Radiological studies were done on twenty-one patients of neurofibromatosis concerning spinal deformity. The age at the examination ranged from 3 years to 52 years. Scoliotic curvature with vertebral rotation was found in 16 cases. The degree of curvature was from 5 to 117 degrees (mean 47 degrees) by Cobb's method. 8 cases of them had relatively sharp curve with typical radiological changes of the spine characteristic for neurofibromatosis, that is, penciling of the ribs and dystrophic changes of the vertebrae, whereas kyphosis was recognized in only one case. Atlanto-axial dislocation was seen in one.
1206 subjects of ages 10 to 16 in Miyazaki district were studied for a scoliosis examination in 1979 and 1980. Initial screening was performed with the physical examination by orthopedic surgens and the moiré topography at standing position. The scoliosis of childrens with a Cobbs angle of over 11 degree was found 1.3 percent roentgenographycally. Especially 3 cases of them (0.3 percent) were over 20 degree. Moiré topography at anterior flexed position seemed to emphasize the rib hump and to be useful to document it objectively.
By analyzing 55 cases of the female patients with sacroiliac joint pain clinically and radiologically, the following results were obtained: 1. Six cases (11%) had the pain originating in the sacroliac joints. 2. The pelvic load test was positive in five cases out of the above six cases. 3. There was no relationship between the abnormal mobility of the pubic symphysis and the pain from the sacroiliac joints.
In order to evaluate the trunk muscle strength and the trunk flexibility, we modified the Kraus-Weber test and applied it _??_ to the healthy workers and the workers of low back pain in the ship industry. There were obvious difference between 1066 healthy workers and 241 workers of low back pain with reference to the trunk raising test, finger-floor distance and straight-leg raising test. Majority of the workers of low back pain revealed weak strength of the abdominal muscles and the back muscles, and decreased trunk flexibility, and high rate of test elicited pain as compared with healthy workers. It was concluded that the strengthening of the abdominal muscled and the maintenance of good flexibility of the trunk were important factors to prevent the low back pain.
The purpose of this study is to clarify the extent of conservative treatment for the lumbar disc lesion. For 117 cases which were clinically diagnosed as lumbar disc lesions, water soluble contrast myelographies were performed, and the findings of them were classified according to Kawazoe's method. The relationship between the type of myelogram and the results of the treatment was discussed. The cases of “normal type” were mainly treated conservatively and 70% showed an improvement. 50 percent of cases of “root type”, in which myelograms show the defect of the root sleeve, were conservatively treated and the rest were surgically treated. There were no significant differences in the results of the treatments between these methods. 70 percent of the cases of “lateral type”, in which myelograms show narrowing of the contrast column, were treated surgically. Follow-up results showed that the cases of this type should be treated surgically.
34 Patients with lumbar dise herniation who were operated on have been discussed. The most frequent symptom was low back pain and leg pain. The pain was mostly severe and 8 patients (23%) could not walk for themselves owing to the pain. Clinical symptom was not so remarkable as that found in young people. Positive straight leg raising test 76%, muscle weakness 65%, sensory disturbance 44% and reflex change 44% were found respectively. Post operative course was satisfactory in 88%.
Cauda equina lesions due to lumbar disc prolapse are very rare. We have experienced nine patients with cauda signs out of eight hundred thirty six operated on lumbar disc lesions. The incidence was 1.1 percent. The clinical investigation of nine patients were as follows: a) The levels of the disc prolapse in these nines were one with lumbar 3/4 disc prolapse, six with lumbar 4/5 disc prolase and two with lumbar 5/sacrar prolapse, frequencies of these levels were the same pattern as those without cauda equina signs. b) Motor and sensory changes (root sign) were different from prolapsed level in seven among nine patients. c) Operative procedures were performed by laminectomy and disc removal in eight and anterior interbody fusion in one. They were usually operated on by posterior decompression. d) Results of follow-up were good (one) and excellent (seven) and these all patients returned to primary occupation except one fair patient with S. L. B. e) Grade and duration of paralysis have an important influence upon the prognosis, so without regard to the grade of paralysis, immediate operation (emergency operation) brings on excellent prognosis.
