1448 feet in puberty were evaluated roentogenographically by both Yokokura's and Giannestras' methods, and characteristics of the foot in puberty were investigated. The longitudinal arch of the normal foot in puberty revealed to be low compared with it in adult. Roentogenographical standard values for differential diagnosis of flat foot were obtained.
The pre and postoperative electromyographycal and ADL evaluations were made to the hemiplegic patients who had had spastic equinovarus, hammer toe deformities. Vulpius's procedure, tenotomies of flexor hallux longus et digitorum longus, lateral transfer of tibialis anterior and these combination were the method of choice used for these corrective operations. One of the results showed flexor synergy which had been sheltered behind extension synergy had become predominant, resulting in somewhat resemblance to the normal gait pattern, improving pt's ADL besides tenodesis effect made by these methods. There are, however, lots of factors influencing the results such as the degree of spasticity, hip-knee joint contracture.
We experienced a patient with clubfeet due to spina bifida occulta. Case: A 10-year-old girl Chief complaint: Bilateral clubfeet History of present illness: Both clubfeet noticed at eight years of age have gradually progressed. Laminectomy performed at ten years of age revealed low placed conus medullaris.
2 cases of cogenital knee dislocation with congenital dislocation of the hip and pes calcaneus were reported. Case 1, female, 2 days old. At birth it was evident that both knees could be hyperextended so that the infant's toes touched the abdomen above the hip. Also, there was limited abduction of the hips and both pes calcaneus. Manipulation and alminum posterior splint bringing the knee into corrective flexion was started immediately the 2nd day after birth. The knees were reduced in 3 weeks. The Pavlik harness was applied not only to reduce the bilateral dislocation of the hip but also to maintain the knee flexion. The hips were reduced in the 4th weeks. When the child was last examined at the age of 4 years and 7 months, she could walk and run normally and had a full rang of motion and no instability in either knees. Further treatment was considered unnecessary. Case 2, female, 2nd days old. Examination of the right leg showed the hip and knee to be normal, whereas the foot revealed a pes equinovarus condition. The left leg showed dislocation of the hip and knee with the foot showing a pes calcaneus condition. Manipulation was begun on the 2nd day. The left knee was reduced in the 1st week. The right pes equinovarus was corrected by the posterior release when the patient was a year old. In conclusion, the congenital dislocation of the knee reduced early by conservative treatment, will develop into a normal knee joint. Pavlik harness is effective not only to maintain the flexed position of the knee, but also to reduce the dislocated hip.
Seventeen hips in 12 infants with congenital dislocation of the hip treated by Hanausek's apparatus for the past 6 years were roentgenologically evaluated with an average follow-up period of 2 years and 7 months. Majority of the cases had been unsuccessfully treated with Pavlik Harness and the ages ranged from 3 months to nearly 2 years with an average of 8 months. The results obtained were as follows: 1) Satisfactory results were achieved in 13 hips (76.5%). 2) In 3 hips (17.6%) occurred growth disturbances of the femoral head was suspected to osteoarthritis for the future.
The investigation of eight cases of this special type of coxa vara treated by ope rative transposition of the greater trochanter which was performed at an age between four and nine years, was made. Positive Trendelenburg sign caused by insufficiency of the abductor of the hip was improved successfully after the operation. In unilateral cases of the deformity, limping gait caused by leg length discrepancy due to shortend femoral neck was not improved. Growth influence for the upper end of the femur after the operation was discussed.
Varus osteotomy was carried out in 9 cases of the Perthes disease, in which femoral heads showed “lateralization” radiographically. Post-operative clinical courses are followed and the influence of the operation on the natural history of the Perthes disease is disscussed. 1) The “lateralization” of the femoral head is almost cancelled by this operation, and re-lateralization is not found. 2) Preventive roles of the operation against the progress of the Coxa Magna Plana are shown. But active remodelling of the deformities already exist is not found. 3) the varus osteotomy appears to fascillitate the “healing phase”, but the deviation from the natural history is not nessussarily clear.
