Anhand eigenes Krankengutes von 226 Schaftfrakturen in den verschiedenen langen Roehrenknochen, die fuer dieses Studium ausgesucht waren, wurde die Bedeutung einer Zug-Druck-Kraft im Bereiche der Fraktur nach klinischer Untersuchung und Beobachtung erfasst. Das Objekt der Untersuchung und Beobachtung war der Verlauf der Frakturspaltue-berbrueckung, das Verhalten eines eingebrachten Osteosynthesematerials, sowie die Bildung des Kallusses. Es stellte heraus, waehrend der Fixationsperiode das Frakturende sehr haeufig deutliche Knochenresorption zeigte (besonders beim Oberschenkelknochen). Aus dieser Beobachtung laesst sich ueber die Bedeutung der Zug-Druck-Kraft folgendes sagen: Zunaechst ist die Zug-Druck-Kraft mechanisch fuer das staendiges Kontakterhalten der Frakturflaechen bedeutsam. Sie sorgt nicht nur stabile Fixation, sondern verringert auch die Last auf das Osteosynthesematerial, damit die auf den betroffenen Knochen uebertraegt. Es beguenstigt dadurch die Knochenheilung, stellt die Knochenwiderstandsfaehigkeit wieder her, und zwar wirkt der biologische Effekt ein. Somit sollte ein Osteosynthesematerial sowohl struktuell auch eingenschaftlich nicht die Zug-Druck-Kraft beeintraechtigen muessen.
The case of the anterior dislocation of the radio-ulnar joint with no fracture is presented. On first examination right forearm was found locked in supination and the wrist showed a deep depression posteriorly at the site of the ulnar head. Manipulation under general anesthesia was not successful and open reduction was followed. The reason not successful to reduce was suggested the soft tissue swelling and the severity of dislocation. Arthrography after reduction showed the rupture of the articular disk.
Sternoclavieular joint dislocation, esppecially posterior dislocation is uncommon. Three cases of sternoclavicular joint dislocation that we have experienced in these 3 years was reported in this paper. Case I was posterior dislocation for trauma and we treated with open reduction. Case II was old anterior dislocation and we treated with tenodesis of fascia lata. Case III was habitual dislocation. Sternoclavicalar joint dislocations are difficult to manage. We think that closed reduction should be attempted initially, and open reduction should be reserved for irreducible posterior dislocations and anterior dislocations that could not be reduced.
Operative treatment was applied for an old unreduced dislocation of atlas with nonunion of odontoid process and incomplete C-1 quadriplegia. Reduction wasn't performed with conservative treatment such as skull traction and halo-pelvic traction. Furthermore, reduction wasn't succeeded through transoral approach, but decompression was performed with resection of anterior arch of atlas and odontoid process. After all, posterior cervical fusion from occiput to third cervical vertebra was performed, so pain and paresthesia were improved.
In a series of 32 fractures of odontoid process of axis, 16 cases were fresh and 16 cases were old fractures. Almost of the fresh cases were treated conservative methed and obtained bony union and relieved from cord symptomes. Almost of the old cases presented atlant-axial instability and 10 cases were suffered from delayed myelopathy. For the preventing delayed myelopathy and treatment of delayed myelopathy due to non-union of fractures of the odonteid process, fusion of the first cervical vertebra to the 2nd is adequate.
Twelve interarticular fractures of the calcaneus were treated by the modifications of Kashiwagi's method. The terms of the follow-up were average three years and two months. The results are satisfactory. The fractures involving the thalamic portion of calcaneus is rarely due to direct vertical compression and usually due to a shearing stress combined with compression in a rotatary direction. By the rotation of the fragment in normal position the fundamental deformity is corrected and the tuberjoint angle is restored. We think that the anatomical reduction of the fractures produces good result.
From Augast 1975 we treated 26 patients (8 men and 18 women) with trochanteric fractures of the hip by Enders method. The results of this treatment were almost satisfied. (1) There was minimum operative stress to the patient. (2) In 21 patients early weight bearing were possible. However one-third patients complained the knee joint pain.
Fracture involving the lower femoral epiphysis in growing children are relatively uncommon. We have experienced seven cases of fracture of this type. Three cases which had valgus deformity of the knee at the time of the initial injury showed good remolding. Two which had had intraarticular fracture showed the shortening of the femur and one of them had been performed by the lengthening of the femur. The purpose of this paper is to discuss fractur involving the lower femoral epiphysis from both the clinical and the experimental point of view.
