From 1965 to 1973, 23 cases of calcium deposits were treated, 5 of these had bilateral involvement, making in all 28 shoulders. This disease was twice in female than in male. The average age was 45.8 years. Most common occupation was housewife which accounted for 47.8%. There was some correlation between the configuraton and density of the deposit and the course of the clinical syndrome. The disease, regardless of the stage of the stage of the symptom, is better first treated by conservative measures, and failure to it justifies surgical excision of the calcific deposit.
Rupture of the rotator cuff is much more frequent than was previously suspected. Originally this was considered to occur in men who sustained violent trauma. At many autopsies, Codman, Grant, Takagishi and Yamada etc., recognized degenerative change of rotator cuff in considerable many number of men above 40 years old. In our clinic, we have experienced 9 cases of rupture of the rotator cuff during past three years. There were 4 men and 5 women between 23 years old and 79 years old, 49 years old on an average. 4 cases of them were the disease in left shoulder and 5 were in right. In most cases, they had the anamneses of trauma. Diagnosis was made by clinical symptoms, radioscopy and arthrography. Conservative treatment was generally performed. Shoulder joint was hold by plaster spicas placing the arm in abduction for a period of 4-6 weeks. After that, rehabilitation was done. McLauglin tendon suture was performed upon the 3 cases which were diagnosed complete tears with large of rotator cuff or which hadn't shown any effect by conservative treatment. Excision of acromion and lig. coracoacromial were performed at the same time. After treatment, all of 9 cases offered good movement of the shoulder joints.
A follow-up study of 52 cases consisting of 12 malignant, 40 benign was carried out mainly in term of the therapeutic procedures. Bone cyst, osteosarcoma and osteochondroma were relatively frequent in the humerus and eosinophilic granuloma in the clavicula. Radiation was effective for 2 scapula tumors. It was indicated that a partial or total resection of the clavicula together with tumors was the choice of treatment for clavicula tumors. It will be possible to evaluate the shoulder prosthesis more succesfully by using adequate endoprosthesis.
Twenty patients having the cerebral vascular accidents were observed by X-ray photograph, ROM (passive) of the paralytic shoulder, EMG of M. biceps brachii and M. triceps brachii, and so the spectrum analysis of EEG. Eleven patients were observed with the dislocation of the paralytic shoulder. The paralytic dislocations was reduced in supine position, and so ROM of the shoulder was inproved too. On all patients with the paralytic dislocation of shoulder, interference voltage of M. triceps brachii was not observed. EEG of the all patients was observed usually dominant slow waves on the lesion side.
The authors experienced 40 cases who have been operated on for traumatic dislocations of the acromio-clavicular joints. Follow-up examinations were made on 29 out of 40 cases on an average of 8 year and 3 months after operations. There were no significant deferences between the results of two major procedures: transfixation with Kirschner's wire alone and in combination with 8 figure wiring. They emphasized that the latter is a more beneficial procedure which is able to get a stable fixation and to begin early exercise without external fixation.
Recurrent posterior dislocation of shoulder joint is rare lesion. My patient is a twelve years old female. In July, 1972, open reduction was carried out taking Scott's posterior glenoplasty with Bankart's capsulorhaphy. One year after operation, fatigue, pain and click that she complained before operation, are distinguished completely. Causes that origate this lesion are not distinct yet except one by injury. But I observed hypoplasy of posterior glenoid during the operation. So I think the lesion is originated by combining this element with depreciation of muscular power. As theraphy of this lesion, I think, it is effective to try to strenghen muscular power cinservatively. I think it is better to use open reduction when I can't expect any effects by using conservative theraphy after I use it for about one year. It is more effective, I thing, to use several methods at the same time than one method in such operations.
Six shoulder joints of five cases with recurrent anterior dislocation were treated by the Putti-Platt procedure. The age distribution was ranged from 16 to 24 years. At first, five joints dislocated by trauma and one without trauma. Five joints got no special fixation after primary reduction. On X-ray check in approximately 60° internally rotated position, revealed bony defect of humerus in five joints, and the capsules were found extended more or less in all of them on arthrogram. Detachment and looseness of the capsule and avulsion of the glenoidal labrum were found at surgery. Except one joint had no recurrence of dislocation after surgery and showed slight limitation of external rotation of the shoulder joint. No disabling in daily life was complained.
