting were analysed based on clinical symptoms and functional radiograms. A good clinical result was achieved by 85% of the patients with a roentgenographic evidence of fusion occurred in 58%. Nevertheless the cases who indicated roentgenographically the incomplete union, were clinically good in 80%. In only anterior lumbar fusion, the cases with pain lower extremity had the poor result. In 20 cases operatively treated, the cause of sciatica were identified. It is suspected that the operation has some influences in degenerating the lower or upper disc.
This is a statistical study on digital fracture and amputation observed in 123 employee of Yasugi Hitachi Metalworking Factory from January 1969 to June 1972. Digital fractures were 95 cases and digital amputations were 28 cases. Both were commonly observed in the twenties, thirties and fourties of ages. An occurrence of the accident was at 1p.m, and 6p.m. most frequently. Causes of many accidets were mechanical press between the iron materials and crushing down with machines. The types of fractures were almost transverse-fractures and demolished fractures. The greater part of the casses were male and the left side was more involved than the right. It was the left middle finger that was injured most frequently. As to phalanges, distal phalanx was accounted for 75per cent. Most of the therapy included the unoperated treatment, such as metalic fixation. As the results of the treatment, disturbances of joint-function were 10 cases, deformations 10 and pseudoarthrosises 2. Upon investigation for the therapy, it was concluded that in the case of open fracture crushed skin wound should be treated with careful cleansing and debredment.
In order to improve conventional hand-finger splints, we doveloped a new type of finger splint. The splint consists of a wrist cuff with two wire holders and piano spring wire which attached to the plastic coated trough. With this splint, you can assist the finger movement in any direction and any extent you want. Therefore you may apply the splint to several kind of finger disabilities, for example, radial nerve palsy, median nerve palsy, ulnar nerve palsy, and finger ulnar deviation. It may be also used to pre-and post-surgery of finger tendon troubles. This K. U. Finger Splint has following features; 1) simple to make 2) light weight 3) excellent adjustability 4) cosmstically acceptable 5) inexpensive 6) may apply to lots of finger disabilities.
It is the purpose of this article to review the literature and to report on our experience with two cases of the rupture of the bilateral Achilles tendons. Only four cases have been described in detail hitherto. Case 1. A thirty-four-year-old house wife sustained the rupture in the sudden movement of the dorsiflexion of the left ankle and of the right in the next step. Case 2. A thirty-seven-year-old male teacher suffered from the same mechanism in a relay race. There was no remarkable change in the whole body and no achillodynia in the operative finding.
The transplantation of the tibial tubercle were performed on the five children aged three to twelve. Operative treatments, principally used Hauser's method, were done and the results were obtianed satisfactorily. And in another case, 22 year old man who had never been treated since he was diagnosed as having congenitalbilateral dislocation of the patella, has muscular atrophy and muscular weakness on both thighs, but he had neither limitation of movement nor complaints of his walking. The view that the operation on the tibial tubercle is unsuitable for children has been widly held currently because the premature closure of the epyphysis occurs and it often causes recurvatum deformity and genu valgus. But these experiences gave the contented results without any re-dislocation. They suggest that it may be done for children, while adequate bone attachment and transplantation adding soft-tissue operation are remarked.
With regard to delayed or non-union, fifty-eight fractures of both bones of the forearm were reviewed at our orthopaedic department during twenty years from 1953 to 1972, and thirteen cases were found to be unsatisfactorily united after initial treatment. The incidence of delayed union was 22.4per cent. All the patients were over the age of fifteen and no delayed union were occured in children. Twelve patients with delayed uniou had been operated as initial treatment, but the operative techinique varied in each cases, fixation by wires, screws, plates and intramededullary rods. All the delayed union occured iu fractures of middle third of both bones of the forearm. The f actores most affective to delayed union of fractures were incorrect techinique of bone fixation. The common errors were lack of rigid fixation, too small of intramedullary rods, unsatisfacotry reduction, especially in pronated position, and no combinatioin with bone grafting. Early mobilization was also conductve to delayed union particularlly of fractures of both hones of the forearm. All cases were related to inadequate surgery and after treatment. There is no doubt that in the surgery of fractures of both bones of the froearm the important principles are rigid fixation, reduction into anatomical correct position, and that bone grafting sholudld be combined in cases of adult. Usually immobililization should be continued for a minimum of three or four months after the operation.
