A 22 year-old man was admitted with two months' history of grdually increasing pain and swelling of his left knee joint. He had been injured his left knee in a motorclycle accident sixteen months ago. The wound penetrated into the joint cavity through the medial site of the patellar tendon and was completely healed with no clinical sign. A present X-ray film showed a small hemi-spherical osteolytic lesion on the posteroinferior surface of the medial condyle of the femur. The lesion was surgically excised and diagnosed as epidermoid cyst.
Five kinds of physical tests, Adson, Wright, Eden, Morley and 3 minutes test were examined for 312 normal persons and 95 Thoracis Outlet Syndrome patients. Positive rate of each tests were compared between normal and patient group. Following conclusions were obtained. 1. Radiating pain in Morley test and positive 3 minutes test (Roos) seemed to have highest diagnostic value. 2. About one half of normal persons showed positive Wright test. 3) Although positive rate is low, Adson test is considered diagnostic of thoracic outlet syndrome.
The experience with 20 first rib resections by transaxillary approach in 20 patients with thoracic outlet syndrome, since November 1976 until March 1980, is reviewed. First rib resection has afforded relief or improvement in 15 cases (75%), but no satisfactory results in 5 cases (25%). Of the preoperative findings, reappearance of the symptome at the vascular test seems to affect the prognosis of the operation.
38 patients of vibration syndrome were examined by following methods, Adson's test, Wright's test, Morley's test, cervical root compression test, Allen's test and 3 minutes abduction external-rotation test. The author obtained the interesting results of this examinations, and presumed a hypothesis. Some sort of symptoms in vibration syndrome were caused by autonomic nerve disturbance that might be occurred somewhere between cervical vertebral foramina and the retroclavicular space.
Our recent experiences in treating haemophilic arthropathy surgically with replacement therapy of anti-haemophilic are presented in this paper. We treated four patients surgically, with age ranging from 17 to 58 years. All were affected with haemophilia A, and the grade in the DePalma's classification ranged between Grade 1 and Grade 4. The most frequently affected joints were the hip and knee joints accompanied with pain and contracutures. In one case was found a severe degree of intramuscular bleeding in the iliopsoas and buttock muscles with femoral nerve palsy. Joint contractures were treated by muscle release and Achilles tendon lenghening with combination of Quengel cast applying and leg traction. The intramuscular haematoma in the iliopsoas was successfully removed surgically.
Surgery of a pseudotumor in a patient with hemophilia has been avoided not only because it was so hard to control postoperative bleeding, but also because the danger of infection was geat. A patient with pseudotumor of hemophilia A was treated by resection with great care of pre and postoperative management of bleeding. At the post ope. 15 days, pain and swelling occured suddenly at the resection site. Therefore we increased the dose of infusion of Factor 8 per day to 3000 units following bloody aspiration of 300cc. After the small recurrence, the control of bleeding has been good and no recurrence has been seen till now.
Recently we experienced a case of rapidly destructive coxarthrosis. The patient was a 78 year-old woman, and her chief complaint was left hip pain. Histopathological specimen showed the complete coincidence with that of avascular necrosis. Inflammations, rheumatoid arthritis, metastatic tumors, neurogenic arthrosis were all neglected. Then, we came to a conclusion that the nature of this disease is avascular necrosis occurring on the background of senile osteoporosis, and that mechanical fragmentation and chemical osteolysis accelerate the destruction of the hip joint.
We observed chondrolysis of the hip joint in an adolecent boy without slip of the capital femoral epiphysis, infection, rheumatoid disease, or other known disorders. The patient is 13 years old boy, and came to this hospifal complaining pain in the hip joint. He was treated with non-weight bearing, analgesics, and antibiotics. However, for two years after admission, his ROM was reduccing unfortunabely.
We report a case of osteochondritis dissecans of the lateral condyle of the tibia. The patient was a 50-year-old man, who had suffered from pain of his left knee for a week. Roentgenograms at that time showed osteochondral defect in the lateral condyle of the left tibia. Arthrotomy was done and intra-articular free body, which was found under lateral meniscus, was removed. Histologically, the removed fragment was composed of viable hyaline articular cartilage, but subchondral bone showed necrosis. These findings led us to a diagnosis of osteochondritis dissecans of the lateral condyle of the tibia on this case.
