This report concerns two children with aseptic necrosis of the capitulum humeri. Case 1-A boy aged eight years was brought with slight swelling on the lateral aspect of the right elbow and limitation of range of motion of the elbow. The elbow was immobilized in an apparatus for a few months. Case 2-A boy aged ten years with moderate swelling on the lateral aspect of the right elbow and impairment of elbow movement was treated by bone-peg grafting into the capitulum humeri surgically. The results were compared with clinical features, function of the elbow and roentgenographic views. In conclusion, the latter obtained more excellent results than the former.
Aseptic necrosis of the sesamoids of the first metatarsal bone is rarely reported in the past. Recently, a patient with such lesion was admitted in our hospital; A Case: A woman aged 21, without any overt trauma, found sore at the left great toe region while walking. Clinical examinations revealed slight tenderness on lateral aspect of the distal end of the left first metatarsal bone and pain on dorsiflexion of the great toe. Urine and blood examinations showed normal data. On X-ray examination the lateral sesamoid of the first metatarsal bone was separated by antero-posterior and lateral views and stippled radioopacity by the axial view. She was diagnosed as aseptic necrosis of the sesamoid of the left first metatarsal bone. After sesamoidectomy the pain disappeared. The same diagnosis was made by histological examination.
Aseptic bone necrosis of the femoral condyle has been reported few so far. This is a case-report of a patient, 28 years old female, with aseptic bone necrosis of her right medial femoral condyle, who were operated by the method of pedicled patellar transplant. She had a history of taking steroid therapy for 2 years because of systemic lupus erythematosus and complained of gradually increasing pain of her right knee joint, showing bone destruction at the medial condyle in X-ray. Pedicled Pateller transplant reported by Merle d'Aubigne was done. After surgery the results was satisfactory. She is now able to walk without using a stick.
Seven patients of chondropathia patellae and patello-femoral arthrosis were operated by ventralisation of tibial tuberosity during 1974 to 1976. Their average length of follow-up was 1.8 years and the maximum was 3 years after operation. All knees of these patients were characterized by either malalignment (patella subluxation, patella alta) or a history of a blow the knee cap. In arthroscopic examination, cartilagnous surface of the patella showed degenerative changes of various forms. This operation gave satisfactory results in all cases with regardless of age, the severity of preoperative symptoms and x-ray findings. It is supposed that the indication of this operation could include not only early stage of patello-femoral arthrosis but also severe stage.
Twenty patients (twenty-five hips) of total hip replacement were subjected to 99mTc-scintiscanning at 1-83 months postoperatively. In normal cases an initially high uptake was found to decrease to a normal level up to 8 months postoperatively. In twelve patients (sixteen hips) with no pain, all but one hip had normal scintiscanning. In three patients (four hips) with pain about the hip on weight-bearing, however, all but one hip had abnormal scintiscanning. It is suspected that 99mTc-scintiscanning is a supplementally useful aid for the detection of complications after total hip replacement.
Total hip replacement surgery with K. Y. M. rotation type prosthesis were performed on 44 hips in 37 cases. The head of this prosthesis is made of high density polyethylen. The replacement surgery was done in 19 hips with ostheoarthritis, 7 hips with rheumatoid arthritis, 3 hips with aseptic necrosis of the femur head, 8 hips with femur neck fracture and 6 hips with weared high density polyethylen artificial head. Short term results on 18 hips, from 3 years to 4 years after operation, showed fairly good result except one case with cup loosening.
The complication of total hip replacement surgery (K. Y. M. rotation type) were found in 7 out of 44 operated hips. 2 cases of them were loosening of the cup which were found 1 year after and 4 years after surgery. Breakage of the C. O. P. femur stem was occured in one case at 1.5 years after operation. Wear of the neck of H. D. P. prosthesis, causing to ectopic ossification, was found in one case. Immediate postoperative dislocation of the prosthetic head were found in 3 cases. After reduction, they were fixed in plaster cast in 3 weeks. Thereafter, they were brought in succesful course.
During from 1974 to 1976, 1735 newborn babies were examined at 5th days after birth for hip joint laxity. Among of them, 11 babies were found positive click sign (0.46%) and treated immediately with modified Pavlikharness or diaper. Three months after, 5 babies were found congenital dislocation of the hip among the 1019 babies, who were having no pathological findings at initial examination.
