The present study was performed to clarify the effect of chemotherapy in 21 specimens removed from 15 patients with bone and joint tuberculosis. Histologically, tubercles became rapidly atrophic after treatment with chemotherapy. In caseous foci, epithelioid cell wall became rapidly atrophic and perifocal exudative inflammatory process also rapidly decreased in degree after treament with ceemotherapy. In such a wall, production of collagenous fibers was markedly depressed. Accordingly, histopathological features of tuberculous lesions is very important at the end of the treatment, in clinical view point.
Case 1: A 51 year-old woman visited our outpatient clinic on September 9, 1975 because of swelling and pain in the right knee. She had experienced abdominal typhoid in 1945. In 1954, she first noticed that her right knee was painful and swollen, and the knee pain lasted thereafter. On physical examination, her right knee was slightly swollen and local heat and tenderness on the medial condyle of the femur were noticed. Antibiotic therapy was not effective. She was admitted to our hospital on May 1976 for detailed examination. Laboratory findings were normal except for positive CRP and elevated ESR. On X-ray examination of bone, there were abnormal radiorucent area like Brodie's abscess in the distal end of the right femur. The pus gained from the cavity showed positive serological test for abdominal typyoid. She has now usual activity of daily living after operation. Case 2: A 21 year-old woman complained of swelling and pain of the left clavicle since February 1976 and experienced pustulosi palmaris et plantaris on May 1976. Findings of the clavicle were those of the osteomyelitis both radiologically and histologically. We consider that the osteomyelitis may have some association with the pustulosis palmans et plantaris.
A seventeen years old girl suffering from pain and swelling of right knee joint was diagnosed as synovial chondromatosis, which is an uncommon condition among those intraarticular loose body forming conditions —so called osteochondromatosis. The gross and microscopic features of this case met the criteria of the condition. Though there are many reports, there is no standard treatment concerning the necessity and range of synovectomy.
Recently we have experienced 3 patients which treated by method of transplanting and fixing their own articular cartilage with bone pegs made from their tibial bone. Three cases consists of an osteochondral fracture, an osteochondritis dissecans and an osteochondritis necroses. Particularly for the patient of osteonecrosis situating on medial femoral condyle and medial tibial plateau, we have treated by tibio-femoral joint. Postoperatively two patients of the former have normal range of motion without pain, while the later of three has no pain showing a little disturbance in the movement of the knee joint.
The observations of the cases of multiple peritendinitis calcarea in young sisters aged 23 were 20 are reported. Calcium deposits about joints associated with acute pain are generally considered to be a clinical and pathological entity. The disease is apparently a self-limited one, and the symptoms generally subside within two weeks. The shoulder is the most commonly involved area, but there is an increasing number of recent publications dealing with calcifications of other joints. The conditions of the disease are well discussed in the literature, and the diagnosis is not difficult when it is kept in mind, but the etiology is remained unknown. It is believed that the deposition of the calcium salt is actually the end result of a necrobiotic process. Compared with the disease of unifocus, multiple peritendinitis tends to occur in younger female and without any remarkable trauma. The discussion of familiar cases may contribute to the etiology of the disease from a viewpoint of any disposition.
We have studied eleven patients of juvenile rheumatoid arthritis. JRA is a diffuse systemic disease and the onset of the disease may be subtle. Often conspicuous evidence of the rheumatoid arthritis is lacking for months. Monoarticular and polyarticular arthritis occurred as the first manifestation and often they had a slight attack of fever. The erythrocyte sedimentation rate is the most useful test. Its elevation is taken to be evidence of active disease. The roentgenographic finding (regional alterations) is helpful for diagnosis. The dangerous complication is rarely and the prognosis for life is good.
The specimens used in this study were taken from four divers having died for the acute decompression sickness. Cace 1 died immediately after diving and Case 2 died 10 hours after diving. Multiple, round-shaped vacuoles consisted of air bubles were present in the bone marrow cavities on the femoral heads. Sludging of the red blood cell in the dilated venules and platelet aggregation adjacent tg the seen. Case 3 died 5 days after diving, and Case 4 died 14 days after diving. Extensive necros is with platelet aggregation and microthrombus in the arterioles and sinusoids were found in the cases. Other findindings were similar to that of Case 1, 2. Platelet aggregation and microthrombus may result in osteonecrosis in conclusion.
Seven adult patients with osteoarthritis due to dysplasia were treated by the medial displacement osteotomy of Chiari. Age of the patients ranged from 25 to 56 (average 41). The following results were obtained clinically and radiologically. 1. The releaf of gait pain, the improvement of A. D. L., R. O. M. and limping in 5 cases. 2. The improvement of CE Angle, Acetabullar-Head-Index and the muscle leverage in 7 cases. The widening of joint space in 4 cases. The disappearance of cyste in 1 case.