In our clinic, 64 patients were surgically treated for lumbar disc herniation. The clinical follow-up fo these patients was performed by questionnaires on an average of postoperative 5 years and 8 months. 1. The average age of the patients was 33.7 years, the youngest being 16 years, and the oldest 66 years. 2. Forty-seven were male and 17 were female. 3. The commonest level of the disc removal was L. 4-5 (60.9per cent). 4. In 64 patients, 54 lumbar disc herniations were found, in five there was adhesions and thickness of lig. flavum, in two there were varcies, in two osteophytes caused the nerve root pressure, and in one nothing was found. 5. The clinical results were based on relief of pain, the need for analgesic medication, the distriction of physical activities and the return to eployment. Nineteen per cent achieved excellent results, and 64per cent satisfactory results (good and fair).
234 cases of lumbar disc herniation were operated on by anterior approach (213 cases) and posterior approach (21 cases). Of these operative cases 87 cases, which have elapsed over 1 year after surgery, were followed up and the results of clinical evaluation due to difference of surgical procedure are discussed. [Results] 1) Over-all results in anterior approach (78 cases) revealed “Excellent” results in 55 cases (70.5%), Good” results in 21 (26.9%), “Fair” results in 2 (2.6%), in posterior approach (9 cases) “Excellent” results in 5 (55.6%), “Good” results in 4 (44.6%), “Fair” or “Poor” result in none. 2) Investigating these results from disc lesion level, anterior approach revealed “Excellent” results in 40 cases (74.4%) in L4-5 disc lesion, on the other hand, posterior approach revealed “Excellent” results of 5 cases (83.3%) in L5-S disc lesion.
There are 105 surgically operated cases in our clinic for the lumbar disc lesions between the period of '68 to '73; these are observed for four to sixty two months and reported the end-result datum. Our surgical techniques are osteoplastic partial facetolaminectomy (Kondo's method) and replaced lamina fixation with the screw nail (Teshima's method). Our laminectomy is the favorable method in that it allows a wide field of surgical operation thus making the operation easier, enabling the surgery to be performed perfectly. We believe it is necessary to take into consideration of H-graft or Langenskiold's spondylodesis in case of instability of the vertebral body, narrowing of the vertebral disc space, or particulary those who are engaged in hard musclar laborer. The methods of our laminectomy proved a good result.
We studied the long term results of lumbar disc herniation operated with Love's method and wide laminectomy. Data were reviewed on 167 patients operated in 1963-1973. On follow up at 1-10 years, 24% of patients were free from symptoms, and 57% were improved. Patients with herniation between L4 and L5 had worse results than L5 and S1. In patients with bulging discs, the incidence of residual symptoms was more frequent than complete herniation. Narrowing of disc spaces was increased in 75% of patients. But patients with narrow discs mostly had good results.
The dorsal dislocations of the metatarsopharangeal joints are uncommon. Recently we have experienced a case of these dislocations at 2nd, 3rd, 4th metatarsopharangeal joints. These dislocations could not be reduced by manipulation under lumbar anesthesia next day after injury, they were, therefore, necessary to perform open reduction. Judging by the operation findings, we considered that most significant irreducible factor was fibrocartilagenous plate.
Recently on account of traffic accident or others, we experienced many fractures of the foot. In those of them we met the very rare cases: fracture-dislocation of the tarsal navicular, fracture-dislocation of the second cuneiform, and fracture of the lateral process of the talus. First case and second case were treated operative and the last was non-operative. They were good reslt, so we report with some comment.
Twenty-two fractures of phalanx of finger, toe and the others were treated by closed reduction, percutaneous pin fixation, and early motion, which was obtained by using Riordan-fixation Pin. In this series, we gained a full range of motion. The major advantages of this method are that, no external immobilization is required, early movement and very easy to perform, but also have a little disadvantages.
113 cases of diaphyseal fractures which had been treated with the K-U compression plates were collected and discussed. Cases of delayed union or none union were seven that formed 6.2 per-cent of all cases, almost all of cases resulted in unsuccessful bone union, dued to inadequate technique of surgery and unsuitable treatment after surgery. Only two cases showed spongeal appearance of cortical bone. And other two cases gave rise to refracture after compression osteosynthesis. It was assumed that some of the causes of refracture were loss of stress to bone by existence of a compression plate.
We have experienced seven cases of the lesion of the adipose tissue in the knee joint, in each of which an operation was performed. Particularly we have examined three cases, in the first of which a pedunculated solitary lipoma, located on the medial meniscus, was found to be the cause of internal derangement. The second was a case of a lobulated, pedunculated intra-articular lipoma in the lateral suprapatellar pouch, which was preoperatively diagnosed an injury of lateral meniscus. The third was deonstrated to be a case of snapping knee due to impinging of a hypertrophied infrapatellar fat pad in a rheumatoid knee.