A case of severe fracture of the pelvic ring. 1) Displacement could not be corrected by pelvic sling. 2) Stability of the pelvic ring was improved by osteosynthesis at left ilium and bonegrafting at the symphisis.
We recently experienced a case of gas gangrene. The case was 29 years old woman, she fell down to the valley on July 2, 1972, and injuried left femur open fracture. The wound was highly damaged and flexor muscle ruptured completely. After adequate debriedement, we closed the wound primary at once. The next day she complained severe pain and cold sensation of the left leg, but general condition was so good, we observed her condition. Two days after injury, the wound become highily swelled and bad smell, tachycardia, drop of blood pressure, unconsciousness was noticed, and x-ray finding showed the typical shadow of gas gangrene, so we decided amputation of the left leg. But after operation general condition had not become better, and swelling infiltrated toward inguinal and hypochondral region. She died on July 7 at last. We realized importance of early diagnosis and early treatment, so reported this case.
A 31-year-old male sustained oblique fracture of shaft of the right femur by car accident, which was operated on by intramedullary nailing and wiring. The nail was removed after 11 months when the fracture was thought to heal perfectly on X-ray. Four months after removal of the nail, he was suffered from sudden pain in his right thigh when going up stairs, and could not walk. X-ray revealed a transverse fracture at the site of looped wire. The fracture was operated on by intramedullary nailing. At operation, no corrosion of wire was seen but errosion of the cortex. Partial fibrosis of the bone trabeculae and osteoclasts were found on histological examination.
Two cases of avulsion fracture of the tibial tubercle are reported. They were fifteen-and sixteen-old boy injured their left knees when they jumped in volley-ball practice. Roentgenographic examinations revealed displacement of the tubercle with extension of the fracture into the knee joints. Fractures were treated by open reduction and internel fixation and the knees were immobilized in extension for four weeks. Two months after operations, they had full range of motion of the knees and no complaints.
We have experienced 23 cases of fractures of Os calcis for the last 7 years. We discussed the results of the treatment and emphasized the difficulty of the method of the treatment. We treated the patients with three different methods, simple plaster cast, Westhues method and open reduction with iliac bone graft. We attracted the special attention to the importance in handling the soft tissue of the heel area following the calcaneal fracture. Relationship between the painful foot and roentogenographic changes of subtalar joints and Chopart joint was discussed. Arthrography of these joints were performed.
Good results were obtained in osteotomy or treating fractures by using Resin (Methylmetaacrylate) as the external fixation. In spite of simpler technique compared with the usual methods, sufficient strength of fixation was recognized in our method. Twelve cases (congenital dislocation of the hip; 6, supracondylar fracture of the humerus; 3, osteotomy for varus deformity of the elbow; 1, malunited fracture of the forearm; 1, fracture of the jaw bone; 1) were treated by this method. In subtrochanteric osteotomy four Knowles pins were inserted into the femur and linear osteotomy was made with two pins in the proximal portion and remaining two in the distal one. After closing the wound adequate position of the osteotomised site or good adaptability of the hip joint were obtained in all dimensions under the fluoroscopy, and external fixation with Resin was done immediately. The authors stress that this is the advantage of the method. In the treatment of the supracondylar fracture of the humerus a Kirschner wire was inserted into the proximal fragment and another one into the distal fragment. Adding the traction force by applying traction apparatus to the distal Kirschner wire, the displacement was corrected, and then the two wires were fixed with Resion on the both radial and ulnar sides. As no splint is applied varus or valgus deformity of the elbow and circulatory disturbance can be checked easily under the direct vision. The method seems to have a good place in subtrochanteric osteotomy or treating certain fractures in children or young adults.
New device for the compression osteosynthesis, with which compression force up to about 90kg could be applied, was made and the author used it in combination with conventional plate and intramedullary nail for the treatment of fractured long bone with success. Although in butterfly fractures ft is sometimes difficult to get a stable ûxation using a intramedullary rod only, after nailing and compression the third fragment was interposed firmly between the main fragments, and the rigid fixation could be obtained. In some types of avulsion fracture, pinning and wiring (like a 8-figure wiring) was applied more effectively by method of wirethreading through a small hole which was made at proximal end of the pin.
