A review of fracture cases treated with the K-U compression plates we have developed revealed treatment problems occurred in several. Most important problems involved the basic technique of compression plate fracture treatment, i. e., the method of plate and screw use, appropriate management of a large bony defect, interpretation of X-rays and overestimation of plate or screw strength. Closer attention to basic technique in management of fractures and refinement of technical skills employed by surgeons will result in better clinical success using this form of therapy.
A 8-year-old boy suffering from a pathologic fracture of his right humeral shaft, visited to our clinic on 15 MAY, 1980. His clinical diagnosis was suspected as a Ewing's Sarcoma and he had to get open biopsy which showed Ewing's Sarcoma histologically. As an amputation surgery was refused, immediately Adriamycin was given and radiation therapy was started. On 3 months after these initial therapies, X-ray findings showed sclerotic changes. However, 1 year after the biopsy, a radiolucent area on the right humerus which was made by the biopsy was bigan to enlarge with secondary pathologic fracture. And so, recurrence of the tumor was suspected firmly. Disarticulation of the right glenohumeral joint was done. However, histological study showed no recurrence. After disarticulation IFN-β was given intravenously since July, 1981 to 113, 000, 000 I. U totally on MAY, 1982. The side effect of IFN-β was high fever which was disappeared by medication. 2 yeas after the biopsy, he is living in high spirit without any metastases.
Long term roentogenographic review of 26 patients with 34 hips involved with Perthes-like change after treatment of congenital dislocation of the hip was made. Early roentogenographic findings in the femoral head with Perthes-like change were too variable to classify clearly. Deformites of the proximal femur of these patients after growth were flattening of the femoral head and shortening of the femoral neck in variable degree. The resultant deformities of the proximal femur varies with amount of the epipysis involved. The results suggested that the cause of Perthes-like change was intra chondroepiphyseal vascular disturbance due to increased pressure of the femoral head caused by forced frog leg position at the time of treatment of congenital dislocation of the hip.
When Chiari osteotomy in coxarthrosis with severe acetabular dysplasia were considered ineffective, bone grafting to osteotomy site after medial displacement osteotomy was effective procedure. This procedure was performed in the four cases. Three cases of them had satisfactory results, but one poor because of severe contracture of the hip joint. In the coxarthrosis with severe acetabular dysplasia in which acetabular head quotient was less than 50 and CE angle negative, Chiari osteotomy with bone grafting was seemed to be one of the effective procedures.
Immobilization of the hind limb in a straight leg cast produced hip dysplasia of varying degrees in the growing puppy. Only slight degenerative changes were found in the hip with subluxation. No progression of degenerative changes was noted in one year follow-up. Completely dislocated hips showed characteristic deformity of the femoral head and severe acetabular dysplasia. Significant cartilage degeneration was noted which appeared to have progressed with duration of the dislocation. Characteristic changes were severe reduction of Safranin-O staining, fibrocartilaginous proliferation (pannus formation) and hypocellularity.
A 31-year-old woman with bilateral dislocation of the head of the radius was reported. She was seen with complaints of righ elbow pain and limitation of forearm pronation for one month ago. Her disability of the elbow occured after holding her child in her chest for thirty minutes, and there were no symptome before that episode. Roentogenogram showed bilateral dislocation of the radial head. Since there was no history, dislocation was th to be congenital. Dissection of fibrous band that impinged the radial head and resection of radial head resolved her complaints and she regained free motion of forearm without pain.
Fractures of the upper end of the humerus are common and account for 4 to 5 per cent of all fractures. Fourty-seven cases of this fracures were treated in our clinic for the last seven years. According to the concept of the Four-Segment classification (Neer's classification), the patients were classified into Minimal displacement (66%), Two-part displacement (22%), Three-part displacement (6%) and Four-part displacement (6%). Relationship between the results of treatments and type of Neer's classification were analyzed in this study.