Electric motor reamers, composing with the same size concave and convex spherical parts. were used to the arthrodesis of the hip. The cartilage of the head of the femur was reamed out with the concave spherical reamer and the cartilage of the acetabulum was reamed out with the convex spherical reamer. Cancerous bones of the head of the femur and of the acetabulum were brought in direct contact, on each of the same size spherical surfaces. By this method, arthrodeses of the hip were performed within 90 minuts and 600ml. bleeding in average.
High tibial osteotomies were carried out by our method for the 17 knees including 11 osteoarthritis, 3 spontaneous osteonecrosis and 3 others. The operations were carried out through medial approach. The varus deformity was corrected by a opening wedge osteotomy followed by fixation using plate and bone grafts taken from proximal part of the tibia, and the valgus deformity was corrected by closing wedge osteotomy, which were fixated by “Zuggurtung” method. Follow-up study revealed that the 7 osteoarthritic knees were free from pain but the 4 knees were not improved, and the another 5 knees were improved. No complications were encountered.
We studied on the rotation and tibial torsion of the leg in both normal and osteoarthritis of the knees using the horizontal cross rotatory tomography. Method: With the knee full extended, tomographs were taken at following three levels and measured, calculated for t-test of two independent means. (P=0.05) 1 femoral condyles 2 tibial condyles just below the articular surface 3 malleoli Results: 1 External rotation of the leg at knee joint increases in osteoarthritis com pared with normal knees. 2 The mean angle of the tibial torsion in osteoarthritis is not different statistically significantly from normal knees. 3 In operation, it is important not only to correct varus deformity but also excessive external rotation.
Nous décrivons tout d'abord les symptomes de la chondropathie rotulienne; nous rappellons ses examens divers et traitements. La manifestation clinique attribuée à la chondropathie rotulienne chez les jeunes sujets féminins relève assez fréquemment de plusieurs causes associées, la laxité articulaire, le traumatisme et les autres. Nous penserions, cependant, qu'elle montre la dégénérescence chondrale aussi banale que l'arthrose fémorotibiale au point de vue histologique, tandis qu'elle consiste d'une autre entité clinique. Jusqu'ici il existe peu de travaux d'ensemble consacrés à la chondropathie rotulienne au Japon. On pourrait la trouver plus fréquemment qu'on pensait, si plusieurs étapes devront être systématiquement franchies. Car c'est le premier pas vers l'orientation thérapeutique. Nous avons réalisé à ce jour les méthodes d'Elmslie-Trillat, Maquet ou Bandi, Slocum à la chondrectomie partielle selon l'état réel du cartilage rotulien. La prépondérance des résultats excellents se maintient malgré le recul est court.
We investigated eight cases of the knee contracture, which were treated by Judet's method or its modification. They were classified into following three groups. group A: Femoral shaft fractures which were treated by Judet's method. group B: Fibrous contracture of the knee joint after infection, in which arthroplasty was combined with Judet's method. group C: Old knee joint fracture, in which detachment of adhesion of the knee joint and Judet's after-treatment were carried out. Results: All cases of the group A and the cases of patellar fracture belonging to the group C were good, but the cases of ankylosis of tibiofemoral joint were not so good.
A 52-year-old man and a 74-year-old man with neurogenic muscular atrophy with scapulo-humeral distribution of late onset were reported. Their clinical neurological features consited of 1. onset of the disease at the age of 52 and 73 2. no heredofamiliar history 3. slow progression 4. mucular atrophy and muscle weakness with scapulo-humeral distribution 5. EMG findings and muscle biopsy showed neurogenic changes. 6. fasciculation was observed, and 7. no bulbar palsy. Difference between these cases and Kugelberg-Welander disease was discussed.
We examined radiographically and clinically the correlation between aging and low back pain with or without radiating pain in 1015 patients. The symptomes of the extremities tend to increase with aging. Osteoarthritic change of facets precedes the deformities of vertebral bodies. The former is seen in 50 per cent of patients under the age of 30, the latter in 97 per cent over 50. Lumbosaral angle tends to increase slightly with aging. There is a tendency that the patients with radiating pain have its larger angle. Narrowing of disc space was detected more frequently in older patient than 40. Those with particular form of laminae have had more frequently the symptome of the lower extremities than those without it.