Coxa Magna is characterized roentgenographically by enlargement of the femoral head and neck. 30 cases of congenital dislocation of the hip treated by open reduction between 1955 and 1975 in our clinic were followed on an average of 5 years and 8 months after the operation. Out of this group, 10 cases showed no deformity of the femoral head, 16 cases did Coxa Magna, 4 cases did Coxa Plano-Magna. The incidence of Coxa Magna was low in the group of those treated by open reduction with detortion-varus osteotomy followed by cast application in a slightly abducted and flexed position of the hip. As a conclusion, the occurrence of Coxa Magna mainly seems to depend on the amount of pressure between the acetabulum and the femoral head.
Eight cases of congenital calcaneo-valgus foot which were treated at Kyushu university hospital were followed up. Only two were unilateral, and the others were bilateral. All of them were corrected by plaster cast at first, followed by the shoes type apparatus. The cases whose treatment were begun under 6 months were well corrected, but on the other hand at the cases over 9 months deformities tended to remain.
For the correction of the relapsed club foot, Evans' method was prefered. The results, after this procedure, were satisfactory. But the fusion of the calcaneocuboidal joint leads to a variable but inevitable loss of tarsal motion. Another problem is postoperative pseudoarthrosis of the calcaneocuboidal joint for four or five years old cases. The disadvantages of Evans' operation have led us to try a new method. It preserves the calcaneocuboidal joint, it requires a abductive osteotomy of the calcaneal neck. In selected instances, this has been a very helpful addition to the surgical method for club foot.
Four cases of the hangman's fracture were described; two patients were involved in the traffic accidents, one was involved in a fall and the fourth was unknown about its injury. However the conservative treatment as in all cases were adopted, there might be a question whether the fusion of the vertebral body should be done. This type of the fracture of the axis pedicle, seemed to become recently more common than usually supposed because of the frequent automobile accidents with their high speed.
Skeletal traction by Steinmann's pins through the iliac crests was applied for 2 cases of fracture dislocation of the lumbar spine. In a male case aged 37 years, severe displacement of his (4th) lumbar spine was favourably reduced by skeletal pelvic traction, and Harrington's instrumentation was applied one month which enabled early rehabilitation. In a secand male case aged 34 years, the severely displaced Ist lumbar spine was failed to reduce because of rib fractures and plumonary complications.
Investigations were made on the admitted patients with complete quadriplegics while patients were on supine and on elevated position with and without applying abdominal bandage respectively. Clinical data including blood pressure, puls rate, respiratory rate, blood gass analysis were examined on each condition. The data showed tachycardia, hyperventilation, marked hypotension, increased PO2 and decreased PCO2 on the patients standing without abdominal bandage as compared with patients on lying position. The data of patients applying abdominal bandage were in between them. The results suggest there may be some regulation to enhance more efficient gaseous exchange other than decreasing vascular resistance to maintain circulatory volume in the brain of these patients who can remain in consciousness during marked hypotension.
ADL of twenty-three Pattents (male: 17, female: 6) with cervical spinal cord injury were reported. The nine cases were achived on independence of ADL. And others were not achived. The blockade factors were high level of paralytic cervical spinal cord, muscular strength, body weight, incontinence of urine and advanced age.
Torticollis accompanying abnormal rotatory motion of the atlantoaxial joint is described in the Jinnaka's Orthopedics as inflammatory torticollis, but its occurence with no known incident of inflammation is not rare. In 1968 Wortzman reported 23 cases of such torticollis as “rotary fixation of the atlanto-axial joint”. Another 17 cases are reported as “atlanto-axial rotatory fixation” by J. William in 1977. In the past year we have had the opportunity to observe three similar cases which we would like to report. One case is of a 11-year old boy to whom torticollis occurred three months ago without any apparent induction at all. He improved temporarily after application of cervical traction by a doctor in the neighborhood. Later he visited this clinic upon recurrence of aggravating symptoms. The wryneck was corrected by continuous application of cervical traction by placing the patient on a reclining table, but there is recurrence of symptoms when the traction is removed. A corrective cast is now applied to the affected region, which is being observed further. The second case involves an 8-year old boy who experienced torticollis one month after having had an episode of tonsillitis. Traction had been applied for two weeks for correction. He is now wearing a cervical cuff and is being observed further. The third case concerns a 12-year old boy. A scoliosis was detected in the course of a physical examination at school. There are no symptoms of which the patient is aware, nor would he admit that there is scoliosis. No corrective action has been taken. He is visiting this clinic for further observation.