The domed osteotomy has been successively performed for 4 cases with the varus deformity of the elbow joint in children, which was caused by the transcondylar or supracodylar fractures of the humerus. The advantages of the new technique of the domed osteotomy against the varus deformity are as follows: 1. The correction in open operation is possible for the varus deformity, flexion disturbance and displacement of the internal or external rotation of the fracture region. 2. the correction of the radial prominence out of the humerus is able to perform by the displacement of the distal portion. 3. The extreme varus deformity is also able to correct, which is difficult in operated by usual wedge osteotomy. 4. By the wider cotact of cutting region as other methods, the bone union is more expected. However, we understand that the method has some disadvantages such as the complicated operation technique, and possibilities of happend trouble of the ulnar nerve palsy by the increased tension of the ulnar nerve. But we prevent it by the ulnar nerve release, or shortning of the humerus.
Replantations of 133 completely amputated fingers in 87 patients performed from June, 1972 to December, 1980 were studied. Ninety three digits survived (70%) and forty failed (30%). Survival correlated most closely to the mechanism of injury and there was a definite relationship between the number of arteries repaired and survival rate. The group of two arteries repaired had a greater potential for survival (82.6%), compaired with one artery repaired (67.3%). We tried to evaluate the cause of failures in the forty replantations that were unsuccessful and found that the majority of failures were secondaly to vascular thrombosis (72.5%). Other causes of failure were venous insufficiency (20%) and failure to vascularize (7.5%). The majority of thromboses were on the arterial side. The possibility of such factors causing loss of the digit is reduced by increasing the number of vessels repaired. In most digits, threfore, two arteries and at least two or three veins should be repaired routinly.
We reviewed 6 cases (6 fingers) of amputation through distal phalanx or DIPJ, so called zone I and II, of the children. 3 cases of them were successful and the other 3 cases were failed. In all but one only digital artery could be anastomosed. It is common there was no veins that could be anastomosed at this level of amputation. It is the most important problem how to avoid or decrease the venous congestion in these cases. In successful 2 cases fish mouth incision was made at the end of the fingers. While in failed 3 cases only milking was added. We stressed that only arterial anastomosis and fish mouth incision could lead to success of replantation of the amputation through Zone I or II.
A microvascular technique was used to transfer a living fibula to replace the lower end of the radius after massive resection for giant-cell tumor and pseudoarthrosis of the tibia after trauma. A sixty-three years old female with a giant-cell tumor was treated successfully and regained her right forearm function early. The other case with non-union of the tibia showed complete occlusion of anastomosis in his arteriograms and poor callus of the osteosynthesis.
We measured the subcutaneous tissue blood flow rate of foot with various positions using local hydrogen gas clearance. The blood flaw rate was highest when the foot was placed level with the heart in supine position. On the contrary, standing position was found to significantly decrease the blood flow rate by 50% as compared with supine position:
Five cases of acetabular fractures were reported. Two cases were the fracture of posterior wall with dislocation of femoral head. Thease dislocation were immediately reduced, and fracture of posterior wall were treated with open reduction and fixation by screw nail. Two cases were the transverse fracture with the fracture of posterior wall, which cases were treated conservatively. The prognesis of these four cases were exellent. Another one was the old case of T-shaped fracture and this one was operated by T. H. R. with shelf. The prognosis was good.
75 cases of medial femoral neck fractures operated in our clinic during past 4 years were reviewed. 10 cases were treated with Compression Hip Screw (CHS) only and 8 cases with CHS+AO screw. In this review, a comparison study of the results by each method was reported. And we believed that CHS+AO screw method is suitable for some types of medial femoral neck fractures
We have treated 66 cases of trochanteric femoral fractures by using Compression Hip Screw. The incidence of local complication was no more than 5 percent, although the patients underwent a weight bearing from the early stage of post operation. This method seemed to be very useful, which the patient can undergo a weigh bearing and leave the bed from the early stage of post operation.
Birth trauma, particularly femoral fracture, have been rarely found and few are followed up for a long time. We had three babies with femoral fractures treated by Bryant's traction and they showed good results. Perfect anatomical reduction was not essential for perfect function, because deformities in babies have corrected themselves spontaneously.
Five cases of osteochondral fracture of the patella treated surgically were reported. All patients were women who complained of persistent pain and limited motion of the knee. The ages of patients were ranged from 13 to 16 years, with an average of 14 years. The involved knees were right in 2 cases and left in 3 cases. In 3 cases, hypermobility, subluxation of the patella and the high standing patella were found. The fragments were removed in 4 cases, and the medial patellar retinaculum was duplicated in one case. All patients are favorable in clinical condition except for one with a slight limitation of knee motion.