The purpose of this clinical study was to determine deformities and synptoms of the thoracic and lumbar spine produced by fractures and dislocations. After reviewing 78 patients with neurologic defecits related to spinal fracture dislocations of the thoracic and lumbar spine, we found that neurologic defecits were severe on having unstable spinal injuries. Kyphotic deformties or lateral deformities were remarkable in the patients having slice fractures. Posttraumatic spinal deformities may cause back pain and damaged spinal cord may evoke phantom pain in the palaplegic legs. From these results we found that treatment of the spinal injury with neurologic defecit was most beneficial in restoring spinal alignment using our operative procedure.
4 cases of thoraco-lumbar and lumbar scoliosis were treated by anterior surgical correction and Internal fixation with Zielke's instrumentation (V. D. S. methods) One of the idiopathic scoliosis obtaind perfect correction of the curvature. 2 patients of the kypho-scoliosis due to polio-myelitis had been treated satisfactory by 2 stage operation, first V. D. S. methods, then followed Harrington instrumentation and posterior fusion. Although the surgery is demanding, the results in selected cases make it a very attractive solution to the problem of thoraco-lumbar and lumbar curve.
Since 1973, we have treated surgically 35 cases of lumbar spinal canal stenosis. They are 22 men and 13 women, average age is 58. They include Degenerative (34%), Combined (52%), Post-operative, and Spondylolisthetic type, but no Developemental and Congenital type. The operative procedures are laminectomy for 32 cases, partial laminectomy for 2, anterior spinal fusion for 2. Posterolateral spinal fusion was added for 2 laminectomy cases. Intermittent claudication, lumbago and numbness of leg are common complaints. By the surgical treatment, intermittent claudication is relieved in all cases but one. Lumbago and numness are tend to remain, especially in degenerative spondylolisthesis. In degenerative spondylolisthesis, laminectomy increases the instability of vertebra, and the nerve roots are entrapped in the lateral recess more often than in other type of stenosis. So sufficient decompression of the nerve roots and spinal fusion procedure should be added.
A study was carried out to obtain the adequate CT picture of thoracic spinal canal using a cadaver vertebra. EMI CT 5005 scanner was used and 13mm thick slice of cadaver vertebra was obtained. After obtaining of CT picture, we made a same thick specimen of cadaver vertebra and compared CT picture to softex x-ray picture. The best condition of thoracic spinal canal by CT showed nearly 400 EMI units in window width and 150 in level. Scanning angle of thoracic spinal cannal was permitted within 10° in mesurement and in configuration. The precise location of being scanned was known by using different lengh of radiopaque catheter markers taped on a patient's back and comparing CT pictures to x-ray picture. Normal thoracic spinal canal was examined and we observed normal thoracic spinal configurations and confirmed that the ratio of frontal diameter to sagittal diameter had a pattern.
We have established a New Cell Line, named KG 1, derived from 66 years old man's right humerus which had fractured pathologically because of metastasis of renal cell carcinoma. In this New Cell Line, we obseved micro villi by electro-microscope, and placental type of membrane-bound arylamidase by enzymological technique.
We have recently experienced a case of Chondromyxoid fibroma which is rare and benign. The patient was a 43 year-old man suffering from a pathological fracture of the left tibia. Physical examination showed sever tenderness and slightly diffuse swelling on the left lower leg. Roentgenograms revealed a lucent lesion in the proxymal part of the left tibia. The patient was treated with curettage and bone graft. At present, the bone fusion is not very good, and roentgenogram reveals a sign of recurrence of the lesion. Thererfore the patient should be carefully folluwed up.
A case of malignant hemangiopericytoma of the sacral region in a 25 years old male was described. He was addmitted to our hospital with chief complaint of severe sacral pain and numbness of the bilateral lower extrimities. Rentgenograms revealed a fist-size lytic lesion at the sacrum, angiographically, malignant findings such as hypervascularity, tumor stain were observed. The biopsy was performed for the purpose of the histological diagnosis, microscopically, the tumor possessed a rich vascular component of capillary-sized blood vessels with epitheloid cells (pericytes) closely packed between and around the vessels. Reticulum stain showed the general pattern of the reticulum sorrounding groups of cells rather than the individual cell. He received cobalt 60 beam radiation (total 7, 000 rad) but failed to respond to this therapy, chemotherapy (Ifosfamide total 10g) given recently to him intravenously seemed to be effective.
