Subuctaneous tendon ruptures in the hand are fairly not rare. Fifteen cases of tendon ruptures of the hand were treated during 1976 to 1981 at the Kokura Memorial Hospital. In this paper, the etiology, site, mechanism of onset and method of treatment of these tendon ruptures is discussed. Five of the 15 patients were male and ten were female. Tendon ruptures in left hand were four and in right hand were eleven. 10 cases were extensor tendon ruptures and 5 were flexor tendon ruptures. Thirteen of the 15 patients were treated with surgical procedures. The tendon ruptures were associated with rheumatoid arthritis in five cases, 2 resulted from dorsal dislocation of the distal head of the ulna, 2 followed tenosynovitis caused by repeated active flexion during work, 2 were caused by sudden forced hyperextension and 3 were caused by Colles' fracture. All of the extensor tendon ruptures were over the dorsum of the wrist, where the tendons had been weakened by trauma or disease. In acute cases, repairs were made with bridge tendon grafts, Whereas in chronic cases the method was tendon transfer. The flexor tendon ruptures occurred at the site of insertion of the tendon in 2 cases and sudden hyperextension of the involved finger was probably responsible for the injury. 3 of the cases of flexor tendon rupture occurred within the tendon itself, the involved digit being the little finger or thumb and occurred where the direction of muscle contraction and tendon excursion was different. In these cases, attrition of the tendon probably preceded the rupture.
At the handmade wooden household furniture workshops, various kinds of accidental injuries in the hands of workers are often apt to occur. We have experienced so far in total 13 cases the treatment of severe hand injuries occurring at these workshops recent 2 years. In case of open fresh hand injury, we make it a rule to perform primary repair operation as far as we can. Generally, fairly good results of the treatment were obtained in the clean cut cases but, in the crushed and mutilated cases, the results were poor.
Restoration of elbow flexion in paralytic disorders is a most important problem. Three cases of poliomyelitis and seven cases of brachial plexus injury in which muscle transplantations had been performed to restore elbow flexion have been reviewed. The average follow-up period was five and a half years. The results were graded by active range of motion, muscle power and Mayer & Green's criteria. The results of seven cases of Steindler's operation are excellent and good except for one case. The mean of flexion contracture is thirty degrees and active flexion is one hundred twenty-five degrees. The results of two cases of Clark's operation are excellent and good. The result of one case of sternocleidomastoid transplantation is poor.
During last four years, the injuried flexor profundus tendons of 24 fingers were treated in our clinic with in various methods. This paper reports the clinical results of these fingers. Twelve of them were severed and remainings were ruptured. The five fingers which were treated with static methods such as arthodesis and tenodesis have obtained good results, and the nineteen fingers reconstructed with tenoplasties, fourteen have had satisfactory results, three unsatisfactory results, and the motions of the two fingers have not changed remardably, according to Stark's classication. In our experience, advancement of the profundus tendon should be selected as first choice when the length of distal tendon stump is within 1.0cm. Free tendon graft through intact sublimis tendon applied for selected patients were restored usefull range of motion of the fingers.
Epicondylitis lateralis of the elbow (tennis elbow) is a common lesion. For the chronic cases, the treatment is not so easy, so that we tried to treat it with the application of new type brace which is modified the dorsal cock-up splint. Materials are 19 cases of the chronic tennis elbow. Male is 8 persons and female is 11. The utilizing period is average 3.6 weeks. The interval from onset to the application of the splint is about av. 9 months. The important point of this splint is to maintain the wrist in slight dorsi-flexed position. So that the extensor carpi radialis muscles are kept in relaxation. During the use of splint we permit to move their arm freely in working or ADL motions. The follow-up period is more than 8 months. Results are follow; effective are 9, unknown are 7 and not effective are 3 cases. For the cases of rheumatoid arthritis, the effect of this splint is not expectable.
