We experienced a rare case of myositis ossificans progressiva complicated by bilatelal hallux valgus, multiple exostosis and synostosis of the forearm and obstructive deafness. He was admitted february 5, 1971 at 5 years of his age. During the past 5 years, ossification of the neck, spine and shoulder joints were progressive. Particulalry the neck and spine have been ankylosed. However, cardiac muscle, diaphlagma, tongue, larynx and sphincters were not involved.
This study is based on the analysis of the results of 21 operated quadriceps contractures from 1954 to 1975. There were 13 proximal tenotomies of rectus tendon, 2 excisions of the scar in the muscle, 1 Thompson's quadriceps plasty, and 5 proximal tenotomies of rectus tendon with tendon transfer. The results of proximal tenotomy tends to the recurrence, but the results of proximal tenotomy with tendon transfer are satisfactory.
This report is to describe arteriographic findings of vertebral, anterior spinal and radicular arteries by selective angiography accoding to Seldinger's method performed on 48 cases with disorder of cervical spine and/or cord. There are 31 cases of cervical osteochondrosis in which many vertebral arteries showed local displacement and anterior spinal- and radicular arteries were clearly visualized in one disc lesion and they were not nearly visualized in multple disc lesions. Five cases with ossification of posterior longitudinal ligament demonstrated almost normal vertebral arteries, but rare appearance of anterior spinal- and radicular arterier. The arteriographic findings of other cervical disorder such as disc herniation, spinal tumor and cord injury were also reported.
We have analyzed a series of 28 cases of cervical spondylosis treated surgically: myelopathic form is 19 cases, radicular form is 5 cases, combined form is 4 cases. Twenty-one cases of cervical spondylotic myelopathy have been investigated by evoked electromyography. The following results were obtained. 1. H-wave could not be elicited by 3 out of 21 cases. 2. Eighteen cases were divided into 3 groups using H-wave as an index. Group 1: 9 with a high plateau level. Group 2: 3 with a high plateau level and much fluctuation. Group 3: 6 with more fluctuation and slow undulation. 3. We found some correlation between the classification as above described and clinical signs in this series. 4. Operatively, anterior interbody fusion may be suitable for group 1 and laminectomy for group 2 and 3.
Since 1970 decompressive surgery has been performed upon 30 cases of cervical myelopathy due mainly to the ossification of the posterior longitudinal ligaments. Anterior decompression was carried out by way of subtotal vertebrectomy and the resection of the ossified posterior ligaments for 23 cases, followed by anterior interbody fusion with the strut bone grafting. For the remaining 7 cases, decompression laminectomy was operated on and for the last one both procedures. The anterior decompression results more effective improvement of ADL than decompression laminectomy. We thus far conclude that the anterior decompression is more advisable for those that ossifications were localized below the C3-4 level in the cervical spine.
Since 1970, thirty-one “osteoplastic enlargement of the spinnal canal” have performed in our clinic on the patients with disorder of cervical cord who had had the indication of posterior decompression. The advantages of this operation are 1) decompression of the cord at both posterior and lateral sides, 2) to prevent increasing instability of the cervical spine, and 3) to reduce delayed compression of the cord caused by adhesion and scar. There were 16 cases of cervical spondylotic myelopathy, 11 of ossification of posterior longitudinal ligament, 2 of spinal cord tumor and 2 of cord injury. The follow-up studies, from one month to 5 years and 6 months, showed enlargement of the canal, improvement of symptoms and also thickenning of remained laminae (average 3.6mm). The proportion of the enlargement of the canal, measured by X-ray films, ranges from 16.7% to 53.8% (average 37.0%).
We investigated the prognosis of untreated 42 flat feet The results were as follow: 1) Untreated infantile pronated feet; pronation deformity of the heel tended to decrease to a certain degree as infant grew older, but the lowering of medial longitudinal arch, mainly due to the naviculo-cuneiform sag, remained. 2) Prognosis of the congenital calcaneus feet revealed to be good. We usually need no treatment of this deformity except the case with strong contracture of dorsiflexsors. 3) As generally accepted, prognosis of the congenital convex pes valgus is miserable. So this deformity must be diagnosed and treated as possible as early. We could not follow the prognosis of the congenital calcaneo-valgus foot, but we think we can not expect the spontanous correction of this deformity from our clinical experience.