The Hoffmann's external fixation device was employed in the treatment of twenty cases of tibial fracture. Sixteen cases were open fractures and the remaining four cases were closed fractures. The device was used for six to eighteen weeks. Afterwards patellar tendon bearing brace was applied and the patient was allowed to walk under full weight bearing. The main complications observed were the loss of ankle dorsiflexion and minor angulation at the fracture site.
A 32-year-old man was seen with one-year history of nontraumatic right leg pain, which became usually worse at night. X-ray revealed a round circumscribed sclerosis in the anterior aspect of the tibia. 99m-Tc scanning demonstrated the increased activity around the nidus in the tibia. Thermogram also showed a hot spot at the same region with the 99m-Tc scanning. Histological findings were charactrized by vascularized connective tissue, numerous irregular woven bone with osteoid, and a small number of giant cells like a osteoclast in the field.
The treatment of solitary bone cyst due to local injections of steroid was reported by Scaglietti, et al. in 1973. They have been obtained excellent results. Recently we experienced two cases with solitary bone cyst which have been treated by Scaglietti's method. The first case (eleven-year-old female) was solitary bone cyst of calcaneus. The second case (five-year-old male) was solitary bone cyst of radius. A few months later of the local injections, ossification was appeared in both cases. We considered that Scaglietti's method was safety, useful, and effective treatment.
A case of benign chondroblastoma of the talus accompanied with gout was treated. This case was rare because he was relatively aged man and tumor location was the tales. The curretage and bone grafting was performed to this lesion, and the tumor did not recur 5 months after operation.
Yaghmai has reported that the presence of hypervascularity in malignant bone lesion, aneurysmal bone cyst and giant cell tumor is a distinguishing sign for their differentiation from chondromyxoid fibroma. But, our two cases of chondromyxoid fibroma revealed the evidence of vascularity in the tumor area with stain. There is no evidence of recurrence in our two cases so far.
Chondromyxoid fibroma is one of the rare benign neoplasms. The authors have been experienced a case of malignant fibrous hissocytoma changed from chondromyxoid fibroma. A forty three-year-old male was admitted with a pathological fracture of the proxymal part of the left tibia. Curettage and bone grafting were performed. The neoplasm was diagnosed as chondromyxoid fibroma. However, the patient was reoperated because of a local recurrence after twenty months. Moreover, three months later, radiographic evidence of metastases was observed in lung and other regions. The patient died as a result of general metastases. The final histological diagnosis was malignant fibrous histiocytoma.
A 71-year-old male had onset of pain in the sacral region about 10 years ago. A part of tumor found in the sacral region was diagnosed on biopsy as a chordoma, surgically removed and treated with irreadidtion but the symptoms did not disappear. The patient died 8 years after biopsy. Post-mortem autopsy disclosed that metastasis was found in the lungs, the pleura, …etc. The histological examination revealed that in the early sample lobular arrangements of the large vacuolated or physaliphoroas tumor cells were found, and in the late sample, anaplastic spindle cells were presented.
Ganglia are most frequently found in females. They occur most frequently about the wrist joints, volar surface of the finger and dorsum of the foot, but rarely about the elbow joint. Two cases with paralysis of deep branch of the radial nerve were reported. Case 1—woman aged twenty-eight years. She found an ill-defined, oval elastic tumor about 2.5cm, in length on the annular ligament. Case 2—man aged sixty-seven years. He found an oval elastic tumor about 3cm. in length on the radius head. Two ganglia compressed both superficial and deep branch of the radial nerve. Three months after operation, there were full evidence of functional recovery.
Usually neurinoma of peripheral nerve is solitary and multiple neurinoma is uncommon. Reports of multiple neurinoma have been found only about ten cases in Japan. We had a case in which seven tumors were excised from three different parts of the right lower extremity. The case was further complicated by intracranial meningioma. In other countries, it has been reported that incidence of multiple neurinom is greater than that in Japan.
We experienced 2 cases of multiple neurilemmomas occurred in the peripheral nerves, which were few reported up to date. Almost all of the tumors were extirpated and diagnosed pathohistologically as the mixed type neurilemmomas (Antoni A+Antoni B).