Giliberty bipolar endoprosthesis was implanted in thirteen cases. Ten cases were treated for medial fractures of femoral neck, and two cases were treated for Austin-Moore prosthesis which were painful, and one case was treated for the bone tumor of femoral neck. The follow-up-term was on the average 6.4 months. The age was on the average 64.4 years old. Twelve cases were good and another case was dislocated as only a complication. We took measure of the mobility of the bipolar hip prosthesis. It was proved that the mobility of the cup and femoral head was larger than that of the acetabulum and cup. We thought that Giliberty bipolar endoprosthesis would reduce frictional forces which were created about the hip in cyclic loading of Austin-Moore endoprosthesis.
Classification of the degree of ectopic ossification using the category of Hamblen following hip operation (44 total hip replacements, 45 femoral head replacements, 20 hip arthrodesis, 24 Chiari's pelvic osteotomies) revealed that 32 hips (24.1%) of 133 operated hips had ectopic ossification about the hip of various degrees. Osteoarthritis of the hip and remaining bone dust after hip operation showed a significant positive correlation with ectopic ossification. Age, sex and the degree of surgical trauma did not show apositive correlation with ectopic ossification. Ectopic ossification did not seem to affect the function of the hip except Grade III.
Vascular tests for thoracic outlet syndrome are considered to be one of the important diagnostic aid in order to determine the localization and the severity of neurovascular lesion at the thoracic outlet region. However, the mechanism and significance of vascular tests are still unclear. This is to report our clinical and autopsial study to try to clarify the exact meanings of each vascular test. Materials are 72 cases in 48 patients with thoracic outlet syndrome (46 cases in 39 patients recieved first rib resection) and 21 cases of exploration in autopsy. Positive Adson's test, although the incidence is quite low, may suggest severe lesion at the scalen triangle. Eden's test indicate lesions at the costo-clavicular space. In this positive the clavicle moves most to the posteromedial direction among the various positions. Abduction-external rotation test and Wright's test show neurovascular compression mainly at the costo-clavicular region and partly at the scalen triangle. These positions make the neurovascular bundle tracted foward the lateral. Compression at the subcoracoideal region is not the main cause in Wright's test.
Dullness, cold sensation and swelling of the upper limb are popular symptoms in patients with thoracic outlet syndrome (TOS). These symptoms seem to come from vascular; either arterial or venous, disorders of the upper lim. This is to describe hemodynamic study in measuring skin temperature of the hand in various positions of the upper limb in comparison between patients with TOS and normal persons. There were 79 cases in 59 patients with TOS, in which conservative treatment was taken in 65 cases in 45 patients and first rib resection was performed on 14 cases in 14 patients, and 28 cases in 14 normal persons. Patient or person was kept rest for 30 minutes before the test in room temperature at 23°-24°. Results; 1) Skin temperature at rest in patients are lower in the affected side than in the normal side. As the temperatures show lower, occurrence of severe cases in symptoms seems to increase. 2) Skin temperatures are lowest in abduction-external rotation position and Wright's position among the various position of the upper limb. 3) After cold stimulation, skin temperatures of the affected side become lower rapidly and recover quite slowly. 4) In cases of first rib resection, skin temperature is higher after operation than before operation.
We studied to apply the thermography for explicating the pathophysiology of thoracic outlet syndrome. We found that the affected side, paticullary the site of sensory disturbance, was low skin temperature on the thermogram at rest in 60% of 17 cases. Remainding cases were equal at rest, but after cooling the affected side was lower than the normal side or control group and elevation was slower. After treatment the affected side was not different from the normal side on the thermogram.
The features of thoracic outlet syndrome as follows are very important: 1) Symptoms appeared even in a posture that had not influence on radial pulse. 2) The frequency of brachial plexus tenderness associated with radiating pain was extremely high in the affected side. 3) Sensory disturbance was noticed chiefly along the ulnar side of the arm. 4) Many patients complained of various symptoms in addition to those of upper extremity. 5) Compression lesions of the brachial plexus were found by surgical exploration. From the above, we consider that thoracic outlet syndrome may be one kind of entrapment neuropathies of the brachial plexus.