The elder sister, four year and eight month old, was born with marked congenital vertical talus in bilateral feet and CDH, hypermobility of the joints. The right foot was operated with soft tissue release and open reduction of dislocated talo-navicular joint. The result of the surgery was satisfactoric. The younger sister, two year old, showed marked retarded growth and development, congenital vertical talus, CDH, hypermobility of the joints as well.
This paper reports a follow-up study of 23 cases of congenital pseudarthrosis of the tibia treated at Orthopaedic Department of Kyusyu University during fifty years from 1925 to 1975. It is of note that these 23 cases represent less than 0.1 per cent of the more than 25000 patients treated in our department of Orthopaedic Surgery. The distribution by sex and side affected is as follows; 1) Male: Female=12:11 2) Right: Left=8:15 Of the seventeen cases of pseudarthrosis, eight had café au lait spots of skin pigmentation and the familial incidence of the pigmentations had been found in six of these eight cases, four were diagnosed neurofibromatosis, and four were fibrous dysplasia. This incidence seemed to suggest the relationship of these three diseases or conditions. Thickenning of periosteum affected was found in almost of the cases, and it may relate to the pathogenesis of congenital pseudarthrosis of the tibia. The methode of operation, that we have been employing, is repoted in this paper and we suggest that it is important to fix the fragments so firmly and to use bone grafts. We, orthopaedic surgeons, should never amputate the leg. Keep tring, keep tring.
Case 1. A one-year-old boy had congenital persistent dislocation of the right patella, he was treated with modified Tavenier's procedure and medial hamstring lengthning. Case 2. A girl, aged twenty-two, had recurrent dislocation of the right patella, she was treated with the operation of Hauser. Case 3. A girl, aged seventeen, had bilateral dislocations of the patella. Operations of Hauser and Campbell was performed on both sides. Case 4. A boy, aged fifteen, had recurrent dislocation of the left patella, he was treated with quadricepsplasty. We discussed congenital factors and hereditary tendency of these cases and their treatments.
Factors influencing the prognosis of lateral deviation of the femoral head developed after the initial treatment of congenital dislocation of the hip were discussed. 1. Lateral deviation occurred easily with open reduction or Lorentz' method. 2. To predict the occurrance of the lateral deviation, it is necessary to examine the C-E angle and the changes of the acetabular angle from time to time. 3. The prognosis of the cases of lateral deviation simply due to exaggerated anteversion of the femoral neck or due to unknown factor was good without any more treatment. However, those due to femoral head deformity had so poor prognosis as to require further surgical treatment.
Three femoral heads with non-traumatic aseptic necrosis were excised surgically, and then investigated histologically. Case 1: 57 year-old female with aseptic necrosis of femoral head associated with osteoarthritic features. Case 2: 47 year-old female, after steroid therapy for sarcoidosis Case 3: 34 year-old male, following steroid therapy for systemic lupus erythematosus. There were no specific histological findings in three cases, which are related to the original disease.
40 total hilp replacements in 37 patients, Charnley and Charnley Müeler type have been operated on in our clinic since 1971. The surgery was operated on 27 cases of osteoarthrosis, 5 of nonunion of the fracture of the femoral neck, 5 of aseptic necrosis of the head of the femur, and one case of failed endoprosthesis, ankylosis of the joint and Charcot's joint respectively. Out of 40 hips, 25 of wire breakage, 8 of non-union of the greater trochanter, 2 of the loosening of the socket, and the dislocation of the head and perforation of the femoral cortex in each case had been took place after surgery.
Since 1971, eighteen total hip replacements in seventeen patients have been performed in our clinic. The age ranged from thirty eight to seventy seven years. Eleven joints in ten patients were replaced by McKee type, six Charnley type, and one Weber-Huggler type. The operation was most effective for the relief of pain. The improvement of gait was good. There was no infection, but the loosening of acetabular component was three cases. Four cases treated with arthrodesis in contralateral hip and one rheumatoid arthritis with bilateral total hip replacement were unsatisfactory to improvement of gait and A. D. L.