The five cases of the unstable knee due to old rupture of the anterior cruciate ligament and the medial collateral ligament were operated by following method; 1) the tendon of the semitendinosus muscle was cutted out at proximally about 15cm length, 2) a hole was penetrated from the medial condyle of the femur—passed through the intercondyloideal fossa and further through the articural surface of the tibia—to part of the tuberositas tibiae cutted off previously, 3) the tendon as above mentioned was inserted in this hole and pull out to the tibia, 4) the tendon was tightly sutured and fixed to entrance and exit of this hole. Satisfactory results were obtained in our all cases.
Zweck dieser Arbeit ist, die Ergebnisse der konservativen und operativen Schlüsselbeinbruchbehandlung zu vergleichen und so die Indikationsstellung zur Operation klarer zu umreissen, und zugleich die operative Vorgehen (Drahtumschlingung), die in meiner Klinik gewöhnlich ausgewählt wird, zu betrachten. Meine Krankengut umfasst 90 Brüche, davon wurden 54 konservativ und 36 operativ behandelt.
50-year-old woman, was brought to the hospital on September 17, 1973, along with her severed right forearm which had been completely amputated by machine approximately 30 minutes prior to admission. Replantation was performed by bone fixation, arterial and vein anastomosis, nerve suture, tendon and muscle suture and skin covering. On the 14th postoperative day, reconstructed radial artery occured rupture. Ruptured radial artery was restored with autovein-graft immediately. But on the postoperative 21th day, the patient had died with acute hepatitis. Histological finding of the ruptured arterial wall showed infected change.
The first clinical cases of composite graft of skin and fat were reported by Daniel and Taylor (1973). O'Brien et al (1973) and Harii et al (1973) have also reported on some successful cases of groin flap transfer. The authors reported five cases of distant transfer of an island flap by microvascular anastomosis. The groin flap was used for four cases and a hypogastric flap was used for one. In all cases, end-to-end anastomosis of vein and end-to-side suture of artery were performed. All grafted flap was taken completely and no complication was noticed during the operation and after the surgery.
It is the purpose of this paper to follow-up the results on our cases of 16 neck and 18 trochanteric fractures of the femur, which had been treated by the cross-screw fixation technique with the Y-screw during past seven years. In the neck fracture of the femur, it is hopeful that the low angle screw is inserted as possible as obliquely through the Adam's bow and the cross angle of the two screws is made up the sixty degrees on the anteroposterior view. The results was influenced by the comminution at the postero-inferior aspect and the acceptable reduction of the medial cortical buttress of the femoral neck. The stability may be restored by reduction in the valgus position rather than the varus position. On the other hand, in the trochanteric fracture of the femur, the cross-screw fixation technique had good results in the stable type but had no indication for the unstable type of this fracture. We consider that union is almost certain to occur, when by some means the stability and its maintenance of the calcar femorale is obtained.
1. A follow-up study was performed on 68 patients, 20 male and 48 female, whose femoral heads were surgically replaced by prosthesis. Those patients included 58 cases of fracture of the femoral head, 35 fresh and 23 old, seven cases of avascular necrosis, two cases of fracture-dislocation, and one case of coxarthrosis. 2. The age of fracture cases at the time of operation ranged betwee 44 and 86 years, 66.5 years on the average, and the duration of follow-up was eight months to ten years and seven months, two years and ten months on the average. 3. Results of the treatment revealed neither difference due to the types of the diseases nor difference between fresh and old fractures. 4. Difference in surgical technique also did not give any influence to the result of the operation. 5. Good result was obtained when bone cement was used, but the result was poor in those cases with acetabular protrusion and those in which the acetabulum was reamed. 6. Considerable difficulty in daily activities was found in 34per cent of femoral neck fracture. 7. Pain diminished gradually as the time elapsed in 61.7per cent of the patients, but no correlation was found between the pain and X-ray findings except in those with acetablar protrusion.
Scince the development of the replacement of the femoral head by the intramedural type of the prosthesis many articles have been reported, and some long-term reviews have showed that the operation is still reliable and has definite indications. Acording to some of those, the statistical results with the Austin Moore prosthesis were better. So in our applications of the prosthesis, postoperative exercises were started as early as possible. Conclusively, of our 17 operated cases the earliest walking exercise with walking-aid was carried out on the 6-th day after surgery, and the average duration of bed exercise was 11 days. The obstructions to the post-operative programs were operative or early complications of the surgery, getting worse of hypertension, muscle weakness, postoperative hematoma. In our review, the replacement of the femoral head by the Austin Moore prosthesis without any postoperative complication, seems to be the best way for the earlier rehabilitation.
