Twenty-one acetabular osteophytes in osteoarthritic hips were studied by means of X-ray and histological examination using tetracycline labelling method. The osteophyte could be observed most clearly by tomography pre-operatively. Intense tetracycline fluorescence was seen along the osteo-chondral junction of the osteophyte. As for the distribution of tetracycline, fluorescence of the osteophyte was similiar to that of capital drop. Intense tetracycline fluorescence at the osteo-chondral junction of the osteo-phyte was seen in 16 joints, mild in 4 joints, and no fluorescence in one joint. The tetracycline uptake was more prominent in the unstable osteoarthritic hip.
A follow-up study was performed on 30 hips in 29 cases. The age at the time of operation ranged between 29 and 77 years, 61 years in average. The duration of follow-up was 12 months to 3 years and 11 months, 2 years and 3 months in average. Satisfactory results were obtained in 26 hips (86%), especially fresh fracture of femur neck was excellent. Proximal migration was found in 12 hips (40%) and the result was poor than the cases which had no proximal migration. Ectopic ossification was seemed in 9 hips and the result was good.
Femoral head prostheses with long stem were applied for following three cases after resection of the proximal femur with bone tumor: The first case of a 15-year-old boy was malignant degenerated multiple cartilaginous exostosis extending in the proximal femur. The second case of a 21-year-old man was well-differentiated chondrosarcoma extending in the proximal femur with three recurrences after wide resection. The third case of a 26-year-old female was giant cell tumor of the femoral neck. At present all patients are free from symptoms and are satisfied with the operative results. The prosthetic replacement operation is thought to be encouraging for treatment of some bone tumors in the proximal femur.
We experienced the epidermal cyst in bone. The epidermal cyst of phalanx is a rare condition, being reported only 17 cases in Japanese iterature. Roentgenograms made revealed an osteolytic lesion. Treatment was curettage and filling of the defect with bone graft. Histological diagnosis was epidermal cyst.
Recently we have experienced a case of desmoplastic fibroma involving the femur. To our knowledge, fifty five cases have been reported since the first ease report by Jaffe in 1958. The patient, 38 years old male, was addmited with chief complaint of pain in the left lower extremity. On X-ray examination of bone, there were abnormal radiolucent area in the neck of the left femur. Histologically, the majority of the tumor consisted of collagen fiber and fibroblast was expanded diffusely. In the peripheral of the tumor, there were some giant cells. Curettage and bone grafting was carried out. He has now usual activities of daily living after the operation.
Recently we experienced three cases of tumors or tumorous conditions in the femoral neck of children. Case 1. A boy, 13 years old, was treated with resection and autogenous bone graft. The histological diagnosis was nonossifying fibroma. The course was satisfactory. Case 2. A girl, 7 years old, was treated with homogenous and autogenous bone graft. The histological diagnosis was solitary bone cyst. The course was satisfactory. Case 3. A girl, 11 years old, She had already sustained the pathologic transcervical fracture and was treated with curettage, accurate reduction, bone grafting and internal fixation. But the femoral head was followed by aseptic necrosis. The histological diagnosis was granulation surrounding the necrotic bone tissue. Therefore the pathologic diagnosis couldn't be established.
Malignant Fibrous Histiocytoma with diver's bone infarct is rarely reported. 51 year old man, engaged in diving for about twenty three years. He was treated operativery, bone grafting in the head of right femur and left humerus, under a diagnosis of diver disease when he was age of thirty two. He was admitted with a pain in right thigh in January 1978. Tumor was palpated in right thigh with local heatness and swelling. Roentgenogram in right distal end femur and bone scintigram revealed a high concentration at the site of the lesion. Arteriogram showed a hypervascularity at the site of same lesion. Amputation and infusion of anticancers was performed. However it is interesting whether there is relation shiip between bone infrartcion and tumor or not.
Recently, we have experienced unusual cases of solitary bone cyst or cyst-like disease. Solitary bone cysts are usually found during the first two decades of life. But our 2 cases were 40 and 49 years of age. The wall of cyst is usually lined by a thin layer of connective tissue. But in 4 cases except 1 case, the walls of cysts were not lined by a thin layer of connective tissue. In a case of boy 15 years of age in which the lesion was in a ilium, the fluid was not evaculated at the first operation, but the fluid was evaculated at the second operation.