Lymphosarcoma of the left humerus was experienced recently. The patient, 72-year-old male, was admitted complaining of severe pain over the left elbow. X-ray examination revealed osteolytic change in the left humerus. The excised tissue was diagnosed histologically as lymphosarcoma, which was followed by irradiation therapy resulting in remarkable effect.
Primary malignant fibrous histiocytoma of bone has recently become an established diagnosis for some tumors. There are more than 130 well documented cases. In this paper a case is reported. 81 years old man. Roentgenogram revealed a large lytic area in the right femoral shaft. Angiography showed a fine neovascularity at arterial phase and an uneven stain at capillary phase. Tumor was resected en bloc from the femoral shaft. Femur was filled up an internal fixation with the bone cement plugging in the bone deficiency. There is no evidence of recurrence and metastasis for eight months after the operation.
Spinal metastasis with paraplegia are mostly followed by carcinomas and seldom by sarcomas. Bony metastasis of sarcomas occurs in reticulum cell sarcoma, neuroblastoma, myogenic sarcoma and malignant melanoma. It is difficult to operate the metastatic spinal tumor successfully, and the prognosis is also poor. Malignant melanoma which was found primarily by spinal metastasis with paraplegia is rare. We, recently, experienced this rare case and reported about the course, findings in the surgery and treatments.
Bone cement was used to repair the fractur as well as to fill the bone cavity caused by bone tumors in 18 cases. Malignant bone tumors 8, benign bone tumors 6, tumorous conditions 4. The results of bone cementing for bone tumors were satisfactory in all cases. In 2 cases of malignant fibrous histiocytoma, local recurrence was found within one year. In 4 cases of secondary bone tumors, all the patients were given relief of pain obtained functional improvement. In 6 cases of benign bone tumors and 2 cases of aneurysmal bone cyst, no recurrence was found within a follow up time between 5 months and 5.8 years.
Two cases of glomus tumor, showing bony changes in radiographs, were reported. In radiographs, case 1 showed a cystic change and case 2 showed a dorsal eroding change in distal phalanx of the thumb. Complete excision of the tumor relieved the pain. Histological studied showed well defined vascular spaces surrounded by epitheloid cells characteristic of a glomus tumor.
A case of osteochondromatosis of the hip is presented. A 56-year-old man was first seen in November 1978, complaining of pain and stiffness of the right hip of ten years' duration. There were moderate thigh muscular atrophy and some restriction of the hip movement. Surgical explosure was made through a Hütter approach, and ten pieces of free bodies were removed from the joint with partial synovectomy. Eleven months after operation, the patient was very pleased with his surgical result, because of no pain and a little restriction of the hip movements only. There were no recurrence of loose bodies and no evidence of osteoarthritis of the hip joint on X-rays.
We have recently experienced a case of osteochondromatosis of the hip joint. This patient is 22 year-old man who suffered from osteochondromatosis of the hip joint and operated from 4 years ago. Three years later, he should be susteined arthrodesis due to recurrence of osteochondromatosis.
The case is 23-year-old male. Clinical findings are motion pain and restriction of right hip joint and fedricula. Antituberculous therapy was carried out, but it was not effective. Arthrodesis was carried out with success. Laboratory findings are positive CRP, positive Mantoux test and elevated ESR. Roentgenographic findings are narrowing of the joint space and soy bean size radio lucent area in the acetabulum. Operative findings are generally brown, partially dark-red synovium and erosion at the articular surface of the femoral head. Microscopic pathology shows histiocytes, phagocytes containing hemosiderin, foam cells containing lipid and infiltration of lymphocytes and plasma cells.
The patient, a 55 years old farmer, noticed the pain of the knee joint and hydrops (sometimes bloody) 22 years ago, and operated 10 years ago in our clinic. It was partial synovectomy and then irradiation was additioned. The result of patho-histological study was proved to be PVS. But since immediately after discharge the nodule recurred and enlarged gradually. 10 years later the nodule grew to the size of fist and some other nodules was also recurred around the knee with diffuse tumorous swelling of synovium. Total synovectomy was done from both anterior and posterior approach. On patho-histological study there was proliferation of round synovial cells and histiocytic oval cells which contained the hemosiderin pigment. Multi-nucleated giant cells and foam cells were also found. This case was PVS, we supposed, similar as Jaffe insisted. Postoperative couse was regular, but we must observe it carefully from now on.