Tumoral Calcinosis is a rare condition that appears to be periarticular calcification. We found a seven-year-old male patient with a right knee lesion of this disease. We tried phosphorus deprivation therapy that some authors have recently reported to be effective.
Tumortal calcinosis is a rare disease, named by Incran in 1943, that was characterized by periarticular calcification and hyperphosphatemia. We have recently seen a patient with this disorder and treated with surgical procedure, thyrocalcitonin and 1α-hydroxycholecalciferol. In January, 1977 a three-year-old girl admitted to our clinic with painful masses in the both feet. The level of serum calcium was 10.0mg/dl and that of phosphorus was elevated to 6.2mg/dl. The masses were surgically removed but they recurred seven months later. In September, 1979 painful mass was found adjacent to the right knee. Regrowth of the masses in 1977-1981 interval necessitated five moresurgical procedures in the region of the right knee and both feet. The patient was treated with thyrocalcitonin and 1α-hydroxycholecaciferol with no clinical improvement during four months in 1981. Medication of phosphorous deprivation have been attempted.
A case of xanthomatosis was reported. The patient was a 45-year-old man who was affected with tumors in the elbow, the dorsum of the hand, region of the patella, the tibial tuberosity, the Achilles tendon, and the dorsum of the feet. The largest of the tumors was 6×2.5cm in size. This was a rare case of multiple tumors. Such large, and multiple cases were found only 4 in 173 cases reported by Fahey. Prior to the present case, only two similar cases were reported in Japan. In the present case, no history was observed about familial hyperlipo-proteinnemia. From the analysis of serum lipoprotein it was concluded that the patient might belong to type II(b). In the treatment, all the tumors in bilateral feet and Achilles tendon were excised and it was found had been originated from the tendon itself itself or from ligament composed of tendinious tissue. The patient took a satisfactory post-operative course for seven months of observation.
A 28 year-old man noticed the tumor on the dorsal region of the left wrist after minor trauma. The wrist was occupied by multilobulated tumor for three years. Radiograph showed osteolytic lesion of the lower end of the radius and of the proximal carpal bones.
We reviewed a case, who was 42 year-old male, of neurofibrosarcoma, occurred primarily at the calcaneal region, with a metastasis to the left inguinal lymph node two years later after amputation below the knee, because of twice recurrences followed twice extirpations. We had diagnosed the primary tumor as neurofibrosarcoma, because the amputated tumor consisted of, histologically, spindle shaped cells with cart wheel pattern. Two years later after amputation, the left inguinal lymph node had been palpable with a tendency of slow growth. Its size had been measured 9×9×11cm 9 years later after amputation. We perfomed the extirpation of the left inguinal tumor. Microscopically, the extirpated tumor consisted of the above described cells with more pleomorphism and atypism. In silver stain, cart wheel pattern, as above described, was seen partially, and at the other part fine reticulin fibers waved and paralleled. It was concluded that it was the metastatic tumor to the inguinal lymph node from the primary lesion.
Recently we have experienced two cases of rhabdomyosarcoma. The first case was a 20-year-old female student whose left forearm was affected by a tumor of the brachioradial muscle. The second case was a 46-year-old male teacher whose left chest wall was suffered from a tumor of the intercostal muscles. These two tumors were proved to be an alveolar rhobdmyosarcoma by histological study. After resection of the tumor, radiotherapy and chemotherapy were carried out. The first case is fine neither reccurrance nor metastasis for more than one year. The second case was dead because of local reccurrance and metastasis to the lung after nine months.
When rats were injected intradermally with an oil emulsion of native type II collagen, approximately 40%, of them developed an imflammatory polharthritis. SD rats developed polyarthritis with high incidence, approximately 90%, after injection of 1) high dose of bovine type II collagen or 2) bovine type II collagen containing the synthetic adjuvant MDP (muramyl dipeptide). Whereas the usual dose of collagen alone produced polyarthritis with low incidence, approximately 50%, and MDP alone was non-arthritogenic.