Forty five case of Osgood-Schlatter's disease durling last five years in our clinic were followed up. The follow-up term ranged from six months to five years. Twenty nine of 45 cases had some complaints on their knees at follw-up. The commonest one was pain at kneeling or sporting. Six cases were treated surgically with complete relief. Four of them were so-called unresolved Osgood-Schiatter's disease and the other two cases were bursitis of deep infra-patellar tendon bursa.
Twenty cases of stump pain at finger level were treated for least three years. They are examined with the color thermo graphy, nerve conduction velocity meter and microscopy. (Color Thermo Graphy) Cold area is founded at stumped finger and its sensory nerve area. (Nerve Conduction Velocity) Sensory N. C. V. is slow down at stumped nerve as compared with opposit sound nerve. Both ulner n. and median n. have a same tendency. (Microscopy) Stumpneuromas are founded ten cases. They are always adheded to scar tissue, vessels, and bone cortex. In order to prevent stump pain, we have tried to shield funiculus from adhesion by epineural covering.
A ten-year-old boy was sustained an extreme contused wound with wide skin loss in his left leg and foot because of a traffic accident in August 1980. When he visited our clinic in April 1981, his foot exhibited a marked Pes equinus deformity accompaied with keloid and fistura. In roentgenograms, a moth-eaten appearance of ankle joint and ankylosis of tarsal bones were observed. These osteomyelitic changes and Pes equinus deformity were caused by unappropriate primary treatments. It is necessary for his foot deformities to be corrected. Which measure should be taken, such as release operation, arthrodesis, astragalectomy or amputation?
Since April 1977, arthrographies were carried out for the 115 secondary osteoarthritic hips in 101 cases. In 45 out of the 115 hips, villus-like defects were found on the arthrograms at medial and lateral aspect of the transverse ligament in the advanced stage of osteoarthritis. The defects had no correlation with a pain. The results of operation followed-up over 6 months were compared with the pre-operative functional arthrograms, which were thought to be useful for indicating the operative method.
The results of shelf operation after Lance-Jinnaka's method for the dysplastic hips were reported on the 55 hips in 52 patients aged over 11 years with an average of 20 years 7 months. Follow-up periods ranged from 10 to 23 years with an avearge of 13 years and 8 months. Fourteen hips (74%) out of 19 pre-coxarthroses and 25 hips (69%) out of 36 coxarthroses were evaluated by x-ray as excellent and good. While no arthrotic findings occurred in the dysplastic hips, it appeared in 15% of the subluxated and in 68% of the dislocated hips. Clinical assessment according to the JOA score system revealed that the points were accounted over 90 in the patients with dysplasia and subluxation, being about 10 points higher than those in the patients with dislocated hips. Lance-Jinnaka's shelf opeartion is, therefore, considered to be promising for the dysplastic hips in the adolescent ex3ept for the dislocated hips.
Fourteen Moore's prosthetic replacements were carried out on ten patients with corticosteroid-induced avascular necrosis of the femoral head. The diseases for which corticosteroid therapy was applied were renal transplantation of 5 cases, systemic lupus erythematosus of 2 cases, and nephrosis syndrome of 3 cases. Six patients were men and four, women. Their ages at the time of surgical treatment ranged from twenty-four to thirty-six years with a mean of thirty years. All but one had bilateral femoral head involvement. Follow-up ranged from one year to six years and eight months. In the follow-up, roentgenograms showed several changes such as loosening, periarticular calcification, distal migration and proximal migration. Ten patients were clincally evaluated by the method of the criteria of coxarthrosis compiled by Jap. Orthop. ASS. The results of treatment were rated good or excellent for pain, mobility, gait and ADL.
Bateman type prosthesis were used for ten cases of hip disorder since 1980. Six cases were femoral neck fracture, four cases were O. A. of femoral head. They included four cases of salvage operation. Bateman type prosthesis was thought to acquire a better R. O. M. and A. D. L. ability in eally period, comparing with Austin Moore type prosthesis.