A review of musculoskeletal tumors in our hospitals yielded 26 lesions with features allowing classification as malignant fibrous histiocytoma (MFH) on a purely histological basis. The clinical findings in the 26 cases with follow up information are presented. The MFH is the most common soft tissue sarcoma of late adult life, and any tumors previously diagnosed as liposarcoma, fibrosarcoma, or rhabdomyosarcoma are probably examples of MFH. The tumors of bone are previously diagnosed as giant cell tumor, plemorphic sarcoma or fibrosarcoma. They occur radiologically as osteolytic lesions with or without marginal sclerosis developing in metaphysis or epiphysis of long bone. The 5-year cumulative survival for the bone and soft tissue tumor was equally 54.0 per cent.
We examined correlations between cellular immunity and clinical courses of malignant tumors of bone and soft tissue, using immunological skin tests. We used purified PHA, Su-Polysaccharide, Streptokinase-Streptodornase and PPD. 1) Values of initial skin tests correlated with the prognoses of malignant tumors. 2) Values of initial skin tests of patients with malignant tumors were lower than those of patients with benign tumors and healthy people. 3) Values of skin tests got lower as the clinical stage went worse. Several skin tests must be performed frequently, and we should summarize them with other clinical features and serological findings to know the stage and prognosis of malignant tumors.
Recently, Immuno-therapy plays an important part of therapy for malignant tumors. This time we examined T-cell subpopulation of tumor bearing patients. Healthy men and benign tumor patients have similar range distribution as controls. Malignant tumor-patients have lower range than the former. Especially, a case of Osteosarcoma, 15 years old-girl, showed good correlation between her clinical stage and T-cell subpopulation. The value of preamputation is 45%, and post-amputation 38%, and 2 months after amputation inproved up to 55%. But appearing metastasis to the lung, it showed decreasing to 28%. Considering of this case, T-cell subpopulation reflected her clinical stage and the activity of host-immunity.
Four cases of metastatic carcinoma of long bone were treated surgically. All lesions were replaced by bone cement and fixed by internal fixation (three Küntcher intramedullary nails and one plate). All patients were given reief of pain and got improvement of A. D. L..
Clinical data of 108 cases (369 examinations) of definite or classical rheumatoid arthritis were analysed statistically and discussed on the correlation with immunoglobulin (IgG, IgA and IgM). IgG has increased to 1712.8mg/dl in average and showed a high correlation with ESR, γ-globulin and general symptome index. IgA has increased to 289.4mg/dl in average and showed a high correlation with ESR, β-globulin, γ-globulin, CRP and general symptome index. IgM has increased slightly to 160.2mg-dl in average and showed a low correlation with other clinical data. Immunoglobulin has showed little correlation with anemia and leucocytosis.
Two sibs, aged 35 and 28 years, respectively, presented a phenotype intermediate between that of Hurler and of Scheie syndromes. Both had severe dwarfism, characteristic facies, corneal clouding, dysostosis multiplex, restriction of joint mobility, umbilical and inguinal hernias, hepatosplenomegaly and normal intelligence. Both were found to excrete large amounts of acid mucopolysaccharides with a major fraction consisting of dermatan sulfate and a small amount of heparan sulfate. Peripheral leucocytes from these two sibs exibited α-L-iduronidase deficiency. In view of these findings, they were diagnosed as Hurler-Scheie compound heterozygosity but the possibility of another mutation at the iduronidase locus might also be considered.