The Munktel HEPA-filter is used in our bio-clean operating room. The filter pannel sized 2.6m×3.6m is composed with twenty HEPA-filters. In order to improve hoirzontal laminar flow, three return grills are furnished on the opposite wall and two sliding walls are set in bilateral sides. The HEPA-filter works in three different steps as following manner. In the low step two HEPA-filters are work, in the medium step nine filters, and in the high step twenty filters. In the high step working condition, ventilation of the room is increased to 240 times per hour and the class 100 of bio-clean air is accomplished within only five minutes.
The electrical current has been applied for fracture healing. Bared tip, one and half centimeter in length of a multistrand stainless-steel wire insulated with Teflon was inserted into the bone marrow as a cathode and the anode was fixed on the skin. The power pack with 9 volt battery modified to discharge a constant current of 10 microamperes inspite of variable resistence was connected in between both poles. All the patients were sustained either of the fracture of the femur or the tibia. Five patients with non-union, five with delayed union and four with fresh fracture were included in this series. Complete healing of fracture was obtained in thirteen out of fourteen cases. Electrical current thus applied might be said to enhance bone formation and is promising for the treatment of fractures, especially for non-union or delayed union.
Out of 22 cases of fracture-dislocation of the hip, 16 cases, including 13 posterior, 2 anterior and one central dislocation, were treated srgically for the past 5 years. Three dislocations were reduced within 48 hours and the remaining after 5 days or more, being on an average of 47 days. While the satisfactory results were obtained in the former 3 cases, the results were entirely unsatisfactory in the remaining but one. The authors emphasized that the surgical interventions should be carried out as early as possible, if indicated.
For recent six years, from September in 1969 to August in 1975, sixty-three patients with sixty-four fractures of the femoral neck and trochanter were operated in Yamaguchi-Rosai Hospital. As one patient had bilateral operations and seven were revised, so operations were seventy-two in all. As concerns the method of the operation, fifty-six operations of seventy-two (77.5%) were ostesyntheses and eleven were replacement operations to prostheses. In point of the site of the fracture, operations for fracture of the femoral neck were twenty-five (34.7%) and the rest was for the trochanteric fractures. In the femoral cervical fracture, the ratio of osteosyntheses to prostheses was thirteen to ten, and in another group, forty-three to one. These patients are usually old and having any complications, therefor have to be prevented various secondary diseases of bedsore, inflammation of urinary tract, stiffness or contracture of joint, dementia and so, which are caused by prolonged bedridden lying. If patients are able to be permited exercises on the bed or in Hubbard tank in a few days after operation, the operative therapy is reasonable.
Since 1972 we have treated intracapsular femoral neck fractures withcrosswise inserted double cancellous bone screws. In this paper our technique and the follow-up results are mentioned. The conclusions obtained are as follows: 1. Twenty-four of thirty cases were treated successfully. 2. Regardless of the age of the patients satisfactory bone union was obtained provided that the surgery was carried out within a month after injury. 3. The types of fracture belonging to Garden's stage III and IV and those out of permission on the alignment index were inclined to nonunion. However, these factors were not always the cause of the nonunion. 4. In our cases the causes of the nonunion were severely comminuted fracture, early weight bearing or pathologic fracture. 5. On the incidence of femoral head collaps in this series it is impossible to express our opinion because of the short period of follow-up.
75 cases of diaphyseal fractures were collected and discussed. Cases of delayed union or non-union dued to inadequate technique of surgery and unsuitable treatment after surgery. There were successed in bone formation with reoperation, but range of motion were disturbed and majority of cases complained of difficulties in their daily lives.
We reviewed the calcaneus fractures with the subtalar joint disruption which had been reduced with a Steinmann pin as original method and the calcaneus was transfixed with Kirschner wires to the talus, cuboid or navicule for maintenance of the reduction. The plaster fixation was not applied and exercise of the ankle joint was instructed as soon as possible. Full weight bearing was started twelve weeks after reduction. Results were excellent in 4 cases, good in 2 cases fair in 3 cases and poor in 1 case. Nine of them were able to come back their orginal jobs.
