We reviewed 16 trochanteric and 21 femoral neck fractures in last two years. Out of them 10 cases, which were 4 trochanteric and 6 neck fractures, were operated with a compression hip screw. All of trochanteric fracture united satisfactorily. Two of 6 neck fractures were secondary treated by prosthetic replacement from re-fracture by falling from the bed and technical failure. We paid special attention to the following points; 1) varus dislocation of the fractured head is undesirable for use of the screw. 2) A tip of the screw must be correctly installed in the center of the femoral head and is apart about 1cm from the surface of the head.
From April in 1975 to June in 1979, 74 cases of the femoral neck fracture were treated in the Red Cross Hospital of Fukuoka. The type of the fractures were; 23 medial and 51 lateral fractures. Compression hip screw was used in 7 cases of 23 medial fractures and 21 of 51 lateral fractures. At an average follow-up of some 2 years, the rate of good result was about 80%.
The late results of the prosthetic replacements of femoral head in Yamaguchi Red Cross Hospital during the period from January 1969 to December 1978 (10 years) are reported. During this period, 159 cases of the fractures of the femoral neck and 29 cases of the femoral capital necrosis were treated. Among these cases, 86 cases were treated by osteosynthesis and 57 cases were treated by prosthetic replacement. Fifty-four of the latter are followed up in this paper.
A half of the new type of a KU compression plate has slots alone for screws seated in bone to slide to maintain the apposition of the fragments even when the bone absorption occurs at the ends of the fragments. The middle part of the plate should be bent to elevate from the bone surface slightly, otherwise the angulation of the fracture site to the opposite side will occur following the tightening of the screws in the sliding slots. The bone cortex under the half of the plate with the sliding slots should be thick enough not to break following the tightening of the screws.
1) The end result of twenty patella fractures which were treated surgically in the past seven years was reviewed. 2) Seventeen cases were treated by so called dowble circumferencial wiring method, three were partial patellectomy. 3) Dowble circumferencial wiring methoed is characterized by easy reposition and firm fixation. 4) The result of partial patellectomy was poor or fair. 5) From our results, we suggest almost all cases can be treated by our method, especially fragment fracture of patella is best indication.
Intercondylar T or Y-shaped fractures of the lower end of the humerus are uncommon. In the fifteen and a half years between 1964 and June, 1979, only ten patients were treated for this condition at our Clinic. Of these six patients, we are able to reexamine. All six were of Riseborough and Radin's (1969) types IV. Two fractures were open. The average of age at the time of injury was thirty-five. A 62-year-old lady was treated with Kirschner-wire traction. The other five cases were treated by open reduction. The average follow-up period was two years and nine moths. At follow-up, the range of motion at the elbow joint averaged 25-125 degrees. Rotation of the forearm was full in all cases. Four patients had good result after the open reduction.
An improved method of closed irrigation-suction system for treatment of bone and joint infections is considered essential for the prevention of obstruction of the tube. Crisscross flow-reversal system with double tubes was used. Furthermore, channel changer system for the reversal flow was made. Among 172 treated cases, 148 (86.0%) were successful, 7 cases (4.1%) were improved, and 17 cases (9.9%) were failures. Electric detector for the leak of the solution was made.
This article is aimed to discuss the results of the treatment, using composite reattachment performed to injuries of fingertips. The results are also analyzed through factors, assumed to effect the survival of replanted parts. The final shapes obtained after replantation are found to be classified into three types. These types are referred respectively in relation to blood supply.
It is important to make open hand injuries with wide crushed wound healed primarily. Pedicle skin grafting has been done for this purpose. However, a risk of infection and a difficulty in supporting the arch of hand in this method are the problems to be solved. Trimming the wound edge to make a small and single-formed skin defect is essential for primary wound healing. One of the causes of deformity and pseudoarthrosis after multiple injuries of hand is to start exercising befor a bone union is not completed. It has been cleared that firm fixation of the fractured bone independently from the neighboring joints is necessary.