In past seven years, since she had been diagnosed thoracic outlet snydrome, has been carried conservative treatments and surgical procedures: total resection of the left 1st rib (1971), resection of scalenus and minor pectal muscles (Jan. 1972), King' operation for left ulnar paresis (Feb. 1972), neurolysis of left ulnar nerve (Mar. 1972), Bristow-McMrray' operation for left shoulder subluxation (Mar. 1973), neurolysis of brachial plexus and lengthening osteotomy of clavicle (May 1973), unscrewing and translocation of coraco-brachial muscle (Jan. 1974), synovectomy for foot inflammation (Jun. 1976), and neurolysis of brachial plexus and partial resection of left clavicle (Mar. 1978). In spite of the many surgical procedures, however, the synptom was remained. In present, she has been the clinical symptoms and signs: 1) repeated swelling and pains on subclavian, elbow and foot regions, 2) edematous and slight cell-inflammation in pathological finding of soft part tissue, 3) normal or slightly increased blood segmentation rate, 4) R. A. (-), C. R. P. (-), and ASLO 20x, and 5) nomal γ-globulin in blood serum. Fibrositis with thoracic outlet symptoms may be suspected.
A total of 43 first rib resections have been performed in 38 patients for 6 years (1973-1979), 5 patients having bilateral operations separetely. The operative approaches were used axillary. We evaluated the postoperated clinical status in all patients operated on. Surgical results in the 43 operations are shown the following: 11 (25.5%) obtained excellent and 22 (51.0%) good and 10 (22.5%) fair. Complications consisted of two pneumothoraxes and two rib regenerations.
Operative treatment for thoracic outlet syndrome had been performed on 17 cases (23 arms) for three years recently. We had comparatively satisfactory results. But we had a few cases with poor results. Synthetic evaluation was classified as excellent 7 arms (30%), good 9 (39%), fair 4 (17%) and poor 4 (13%). We analyzed these results. Resection of the first rib through axillary approach was more comfortably improvement than release of the scalenus anterior muscle through supraclavicular approach or axillary approach.
The authors observed 25 cases of fracture-dislocation of the cervical spine without severe spinal cord injury treated in our clinic during the year 1955 and 1977. Among 16 cases with some degrees of neurological deficit, cervical spinal fusions were carried out in 8 cases of which the results were excellent in 3, good in 3 and fair in 2 cases. These results were superior to those of the cases treated conservatively. They recommended that the early spinal fusion is treatment of choice for unstable fracture-dislocation with some neurological deficit.
Two hundred and seventy-six fresh fractures in 275 patients experienced for the past five years were statistically analysed. Out of 275 patients, 189 were females, and the ages ranged from 8 months to 90 years with an average of 49 years. One hundred and eighty-five cases were fractures of neck of the humerus, 75 great tuberosity and 16 fracture-dislocations Concerning so-called “downward subluxation”, 17 cases were found in 99 cases, which were examined by a X-ray at standing position with a load of 4kg. to the arm.
The treatment of injuries known as Monteggia fracture has difficult mechanical problem. Open reduction and reconstruction of the annular ligament had been performed in 2 chronic cases. We are satisfied with the results obtained.
Fracture of the scaphoid should be early recognised and adequately treated. Poor treatment or no treatment leads to non union. We have treated 5 cases of non union of the scaphoid from 1977 to 1978. One was treated by a plaster splint and four cases, by bone grafting. The results were satisfactory in all cases.
Seventy-three patients (74 trochanteric fractures) ranging from 60 to 92 years of age have been operated with internal fixation method using Jwett nail plate. Females occupied about 80% of all cases with trochanteric fractures, which were classified into 33 (44.6%) stable fractures, 36 (48.6%) unstable fractures and 5 (6.8%) subtrochanteric fractures. Complications such as migration and penetration of the nail were found in 25.3% of the cases. Follow-up results revealed that 73.7% of the cases were satisfactory in walking ability and 86.9% were satisfactory according to pain.
We reviewed 115 trochanteric fractures treated surgically from January 1972 to February 1978. Sixty-eight of 115 fractures were operated by the nail-plate method. In these two groups, we compared operating time, volume of bleeding and start of weightbearing. Consequently we found that Ender's method was superior to the nailplate method. In his method to get the solid and stable fixation, it is necessary to insert the pins into the proximal fragment to more than two-thirds of its length, but not to concentrate them in the lateral part of the femoral head.