Bateman's single-assembly total hip prostheses were used in 18 cases of fracture of the femoral neck and aseptic necrosis of the femoral head from August 1980 to march 1981. 12 patients were discharged with satisfactory ambulatory status, while 6 patients showed poor results. Prolonged period between the onset of injury and the time of the operation appeared to be the main cause of the poor results. Cases of good results showed no pain and appeared to have better range of motion comparing with other femoral prostheses.
We have recently experienced a case of Extr-abdominal desmoid which is relatively rare and benign. The patient, eight-year-old boy, had first noticed a painless mass in the right femoral region four years before admission. The mass subsequently increased in size and he had got to walk with a limp. On physical examiation, a firm, nontender mass, measuring ten by seven centimeters, was palpable in the anterior part of the right femoral region. The tumor was resected as widely as possible with intact muscular tissues surrounding it. There has been no evidence of recurrence and metastasis for nine months after the operation, but we must also follow up the case from now on.
A male baby was born with a thumb-size tumor of the right thigh. It had grown slowly. When he was 19 months old, the mass was grown rapidly with local heatness. At 20 months old, opeartion was performed. A large multicystic tumor was discovered and excised incompletely. Histology showed a large number of dilated lymphatic channels contained with eosinophilic amorphous mass and lymphcytes. The tumor was diagnosed as cavernous lymphangioma. At 30 days after operation, lymphatic fluid was accumulated in operation part and secondary infecition was noticed. Drainage was carried out for 9 days and then lymph accumulation disappeared. There have been no further complications.
Neurilemomas rarely occur as multiple tumors in the peripheral nerves. Recently, we experienced a patient manifesting 2 tumors. One tumor involved the left ulnar nerve trunk in the ulnar tunnel with progressive sensory abnormalities and motor weakness. Another tumor in the back involved dorsal branch of the right thoracic nerve with progressive tenderness. The excised tumors were elastic and hard, yellow-white colored and measured about 1×1cm in diameter. Pathological diagnosis of both tumors were typical neurilemomas showing Antoni type A and type B tissues. In this patient, there was no sign of neurofibromatosis (von Recklinghausen's disease) in any of the clinical data. This was a rare case of ulnar-tunnel syndrome secondary to a neurilemoma in the ulnar tunnel.
A forty four-year old male case of Xanthomatosis was reported. All kinds of xanthomas except xanthelasma (most of them were tendon xanthomas) were found on his extremitis. He had Type-IIbhyperlipoproteinemia. The mode of autosomal dominat inheritance was strongly suspected from his positive family history; his mother had hyperlipoproteinemia without xanthoma and his son had a tuberous xanthomas. Most of the xanthomas were resected for cosmetic reason. In spite of imperfect resection he was satisfied with the result.
Two cases of extra-abdominal desmoid tumor were reported. Case 1: 65 year old woman. She developed a hard mass in the right arm. This tumor attached to the humerus at the deltoid inserition was excised. Case 2: 39 year old woman. She was admitted to our hospital with constant dull ache in the left thigh. There was limitation of movement of the left hip joint. We found the abnormal shadow of the left external rotation muscle group on the CT scan. Surgical excision performed and was followed by irradiation. The possibility of the recurrence was suggested in the histological examination.
The recurrence of an aneurysmal bone cyst after bone grafting seems to be rare. We reported a case of the recurrent aneurysmal cyst of the Talus. A 30 years-old male complained of the recurrent pain 15 months after the first opeartion. Roentgenograms showed an enlargement of the cystic lesion. At the first operation showed the histological findings suggesting an Aneurysmal bone cyst, a giant cell tumor was not complelely neglected. However, at the second operation revealed the charactreristic findings of an aneurysmal bone cyst.
Since 1973, we experienced twenty patients with solitary bone cysts, such as eight cases in humerus, nine cases in femur, one case in tibia, and two cases in fibula. In the fourteen patients who received curettage and bone graft, seven cases were rated as “healed”, three cases as “imcomplete healing”, and three cases as “recurrence”. One case failed to follow-up. Imhauser's procedure was performed for two cases with bone cyst in femur, and all were healed. For two cases of bone cysts in fibula, only curettage was performed, and one case recurred. Two patients with pathological fracture of the humerus, received only cast-fixation. One was rated as “healed”, the other was rated as “imcomplete healing”. Conclusion 1) Curettage and bone graft had 21.4% recurrence rate, and in younger children it was more difficult to obtain sufficient amount of bone for grafting. 2) Imhauser's procedure dose not require curettage and bone graft, so this procedure has less burden upon little children.