During six years period from 1973 to 1979, we have treated eighty-one cases (one hundred thirty-one digits) of flexor tendon injuries, of which fifty-six cases (eighty-one digits) were reviewed and reexamined. The average age of these patients was twenty-three years with a range from one to fifty-two. There were fourty-nine males and seven females. The site of the laceration according to Kleinert's zone division, 83% of the patients were in zone 2 and zone 3. Primary (or delayed primary) repair was done in thirty-one cases (fifty-four digits) and free tendon graft was done in twenty-five cases (thirty-seven digits). Comparing the result primary (or delayed primary) repair with free tendon graft, excellent and good results were obtained 85% in primary (or delayed primary) repair and 36% in free tendon graft. In the cases of primary (or delayed primary) repair, the result treated within fourty-eight hours after injury was better than the cases treated over fourty-eight hours. In the cases of free tendon graft treated over six months after injury, good result was not obtained. Both sublimis and profundus tendons being lacerated, the better result was obtained in the cases repaired both tendons than profundus only.
A 59 years old woman was first seen by us in December 1953 with chief complaint of gradual flexion deformity of fingers of both hands. The flexion position of the digits was diminished by palmar flexion of the wrist. The volar aspect of the right forearm was explored. The flexor digitorum profundus muscle was quite dark in color and tightened. Tendon transfers were done. The microscopic examination of the muscle revealed tubercle formation consisting of epitheloid cells without necrosis. The case was diagnosed as muscular sarcoidosis. Since then, the patient has been treated with cortisone. The flexion deformity of the left hand cannot be improved. On the other hand, all digits of the right hand can be fairly well extended.
The records of 22 cases of tardy ulnar nerve palsy in 22 patients have been reviewed an average of 3, 4 years after operation from 1971 to 1979. An operative prognosis for the patients who were treated surgically within 3 months from the onset of ulnar nerve palsy is excellent, although preoperative examination of EMG or MCV revealed an abnormal findings. The patients who were operated between 3 months and 12 months from the onset were divided into two groups due to a difference in prognosis; An excellent prognosis was seen in the patients of group I, who showed normal NMU voltage, or high amplitude voltage with over MCV 41m/sec. The patients of group II had poor prognosis, who showed low amplitude voltage, or high amplitude voltage with below MCV 20m/sec in preoperative examination. An poor operative prognosis was seen not necessarily consistent with the findings of preoperative examinations of EMG and MCV for the patients for whom surgery was done after 12 months or more from the onset. In conclusion, the most effective factors on a postoperative prognosis for ulnar nerve palsy are the preoperative time from the onset and the grade of preoperative palsy examined by EMG and MCV.
The results of eighteen cases of cubital tunnel syndrome in seventeen patients have been investigated after King's operation, anterior transposition, or neurolysis including release of the aponeurosis. At operation the nerve was constricted by the flexor carpi ulnaris aponeurosis in all cases. Additionally, we found a pseudoneuroma of the proximal of the constricted part in fifteen cases. Recovery was satisfactory when operation was performed within three months of the onset of symptoms, and was most unsatisfactory in the cases caused by osteoarthritis of the elbow. Then, the authors discussed a pathogenesis of cubital tunnel syndrome.
A case of a 19-year-old girl with bilateral congenital persistent dislocation of the patella is reported. The patient was operated by Hauser and Campbell method on the left knee. Two years and three months later, clinical and subjective assessment is satisfactory.
Sixteen patients of traumatic hemoarthrosis of the knee joint were examined through arthroscopy, of which findings were compared with those of arthrography and radiography. Meniscus tear was found in four cases on arthrogram, but arthroscopically recognized in only one of them. Arthroscopic examination revealed meniscus tear findings in other two of normal arthrograms concerning meniscus configuration. Rupture of the medial collateral ligament in both the superficial and the deep layer was seen arthroscopically in six cases, while it could be recognized in five of them on the arthrogram. On rupture of the cruciate ligament, five cases of complete rupture were proved arthroscopically and stress radiologically and three cases of incomplete rupture were proved only by arthroscopy. Arthroscopic examination is greatly valuable in locating tearing area and determining the degree in the deep layer of the medial collateral ligament and anterior cruciate ligament, and is also very helpful for accurate diagnosis of meniscus tear.
