The authors examined 125 hips in 74 cases of congenital dislocation, which elapsed 5 to 22 years (average 12.3 years) after reduction. The results obtained were as follows: 1) Of the cases examined, a majority e, i, 85.6% showed good functional results: in younger age groups under 3 years old at the time of reduction were morc favourable. 2) Excellent cases in function were not always normal in roentgenographic findings. In the cases with normal function, 32.23% showed poor roentgenographic findings, and the authors suggested that they had to be followed in future. 3) In the cases with epiphysitis and unconcentric position of femoral head at the end of treatment, the results were very poor.
I made a statistical survey of 209 cases after the reposition of the congenital dislocation of hip joint in recent 3 years. Most important matter of my findings is that there were plenty of cases of subdislocation or so-called “Perthes' disease-like changes” in 23.5%. Strictly speaking, this ratio would promote when exactly examined, and when the limitation of mobilities is considered the anatomical cure would be far diminisch. But the anatomical result of the infants under one year is far good than the older. Early treatment is very important for the congenital dislocation of hip joint.
We have examined two patients of Volkmann's contructure in forearms, and two, electromyographically suspected same disease in the legs. One of them developed severe pains after casting of the leg, and the other has the ankylosed ankle. From this examination results are as follows; In one muscle, no electrical discharges are seen in some part in the other part only the fibrillation voltages are seen, and in the remaining parts the normal finding are obtained. Such that, there are great differents as to site even in a muscle. One patient, was normal in EMG before operation, has showed many complex motor unit voltages in the extensors of the forearm after the shortening-operation of the radius and ulna.
A man, aged 24 years, suffered from Monteggia's fracture. His radial nerve was damaged between head of radius and volar surface of capitulum of humerus. After the radial nerve was liberated from the damaged area, the head of radius was reduced and the fractured ulna was successfully treated by intramedullary pinning with Kirschner's wire. As the radial palsy didn't recover after 7 months, the tendon of flexor carpi ulnaris muscle was transplanted to the tendons of extensor digitorum communis muscle and extensor digiti minimi muscle. After this operation, his 2nd, to 5th, fingers recovered their extension power. Two months later, the tendon of flexor carpi radialis muscle was transplanted to the tendon of long and short abductor muscle of thumb. Although the extension of fingers and abduction of thumb became almost complete after 14 months from the injury and 5 months after the tendon transplantation, myograms demonstrated that the radial palsy yet exsisted and the function of flexor carpi ulnaris muscle was altered as the extensor of fingers but not that of the flexor carpi radialis muscle.
The healing of fracture has an important connection with the condition of lateral dislocation. On the other hand, it is inaccurate to guess only by looking at the X-ray films of the lateral dislocation of fracture of long bone with naked eyes. Authors designed a new mathematical measurement as follows: As shown in Fig. I, the distances between lateral faces (M & N) and the lengths of riding parts (X & Y) at both ends of the broken bone are determined at two X-ray films projected from such directions as to intersect at right angles. With the Ratios of these lengths to distances, (X/M, Y/N) ratio (d) of the sagittal length of the riding part to the diameter of the broken bone is obtained from the graphs in Fig. II drawn by previous calculation. Ratio (D) of area of the riding part to the cross-section of the broken bone is showed as a function of ratio (d) on the oblique line in Fig. II.
I reported a case of bilateral anterior simultaneous hip dislocation, with small fracture of the posterior superior acetabular edge. When shock not exists, with bilatera dislocation of the hip, both side may be reduced without an interval. Dreaded necrosis of the caput femoris has not followed this instance of simultaneous traumatic dislocation of both hip. This instance not required operative fixation of the acetabular lesion.
Supracondylar fractures constitute the most frequent type of fracture in children. In cases with marked displacement the swelling may be so marked that manual reduction is difficult. Also a high incidence of postoperative deformities, particularly cubitus varus deformities, has been found. As the fracture line was transverse and extended backward and upward, improper reduction and immobilization are responsible for many of poor results. In the case which showed marked cubitus varus deformity, x-ray showed the distal fragment inwardrotated and sometimes displaced medially. Particularly cubitus varus deformity was mainly due to the inwardrotation of the distal fragment. It is most important to reduce the inwardrotation of the distal fragment and to maintain that corrected position. To prevent the displacement of the rotation, the forearm maintain in middle or slight pronated position. The author's method of the reduction was reported.
We tried to a statistical observation of the accident injuries and the surgical diseases (9718 cases, during 1945-1951) at Takata Coal Mine Hospital, and came to the following results. 1) As for the injuries, contusion is most freqnent, secondarily contused wound. 2) The accidents are most frequent in 1945, and more on October and September, probably due to the forced increase of production. 3) The injuried parts of body are most frequent in upper limbs, successively more under limbs, body, head. In order subdivision, are most in finger, next in foot. Generally in the right side are more frequent. 4) The accidents due to chiefly by coal-fall, next by coal-waggon. 5) The shaft-workers, especially coal-miners and excavators, are most frequently injuried. 6) Of the surgical diseases, suppuration and neuralgia are found most often. The shaft-workers, especially coal-miner were suffered most frequently from those diseases.