The report of Fat Embolism Syndrome is rare in Japan. Since July 1976 among 14 cases of severe trauma, 5 cases of Fat Embolism Syndrome were found by Turuta's criteria. Respiratory features, Anaemia, Low PaO2, Tachycardia, Pyrexia and Thrombocytopenia were found in all 5 cases. One patient died during the period of hospitalization.
Two-patients with spontaneous rupture of the tendon of the extensor pollicis longus, after the fracture of the lower end of radius are reported. They are operated by mean of the tendon transfer of the extensor indicis, and are obtained the good results. The etiology and the pathology of the conditions are refered.
Two cases of ulnar tunnel syndrome were reported. In one patient who was treated conservatively, it was suspected that the cause of the nerve impairment was edema due to the trauma. The other patient was operated on and it was found that the ulnar nerve was entrapped by the deep branch of the ulnar artery which traversed on the palmar surface of the nerve in the narrow Guyon's canal. Neurolysis was carried out. Recovery was uneventful. He returned to his work three weeks after the operation.
The relative contributions of scapular and glenohumeral movements to scapular plane abduction of the upper exterimity have been investigated using a direct electrogoniometric method on 15 normal men. From this study the following conclusions seem to be justified. (1) Scapular and gleno-humeral movements are continuous throughout the whole range aduction in the scapular plane. (2) The maximam abduction range is 140° on an average. (scapular movements: 37.5°, gleno-humeral movements 102.5°). (3) Between 40 and 130 degrees, the amplitude of the gleno-humeral movement is twice as large as that of the scapular movement. (4) The track of abduction while elevation is somewhat different from that while depression.
This paper reports two cases of loose bodies developing in the hip joints of the patients who visited our clinic because of limited movement and pain of the hip joint. They recieved operation in our hospital. Case 1: 25 year-old female has noticed the pain of her right hip joint while standing and stooping since 3 years ago. As the pain gradually increased and sometimes caused “locking”, she visited us. She was operated on, and was diagnosed as osteochondromatosis histopathologically. Now, 10 months after operation, she is working without trouble. Case 2: 23 year-old male complained of limited movement and pain of the right hip joint after traffic accident, which caused an injury of the right thigh and an eye ball rupture. Histopathological diagnosis showed osteochondritis dissecance. He got well two months after operation.
This report is based on our cases of 43 total hip replacements for past 4 years after fracture of the hip in the aged. The indications are summarized as follow for Total Hip Replacement after hipfractures. 1) fresh case of displaced fracture of the femoral neck in more than 70 yeas old of age. 2) non-union following after the femoral neck fracture in more than 60 years old of age. 3) necrosis of the femoral head after fracture in more than 50 years old of age. 4) as revision for complication after Moore's Prosthesis replacement arthroplasties. 5) post-traumatic arthritis after fracture-dislocation of the hip in more than 55 years of age.
Recently we have experienced 4 patients of the congenital radioulnar synostosis. 3 cases were bilateral radioulnal synostosis and 1 case was unilateral. 2 of the bilateral cases were treated by method of resecting their radial head and fixing their forearms in supination with a kirschner wire and a screw. Postoperatively 2 patients have been improved ADL.
We experienced two patients with congenital bilateral absence of the fibula. Case 1; A 8-month-old boy with bilateral clubfeet at birth, associated with anterior bowing of the both tibiae. Instead of the fibula, the fibrous band developed at the lateral side of the tibia. Soft tissue release operation and Achilles tendon lengthning were applied to correct the foot deformity. Case 2; A 3-year-old girl with the anterior tibial angulation, talipes valgus and the left leg was 2.5cm shorter than the right one. This patient was treated with plaster cast and prosthesis.
Though avascular necrosis of the femoral head following the treatment of CDH has remarkably decreasd by the inducement of Pavlik harness, it is not completely vanished. From the follow-up study of 78 CDH hips which were easily reduced by Pavlik's method, 3 avascular necrosises were found. After the result of reinvestigation of the detail of these three cases, the authors concluded that one of the most influencing factor of it is the direct trauma delivered on the femoral head by posterior rim of acetabulum at the time of reduction. The trauma could be minimized if the hip joint is flexed more than 90 degrees until the reduction is obtained.