From Nov. 1977 to Oct. 1979, meniscus lesions were diagnosed in 61 knees by means of clinical symptoms and signs. In all cases both arthrographic and arthroscopic examinations were performed, and in some cases explorative arthrotomies were done. Meniscectomies were done in 50 knees. Retrospective observation of arthrograms revealed some abnormal findings that had been overlooked before.
The technique and evaluation of arthrography for meniscus lesion of the knee was studied. Clinically diagnosed meniscus lesions were 51 cases but resected menisci were 48 cases—24medial and 24 lateral. Accurate diagnosis of arthrography was 23 out of 24 cases (95.8%) in medial and 20 out of 22 cases (90.9%) in lateral, arthroscopically 22 out of 24 cases (91.7%) in medial and 23 out of 24 cases (95.8%) in lateral. Arthrographically the type of lesions were complicated in the posterior horn of the lateral meniscus and arthroscopically the posterior segment of the medial meniscus was sometimes unclear.
We tried to make an experimental model of arthritis in rabbits by means of repeated intra-articular injections of homologous liver lysosome. Fourteen out of twenty-two knee joints which were injected with liver lysosome showed inflammatory reaction. The grading of the inflammation was examined by clinical and histological investigations. The histologic investigation of the synovial membrane of joints showed distinct signs of chronic inflammation, such as hypertrophy and hyperplasia of synovial lining cells. The stratum synoviale was enlarged and thickened. The tissue were infiltrated by lymphocytes and plasma cells. Serum antitrypsin activity was determined by the method of Dietz et al. Increased antitrypsin activity was observed in the rabbits in which distinct arthritis occurred.
We reported on the Leucocyte Infusion Therapy for RA. This new therapy is very dramatically effective for the patients of stage I or II of RA, and 66%-patients of stage III or IV of RA, too. This new method is very hopeful for RA treatment.
Two cases of RA hip joints relieved spontaneously were reported. Radiographic measurements such as Shenton's line, Ilio-Ischial line, acetabular depth and distance of femoral head-pelbic brim were used for estimation of rates of progression of RA hip joints. Total hip replacement, though it has been described as a treatment of choice for RA hips, should be performed for only selected cases.
Although for past 2 and half years 95 knees with degenerative osteoarthritis were operated on at Ishikawajima-Harima Hospital, it is only 2 knees that prosthetic replacement was used. So called “intra-articular surgery” was applied to 88 femoro-tibial and 3 patello-femoral OA knees and they showed good results. It is of significance to recognize that the result of this surgery depends on the postoperative management.
Gait patterns of the twenty patients treated by total hip replacement were analyzed using the two dimensional analysis of floor reaction forces. This report discusses the sagittal component (α-diagram) of the floor reaction forces. The α-diagram appears as an inverted heart pattern in normal gait. But the α-diagram before and soon after the operation looks like a water drop or like a pear shaped pattern. In the cases where the operation was not so successful the size of this diagram was smaller than normal and the unweighting effects decreased during the mid stance phase. In excellent cases the size was smaller on the side operated on. This method was very useful to evaluate the walking ability.
The purpose of this work is to study the secondary changes in proximal end of femur following the experimental unstable hip joint. These unstable hip joints could be produced by immobilizing the knee joints of young rats in full extension. They were classified into 4 groups according to the immobilizing period. Group I: 1 week, Group II: 2 weeks, Group III: 3 weeks, Group IV: 4 weeks. Group I grew up to the normal hip joints. Group II and III gradually obtained the concentric hip joints but finally some deformities of femur remained. Those were as follows. 1. Small femoral head and short neck 2. Excessive femoral anteversion at 18 degrees 3. Neck—shaft angle showed Coxa Valga. Group IV progressed to complete dislocation and oftenly formed the secondary acetabulum and showed the severe deformity of frmoral head.
Roentgen and clinical investigation of seven cases with congenital dislocation of the hip joint was performed. In this follow-up study, the deformity of the proximal end of the femur such as shortness of the neck of the femur and elevation of the greater trochanter had become worse, although osteoarthritic change were not yet apparent at the time of this study.