The patient is a six-year-old boy who developped pain in his right knee after minor trauma to the right knee. He was seen by us 2 months later with the chief complaints of limp and extension block of the right knee with atrophy of the Quadriceps muscle. Plain roentogenograms of the knee showed no abnormalities of the bone. Arthrogram and arthroscopy revealed no intra-articular abnormalities such as discoid meniscus. The patient was followed at outpatient clinic with the medication of aspirin which relieved pain trasiently. Repeated roentgenographic examination, performed 2 months later, revealed rudiolucent lesion to the posterior aspect of proximal metaphysis of the tibia. Tomogram and bone scan confirmed the Nidus in the lesion which suggested Osteoid Osteoma. The lesion was completely removed surgically. Histological diagnosis was Osteoid Osteoma. The patient has been completely asymptomatic postopertively with full range of motion of the knee.
Osteoid osteoma often outbreaks in tibia or femur. But, this disease in ossa digitorum manus has been rarely reported in Japan. We found a man aged twenty-four with osteoid osteoma in the fourth phalanx proximalis. X-ray examination showed a nidus there and it showed a annular sequestrum. This time, we have reported this case and have given consideration to the clinical and phathological finding of this disease.
Recently we have experienced a 79 year-old female with seconoary chondrosarcoma, derived from enchondroma, occurred in the fifth metacarpal bone of the left hand and the fourth proximal phalanx of the right hand. And also, she had had multiple enchondromas in the fourth and fifth proximal phalanx of the left hand, in the third proximal phalanx, the fourth middle phalanx and metacarpal bone of the right hand, and in the second proximal phalanx, the third middle and proximal phalanx of the left foot. Amputation above the left wrist was done in September 1980, and the other, extirpation of the tumor occurred in the right fourth proximal phalanx was performed in March. The former was histlogically classified as grade II by Evans' subtype, and the latter as grade I.
A malignant fibrous histiocytoma arose in the proxymal tibia of a 52-year-old man who had multiple, symmetrically distrbuted, medullaly bone infarcts. He had been employed as a diver from 1953 to 1957, working in a compressed air enviroment. There had been five episodes of the bends with severe pain in extremities.
Malignant shwannoma is relatively rare disease in malignant soft part tumor. Recently, we have experienced two cases of malignant shwannoma. Case I, twenty seven aged man, is secondary malignant shwannoma of the right radial nerve with Von Recklinghausen disease. Case 2, forty one aged man, is primary malignant shwannoma which has come in the upper cervical region. Both cases took place in bone metastasis of the spine and finally resulted in spinal cord compression syndrome. Decompressive laminectomy and spinal fusion was done but patients have never recovered from paralysis.
Six cases of giant cell tumor of bone were examined electron microscopically. Four cases of them were Grade I (Jaffe-Lichtenstein's classification), one was Grade II, and the rest was Grade III. Giant cells didn't show the evidence of division and there was no remarkable difference in the giant cells among the cases of Grade I, II and III, and therefore they couldn't be considered the principal tumor cells. Mononuclear stromal cells were divided into four types: Type I; immature primitive cell, Type II; the cell more well differentiated than Type I stromal cell and could be seen more frequently in the section, Type III; fibroblastic cell, Type IV; histiocytic cell. Type III and IV stromal cells had some characteristics in Type II stromal cells and therefore they were considered the cells originated from same primitive cell. The resemblance of Type IV stromal cells to giant cells and the findings that stromal cells seemed to be fused or phagocyted into a giant cell revealed the same origin of giant cells with stromal cells. In a case of malignancy, there were findings of atypism in nuclei of stromal cells, a decrease in number of Type III and IV stromal cells, and an increase in number of Type I stromal cells. It seemed that giant cell tumor of bone was originated from primitive mesenchymal cells showing partial fibroblastic and histiocytic differentiation.