Having treated about 50 cases of fractures of the Upper End of the Tibia from April, 1970 to March, 1978 in our hospital we'll report the treatments and results of 16 cases of fractures, the tibial spine and 30 cases, the tibial plateau. It ensures satisfactory results that we encourage patients to muscle gymnastic of the femoral quadriceps as early as possible after injuries in order to prevent muscle atrophy and adhesion of the patella, and that especially in the operated cases we effort to achive anatomical reduction and firm fixation to begin exercise immediately after operation.
The mechanism of a stress fracture of the tibia in runners is discussed. This fracture is incomplate, involving only posterior cortex near or at the junction of middle and lower third of the tibia. It is suggested that the fracture is produced not by muscle contraction but by the jar of each footfall during running as a form of training. The form of the tibia takes part in producing the fracture. The tibia curves in saggital plane anteriorly but changes its curvature posteriorly near or at the junction of the middle and lower third, where the strain applies in such a direction as to open the postero-medial surface of the tibia. All of the above-mentined fractures that the author observed were seen in this location.
Compound fractures of lower extremity are frequently difficult to reduce and maintain in alignment, especially when there is extensive soft tissue damage. Instability, malalignment and soft tissue complication often result in prolonged mobility or failure. Recently we have used the external fixation for twelve cases. The primary treatment of all patients was prompt debridement of the wound and fixation of the fracture with the Hoffmann's device and was able to start range of mation exercise in early time. Secondary procedures was done easily. The average time in the frame was 4.7 months. The mean time until full weight bearing without external support was 6.2 months.
In five normal men, we studied on skill movement of index finger with pursuit tracking task. Single sinusoidal waves on the oscilloscope were used for stimulus. During pursuit tracking task, movements of index finger were recorded by electrogoniometer, and simultaneously e. m. g. of the ext. digitorum communis (E. D. C.) and the ext. indicis proprius (E. I. P.), were picked up using 70μ wire electrodes and were integrated. Movement of index finger and integrated e. m. g. waves were transmitted to degital datas and analized by frequency response. From these studies, the following conclusions were obtained. 1) Index finger can not pursue sinusoidal waves consisted of the frequency of more than 4Hz. 2) Integrated waves of the E. I. P. are linealy related to movement of the index finger. 3) But, those of the E. D. C. are usually on the train during movements of the index finger pursuitng sinusoidal waves of more than 2Hz.
Vertebral spine and pelvis play important roles in support and mobility of the human body. Using stick picture camera the deviation of the angles among spines, pelvis and leg articulations was measured and its relation to integrated EMG of the body supporting muscles was analyzed.
The normal cracked surfaces of the human synovial membrane were observed using scanning electron microscopy. Synovial lining cells were loosely arranged, and faced the joint space. They were composed of two types of cells; one had more cytoplasmic processes and vesicles, the other had fewer cytoplasmic processes and cytoplasmic matrix showed amorphous. They seemed to be respectively regarded as type A and B cell which had been recognized by transmission electron microscopic observations. Furthermore, the characteristic findings of other subsynovial cells were obtained.
The higher level of zinc concentration in tumorous bone tissue of osteosarcoma have been reported in previous paper. The present study was performed in order to clarify the effect of zinc concentration on bone growth in rat. The increasing rate of body weight for 6 weeks, longitudinal length and zinc concentration of femur in rat were compared among the following three groups; A group: administrated with zinc deficient diet for 6 weeks, B group: 100p.p.m. zinc supplemented diet, C group: 500p.p.m. zinc supplemented diet. Both of the increasing rate of body weight (%) and the longitudinal length of femur (cm) in B and C group were significantly higher than those in A group.