Muco-Cutaneous Lymphnode Syndrome (1967 Kawasaki), usually affects the infants of four years-old and downward, has specific symptoms and signs such as fever unresponsive to antibiotics, injection of bulber conjunctva, hard edema of hand and foot, membranous desquamation of finger tip, injection and dryness of mucous membrane of oral cavity and lip, scarlet tongue, indefinte shaped skin eruption, and so on. This lesion often complicated with serous arthritis, but we can find no case report with pyogenic arthritis. This case admitted complaining of 39°C fever continuing for 9 days. Diagnosis of Muco-Cutaneous Lymphnode Syndrome was done by his characteristic symptoms, signs and laboratory findings. On 15th disease day, transient swelling of right hip joint region occured. Antibiotics and steroid agent improved his condition satisfactorily, but he did not walk. On 26th disease day, X-ray film showed right coxitis. Punction of hip joint proved pyogenic infection, and immediately incision for drainage was performed. Post operative course was satisfactory, and he discharged 3 weeks after operation. This case was reported in detail, and relationship of 2 disease complicated were also discussed.
Among 305 patients whose proximal portion of the femur were subjected to roentgenographic examination, we found out evident cyst-like areas in four, aged from twenty-seven to fifty, and several atypical ones. They vary in size from about eighteen millimeter in diameter to six millimeter, and are sometimes multiloculated. All of them were found in the cranial half of the femoral neck, especially cranial most of the neck, where two epiphyseal plates of the femoral head and the greater trochanter meet at puberty. Considered from our roentgenographic observations, some of this kind of lesions were supposed to be caused by a developmental defect of the epiphyseal plates.
Out of 49 cases with the ankylosed hip joint 26 were followed up on the walking abilities and the activities of daily lives, and the following results were obtained. All cases could sit on chair without trouble, and 24 cases (92.3%) were able to walk without difficulties in their daily lives, however, the majority of cases complained of some difficulties in bowing at sitting position except one and in cutting nails except 5 cases.
1. The population incidence of bilateral loose shoulder was 4.0 percent in 14, 658 person. The most important factor of loose shoulder depends upon deficiency of the force of scapula to rotate upward, when the arm is elevated sideways. 2. If the person with bilateral loose shoulder one experience of dislocation shoulder, recurrent dislocation of the shoulder develop more easily. 3. No single treatment is always successful in treatment recurrent dislocation of loose shoulder. At the treatment we must inspect, whether the movement of scapula is lacking or not.
The cause of “Goju-gata” is yet unknown, but in many it is felt to be due to disorder of the biceps mechanism or suprahumeral gliding mechanism. In most the condition can be cured within 18 months after onset by conservative therapy, but in some pain and motor disturbance persist. With the purpose of reducing the length of treatment, surgery was peaformed on 35 cases suffering severe pain. Pain subsided shortly after surgery and remission was attained with in one month in all but 3. However, considerable time was required to regain full range of movement. In 25 cases full range of movement was regained within six months after surgery, but in 10 pain associated with movement and limitation in range persisted for more than six months. Therefore, it is felt adequate functional trainig is necessary following surgery.
628 cases of bone and joint injuries of shoulder and shoulder girdle were treated in our hospital from 1965 to 1973. In this paper we reviewed and discussed the treatment of fractures of the scapula, fractures of the upper end of the humerus and dislocations of the glenohumeral joint. Some cases of fractures of the acromion and coracoid process were treated operatively and all other fractures of the scapula were treated conservatively, good results were obtained. Of 79 cases of traumatic dislocations of the glenohumeral joint, 23 cases were followed up. 3 cases of anterior dislocations redislocated, but were thought not to be recurrent dislocations. There was no recurrence among the 14 cases of recurrent anterior dislocations of the glenohumeral joint operated on, 5 cases by Jinnaka-Oudard method, 2 cases by Bankart's method and 7 cases by modified Bristow's method.
Although the recent literature abounds with explanations for rotator cuff injury and its diagnosis, there do not appear to be consistent observations concerning a well established treatment regimen. Many observations and questions have arisen which concern such matters as ability of the rotator cuff to heal and the relationship of rotator cuff pathology to its etiology. These statements generally indicate that rotator cuff injury is usually caused by trauma to a prevously degenerated tendon. More important than this matter, however, is the idea that treatment by suture alone is not enough. A coherent program including immobilization of the upper limb and other postoperative measures is essential. In this connection, an important consideration in the recovery of glenohumeral motion is that the fundamental function of the rotator cuff may be one of guiding the movement of the greater tubercle.