Two cases of membranous lipostrophy (Nasu) were reported. The first case was a 22 Years old male, who feeled pain in the both ankles. Roentgenograms revealed multiple symmetrical radiolocent areas. He had no psychiatric disorder. His both grandfathers were cousin. Exicion of the lesion disclosed soft, yellow and fatty tissues. Characteristic membranous structures were noted in microscopic observations. The second case was a 32 years old female, who showed various types of psyatric disorders. Her parents were cousin. A psyatrist accidentally found skeletal abnormalities on X-ray. Our further radiological surveys revealed multiple symmetrical radiolucent areas. The histological findings were identical with the first case.
Recently we have experienced a case of CRST syndrome. This syndrome has been defined by four clinical features: (Calcinosis, Raynaud's Phenomenon, Sclerodactylia and Telangiectasia). It has been first reported by Winterbauer in 1964. The patient, 55 years old (female), was admitted with chief compliant of tumor in the bilateral elbows and knees. On X-ray examination, there were abnormal calcifications in subcutaneous tissue of these areas. Histologically, the tumors were made from multiply calcified tissues and surrounded by inflammatory cells. In other respects, we recognized sclerodactylia and telangiectasia in the face and anterior chest wall. On 11th, September, 1979, resection of the tumors was carried out. She is fine after this operation without recurrence for more than six months.
The case described in this report was born with premature labor of 31 weeks and 2 days, and died 20 minites later. Autopsy showed a 26.2cm long, 1680gr premature boy with short arms and legs, and prominent abdomen. X-ray examination showed severely retarded ossification of vertebral bodies; absent ossification of the sacrum, barrelshaped thorax with short ribs of no fractures, very short tubular bones with metaphyseal flare and cupping, and small iliac bones with crescent-shaped inner and inferior margins. Microscopic examination showed disorganized pattern of cartilage, and swelling of cells and reduced matrix of resting layer.
Alkaputonuria is an uncommon metabolic disorder caused by deficiency of the enzym Homogentisic Acid (H, G. A, ) oxidase. So Tyrosine and Phenylalanine are not metabolized completely. H. G. A. is produced, but metabolism dose not advance furthermore. H. G. A. is excreted in the urine and the deposition of H. G. A. in the cartilage and other tissue, produces the clinical picture of Ochronosis. Ochronotic arthritis is characterized by the loss of motion and pain of the spine and large joints (hips, knees, shoulders, and elbows) We have experienced a case of ochronotic arthropathy. The patient complained left coxalgia and gonalgia. The radiographic appearance of spines showed wafers-like calcification, narrowing of intervertebral discs and so called bamboo spine. That of left hip and bilateral knees showed O·A like changes. The urine changed to dark on exposure to the air. Left hip was treated with endoprosthesis. The resected femoral head was black. Pigmentation in the fibrocartilage of the femoral head was obserbed with microscope. We have comfirmed H. G. A. in the urine with chromatography.
Traumatic dislocation of the hip joint with fracture of the femoral head has been rarely reported. Recently we have experienced three cases of this injury and treated fracture of the femoral head by internal fixation using bone transplants with good result.
A case: On March 27 1979, an eleven year old boy sustained injury to the right knee when he fell suddenly on the ground, leading with the right leg while riding on a bicycle. On the day he visited our clinic, there was a moderate effusion of the knee, the right patella was high level and a gap was palpated at the lower end of the patella. The lateral radiogragh showed a small bony avulsion. The operative finding showed that the avulsion fragment consisted of a large sleeve of the articular cartilage and small fragment of bone. The fragment was reduced ad fixed by a wire. In December 1979, the radiogragh showed a subchondral defect in the central area of the patellar articular surface, and arthroscopically, mild fibrillation was found.