We reviewed 29 cases of the congenital muscular torticollis which had been treated by open tenotomy during the period of 1956-1972 in our clinic and evaluated by direct examination in 1978. The treatment consisted of open tenotomy, immobilization in plaster brace to maintain the overcorrected position for 3 to 4 weeks and physical therapy etc. The following conclusion was drawn. 1) Facial asymmetry was improved satisfactorily when the operation was done before 2 years of age. 2) Correlation between improvement of facial asymmetry and that of rotatory motion of the neck was suspected. 3) In majority of cases the contour of the sternocleidomastoid muscle of the operated side located more laterally than that of the contralateral side. 4) The scar of the skin incision had tendency to move upward. Therefore, we think it had better to make the incision at the inferior margin of the clavicle. 5) Cause of the residural wry neck was mainly incomplete resection of the muscles.
54 patients of arthrogryposis multiplex congenita were treated at orthopedic department of Kyushu university for past 52 years. Among these patients, 14 patients with club foot deformity were analysed in this series. Most foot deformities required the limitted surgical release of the soft tissues following conservative treatment and many of the resistant ones also needed expansive arthrodesis within 20 years old. According to these results, we got a conclusion as follows, the club foot in arthrogryposis multiplex congenita should be treated by corrective cast for the first 4 months after birth, subsequently by either posterior release or posteromedial release. Braces or splints should be applied in order to prevent recurrence after those surgical procedures. But, in spite of our effort by the early treatment, gradual recurrence of the corrected foot is inevitable. Therefore, in order to get a lasting plantigrade foot, Evans procedure with posterior release at 4 years old is recommended against the recurrent deformities.
The purpose of this study is to make clear the talar deformities of treated club feet, using the tomography of the talus. 34 feet in 25 patients with treated club feet were investigated. The age at follow-up varied from 7 years to 27 years. The medial deviation of the talar neck, which had been showed by dissecting fetal specimens of club feet, were decreased in treated club feet. This change of the medial deviation suggests to remodel the neck deformities of the talus. Deformities of the talar head could be classified into four types. The type 3 and 4 were seemed to be secondary dysplasia of the talar head by forced correction of the fore-foot deformity. In order to avoid squashing the delicate tarsal bone, corrections for club feet should be very gradually and gently.
Although the finger- and toe-nails are small organs, they play a very important role in daily living. Recently, the authors experienced to treat the seventh case of “pincer nail syndrome” in the world. Here, the 49 years old female case was reported and discussed.
A ten year old girl had a pain of sudden onset in both elbows in November 1977. On examination, there was diffuse tenderness over the common extensor muscles of the joint level. Snapping was noticed on flexion and extension movements. Conservative treatment failed to relieve the symptomes. Then, the right elbow was operated because of it's severity. Inspection showed it as follows. On extending, the annular ligament was seen to slip over the anterior margin of the radial head with a snap so as to lie the radiohumeral joint. Sequent flexion of the elbow resulted in a snap as the annular ligament slipped into the right position. The annular ligament was moved distaly and tightened as not to slip out from the radial head.
We reviewed our experience with de Quervain's disease of 55 patients, 61 wrists from Jan. 1, 1975 to Oct. 31, 1978. Patients of 3 rd decades and 6th decades at age were most affected and females predominated 10:1. 39 patients, 44 wrists were studied. 35 patients of those were treated with conservative treatment consisted in rest or local injection of steroid; while only 4 patients were treated surgically. The results of conservative treatment were probably satisfactory, because 35 of 40 patients (88%) showed excellent or good results. Especially an almost complete cure was observed in all patients (100%) who were treated more than 6 months previously. Besides there was tendency that the result was better as observation period was longer. So it is unnecessary to carry out operation early, and it is wise that the choice of treatment of the disease is decided case by case taking account of the social circumference of the patients.
Aseptic necrosis of the metacarpal bone was rarely reported in the past. It is called “Dietrich disease”. On July, 1977, a 18 year old man visited our hospital for reconstruction of the thumb. In the X-ray, we found accidentally abnormal shadow of the MP joint of the ring finger. That is a depression and widening of the metacarpal head with osteosclerotic change. Biopsy at the MP joint shows aseptic necrosis of bone and granulation.