Revalgisation after detorsion varus osteotomy for C. D. H. was studied in 38 hips of 35 patients. These patients had no avascular changes of capital femoral epiphysis and were observed more than five years. Results were as follows: (1) The degree of revalgisation mostly correlates with changes of the neck-shaft angle gained by the operation, especially of the epiphyseal angle. (2) In spite of the revalgisation, good congruity of the hips which was obtained by the operation seems to be preserved.
1. Out of 100 hospitalized patients with cerebral palsy, 14 patients with dislocated and subluxated hips have been studied. 2. The age at which dislocation occurred in 6 of 7 hips was before 4 years, while the age at which subluxation occurred in 7 of 9 hips was after seven years. 3. It seemed that the tight and spastic adductors was the most important factor in the production of dislocation, but congenital dislocation of the hip was associated with paralytic dislocation in some of our cases. 4. The treatment and results were presented.
After the conservative and/or surgical treatment of the pediatric hip diseases, it is important to bear the stepped and increased exercise. It is responsible that all the orthopedists definitely indicate the step of the daily living and school exercise. Twenty-seven postsurgical patients with congenital dislocation of the hip or Perthes disease were directed the daily exercise that was tried to classify into 10 grade, and were observed on the longterm. Some cases complained the hip pain and claudication after the rough sports or works. The definite direction of exercise for aftertreatment is considered to delay the expected osteoarthrotic deformity.
Thirty patients who had suffered from Perthes disease were reviewed clinically and radiologically. There were one female and twenty-nine males. Bilatenal disorder was in seven cases, right side in thirteen and left in ten. The follow-up interval was between two months and fifteen years with an average of six years, and the age at the time of review was between six years and twenty four years with an average of fifteen years. These patients had been treated by a variety of treatment, conservative (27 joints) and operative (10 joints). The overal results were clinical and radiologically graded into the four groups as defined by O et al.
The results of operative procedures for Perthes' disease (14 cases of curratage-bone graft, 18 cases of cross-bone graft to the femoral neck and 11 cases of capsulotomy) were studied clinically and roentgenologically. In curratage-bone graft, ten out of 14 cases showed coxa planomagna and shortening of the femoral neck. Cross-bone graft had satisfactory results in all cases under 6 year old, but flattened and subdislocated cases over 6 year old had unsatisfactory results. Capsulotomy was followed absorption of the necrotic bone in early time and seemed one of the effective procedures.
A case of Apert's syndrome was reported. A 13 month-old girl: normal delivery. Abnormalities of the hands, feet and face were noticed at her birth. Her hands and feet showed high degrees of syndactylism—the so-called mitten hand and spatula foot. Craniectomy was performed when she was 3 months old. Release of the thumb and the first toe was carried out on the both sides at age of 13 months. It is planed to separate the little finger as next procedure.
Recently we have experienced a case of Werners syndrome with uncurative ulcer over the Achilles tendon. He had a symmetrical retardation of growth with absence of the adolescent growth spurt, graying of the hair, atrophy and hyperkeratosis of the skin, generalized loss of hair, alternations of the voice, cataracts. In laboratory data, specific changes were not especially recognized. Pedicle flap and rotation flap were tried for the ulcer over the Achilles tendon, but could not successed.
A girl aged three years was admitted because of the pathologic fractures of the bilateral femoral necks. She had splenomegaly, sequint, mild generalized lymphadenopathy and anaemia. There was a past history of splenectomy two years ago. Laboratory test revealed a marked increase of acid phosphatase and decrease of blood cholesterol, and Gaucher's cells were observed in the bone marrow taken at the osteosynthesis of the femoral neck.
Spinal cord tumor of children is a rare occurrence and hour glass tumor is extremely rare. Experience with a 7 year-old female with a history of progressive left sided weakness was reported. Myelogram showed a space occupying lesion with incomplete block between C4-7. A large paravertebral mass was found in the left lateral cervical region. We carried out a combined posterior and anterior approach for complete removal of hour glass tumor. Histological diagnosis was neurinoma. Postoperatively she had a rapid recovery from her neurological deficiencies, but roentgenogram demonstrated kyphosis between C6-7. Pathogenesis and treatment of post-laminectomy kyphosis were also discussed.