In 1977, the investigation of Scoliosis by mass-screening examination was carried out for 8880 school children from 6 to 15 years old in Yatsushiro City. (1) Congenital Scoliosis 1 case Idiopathic Scoliosis 81 case Total Scoliosis 82 case 0.92% (2) Structual Scoliosis 8 case 9.8% Transitional Scoliosis 11 case 13.4% Non-Structual Scoliosis 63 case 76.8% (3) Girls 64.6% Boys 35.4% (4) Thoracic curve 53.7% left type 43.2% right type 56.8% (5) Correlation of height and weight is negative. (6) Most patients with Scoliosis is thin.
We experienced 2 cases of the myelopathy by reason of the ossified yellow ligament in the thoracic region. In case I, the patient was 36 year-old man, and its ossified resion was from 9th to 12th thoracic vertebra. In case 2, the patient was 53 year-old man, and its ossified region was from 10th to 11th thoracic vortebra. According to the myelographic block laminectomy was carried out in both cases, including the resection of the ossified yellow ligament. In case 2, the ossification of the dura mater was accompanied. The operative results are satisfactory in both cases. In laminectomy it is important to use the air drill.
The clinical usefulness of the myelography employing water soluble contrast materi al for the evaluation of lumbar disc derangement is well established here in Japan. With the above method, we scrutinize 226 cases out of a total of 235 patients with the intervertebral disc lesion from April 1973 to August 1977. The type exhibiting the root compression occupies as much as 57% of the entire cases in our study and we feel often great embarrassment at the decision of surgical or palliative management of this type of derangement.
The anesthetic management of patients for lumbar surgery is often difficult, due to advanced age, systemic disease, position on operating table. Spinal anesthsia with 2% Mepivacaine have many advantage such as. 1) Good analgesia and muscle relaration can be achieved without respiratory or myocardial depression. 2) Since the patient is induced in the operative position, no movement of the anesthetized patient is necessary. This report describes a technic of spinal anesthesia with isobaric solution. We obtained satisfactory anesthesia in every patient.
Since 1975 twenty patients, fifteen males and two females, with cervical myelopathy have been performed subtotal vertebrectomy in our clinic. Seventeen out of them were followed up after surgery. The postoperative duration ranged from six months to two years and six months. The age of the patients was from twety-seven to sixty-three years. Six patients were fused at two levels, six at three levels and five at four levels. The results of surgery were evaluated as follows, excellent in seven cases, good in eight, fair in one and no change in one.
A case report of the bilateral split feet associated with congenital deformities of hands, including description of operative findings of the feet. A child, aged 3 with bilateral split feet and congenitally affected hands was reported. The patient had complained of stumbling in running and found it difficult to put on normal shoes due to broadening of the forefoot. He has only the little finger on right hand, that is monodactylous hand. On the left hand there is syndactyly between the ring and little fingers, and other digits are absent. In feet, there is a deep forefoot cleft, and, 1st and 5th toes only remain. He had his feet operated to obtain the stability for running.
A ten year old girl with congenital hemihypertrophy was received the stapling surgeries of the lower extremity three times since she was 3 years old. She had 3.5cm of upper extremity length discrepancy and 2.0cm of lower extremity discrepancy when she received first surgery. And now she has 6.0cm length discrepancy in upper extremities and 1.5cm in lower extremities which shows the effective result of the stapling surgery.
A case of osteomyelitis of the femur caused by propionibacterium was reported. A 19 year-old womwan complaining of swelling and pain in the politeal region was admitted in Fukuoka university hospital. This symptom had begun 7 years previously and had been treated at a surgical clinic for cellulitis. After that time there were some recurrences of swelling and pain which were controlled by antibiotics. Roentgenograms showed cystic lesion with sclerosing of the adjacent bone in the posterior part of the intercondylar area of the distal femur. Curettage of the cystic lesion was carried out. Cultures grew propionibacterium wick was sensitive to cephalosporin, chloramphenicol, lincomycin, aminoglycoides and penicillin. Cephalothin one gram per day was given orally for 14 days. Operative wound was healed primarily and patient was discharged 14 days after operation. 5 months later she remained free of symptom.