Cephaloridine (CER) and Tobramycin (TOB) concentration in the bone marrow was examined 1, 2, and 3 hours after intramuscular injection of 1g of CER and 60mg of TOB. Concentration in the bone marrow of tibia 1 hour after injection was 26.0±8.927μg/ml in CER (78.5% ratio to serum) and 3.2±0.898μg/ml (87.5% ratio to serum). Concentration in the bone marrow of tibia 2 hours after injection was 20.6±5.003μg/ml in CER (87.3% ratio to serum) and 1.6±0.480μg/ml in TOB (94.1% ratio to serum). Concentration in the bone marrow of tibia 3 hours after injection was 14.8±4.791μg/ml in CER (91.9% ratio to serum) and 1.1±0.337μg/ml in TOB (84.6% ratio to serum). Penetration capacity of CER and TOB into bone marrow of tibia was was excellent.
Plaster cast has been important for treatment of various orthopedic diseases. But it has some demerit like heavy weight, less radiolucent, no water resistant, etc. We used Hexcelite (Polycaprolactone) for treatment of several orthopedic conditions. Using Hexcelite, we treated congenital club foot, dislocation of hip joint, fracture of hand, and tried to instant orthosis as well. After using Hexcelite, we had following merits, 1) light weight, 2) good radiolucent, 3) water resistant, 4) reusable, 5) good adjustability, and so on.
The etiology of idiopathic necrosis of the femoral head in adults is unknown and controversial. In 1965 it was hypothesized by Jones that excessive corticosteroid and alcohol might induce the formation of fatty liver, with possible subsequent systemic fat embolism, infarction of bone and eventual aseptic necrosis. The Cholesterol, triglyceride and phospholipid levels were investigated in 65 patients with idiopathic necrosis of the femoral head to select patients with hyperlipoproteinemia. Twenty nine of the 65 patients had hyperlipoproteinemia. They were classified by disc electrophoresis. Eleven of them were in type IIa, 16 in type IIb, and 2 in type IV. A definite correlation between idiopathic necrosis of the femoral head and hyperlipoproteinemia was found, while no relationship between diseases associated with idiopathic necrosis of the femoral head and certain types of hyperlipoproteinemia was established.
Experimental data is presented to support the hypothesis that in an acute stage of decompression sickness with intravascular bubble formation, activation of thrombogenesis may occur. Platelet aggregation in the vicinity of intravascular air bubbles and occurrence of thromboembolism were seen in the sinusoidal system in the bone marrow of femurs of rabbits which had decompression sickness. Similar platelets aggregation and thromboemboli were seen in the bone marrow of femurs of experimental rats. Moreover, these rats showed a sharp decrease in the numbers of circulatory platelets. Related evidence linking these observation to intravascular clotting and thrombus formation is reviewed.
Symptomes consisted of pains in the hip or groin, especially after exertion, a sense of fatigue in the limb and a slight limp. Physical examination revealed tenderness along the descending ramus of the pubis and pain at the same area by abduction of the hip joint. Swelling and uneven mineralization at the ischiopubic synchondrosis were observed in roentgenograms. In one case, symptomes had ceased 2.5 years after onset, then no pathologic findings were observed at the ischiopubic synostosis in roentgenogram. It is thought that symptomes are due to excessive mechanical forces acting on the ischiopubic ring, mainly through powerful muscle groups which insert in this area.
A case of necrosis of unilateral femoral head, 70 years of age, which showed rapid collapse was seen in our clinic. He consulted our clinic complaining pain in his right hip joint after slipping down steps. On X-ray check no significant signs were found. During a trip, 3 months later the injury, episode of severe pain took place unabling him to walk. X-ray film showed very advanced stage of aseptic necrosis of his right femoral head, and admitted in our hospital. Total hip replacement was operated on. Necrosis, fibrous degeneration and partial remodelling of bone were found in the specimen taken from the resected head. We would like to diagnose this lesion as rapidly progressed destructive coxopathy.
We have experienced 3 cases of motor disorder of the shoulder and sensory extrication of the lateral aspect of the shoulder due to strokes. Different from Duchenne-Erb and Klumpke type paralysis of brachial plexus in symptom, functional disturbance of fingers and bending disorder of the elbow joint were recognized. One of the 3 was completely restored by concervative program. Neurolysis of the axillary nerve was carried out in the other 2. In one of them, sensational disorder recovered at first and then muscle force gradually. The rest 1 case showed no tendency of symptoms to improvement until approximately ten months following injury but, before one knows, the patient suddenly maintained a good range of shoulder motion. These 3 cases seem to be similar to the quadrilateral space syndrome reported by Bateman.