The literatures of Deltoid Muscle Contractures have been increasing in number since Sato's original report in 1965. The clinical features of this disease are abduction deformity of shoulder joint, prominent scapula, anterior prominent of humeral head, a cord like portion and so on. Histological finding in this disease was mentioned fibrosis of middle part of deltoid muscle. We investigated histological and histochemical findings of this conditions. Histological finding was disintegration of muscle fiber with collagenisation. Histochemically, we couldn't find phosphorylase and Adenosinetriphosphatase activities in fibrous tissue. But we could find a little in several residual degenerated muscle.
We evaluated the results in the treatment of shoulder-hand syndrome in the total of eleven patients. The causes of this disorder were idiopathic in four cases, cervical spondylotic in five and of herpes zoster in two. The treatments were composed of physical therapies, medication of griseofulvine (375 to 500mg per day), stellate ganglion block and continual epidural block in the cervical spine. The continual epidural block was most effective among them. For the better result in this treatment, early diagnosis, elimination of the cause and early therapy seemed to be very important.
We experienced the rupture of the external rotators of the hip, which showed the same symptom that piriformis syndrome revealed. This is a case report of a patient, forty-six years old male, who complained of pain at the left buttock and lower extremity. On examination he had the position with the abduction and external rotation and he had an increase in pain with internal rotation and a decrease in pain with external rotation. Also he had a positive Lasègue's sign and tenderness over the piriformis muscle. On operation, the ruptures of the gemellus superior and the obturator internus was observed at the posterior ishium, caused by the metastatic adenocarcinoma. The ruptured muscles and the tumour was removed and the piriformis muscle was sectioned. The primary lesion was the rectal cancer and the pull-through operation was performed four years ago.
Recently we have experienced 4 patients of pararysis of ramus profundus of N. radialis. Two cases were entrapment neuropathy at the point of Frohse's arcade. One case had ganglion surrounding ramus profundus of N. radialis. One case had injury after operation of resection of tumor.
The authors followed-up 55 patients with tardy ulnar nerve palsy at our clinic from 1955 to 1977, 39 of whom were treated by epicondylectomy, 16 by the deep anterior transposition of the ulnar nerve. The followed results were obtained: 1) According to Tsuge's criteria, the results of epicondylectomy was excellent and good in 61.5% and the deep anterior transposition of the ulnar nerve in 68.8%. 2) As for recovery of extension power of the fingers and sensory disturbance, the deep anterior transposition of the ulnar nerve was superior to epicondylectomy, in cases of the partialy degenerated type of the ulnar nerve, the former was also superior to the latter.
During past four years, we have experienced 101 cases of Habu bite-81 sequela cases and 20 fresh cases. Bitten site were 65 upper extremities, 33 lower extremities, and 3 other sites. Operative findings of bite region were presented about four cases and discussed the factors of sequela. The main changes which make the sequela are hemorrhagic muscle necrosis and hemorrhage of surrounding tissues. To prevent the sequela, we emphasize adequate local incision and decomression fasciotomy.
A case: A fifty-one year old male who was exposed to atomic-bomb explosion, found a small mass in the lateral aspect of the left knee joint on slightly flexed position about 10 years ago. He had swelling and pain according to growth of the mass since 3 years ago. On June 21, 1977, he visited our clinic for aggravated rain on gait. On July 16, 1977, arthroscopy and total meniscectmy with the tumor were performed, which had parrot-beak tear at the free margin. The cut surface showed several small cyst-like areas containing gelatinous material and studied histologically.
The cause of persistent symptoms after menisectomy has been assessed clinically, radiologically, arthrographically, and arthroscopically in 18 cases. We report four cases by lesions of regenerated meniscus and one case by the opposite compartment lesion. These complaints about regenerated meniscus seem to be occured in only such cases as the inmatured granulation and scar like tissue.
The purpose of this paper is to compare with the stability of the experimental fractures of the trochanteric which were fixed with Y-screws, Mclaughlin's nail-plate, Jewett's nail-plate, A-O condyle plate, and Judet's condyle plate. The models of experimental fracture were artificially produced in the dry bone and rypoxy model of the femur. The degree of the stability of these experimental model was measured with Simazu autograpy. The model which was fixed with Judet condyle plate was the strongest in result. We thought that its reason might be due to the screw which was inserted from grater trochanteric.