High tibial osteotomy openations were performed for 14 cases with varus or valgus deformities due to osteoarthritis of the knee joints. From the above experiens, we think that satisfactory postoperative results, including relieves of pain and functional improvements, are well expected, when the patients are selected for operative indications. According to the results of follow up of the above patients, the following points were discussed. (1) On the indication of the high tibial orteotomy for osteoarthritis of the knee. (2) On the postoperative joint movements. (3) On the problems in conventional operative methods and our new operative methods.
In order to clarify the venous circulatory patterns in osteoarthritis of the hip, intraosseous venography was done on 45 osteoarthritic femoral heads. The venous patterns were analysed according to the criteria of the Japanese Orthopedic Association, which is classified into 5 grades of 0 to IV in order of severity of the osteoarthritis, being the severest 0. The results obtained were as follows: 1. While the V. retinacularis sup. and inf. appeared in all cases of grade III, these were observed in a half cases of grade 0, I anp II. The V. circumflexia med and lat. were observed in all cases of grade II and III, being less than 60% of the cases of grade I and 0. 2. Escaping of contrast medium into the intramedullary veins of femoral shaft or pooling in femoral head were observed the more frequently in the severer changes of osteoarthritis.
Clinical observations and pathological autopsies were performed on two cases of three rheumatoid arthritis patients medicated with corticosteroids for long period and finally dead with gastro-intestinal disturbances (hematemesis, bloody stool or ileus-like symtoms). The first case, 45yrs, old female, was dead with ileus like symptoms (abdominal distension, gas retention, pain, obstipation and vomiting), hemorrhagic diathesis and sudden disturbance of consciousness and results of pathology showed subdural hematoma, stenosis of descendant colon, fecal concretion, extensive amyloidosis, aspiration pneumonia, interstitial nephritis and atrophy of suprarenal glands. The second case, 74yrs, old male, was dead with hematemesis and bloody stool and results of pathology showed duodenal ulcer, lung fibrosis, fatty heart, arteriosclerotic atrophy of kidnies, aortic sclerosis, left ventricular hypertrophy, kidney stones and atrophy of suprarenal glands. The third case, 72yrs. old male, was dead with hematemesis and bloody stool, but could not performed autopsy.
In spite of generalization of anti-tuberculous drugs, there are considerable number of patients of bone and joint tuberculosis seen on our clinic. Patient was 37-year-old male, who was seen to our clinic complaining pain and swelling on his left knee. At first, he was diagnosed as gonitis serosa and chronic suppurative osteomyelitis of the left tibia, and was asked to undergo an operation to the tibia, but left it to its natural course. About two months later, swelling appeared on his left popliteal region and became more severe day by day, So, extirpation of the tumor was done to the popliteal region and curettage and auto bone graft were to the tibia. The tumor emerged from between tendinous portion of the medial gastrocunomius muscle and the semimembranosus muscle as was seen in an ordinary popliteal cyst. In the tumor there are much cheese material and yellow serous fluid. Histologically typical tuderculous granulation tissue consisted of Langhans' cells and epitheloid cells were found out.
The infected joints occurs from open trauma to the joint, infection from the adjacent tissue and hematogenous origin. Recently there are frequent chances of contaminations from the intraarticular injection of steroids as a treatment of arthritis. We have experienced threecases of acute pyogenic arthritis of the knee secondary to steroids injection to the knee joint and one case of infection due to penetration into the knee joint by bamboo. All cases were opened surgically and irrigated continuously normal saline and antibiotics for a week. The satisfactory results were obtained in all cases. In the last case, it failed to fined a foreign body roentogenologically. After three times of arthrotomy the foreign body was removed and the infection subsided without contracture.
Synovectomy in the knee joint with rheumatoid arthritis and other chronic synovitis was practised with an electric resectoscope modified Iglesias resectoscope. The electric resectoscope was inserted into the knee joint from stab wound at the lateral margin of the patella. The synovium in the joint cavity was observed and resected with the electric resectoscope under irrigation of Urigal (cytal). A day after surgery, the operated knee was allowed to mobilize and then, weight-bearing. Eleven joints of ten cases with rheumatoid arthritis, a case with tuberculosis, a case with pigmented villonodular synovitis, and a case with chronic synovitis were operated by this method. As far as the followed-up cases are concern, relief of pain is satisfactory and range of motion is recovered as much as preoperatively more shortly after surgery. As a complication, infection was noted in a case and reaction of irrigating fluid, such as hyponatremia, in a few cases.