A 31-year-old woman with rheumatoid arthritis was recieved arthroplasty operation of the left elbow. Under cervical epidual anesthesia a rubber band tourniquet was applied around the left upper arm. Tourniquet time was 100 minutes and tourniquet pressure was unknown. After operation the patient was unable to move the left upper limb below the elbow, all the fingers felt almost anesthesia. 21 weeks after operation, complete recovery of the paralysis was taken place. And in this report, critical factor of the tourniquet paralysis was studied.
We experienced a rare case of tourniquet paralysis. The patient was 18 year-old boy, suffered from complete paralysis of the left hand just after operation using Esmarch-rubber-bandage around his upper arm. The operation lasted 60 minutes. This case showed a pressure paralysis apparently caused by a tourniquet and the three major nerves were all involved. Electrical conduction bloc was found at the pressure point. Very slow but complete recovery occurred: sencory function recovered between the 40th and 100th days, the motor function between 40th and 150th days. The radial nerve was most severly damaged and recovered last of all.
One hundred and four of radial nerve palsy were treated from 1941 to 1952. The follow-up results were classified by Sakellarides's criteria. The following results were obtained: 1) The most frequent cause of palsy was fractures and dislocations in 35 cases. Next in order of frequency were 14 so called “saturday night palsy”, 9 lacerations, 7 cuttings, 7 injections and 6 contusions. 2) The results of motor recovery in 26 conservative cases follow-up were excellent in 19 (76%), good in 4 (16%), fair in one (4%) and poor in one (4%), and those in 16 operative were excellent in 8 (72.8%), good in 2 (18.2%) and failure in one (9%) after neurolysis, and excellent in 4 (80%) and fair in one (20%) after nerve suture.
107 patients of sports injury in the shoulder were statistically examined. 91 patients were treated conservatively for the past two years. In this period there were 9, 027 outpatients and 901 patients (10.0%) had complaints in the shoulder. Patients of sports injury in the shoulder were 1.0% of total patients. 16 patients were treated operatively for the past seven years. In this period 131 patients were treated operatively because of complaints in the shoulder and 12.2% of them were due to sports injury. One case of the posterior dislocation of the sternoclavicular joint and one case of the fracture of the surgical neck of humerus were presented.
Micro-surgical operation in orthopedic surgery (the reattachment of limbs and fingers, the free skin flap, the free muscle graft, the living bone graft, the living nerve graft, etc) is gradually popular. Now a day, a indication of the reattachment operation is a big problem, because of the difficulty and the emergency of the operation and the difference between desire of patient and medical indication. We discussed about factors which will influence the indication of the reattachment operation.
We have observed the pattern of muscle action during rotational movement of the humerus by recording angular deviation and electromyograph simultaneously. Results were summarrized as follow: 1) From the beginning of external rotation of the humerus, electrical activity was recorded from the infraspinatus and the teres minor. During later half of this movement, electrical activity was found from the deltoideus (posterior fiber), the latissimus dorsi, the supraspinatus and the rhomboideus. 2) In internal rotation of the humerus, electrical activity was recorded from the subscapularis. The pectralis major was active in half of the cases, but the deltoideus (anterior fiber) and the latissimus dorsi were inactive during this movement.
Rupture of the long head of the biceps is not uncommon. We encountered six cases with seven tendons of the lesion in last one year. In three cases ruptures were caused by acute trauma. One of them had frequent injection of steroid hormone into the tendon sheath previous to the trauma. Three cases of the rest were spontaneous ruptures included a case with bilateral lesions and rupture of the rotator cuff. The diagnosis can be readily made from the history, symptoms and signs. Specially on inspection the swelling of the muscle belly is prominent on contraction. Surgical repair of the tendon either by suture to the bicipital groove or to the major pectral muscle or to the short head of the biceps obtained the satisfactory results. None of the procedure was done to the proximal cut end, but no trouble observed. Cases left non-treated presented any inconvenience in daily life. A case with massive avulsion of the rotator cuff showed marked degenerative periarthritic changes.