Unangenehme Komplikationen wie Krampfanfaelle sind nicht selten bei der myelographischen Untersuchung mit wasserloesslichem Kontrastmittel beobachtet. Es sei aber meistens an der verwendeten Dosis vom Kontrastmittel zurueck zu fuehren. Anlass dieser Beobachtung wurde es versucht, bei den 62 Patienten so weit wie moeglich die Menge des Kontrastmittels zu reduzieren, wie etwa 1/3 der herkoemmlichen klinisch verwendeten Dosis, wobei stellte es heraus, die gefuerchtete Komplikationen dadurchgaenzlich vermieden liess, denn noch auswertbare Myelographien dargestellt werden konnten. Der angewendete Kontrastmittel war Conray 60 und es liess sich folgende zusammenfassend sagen; 1) Injizierte Fluessigkeitmenge betraegt insgesammt 3.0ml. (Kontrastmittel+Liquor). 2) Mischverteilung liegt in Mittelwert von zwischen (Kontrastmittel:Liquor) 1:1 und 1:2. 3) Naemlich eine Kontrastmittelmenge von etwa 1.3ml. 4) Bei den obigen Bedingungen ist es besser zunaechst den Roentgentisch um 10° schraeg zu stellen. Durch Verstellung des Tisches kann gewuenschter Untersuchungsabschnitt erweitert werden. Fuer die myelographische Untersuchung hat diese Methode sicherlich einige Nachteile, zur Durchsicht eines Bandscheibevorfalls ist es jedoch vollkommen ausreichend.
Two cases of lumbar canal stenosis with severe muscular atrophy were reported. The chief complaints of the patients were gait disturbance and weakness of the feet. Myelographic findings showed a high degree of block at the L3-4 and L4-5 interspaces. Laminectomy was carried out and it was observed that hypertrophic and clover-leaf formed neural arches, thichened ligamentum flavum and posterior bulging of the degenerated discs constituted the factors of the stenosis. A half year after surgery, slight symptomatic relief was achieved in both cases. But it was suggested that in the first case, a 51 year-old man, there was the possibility of co-existence of the atypical Charcot-Marie Tooth disease with lumbar canal stenosis on account of the postoperative course and elevation of serum levels of creatine phosphokinase.
Thirty-two young adult dogs were used to study on the aging process of the femoral head and acetabulum of the experimental hip dysplasia. X-rays were measured from two to twenty-four weeks after the operation. No repair was seen in the resected acetabulum. Changes of the femoral head after the operation were observed as follows. 1) Lateral displacement of the femoral head was seen at three weeks. 2) Upward displacement and flattering of the femoral head found at eignt weeks. 3) Disturbance of epiphyseal growth appeared at eight weeks. 4) High position of the greater trochanter was seen at twelve weeks.
During from 24 Oct. 1971 to 31 Aug. 1976, 3580 newborn babies were examined by orthopedic surgeons using five techniques within a few days after birth. Five techniques are as follows, Ortolani's click sign, Palmèn's test, telescoping test, crepitation and limitation of abduction. Click sign was noted in 91 newborns (2.5%). In the group of click sign negative, crepitation was noted in 167 cases, in which acetabular dysplasia was noted in 29 cases. This high incidence of acetabular dysplasia in the crepitation positive group was the most remarkable finding in these examinations. In order to diagnose the joint laxity, these various technique are considered to be useful. A case was reported, which click sign positive in the newborn, but recieved no treatment was become to difficult case. Other treated cases were all obtained excellent results. In these examination, some dislocation were overlooked, and then we consider that taking roentogenograms and reexamination within three months and six months after birth is valuable.
Use of the Pavlik harness for the treatment of congenital dislocation of the hip of a infant under three months old, has the following two objections, 1) functional reduction may not be obtained because active movement of limbs are still poorley developed, 2) the immature hip joint may be damaged, so as to cause growth disturbance of upper femoral epiphysis. In spite of these objections, from our investigation of 82 joints which were treated in infant under three months old with a Pavlik harness, 68 of them (83%) were successfully reduced and femoral head of these reduced hip were mostly well developed, and fairly good results were obtained.
Follow-up study was carried out in 35 cases of C. D. H., which were treated by closed reduction from 1956 to 1961 in our clinic and was done an interim follow-up report clinically and roentgenographically in 1962. The purpose of this study is to investigate the late results and to predict how these cases would be changed within about 14 years. The results are that the hip joints from the complete dislocation developed much more deformity than these from sub-luxation or acetabulum displasisia, and the hip joints from the younger suckling (1 to 6 month) developed much less deformity than these from the older suckling (7 to 12 month). The late roentgenographical results of the hip joint have been more influenced upon the changes in the head and neck of the femur than the CE angle or acetabulum angle at the child age.
Of about one hundred patients of cervical spinal cord injury experienced in our hospital since 1960 forth-three were out of damage to the vertebrae. All patients except for nine in whom anterior fusion of the spines were performed were treated conservatively. Three patients died of acute abdomen, insufficiency of respiration and hyperpyrexia, respectively. According to ages, eliologies of injury, X-ray findings, activities of daily livings and results of operations our materials were studied.