Regional spinal cord blood flow (S. C. B. F.) was determined in rabbits by hydrogen clearance method. During the measurements, systemic arterial blood pressure and Paco2 were maintained within the nomal limit. After laminectomy at the thoracic region, a platinum electrode, 100μm in diamiter, was inserted from 1mm to 2mm deep into the spinal cord. The mean value of S. C. B. F. was 30.2±1.3ml/100gm/min in the gray matter and 15.6±0.5 in the white matter respectively. There were no remarkable changes in S. C. B. F. while the blood pressure was maintained in the range of 60 to 130mmHg. The value of S. C. B. F., however, showed changes above 130mmHg or below 60mmHg. S. C. B. F. was affected remarkably by the change of Paco2, showing a linear increase with the increase of Paco2.
Partial tissue oxygen pressure in the spinal cord was measured in the rabbits by polarographical method. The study was done in the thoracic cord after laminectomy of T6, T7 and T8 with a small size of needle electrodes being inserted. The average PO2 showed 11.9±0.9mmHg in the white matter and 26.7±3.3mmHg in the gray matter. The blood pressure was maintained within the normal range, 80-120mmHg during the determination. Then the blood pressure was made changed by venous administration of noraderenaline and trimetaphane. The PO2 showed to increase or decrease parallel in proportion to that of blood pressure. In addition, PO2 in the spinal cord showed a rapid increase when pure oxygen gas was inspired through intubation.
The effects of steroids on the bone blood flow was studied using hydrogen wash out technique in rabbits. Intravenous dexamethazone did not cause significant change in the bone blood flow in five minutes after injection. However, in thirty minutes after injection bone blood flow appeared to be reduced as compaired with control.
The effects of high doses of EHDP on the local Pb-acetate induced calcergy were studied in young female rats. A plaque of hydroxyapatite crystals was produced by local subctaneous injection of a lead acetate dilution. Reactions at injection site of dilution were evaluated by the mean diameter and the dry weight of the calcified wheals. At high doses of EHDP (above 20mg/kg/day), the hydroxyapatite crystal deposition were inhibited significantly.
The effects of high doses of EHDP on the healing process of non-immobilized fractures in young female rats tibia were observed roentogenographically and histologically. EHDP (60mg/kg/day for 7 days) failed to affect the formation of the fibrocartilagenous and bony callus, but strongly inhibited the mineralization and calcification of the callus at two weeks after fracture. At 4-6 weeks after fracture, resorption of the dead bone and remodelling of the callus were also inhibited and fracture callus seemed to be osteoporotic roentogenographically in EHDP-treated rats.
The effects of concomitant administration of [Asu1, 7]-eel calcitonin (ECT) to rats treated with EHDP on the healing process of non-immobilized fractures in young female rats tibia were studied. Concomitant, but separate, injeetons of various doses of ECT (10, 20, or 40unit/kg/day) with EHDP (60mg/kg/day) resulted in a promotion of mineralization and calcification of newly formed bone and cartilage of the callus in comparison to rats treated with EHDP alone at 14 days after fracture.
The rate of blood flow of full-thickness iliac bone grafts over a 2-month-interval was studied in 32 adult white rabbits, using the hydrogen washout technique. Our results were as follows. 1. Two weeks after transplantation, blood flow was observed in each type of grafts, but its rate in autografts were significantly higher than that in allografts. 2. Blood flow of autografts proceeded rapidly for 4 weeks and peaked at 4 weeks, followed by a slow decline. 3. Blood flow of allografts did not show an initial rise and remained significantly lower than that of autografts for 4 weeks. 4. The hydrogen washout technique was found to be useful for long term and repetitive determinations of the rate of bone blood flow, such as this experiment in bone grafts.
A case of Paget's disease in the pelvic bone was presented here. A 46-year-old male patient was found unexpectedly a higher value of serum alkaline phosphatase, and was introduced to our clinic in order to get a proper diagnosis. His right pelvic bone which was radiopaque showed an higher up take of 99mTc in bone scintigram. Open biopsy and histological study typical findings of Paget's disease. He was treated with a porcine calcitonin. As to serum alkaline phosphatase, 45.5 K. A. unit came down to 18.9 K. A. unit by the calcitonin medication for 4 months.