A thirteen-year-old boy, complained of a tenderness at the right knee, was suspected osteogenic sarcoma by X-Ray films, in which the periosteal reaction and radiopacity were seen within the proximal metaphysis of the right tibia. The laboratory data were as follows, CRP (+), high value of serum Al-p-tase and accelerated ESR. The angiogram showed no tumorous findings. Histologically, fibrosis with infiltrating lymphocytes and extensive new bone formation in fibrous granulation tissue were recognized. Finaly we make a diagnosis of sclerosing osteomyelitis, not osteosarcoma.
Many reports have appeared in the literature concerning peripheral nerve involvement by ganglion. However, a review of the literatue revealed rarity of reports of an intraneural ganglion. A man aged fifty seven years was admitted in February, 1977, with one month's history of numbness and pain on the right ring and little fingers, and weakness of grip. On examination, there was wasting of hypothenar muscle with clawing of the fourth and fifth digits. There was hypesthesia in the whole area of the ulnar nerve distribution. On March 3, 1977, exploration of the right elbow was performed. A 2×1, 5 centimeters cystic mass was found within the sheath of the ulnar nerve. The tumor was removed and the nerve was translocated anteriory. Five months after surgery, the patient showed almost satisfactory motor recovery, though mild hypesthesia was left in the little finger.
We have studied four patients of paraysis of Ramus profundus of N. radialis. All cases were entrapment neuropathy at the point of Frohse's arcade. Three cases had pseudoneuroma at the proximal point of Frohse's arcade. I case had venous dilatation surrounding Ramus profundus of n.. radialis and its edematous change. After operation of release of Frohse's arcade, 2 cases had recoveries, 2 cases had no recoveries.
Range of joint motion in growing children are different from those in adults. We measured the ranges of major joints motion in 403 healthy children from newborn infant to ten years of age. The results of statistical evaluations showed marked age difference of mean values in external rotation of shoulder, horizontal flexion of shoulder, extension of elbow, extension of hip, extension of knee and dorsi-flexion of ankle joints. And there were no statistical significance between boys and girls under one year old, and are no difference of right and left extremities in all ages.
The characteristics of the fetal movement is a guidepole of the fetal growth development, and it can predict the development of the fetal sensori-motor system in some extent. On the other hand, the fetal movement is also inhibited by mechanical factors as abnormal presentation of the fetus, oligohydramnios, etc. And furthermore inhibition of the fetal movement induces congenital deformity. We made an investigation of the characteristics of the fetal movement on normal babies and babies suffering from cerebral palsy, mental retardation, Down's syndrome and congenital deformity. We have sought if there existed any correlations between these normal and abnormal babies and their fetal movement. The results showed that the characteristics of the fetal movement is helpful to make diagnosis in the field of congenital metabolic disturbance and intrauterine maldevelopment.
A boy, 10 years old, who came to the division of orthopedic surgery for his fracture of right clavicle, showed remarkable appearances of biochemical and radiologic abnormalities of rickets. He suffered from epilepsy following influenza vaccination at seven months after birth and has received anticonvulsant medication over nine years. At about four months since he has been treated with Ethosuximide and Diazepam instead of the administrations of Diphenylhydantoin, Trimethadion, Primidone, Phenobarbital, Mephobarbital and Acetazolamide, enlargements of the antebrachial bone ends disappeared; fraying and cupping of the metaphyses and the wide growth discus on X-ray were almost improved; and elevation of the serum alkaline phosphatase activity (29 B. U.) decreased to 11 B. U..
Recently, a 25 years-old female with osteomalacia in renal tubular acidosis was observed. Radiological examination; Looser's line was found out at scapula, ribs, pubis and ischium; and right nephrocalcinosis. The result of examination showed typical renal tubular acidosis. The treatment was done with vitamine D, sodium bicarbonate and potassium. She had a good course.
André Léri was the first to describe an unusual congenital and hereditary syndrome, to which he applied the term pleonosteosis. The typical syndrome consists of the following features: (1) broadening and deformity of the thumbs and great toes, (2) flexion contractures of the I. P. joints, (3) limitation of motion of single or multiple joints including the spine, (4) short stature, (5) Mongoloid facies (inconstant). This report concerns what is believed to be the first case of Japanese to exhibit this rare entity.
From 1926 to 1976, 23 cases of AMC admitted to our department. 11 cases of these were followed up and studied. Residual defomities of upper extremities did not fully impair their ADL, but that of lower extremities remakably disturbed their walking ability. Continuous manipulation from just after birth could valuablly improve the joint contracuture, but if stopped, the contructure inevitablly developped. According to these results, the early systemic treatment should be necessary to obtain walking ability satisfactorily.