The cause of persistent symptoms after menisectomy has been assessed clinically, radiologically, arthrographically, and arthroscopically in 20 cases. We report two cases by lesion of subluxations of patella and one case by the chondropathy of patella and one case by synovial involvement.
From May, 1979, We examined 28 injured ankle joints by means of stress roentgenograms and arthrograms. Of 28 ankle joints, 6 cases were treated surgically. Indication for surgical treatment is as follows: 1. Positive leakage of the contrast medium into the peroneal tendon sheath. 2. Marked talar tilt and positive anterior drawer test. 3. Painful, unstable ankle joints. In almost all cases, good results were obtained.
An Ankle trauma is frequently encountered in the routine clinicalpractice. In spite of a number of recently published reports, little attention has been directed toward the diagnosis and treatment of this sesion. Significantly, residual complaints of such as pains and motor restriction frequently persist after the treatment. As the ankle joint is stabilized by numerous ligaments, early assessment of the extent of an injury to these ligaments is critical to the method of the treatment and prognosis of the trauma to this area. From 1976 to the present, we have treated 227 patients with ankle traumas. In 46 out of these patients, 25 cases (16 fresh and 9 protracted cases) were without bone injuries and 21 cases (14 fresh and 7 protracted cases) demonstrated bone injuries. Ankle arthrography was conducted in addition to the standard and stress radiography in order to attain the accurate assessment of the extent of soft tissue injuries. The arthrographic examinations demonstrated ligament injuries in 36 out of 46 patients (78%), of which 21 were without bone injuries and 15 were with bone injuries. In addition, abnormal arthrographic findings were observed in all protracted cases where complaints of continuous pains persisted. Of those cases with the radiographic evidences of ligament injuries in the absence of bony traumas, 16 demonstrated injuries to the anterior talofibral ligament, 4 to the anterior talofibral and calcaneo-fibral ligaments, and 1 to the medial ligament. Of those cases with bony traumas, 9 demonstrated injuries to the distal tibrofibral ligament, 1 to the distal tibrofibral and lateral colateral ligaments, 2 to the medial ligament, and 3 to the lateral colateral ligament. Although ankle arthrography is not regarded as a part of the standard diagnostic procedures for the outpatient clinic, this roentgenographic technique has been proved to be of particular value in the diagnosis of injury to the lateral colateral and distal tibrofibral ligaments where the standard and stress radiography has failed. In addition, ankle arthrography appears to be a safe and effective diagnostic procedure in the clinical assessment of ankle trauma.
In 945 of 1913 athletes in Fukuoka University subjective symptoms arising from their athletics were analysed. More than 50 percent of 945 athletes had continued their athletic sports for over than 6 years. Some limitation of motion or pain on motion was present in 52 percent, with female predominance. Of 33 sorts of athletic clubs pain was mainly present in gymnastics and swimming. In the majority of cases, pain was present in knee, low back, ankle, or shulder joints.
In meiner Klinik wurde bisher insgesamt 69 Faelle von Fraktur des humeralen Proximalendes- Collum chirurgicum 45, Tuberculum majus 9, Luxationsfraktur des Schultergelenkes 11 und 5 andere verschiedene Frakturen behandelt und nachuntersucht. Da es sich zum grossten Teil um Fraktur des Collum chirurgicum handelt, welche ueberwiegend mit Haengegips behandelt worden ist, wird es hier ueber deren Behandlung und Ergebnis eingehend diskutiert. Das Ergebnis sowie die gewonnene Erkenntnisse sind folgendes: 1. Von den 69 Frakturen des humeralen Proximalendes sind 9 mit Deformitaet verheilt, jedoch keine Pseudoarthrose beobachtet. 2. Haengegips ist eine hervorragende Behandlungsmethode fuer die Fraktur des Collum chirurgicum. 3. Waehrend der Haengegipsbehandlung muss der Heilungsprozess streng beobachtet werden. In gegebenem Fall muss die Fixation besonders angestrebt oder sogar die Fixationsmethode dem entsprechend geaendert werden. 4. Bei der Haengegipsbehandlung muss die Gewicht des Gipses je nach dem Koerperbau oder der Muskelbildung des Patienten reguriert werden. 5. Fixation mit Hackenplatte ergab kein gutes Ergebnis. 6. Bei der Fraktur des Tuberculum majus wird oft mit Schrauben fixiert. Darueber wird einige wichtige Punkte eigener Operationstechnik beschrieben.