A school boy aged seventeen was involved in Hangman's fracture, in which he has the hyperextension of the upper cervical spine from diving. He has the severe neck pain and the temporary quadriplegia immediately after in ury. Radiological sign showed the fracture of C2 arch resulting from extension and compression of the upper cervical spine following a blow to the head, producing a Hangman's fracture, as suggested by Cornish (1968). Skull traction using Glisson's sling was applied with collar ten weeks after injury and anterior spinal fusion from C2 to C3 was performed eleven weeks after injury.
Since 1968 we have encountered 16 cases of Galeazzi's fractures that we treated and could follow up them. Of them 14 cases are classical Galeazzi's fractures, and two belong to type II by Aritomi's classification. Fresh fractures have been observed in 11 cases, while there are 5 of old cdses (failure of conservative treatment or refracture). With one case given conservative treatment, there remained malunion of radius, subluxation of distal end of ulna and limitation on supination. For the operative treatment of the fracture of radius we used AO plates. Bony union was attained within 4 months. Of 5 old cases only one case had received the bone graft surgery in conjunction. Of the ten fresh fracture cases undergoing operation, due to the presence of moderately comminuted fracurte of radius in one case there occurred a shortenig of radius and limitation of rotation of the forearm. Of 5 old cases two cases belong to ‘unsatisfactory’ cases according to the criteria of Hughston. The foregoing results indicate that when the treatment is conducted with aid of AO plate, superior results can be obtained in comparison with those reported by other investigators.
Recurrent dislocation of the elbow usually follows simple traumatic dislocation and it is uncommon. We treated such a case. The patient was twenty-nine years old man. The initial injury had occurred two months previously and was treated by reduction and immobilization. He visited our hospital and complained of instability of the right elbow. We found radius head was subluxated posterior when he pulled his forearm in supination by himself. The arthrogram showed the laxity of the lateral capsule and collateral ligament. Surgical treatment was indicated. With operation we repaired the capsule and ligament by Osborne & Cotterill method. Follow-up examination three months later revealed a stable and pain-free elbow.
Avulsion fracture of anterior inferior iliac spine is uncommon, and only 19 cases have been reported in the Japanese literatures. A 16-year-old male has broken his left anterior inferior iliac spine as he kicked his friend. We replaced the fragment under direct vision and maintained the reduction by internal fixation.
The results of a study of eighty-one patients with trochanteric fractures in this ten years were reported. Because eighteen patients were lost to follow-up, evaluation was possible in sixty-three fractures. Treatments were conservative in fifteen patients and surgical forty-eight, including six with unstable intertrochanteric fractures treated by Dimons method. Fixation appliances were chiefly McLaughlin nails and Jewett nails, but a few blade plates and Neufeld plates were used in early stage. Although patients usually encourged to sit on the first postoperative day and to have heavy exercises to prevent various complications, three patients died during the period of hospitalization. Because full weight-bearing was not allowed before the complete bone union (average ninety-third postoperative day), various complications of fixation such as penetration of the nail through the femoral head, bending or breaking of the nail did not occur.
En général. le traitement chirurgical des fractures des éxtrémités supérieure et inférieure du fémur est trop difficile d'obtenir suffisament le montage solide, surtout chez des gens agés. Lavis-plaque est la meilleur pour cettes fractures, car le clou-plaque de Mc Lauglin se sont beaucoup cassés ou débricotés et le clou monobloc de Jewette est difficile à poser. De plus, on met la visplaque sans faire aucun éclat, contrairement les coups demarteau pour enfoncer le clou-plaque sont responsible de beaucoup de fissures. Nous avons pratiqués l'ostéosynthèse par Vis-plaque de Judet dans 41 fractures supérieures et 14 fractures inférieures du fémur entre 1970 et 1976. Les résultats de notre serie sont très satisfaisaisants. Nous pensons qu'avec la vis-plaque on a un montage qui est beaucoup plus solide, qui est géométriquement beaucoup plus solide avec 3 grosses vis spongieuses et une Tongue plaque épaisse.
From 1971 to 1976, cast bracing method was applied to 46 fractures of the lower extremities. The ages of patients ranged from 6 to 78 years. Seven fractures were open, 32 closed and 2 pathological. Thirteen fractures were treated by cast brace 4 to 5 weeks after skeletal traction, and 32 fractures after wound healing of osteosynthesis using intramedullary nailing or plating. The fracture healing was favourable in all cases and no pseudarthrosis occurred. Ten patients in the former group could sit in Japanese way, while 21 patients in the latter. No severe stiffness of the knee joint less than 30 degrees was encountered.