A 36-year-old male driver consulted our clinic, complaining the right wrist joint pain on motion. Roentogenographic appearance showed multi-lobulated translucent focus at distal end of the right radius. Initially, curettage and packing with bone cement was performed. Histologically it was diagnosed as giant cell tumor of bone, which consisted of abundant multinucleated giant cells and a few stromal cells. Three months later, local recurrence of the right radius and two soft part tumors at the dorsal side of the right hand were found. Soft part tumors were resected and diagnosed as malignant giant cell tumor, which consisted of a few bizarre multinucleated giant cells and dominant proliferation of stromal cells partly arranged in a storiform pattern. Seven months after the initial operation, neither recurrence nor metastasis was found. Satisfactory active daily life was gained with moderate limitation of ROM at the right wrist joint and the first MP joint of the right thumb.
We have treated two cases of Ewing's sarcoma by radiation and chemotherapy according to the T-2 protocol by Rosen and that by Sutow. Both patients haven't experienced the metastasis and recurrence for about one and half years. We considered that theses protocols would be effective on the treatment of the Ewing's sarcoma and we hope to be completely curable by these protocols.
A case of Ewing's sarcoma which has been controlled by chemotherapy alone was reported. The patient was a 12 year-old female suffering from destruction of the right femur. Physical examination showed severe tenderness and slightly diffuse swelling of the distal thigh. Roentgentgram revealed a lucent lesion and periosteal reaction in the distal epi-metaphysis of the femur. A large extra-skeletal mass and high density shadow in the bone marrow in the distal femur were showed on CT. Intra-arterial infusion of high-dose adriamycin was employed. When she has last seen, twenty months after the treatment, there was no evidence of any recurrence or metastasis.
We use Donryu rats (100g) transplanted Walker's Carcino-sarcoma subcutaneously as experimental tumors. When tumor attained 2cm of its maximal diameter, we injected 3mg Acridine orange intraperitoneally. After 48hr, Argon-Laser was irradiated (5w, 250sec, C. W) on this tumor, and still more on second day from irradiation, we made tumor cells separatedly and stained them by Feulgen method. We measured DNA-content distribution with MMSP-RF, Absorption spectrum with MMSP-TU, and emission spectrum with MMSP-RFF. Still more we checked transtimidal change of intratumor temparature during Argon-Laser irradiation with Thermography & Thermister. As to DNA content distribution, there was no discrepancy between control group (administrated nothing or Acridine-Orange only) and photodynamic therapy group (Acridine-Orange+Argon Laser). As to emission spectrum of intracellular Acridine-Orange, orthochromasic cell has maximal emission peak at 515nm, but metachromasic cell has at 535nm or more longer wave shift. As to emission spectrum of Feulgen stained cells, normal DNA has maximal peak at 610nm, but Acridine-Orange administrated & photodynamic therapy group have maximal peak at 620nm or more longer wave lenght. Shift to longer wave length can be seen also in heat-degenerated DNA. During photodynamic therapy, the highest temparature retained less than 40°C. Adding to these results, photodynamic-therapied Rats could survive more longer than any other therapied rats significantly. And we could observe perfect disappearance of transplanted tumors in some rats. From these observations, we think Photodynamic-Therapy is one of the useful anticancer-therapy.
Thirteen patients (16 joints) with rheumatoid arthritis (RA) and twenty patients (27 joints) with osteo arthritis (OA) were examined for their synovial fluids. Results were as follows: 1) Lipid peroxide level in synovial from RA patients showed a significant increase compared with that from OA patients. 2) β-glucuronidase activity in synovial fluid from RA patients showed markedly increase compared with that from OA patients. 3) A well correlation was seen between lipid peroxide level and β-glucuronidase activity (r=0.70) in synovial fluid from RA patients, but there were a few patients who showed high level of lipid peroxide in spite of their low β-glucuronidase activity. 4) The correlated increase in lipid peroxide level and β-glucuronidase activity was seen in progressive stage of RA joint destruction. 5) Complement titers (CH 50, C3, C4) in synovial fluid from RA patients showed significant decrease compared with that in serum, but there was no correlation between complement titers and serum rheumatoid factor, CRP test, and G. S. R.