The number of the child fractures of the distal humerus treated in out clinic from 1969 to 1979 was 131. This series consists of four groups; group 1: supra condylar fracture (63 cases) group 2: latetral condylar fracture (30 cases) group 3: medial condylar fracture (22 cases) group 4: separation of distal epiphysis (6 cases) All cases of fracture separation of the distal humeral epiphysis were under 4 years old, and they needed to be differentiated from lateral condylar fracture, medial condylar fracture or dislocation of elbow joint. Five cases of them were treated operatively, and one case conservatively.
This paper describes eight cases of intraarticular fracture of the distal radius in which open reduction and fixation were performed. The cases consist of four cases of the anterior Barton fracture, three cases of intraarticular comminuted fracture and one case of Colles fracture. The surgical approach was made on the volar aspect of the forearm through a longitudinal central incision, and a small T-plate, screws or C-wire were used as fixation divices. A follow-up examination revealed that satisfactory results were obtained in five cases but three cases complained of wrist pain during heavy motion of the wrist. All patients returned to their previous occupations.
During the year 1975 and 1980, 157 cases of flexion fracture of the distal radius were treated conservatively except one operatively. Males were injured twice as females. The ages of patients were 22 years on an average, while 90 cases ranged from 10 to 19 years of age. Among 104 cases, in which the position of the wrist at injury could be clarified, 53 cases were in a position of dorsiflexion or radial flexion, while 23 cases were in a position of palmar flexion. The results obtained were as follows: 1) The majority of re-dislocation occurred in a week after reduction. 2) The poor anatomical reduction tended to result in a restriction of motion of the wrist. 3) Regardless of the anatomical results, 93% of the all cases complained of no troubles, which tended to occur in manual laborers.
Recently, we experienced a case of snapping shoulder. Case: A man of 16 years of age had painfull snapping shoulder and its pain was progressive. In arthrogram, we found the long head of bicipital tendon dislocated from bicipital groove at snapping. By local anesthesia operative treatment by Hitchcock's method and excision of anterior capsular tissue which was 3 times thicker than normal was done. 8 months later, shoulder pain and snapping was lost.
Two cases of irreducible fresh posterior dislocation of the elbow were reported. In these cases, manual reduction under general anesthesia was failed and open reduction was carried out. The obstacle for reduction was an interposition of the proximal portion of flexor muscles of the forearm.
Thirty six patients with dislocations and fracture-dislocations of the elbow from 1964 to 1979 were chosen for this study. Of the 36 patients, 23 were men, and 13 were women. The age range for the group was 8 to 63 years. The left elbow was 18 times, and the right, same times. Posterior dislocations account for 90 per cent of elbow dislocations. Lateral, anterior and divergent dislocations are very rare. Fifteen patients had associated fractures. Four cases had compounded dislocation of the elbow with the rupture of the brachial artery. Three patients had mild transient paresthesia of the radial, median or musculocutaneous nerve.
From 1967 to 1979, 34 operations were done for tardy ulnar nerve palsy at Orthopaedic department of Fukuoka national medical center hospital. And 23 cases of them were investigated. The varieties of operation are neurolysis, subcutaueous auterior transfer, intrauscutar auterior transfer, and submuscular auterior transfer operation. According to valuation by patients, the results were exerrent: 9, good: 9, tair: 2, and poor: 3. This time, we examined following matters. 1. recovery of every symptoms. 2. relationship of pre-operative duration and the results. 3. comparison with some operations. 4. study of poor result cases.
166 patients of vihration disease were registered in Tokushima prefecture by the end of march, 1979. Among them, 82 patients were studied clinically and roentgenogaphically. In humero-ulnar joints, a careful stndy of these roentgenograms showed mainly so called bone spur formation and narrowing of joint space. In cervical spine, three were narrswing of intervertebral disc space, bone spur formation malalighment and irregularity of posterior edge of these vertebraes. These significant roentgenographic findings and elinical signs were correlated with the age of patients and the number of years in using of vibrating tools.