During the period from 1964 to 1970, 197 joints of congenital dislocation of the hip were treated with Riemenbügel method at Nagasaki University Hospital, and 112 joints were followed for more that five years after the initial treatment. The follow-up results of 112 joints were as follows: 1. Anatomical healing was gained in 74 joints (83.1%) in 89 reduced cases, and in 5 joints (21.7%) in 23 unreduced cases. 2. The lateralization of the femoral head was observed in 22 cases (24.7%) and the deformation of the femoral head in 6 cases (6.7%), on both of which Riemenbügel had been applied.
Since 1973, we have treated the resistant congenital clubfoot with postermedial release method described by Turco (1971). An investigation was made for tracing such operated case whose followed-up period was over a year. The total cases operated from 1973 to 1977 are forty-four feet of thirty-one cases, of which, thirty-one feet of twenty-two cases were followed up over a year. In the early, the operated age was about at two years of age, recently, the operated age was about at a year of age. Except five feet of five cases two operated in the early, and a foot of which the Kirschner's pin dropped out during casting period, all were got good results, however, this method can not correct the adducted forefoot and cavusfoot, for these, further surgical treatment is necessary. Considering of the development of the foot, of atrophy of the calf mucsles, it is better to shorten the period of casting or prosthesing for surgical treatment early.
Nous avons analysé les résultats des fractures diaphysaires de jambe qui ont été ostéosynthèsé les dernieres cinq ans Bans notre hopital. Nous avons opéré 76 fractures dans 74 cas et nous avons eu 16 échecs, soit 21.6%. Quatroze sur 16 fractures étaient dans 74 cas et nous avons eu 16 échecs, soit 21.6%. Quatroze sur 16 fractures étaient ouvertes et deux sur 16 fermées. On a trouvé 5 pseudarthroses (4 fractures ouvertes) et 6 consolidations retardées (5 fractures ouvertes). Nous les avons décortiqué et ostéosynthèsé par plaque-vissée à compression de Judet ou par fixateur externe de Judet. Dans 7 cas it a fallu supplementer la greffe osseuse iliaque. Tous ont consolidé. Leurs présentation a été centrée sur l'étude critique, c'est-à-dire la recherche du pourquoi des échec. Cinq points nous semblent résumer les problèmes de la chirurgie de jambe traumatique et ont donc été particulièrement dévéloppés: —les pertes osseuses et des parties moelles; —les mauvaises réductions; —les mauvais montages; —les infections; —les truobles psychiatriques des opérés.
Twenty-nine cases of the open fractures in tibia and fibula were treated in our clinic for the past ten years. 3 cases…emergency (not treated). 4 cases…refered in 48hours after first-aid treatment. 6 cases…refered with pseudoarthrosis. 16 cases…refered with infected wound. For emergency csaes and refered in 48 hours after first-aid treatment cases, complete débridement were most important. Pseudoarthrosis cases were treated with bone graft and küntscher-nail or A-O Plate. For infected cases, it was essential to differentiate suppurative germs and sensive antibiotics. Curettege and removal of previous plates and screws were done before skin coverage. After inflammation was arrested in most cases, osteosynthesis had been done secondly. Two cases infected with pseudomonas were difficult to acquire complete cure.
The treatment for the wide ranged defect-pseudarthrosis is difficult. I mention the following facts from my experience which I cured it that was found on the tibia of three-years old girl, twenty-five-years old woman as well as the femur of twenty-years old adults by the fibula graft. 1) Though there are some criticisms against the fibula graft, it could minimize the shortness of the leg. And long after the graft, I could find the changes of bone width in adult. 2) But it needs the fixation for a long time till its complete union. And secondarily we have to take the treatment of the joint into our consideration.
During the years 1967 and 1976, 34 patients with infected fractures of the tibia have been treated at our clinic. Twenty-six fractures were open and 8 were closed which infected after the osteosynthesis. Sixty-eight operations to the soft tissue and osteomyelitis and 32 operations to the fracture were carried out. Satisfactory results were obtained in 28 cases. Three cases showed non-union, and 2 were amputated for the gas-gangrene and circulation disturbance with infection. Remaining one is under observation. Illustrative cases were shown and discussed briefly.
We had opportunities to treat six patients with osteomyelitis complicated after open fractures or reduction of an closed fracture. The infection of bone was extremely resiistant to treatment, so the following points were most important and effective: (1) complete curratage including the removal of dead bone and hard wear from the infected bone, (2) continous irrigation with antibiotics and (3) closing the open wound with skin flap. The treatment of delayed union or non-union was necessary in five cases. The extra-skeletal fixation or intramedullary nailing of bone was applied after the complete control of the infection. As the result of our treatment, two patients were freed from infection: one needed 3 years and another 5 years, two patients were not completely controlled within 1 year, one patient was amputated and one died from another disease.