1. In the following tabulation the 99 ankle fractures are classified in the manner described by Lauge-Hansen as judged from roentrenograms: supination-adduction fracture 15 supination-lateral rotation fracture 48 pronation-abduction fracture 17 pronation-lateral rotation fracture 19 2. The quality of the clinical results and the incidence of the osteoarthritis depends on the accuracy of the reduction and on the degree of the initial injuries of the articular cartilages.
The distal tibial epiphyses may be damaged, when the ankles are injured in children. Injuries involving the epiphyseal plate present special problems in diagnosis and management. In our clinic, we have experienced fifteen injuries of the ankles during past ten years. In eleven of these ankles, epiphyseal plates were injured. These were classified according to the Salter-Harris method. The second type was eight, the fourth type was two and the degloving injury one. The second type produced by abduction injuries were easily reduced by the manipulation and the prognosis of this type was good. The fourth type produced by adduction injuries must be reduced exactly by the operation. In this type, growth plate damages were common and progressive deformities were occured. The degloving injury removed the perichondrial ring and permitted bony bridging between the epiphysis and metaphysis. In this type, varus deformity was occured by the bone bridge.
Bimalleolar fractures have often been dealt with in orthopaedic clinic. Twenty eight patients were treated in this series. These ages ranged from fourteen to sixty six. Fractures are classified according to the Jinnaka system, and abductive type is still more classified three types with the fractures level of fibula. Through the fractures level of fibula, we know the injuries of the tibio-fibular syndesmosis. All the medial malleolus fractures were fixed by screw, but the lateral malleolus were not fixed except of special cases. Twenty two of the twenty eight patients had good result, and the other six cases had symptoms. These symptoms were caused of unfit of joint surfaces and instability of the ankle joint.
Sowohl die Sprungsgelenkluxation, auch die Bänderverletzen bei der Malleorusfraktur sind als nicht seltene Komplikation beobachtet worden. Die Wiederherstellung des anatomischen Verhältnisses sowie genaue Fixation sind deshalb so wichtig, weil dadurch die Reposition des Gelenkes und die Reparatur der verletzten Bänder erfolgt werden können. Bei 111 Fällen von frischer Malleolusfraktur aus meiner klinik wurde es über die verschiedene Typen der Fraktur, über die Indikation zur operative und konservativen Behandlung, über die operative Methoden, und schliesslich über das Ergebnis der Behandlung eingehend diskutiert, Das Ergebnis kann im Allgemeinen als sehr befriedigend bezeichnet werden.
We have treated 68 injuries of the ankle from 1965 to 1975 and examined these cases according to the classification by Watson-Jones. We obtained the results as follows. (1) Arthrography & stressed X-ray findings of the ankle are very important to make a diagnosis of the avulsion of the ligament. (2) The injuries of inferior tibio-fibular ligament must be fixed with the screw in the position of dorsiflexsion of the ankle joint, and it must be removed at 6 weeks. (3) It is very important to take care of not only lateral dislocation but anterior or posterrior dislocation.
Survey on 24 cases of traumatic deformities of the feet were reported with special reference to 5 cases of deformity of the ankle caused by growth disturbances of distal epiphysis of the lower legs which were treated by “zug-gurtung” method following corrective osteotomy. While the epiphyseal arrest was necessary for the cases under the age of 10 years and the “Zug-gurtung” method was not always sufficient, the method was thought to be encouraging for preventing recurrence of the deformity.
The fracture of the neck of the talus in children is believed to be uncommon. Five cases were treated during the period from 1970 to 1975. At the time of the accident, the age distribution of the cases was four to ten years. Of the cases four were males and one female. We mentioned and reviewed the frequency of aseptic necrosis of its body, early diagnosis of necrosis, the differences between adults and children of the talus neck fracture and treatment including the problem of period of immobilization when the aseptic necrosis occurred unfortunately. We stressed early reduction is most important and operative reduction is the best. For early diagnosis of aseptic necrosis, it is important whether we find the subchondral atrophy of talus dorm on antero-posterior view and the tomography is also effective method.