A case of 45-year-old female complaining of both shoulders, both hips and low back pain with gait disturbance, was reported. On the X-ray examination, typical osteomalacic bone changes with Looser's zones were seen. On the biochemical examination, hypokalemia, hypophosphatemia, hyperchloremia and metabobic acidosis were found. Furtheremore sero-immunologically γ-globulin was increased moderately, and RA test was positive. From the findings of renal function test and NH4Cl loading test, this case was diagnosed as Type 1 (secondary) renal tubular acidosis. Acidosis was corrected with Shohl's solution and depletion of kalium was supplemented with potassium gluconate. Coxa vara deformities were corrected by intertrochanteric valgus osteotomies, and now patient became ambulant without crutches.
It has been postulated that anticonvulsant drugs affect calcium and bone metabolism. We measured bone mineral status by direct photon absorptiometry, microdensitometry and blood biochemical examination in institutionalized mentally or physically disturbed 56 child subjects. Low MCI and BMC levels were observed in 24 of 56 patients. Of 56 patients, low Ca, P, high ALP and low 25-(OH)D3 levels were observed in 19%, 26%, 14% and 20% (in 2 of 10 patients), respectively. But the levels of active metabolite of Vitamin D, i. e. 1, 25-(OH)2D3, were normal or high. We investigated the relationship between the bone mineral status and the dose or duration of anticonvulsant drugs. And it was suggested that bone mass was affected by dose of administration rather than duration.
Three cases of vitamin D resistant rickets were reported. All cases showed normal serum Ca level, low serum P level and greatly increased alkaline phosphatase activity, X-ray examination revealed the characteristic cupped and irregular metaphysis of the the wrist. These cases were treated with large doses of Alfarol (1α-OH-D3). Serum alkaline phosphatase was depressed by the treatment while serum Ca and P were not elevated. The bone changes were disappeared by the treatment in all cases. The leg deformity was markedly improved after 2-3 years treatment but one month interruption of the treatment was followed by a relaps of the bone changes and increased leg deformity. It was suspected that the serum Mg level has to be examined when a large doses of 1α-OH-D3 is given.
we have already reported that EHDP inhibited the calcification of growth cartilage, which got thicker. Now we give rats EHDP enough to stop the calcification of the growth plate, and follow the course of recovery with microangiography. 60mg/kg of EHDP were given subcutaneously everyday for a week. Soon after the last administration of EHDP, the growth plate got thicker and the vascularity of metaphyseal vessels decreased. 2 weeks after the dose, capillary buds grew into the plate aborescently and got calcified. After 4 weeks the capillary developed into more functional metaphyseal vessels, and there was already new primary cancellous bone.
Spondyloepiphyseal dysplasia tarda is a rare condition, which Martoteaux et al. first recognized as a disticnt clinical entity in 1957. We observed two patients of this involvement of late. The major clinical findings are short-trunk type of short stature, which becomes prominent in adolescence, and osteoarthritic pain of hips and/or knees in adulthood. The radiographic findings are characterise c hump-shaped build-up of end plates of vertebrae and premature osteoarthrosis of hips, knees, and other large joints.
We were experienced two cases of chondrolysis of the hip joint. One case was idiopathic and another was secondary change following slipped capital femoral epiphysis. Moreover, chondrolysis-like change was recognized in two cases of acetabuloplasty for congenital subdislocation of the hip joint.
Sixteen normal hips in 8 persons and 29 osteoarthritic hips in 19 patients were examined by a computed tomography (CT), calculating CT value of the femoral head and acetabulum. Atrophy of muscles around the hip joints was also measured on CT by planimeter. The results obtained were as follows: 1. The mean CT value of the normal femoral head was 238±8.6 (H. U.) and that of the acetabulum was 199±2.8. 2. The mean CT value of the osteoarthritic femoral head increased in accordance with degenerative stage, reaching to the maximum value of 351±6.8 at the progressive stage, while it decreased to 285±21.3 at the late stage. 3. The mean CT value of the acetabulum showed a high score of 285±21.3 already at the early stage and remained stationary. 4. Atrophy of the gluteus medius muscle was observed at early stage; the gluteus maximus muscle at the progressive stage, and the tensor fasciae latae, gluteus minimus and iliopsoas muscle at the late stage.