We reported 1. 2 Cases of clicking knee, which vanished spontaneously the clicking by degeneration of lateral disc. So clicking of knee vanisches not only by regeneration of meniscus, but by degeneration. 2. A Cases of lateral disc with normal structure.
Author investigated roentgenologically the posterior bone blocks of the ankle of 52 patients who had been treated by bone-block operations for sequellae of anterior poliomyelitis in our clinic. Results obtained were as follows; 1) In the young group, the growth of the bone block was observed in many cases, but in adult it was in a few. 2) The pseudarthrosis of the bone block was occured in 6 cases, and it was caused by the too small or irregular shape of the bone block. 3) The remarkable resorption of the bone block was observed only in 1 case. 4) In the majority of cases, the ranges of motion of the ankle were between 10 to 20 degrees and the average plantar flexion was 103 degrees.
Author examined the human foot pressure in 51 cases of fused feet by means of oppress spur used dental modelling. The feet examined were operated by usual methods of arthrodesis. The preoperative deformities were classified into talipes calcaneus (7 cases), equinus (15 cases), varus (15 cases), planovalgus (one case) and flail feet (13 cases). By this method could be recorded precisely the pre- and postoperative deformities of talipes. According to the records, most excellent results were obtained in equinus deformities, and next in varus deformities but remained slight varus in many cases: in another talipes deformities, some degree of the deformities remained in the usual methods of fusion operations.
I succeeded to catch the condition of vibration of a percussion drill under the many kinds of condition, at the each joint of upper limbs by using of electromagnetic oscilograph, and could get the result as following. 1) The nearer the parts of upper limbs to hold the percussion drill it and it's striking direction, the stronger vibration operates on them. 2) The more irregular and stronger vibration appeares on each joint of upper limbs in a case of using of percussion drill which is held by hands without supporter comparing with a case of using of it which is fixed by supporter.
The authors have made the perspirationsexamination of the skin inflicted upon heat stimuli in several orthopedic diseases, following by the Wada-Takagaki's and the Minor's method, and have measured the electric skin resistance. In the paralysis of peripheral nerves, there is no perspiration of the skin in the area disturbed sensibility. It was found that the changes of perspiration of the skin corresponded to the area of the injuried sympathetic segment in the patients with radicular sciatica, and so it seems to be able to determine the injuried nerves in radicular sciatica. In Volkmann's contracture perspiration decreased in the peripheral. In case of fractures, perspiration decreased in the early time, but it became normal in 3 months. If bones were atrophied, suppression of the sweating was continued later, and drops of sweat were irregular in size.
The first aim of the surgeon in treating wounds is how to close it primarily, and mechanical débridement is the most important procedure. Wound treatment has become easy with penicillin and other antibiotica. However, there still exist many difficulties in treating the infected wounds. Especially, in the case of open fractures, the infected wounds have important effects on the prognosis of the fractured bones. We treated such infected or longstanding wounds with such enzymes as Varidase and Trypsin and made wounds heal very early. After using such drugs the skingrafting or delayed sutures were performed, and the time can be shortened in healing the wounds by using such enzymatic drugs. It was observed that in the granulated tissue the change was remarkable between before and after the use of such drugs. That is, it proved histologically that such drugs have good effect in altering the bad granulated tissue to sound one. Besides, it was observed that Trypsin combined with Hyaluronidase had the most proteolytic effect in comparison with Trypsin alone, Varidase alone, or Varidase with Hyaluronidace.
The biochemical changes were observed as the result of repeated streptomycin-infusion into the cold abscess. In one case of thoracic caries which was infused with 0.3-0.5gm. of SM at intervals of about a week, the pus diluted and tubercle bacilli in the pus decreased markedly in the quantitative cultures, and bacilli were not found by the Ziehl-Neelsen's stain. In one case of lumbar caries which was infused with 1gm. SM at intervals of more about 2 weeks, the pus did not seriously change and tubercle bacilli did not decrease. The human tubercle bacilli (H 37 RV) grew most markedly at range of pH 6.2-6.9 in liquid media (Youman's media), and SM effected much more at the range of pH 7.0 to pH 7.8 of media. The average range of pH of the pus in the 12 cases of cold abscess was about pH 7.5 so that the activity of SM in the cold abscess seems not to be inhibited by the pH of pus. The concentration of SM in serum exhibited maximal potencies after 3-6 hours of the infusion of SM (1.0gm.), but after 48-72 hours few of it was found, and the concentration of SM in the pus was 4.1-19.6γ/c. c. after a week.