Two cases of traumatic anterior dislocation of the ulna at the inferior radio-ulnar joint were presented. Both cases were male. One visited us immediately after the injury and the other three weeks after the injury. This case had been treated in another hospital as fracture of the ulnar styloid process by a long arm cast. Paresis of the median and ulnar nerve was seen in both patients. The acute case could be reduced by manual reduction. In the other case manual reduction was failed and Darrach's operation was carried out four weeks after the injury. Five months after the operation he complained pain at his operated wrist when he carried a heavy thing with his hand. Roentgenograms showed a hollow depression on the ulnar border of the distal radius where face to the stump of the ulna.
We experienced 5 cases of fracture-dislocation of PIPJ and all were treated by surgery. Volar plate advancement by Eaton's method was done to 1 fresh case, while all the others were operated by Wilson's method, that is, open reduction and internal fixation by 2 or 3 Kirschner wires. The result was satisfactory, because pain was relieved and good motion of PIPJ was restored. But on radiological examination osteoarthritic changes were seen on every cases from minimal to severe degree. It was mainly because of damage of articular cartilage by trauma itself. But I think it is essential to achieve complete anatomical reduction of fragments by operation.
Between 1976 and 1979, thirty-nine patients, sixty-seven digits of flexor tendon injury were treated. A direct tendon suture was done, whenever possible, in the digital sheath region. Fourteen digits were repaired with primary or delayed direct tendon suture and thirteen tendon grafts were performed in the digital sheath region. These cases with flexor tendon injury are divided into various zones and evaluated with total active motion in this paper.
The entity of intrinsic plus contracture of the hand was first described by Bunnell and he termed it “ischemic contracture, local, in the hand”. Though it is uncommon, we have often experienced this contracture as a sequela of Habu snake bite. During past four years, we have experienced 19 cases 20 hands of intrinsic plus contracture due to Habu snake bite, which was quite characteristic and different from due to ischemia. We concluded that degree of contracture was severe in digit which was close to bitten site and contructured digit was deviated toward bitten site. Theoretically it is considered that complete releasing of intrinsic muscles makes claw-hand, and Harris emphasized transverse fibers of intrinsic muscle must be preserved. But in our experience, if the contructure is severe and passive hyperextension of M. P. joint is limited, even tranverse fibers and volar capsule of M. P. joint must be released.
Five cases of palmaris longus tendon transfer (Camitz's method) for opponoplasy were presented. Our series were consisted of 4 cases of the carpal tunnel syndrome and 1 case of the press-injury. Our modified Camitz's method is that: the palmaris longus tendon may be lengthened by a distal strip of the palmar fascia and passed through the new pulley using the transverse carpal ligament and then transferred subcutaneously to the tendon of insersion of the abductor pollicis brevis for augmentation of the thumb elevation from the plam. Satisfactory results were obtained in the cases of the carpal tunnel syndrome with appropriate strength, excursion and direction of the thumb movement. But one case of press-injury was unsatisfactory. A indication of this operative method will be discussed in this paper.
34 cases of the fractures of long bone in patients (over 70 year-old) were experienced for recent four years. They consisit of fractures of femur (27 cases), humerus (5 cases) and tibia (2 cases). The methods of operative treatment, pre and post operative complications were discussed with regard to early movilization.
The torsional Stability of the experimental fractures of the femur which were fixed with Küntscher nail, Küntscher nail and transverse screw, Cylinder nail, and Cylinder nail and transverse screw was tested. The degree of the torsion of these experimental model was measured with Kitasato torsional testing machine. The strongest model in this series was that fixed Cylinder nail and transverse screw. We conclude that Cylinder nailing and transverse screwing is best intramedullary nailing method.
We reported 2 cases of the pathological fractures of the femoral neck of children due to malignant tumors, that had been difficult to be defined. Case 1, a nine-year-old boy with rhabdomyosarcoma, was suffered when he fell down into a drain. Case 2, a nine-year-old boy with Ewing's sarcoma, was suffered when he slipped down on his way to school. They were transcervical type of femoral fractures. A fracture which was caused by relatively slight trauma might well be associated with pathological changes in the bone. Fractures of the femoral neck were rarely seen in children. In those cases, capselotomy was necessary for further examination and treatment.