An experimental effort to determine the degenerative effects in the articular cartilage of the knee joint caused by meniscectomy was performed by doing partial and total meniscectomies no the medial compartment of dog's knees. At intervals of 1 to 12 month dogs were sacrificed and knee specimens were placed in an apparatus which recorded rotatory forces and angles. Rotatory laxity was observed between right and left knees of specimens. Gross and microscopic pathorogical changes in the articular cartilage were studied. Result indicated that total meniscectomy leads to more severe joint instability and degenerative changes. Therefore the menisci play on important role in preventing rotatory instability and protecting articular cartilage from degenerative changes.
A condition complaining of knee pain with retropatellar click and tenderness of the inferior pole of the patella was reported. The tongue of the infrapatellar fat pad was impinged between the articular surfaces of the patellofemoral joint. The finding was confirmed preoperatively by arthrography and arthroscopy. Five patients, aged 10 to 48 years, were operated upon and the apex of the tongue was excised. The operation were followed by complete relief of pain. The histology showed chronic inflammation, fresh hemorrhage and fibrosis in the excised tongue.
Roentgenographic investigations of patellofemoral arthritis were done of 237 knees. Age ranged from 37 to 93, average 64 years old. Patello-femoral osteoarthitis correlated with patella alta. Regardless of the femoro-tibial angle or type of femoro-tibial osteoarthritis, patello-femoral osteoarthritis was mostly observed in its lateral facet.
The purpose of this paper is to present why wedged insoles in the osteoarthritis of the knee joint are effective. The twenty cases who were effective or unchanged after the applications were used for radiological and biomechanical study. The differences of findings before and after applying wedged insoles were discussed. Radiologically, tibio-femoral angle and tibial tilting angle produced a tendency toward valgisation of the knee joint. And the distance from Miklitz's line to the knee decreased. According to the biomachanical analysis with the force-plate, the range of transition of the gravity line was reduced in the length and also the area, either standing on one leg or both legs. From these results it is considered that the effects of wedged insoles are due the stabilization of the gravity line and correction of lower extremities' alignment.
For the chondromalacia patellae, displacement of the tibial tubercle is performed by the various methods such as Maquet's operation and Groeneveld's operation. We introduced the oblique tibial osteotomy to displace the tibial tubercle in the medial and ventral direction. This procedure has merits as follows 1) It is unnecessary to graft the iliac bone between the osteotomized fragments, which only slide each other. 2) Bony union of the fragments is good.
A woman aged fifty-eight years was admitted because of the severe pain of the left knee. On roentgenogram, a marked destruction was noted in the medial tibial plateau. Allotransplantation with frozen right lateral tibial plateau was performed. Eight months after the operation she complained pain at her operated knee. Roentgenograms showed a destruction on the medial femoral condyle. She was then treated with total knee replacement. In conclusion it was thought that; Allotransplantation with frozen bone gives little chance for cartilage to survive, so the postoperative joint failed in degeneration or destruction from the lack of the function of the joint lubrication or stress distribution in cartilage.
We think that what we must consider on the treatment of burn is the following: (1) It is very difficult to judge how deep a burn is, immediately after the burn. (2) The most suitable position for extremities for treatment for a burn is that the joints be extended. (3) Fingers and toes are easy to develop a scar contracture with deformities in the early period after the burn is epithelized. (4) There is a possibility of developing an undergrowth at the affected part because of the scar, if the patient had the burn before it was one year old and had such a scar that lacks expandability.
This paper reports three cases with pseudoaneurysms or arteriovenous shunt due to trauma in the lower extremities. Case 1. A twenty-eight-year old man was struck by volt the left gluteal region in accident on shipboard. Angiographic finding revealed pseudoaneurysm of left inferior gluteal artery. He was three times attacked by large hemorrhage from the wound before he was examined at our clinic. Case 2. A fifty-year old man was contused right femoral region in traffic accident. It resulted in swelling, pain and bleeding, but no skin lesion was found. Angiography revealed pseudoaneurysm of the inferior branch of the lateral circumflex artery. Case 3. A forty-three-year old man was stabbed in the posterior region of bilateral thighs. Angiography revealed pseudoaneurysm of deep femoral artery in right and arterio-venous shunt between deep femoral artery and vein in left. We have to notice vascular injuries even in the case with small skin lesion. These vascular injuries accurately by angioraphy. We treated these three cases by ligation of involved arteries and vein.