Continuous closed irrigation has been applied to five cases of osteomyelitis took place after fracture. They are two cases of shaft of tibia, and each of femoral neck, femur and calcaneal bone. The wound was closed and healed completely and the inflammation was subsided duely in all cases. One patient had had two times of irrigation as the tubes were stopped by the tissue debris. After irrigation bone chip grafting was carried out, and in two cases, electrical currency was applied to stimurate bone growth.
For the past 10 years, 267 of 340 cases of the fracture of the leg which have been treated were open. 7 cases of 267 became infectious. 2 cases from the other hospitals were also infectious. All of them were resistant to treatment. 4 cases, which were inserted a plate of screws immediately following the surgical cleansing, were explosively infected postoperatively. Our therapeutic program excudes the immediate operation. The operation to the fracture, e. g. internal fixation with a plate or screws and bone graft, should be performed after the complete healing of the wound. All cases had successfull union and normal function inspite of difficult treatment.
Four cases of infected nonunion of tibia were treated in our clinic in recent five years. All cases had been treated in another hospital. After débridement and sequestrectomy in all cases, three methods were chosen. 1. Extra skeletal fixation using methyl methacrylate to gain immobilization. 2. Bathing affected whole leg in medicated water for the case with wide skin defect. 3. Intramedullary fixation using Küntscher nail with transverse screws.
The authors report three autopsy cases of acute decompression sickness. Two of three cases showed marked necrosis with edema in the spinal cord. Microscopic examination disclosed thrombus formation in the parenchymal, arachnoidal and epidural vein systems in associated regions. It is suggested that the processes of the spinal cord damage were the result of two different stages of tissue injuries: the first is more or less tissue destruction due to autochthonous bubble formation and the second is severe circulatory disturbance especially the disturbance of venous return from the spinal cord.
We treated 3 cases having “vertigo”, which seemed to occur by intermittent vertebral artery compression syndrome. In the 3 cases, a 34 years old female, a 39 years old female and a 45 years old male, all patients complained mainly vertigo at extention of the neck, nausea and headache. We observed central vestibular disorder in neuro-otological examination. And also vertebral angiography showed abnormality. As treatment to 2 cases we performed cervical anterior spinal fusion and on vertebral artery performed Powers and Hardin & Poser operations. At 1 case we adopted conservative therapy mainly by stellate ganglion block. In 3 cases the symptoms occured by intermittent vertebral artery compression syndrome were improved.
The authers measured focal spinal cord blood flow using oxygen electrode and observed its microangiogram in 40 canines compressed cervical cord at the C3-4 sement from the posterir. The oxygen electrode was inserted into the central of the spinal cord 1cm cranially or caudally to the compressed point. After posteriror compression for an hour microangiogram was performed using micropaque. Polarographic oxygen tension may well reflect the focal spinal cord blood flow. The corvical cord blood flow decreased more significantly by two point compression, whereas little decreased by one point compression. Microangiographic findings supported these polarographic deta.
We have observed dynamic studies of the cervical spine by means of cineradiography in patients with cervical osteochondrosis. In this report slipping of the cervical vertebral body in flexion-extension of the cervical spine is the main topic. Slipping of the body was seen in almost every cases of normal person, but the de gree was slight. On the other hand, in patients with cervical osteochondrosis there were some cases which showed definite slipping of the body mainly at the level adjacent above to the level of the lesion. After interbody fusion of the lesion, the slipping of the body increased slightly compared to that of preoperation, especially at the level adjacent above the level of the fusion.
Peridurography (15 cases) and continuous cervical epidural blocks (8 cases) were performed on patients with cervical root irritation. Peridurography is a better method in detecting the changes of peridural space, especially those of intervertebral foramen, and poses less risk than myelography. Therefore, it is a useful diagnostic method for patients with cervical diseases whose symptoms are restricted to radiculopathy. It is safely carried out on outpatients. Continuous epidural blocks can give an instant relief of pain, that is a great pleasure to patients with severe symptoms, and can even completely relieve the symptoms of majority of patients with radiculomyelopathy when applied with cervical traction and steroid injection. Symptoms of radiculomyelopathy was alleviated significantly following continuous epidural block in seven out of eight patients and they were discharged without operation. One patient was treated with cervical anterior fusion because the sympptoms recurred when the epidural block was discontinued.