A case of spinal extradural cyst in thoracic region was reported. Fourteen year old boy was admitted into our clinic on May, 10, 1979. His symptomes were difficult in walking about 2 months ago and numbness of both feet after one month. His thoracic spine was slight kyphosis. His gait was spastic and sensory disturbance was slightly diminished below the level of the tenth thoracic dermatome. X-ray exam. showed that the pedicles of the fifth through tenth thoracic vertebrae were markedly narrowed and atrophic and then interpedicular space were enlarged. Myelogram showed in complete block above area. Laminectomy was done from T4 to T10. A large extradural cyst was encounted. The cyst had a communication with the dural membrane on right seventh thoracic nerve root. Then the cyst was completely removed. Now five months after surgery, the spastic gait and sensory disurbance disappeared.
The case of a 13-year-old boy with tight hamstrings is reported. He walked with his pelvis thrust forward and his knees semiflexed. Examination showed severe restriction of straight-leg-raising and marked limitation of forward bending of the trunk. Myelography showed filling defect in L5 S1 level. Laminectomy was done and intradural tumor was removed. The pathological diagnosis was epidermoid cyst.
It is not rare for spinal cord compression to be seen in malignant lymphoma. By Moshe Friedman's report, it is seen at the rate of 6%. We experienced 4 cases of paraplegia caused by malignant lymphoma. They are three Reticulum cell sarcoma cases and a case of Hodgkin's disease which is the only survival case. First case of Reticulum cell sarcoma died without being rightly diagnosed. Second case died a year and a half later in spite of the good response to chemotherapy (VEMP) and radiation therapy. Third case resulted in neuralgic deficit and was dead without becoming better. The autopsy clarified that there had been metastatic changes in spinal cord, duramater, and brain, . These cases were treated mainly through VEMP method and radiation therapy.
Epidural or spinal injections of 1-2mg. morphine were given to 9 patients with severe acute or chronic pain. All cases had considerable relief of pain, which bigun within 5min., and was effective for 1O-50h. It is suggested that the morphine reached the subarachinoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelationosa of the posterior-horn cells of the spinal cord. This paper presents the preliminary results of the treatment of severe, localized pain by small doses of morphine injected into the epidural or spinal space without important side effect.
To clarify the biochemical characteristics of soft part tumors, we studied acidic glycosaminoglycans in the extracts of malignant fibrous histiocytomas and liposarcomas by colorimetric analysis combined with two dimensional electrophoresis. The results were as follows: 1. Uronic acid content was greater in amount in liposarcomas than in malignant fibrous histiocytomas. 2. Hyaluronic acid was found to be above 80% of total acidic glycosaminoglycans in liposarcomas. 3. Hyaluronic acid, dermatan sulfate, chondroitin 4, 6 sulfate and heparan sulfate were found in malignant fibrous histiocytoma. Our preliminary data suggests that acidic glycosaminoglycans analysis makes it possible to differentiate malignant fibrous histiocytoma from liposarcoma.
Recently, we had experiences of two cases of glomus tumor. Case 1:24 years old. male. This patient was first seen with complaints of severe tenderness and cold intolerance of the left thumb. On examination, reddish tumor was observed beneath the nail with central ridging of the affected nail. At operation, a small rounded tumor with 3mm×6mm in diameter was excised. Histological examination showed glomus tumor (Angioma type) Case 2:26 years old. male. He was admitted to our clinic with complaints of severe pain and tenderness of his right ring finger. On roentgenogram, tiny erosions was noted in the dorsal surfaces of the distal phalanx. Surgical excision was performed. Microscopical and electromicroscopical examinations showed a glomus tunor (Degenerative type)
Extra-abdominal desmoid defined as progressive, locally invasive lesions composed of uniform fibroblasts forming abundant collagen and arising within the skeletal muscle or its fascial covering. It does not form regional or distant metastasis, but the rate of recurrence is high. The basic principle of treatment of desmoids is adequate local excision and local persistence, even after multiple operative procedure, should be controlled by adequate local excision. A extra-abdominal desmoid that appeared in the gastrocunemius and flexor hallucis longus muscles of the leg was reported.