Thirty nine athletes belonging to Yahata Seitetsusho sports clubs are analized the athletic injury about the knee joint. In nineteen patients with collateral ligamentous tears, eighteen treated with non-operatively have returned primary sports. Only one patient received operative repair have not returnrd to satisfactory performance in the primary sports nine months after operation because of instability. In seven patients with meniscal tears, four performed meniscectomy have much better results than those treated with non-operatively. Two patients with cruciate ligamentous tears have not yet returned to preinjury functional capacity because of instability. The results are as follows: (1) meniscectomy is much better than non-operative treatment in athletes; (2) in the treatment of ligamentous tears, to gain the stability is more important than to recover ROM for athletes.
Apophyseal avulsion fractures of the pelvis are relatively rare. We have recently experienced eight cases caused by sports. They consists of six cases at superior anterior iliac crest and two cases at ischial tuberosity. All cases were young men ranged from 14 to 17 years old. The kinds of causal sports were track events for six cases, baseball for one case and soccer for one case. Five cases of them were treated conservatively, and three cases with large displacement operatively. All cases were good results. Also, we discussed the mechanism of them using telemeter-EMG.
Low-Back Pain of Athletes A study on low-back pain was made of a total of 59 athletes belonging to the company's sporting clubs-17 in Rugby football, 27 in baseball, and 15 in women's basketball clubs-by questionnaires, physical examinations and X-ray pictures. The results are as follows. 1. 30 athletes (or 50.8%) had low-back pain at the time of physical examination, and 48 athletes (or 81.4%) had experienced low-back pain. 2. The greatest number of athletes had low-back pain caused during sporting exercises, which indicates that low-back pain was caused in most cases by excessive exercises and overwork. 3. The frequency of low-back pain was high in the order of baseball, Rugby football and basketball athletes, and its effects on daily life were not so great. 4. As for its effects on sporting activities, it seemed that most athletes do sports bearing pain. 5. An examination of X-ray pictures showed that 14 athletes or 23.7% had spine separatation or slip, with high percentages for Rugby football and baseball athletes, 41.2% and 22.2%, respectively. 6. Massage and acupuncture were most commonly used for therapy, and a more appropriate therapeutic system is desired.
Subtalar dislocation not combined with fracture is uncommon and only a few reports have appeared in the literature, we are reporting the very rare case of lateral dislocation of subtalar joint without fracture. The patient was sixteen years old, who was injured by jumped from five meters height. Roentgenogram showed lateral dislocation of the subtalar joint. Reduction was done with ease under general anasthesia. Weight-bearing was begun at eight weeks after reduction. There are no complication, as pain or avascular necrosis, now.
Male cases mainly belong to vigorous age, fourth or fifth decade, but female cases mainly belong to postmenopausal age, sixth decade. Most of the severe cases, dominant in male case, were surgically treated by means of elevation of the depressed articular surface, filling the void beneath the elevated articular surface with cancellous bone grafts, impaction of the split fragment against the medial portion of the tibia and holding the restored tibial condyles with screws, compression bolts and or metal plates. Some cases of remakably comminuted fracture were conservatively treated with reduction by molding and resulted in only slight disability.
From December in 1977 to May in 1981, 21 cases of extracapsular hip fractures were operated by Erder's nail in Fukuoka Red Crose Hospital. 17 cases which were radiological bone union were reviewed. The types of the fractures were 11 stable type and 6 unstable type fractures as classified by Evans. Good result were obtained in 15 cases (89%) on ADL examination, in 12 cases (70%) on roentogenographic examination. Especially, external malrotation occurred in unstable type.
One case of the atlanto-axial dislocation with basilar impression was reported. A thirty six year-oid female who been on the physio-therapy after a fracture of the femur died by the sudden apnea. The findings of autopsy were the stenosis of foramen magnum caused by the protrusion of clivus and basi-occipital and severe degenerative changes of the spinal cord. Roentgenograms revealed an elevation of odontoid process over the McGregor's line and the digastric line of Fishgold. These findings indicated that this case had a basilar impression of the anterior-lateral type.