Vascular pedicled fibular graft was performed in the treatment of the tibial defect. This procedure is indicated for massive bone defect in mid-shaft of tibia or lower part of femur. Case 1 2-year-old Female Her left tibia was absorbed in midpart after osteomyelitis. The defect of it was about 7cm long. Fibular graft with vascular pedicle was transfered in the center of tibial axis and fixed with K-wire intramedullaly entered from calcaneal region. 2 weeks after surgery, callus formation was seen near the both ends of graft. Solid union was gained 4 months after surgery, at this time plaster cast was removed. The grafted bone rapidly became large as same size as tibia after weitght bearing was allowed. One year after she can walk without brace. Case 2 43-year-old Male 20 years before, he sustained open fracture on his left leg. Pseudarthrosis was seen in his left tibia with small defect. The fibula become large compesating weak tibia. The fibula with vascular pedicle transfered to posterolateral side of tibia and fixed with 5 screws. Solid union was gained in the upper end of graft, but union was delayed in lower end. So free iliac bone graft was performed.
We have treated six cases of the pressure sore with musculocutaneous flap. Surgical procedures were as follows, superior gluteal musculocutaneous flap in four cases of lumbo-sacral pressure sore and gracilis musculocutaneous flap in the cases of ishial pressure sore. Postoperative course was seem to be good in the short term follow up study.
In order to study the etiology of the discorders of the patellofemoral joint, 63 patients with knee pain were examined clinically and radiologically. Analysis of the X-ray pictures of these patients were carried out by measurement of patellar index, sulcus angle and Q-angle. Joint laxity were judged by the method of carter. In eight patients of recurrent dislocation of the patella, all of their shape of patella were in Wiberg's type 3. The Q-angle tended to increase in female patients. This angel also increased in patients with patellar dislocation and chondromalacia. In patients with recurrent dislocation of the patella, joint laxity tended to increase, so range of motion in internal rotation and external rotation of hip was increased. There are significant correlations between the sulcus angle and the type of patellar shape, that is, in Wiberg's type 3 the sulcus angle is greater than others.
One hundred and seven patients (145 knees) suffering from osteoarthritis of the knee were treated by the shoe-brace with lateral wedge. In 97 knees that difference of the width of medial joint space between at nonbearing and at bearing time were within 2mm, 48 knees (49.4%) obtained clinical efect. In 48 knees that radiological change were over 2mm, only 6 cases (12.5%) obtained clinical effect and 9 knees of them were treated by high-tibial osteotomy. The shoe-brace with lateral wedge to osteorthritis of the knee is considered to be effective for the knee that radiological change is within 2mm.
Post-operative results are evaluated in twelve knee joints of the twelve patients with knee disorders (eleven of osteoarthritis and one of osteonecrosis) treated surgically by domed high tibial osteotomy. Followed-up period are ranged from eight to twenty months. There were varus deformity in all the cases except for one. Pain and effusion were effectively relieved post-operatively in all of them. They showed a satisfaction with the postoperative results. In the post-operative course, valgus position obtained by osteotomy is found to return to varus posion with decrease of four to seven degrees of femoro-tibial angle (FTA). So carefull management will be necessary to avoid recurring of varus deformity after surgery untill bony fusion is completed at the osteotomy site.
A study of long term results of high tibial osteotomy has been made. 30 cases of high tibial osteotomy were evaluated clinically and roentgenographically an average of 4.8 years after operation. Sixty-seven percent of these cases were satisfactory. But, there are many probrems in these operations. We have reported probrems of high tibial osteotomy in these cases.
Two cases of knee joint replacement using ceramic implant were presented. The first case was forty-three-year old male with osteosarcoma of proximal tibia and the second was sixty-four-year old male with osteonecrosis of lateral femoral condyle. Preoperative design tended to produce too large prosthesis. Other problems complicating this procedure are discussed.
Fourty two patients with cervical spinal cord injury were studied about their shoulder pain and contracture. It the patient had shoulder pain, further study was done about characteristic of pain, its duration, and reference between pain or contracture and injured level of spinal cord. Twenty four cases out of 42 cases (57%) had shoulder pain. Most of them were suffered from severe joint contracture, and there was tendency that the patient with higher level injury of the spinal cord had more problems of shoulder. We recommened the early passive mobilization of the shoulder and the proper positioning of arm on the bed (neutral rotation, the shoulder in 90 degree abduction) to prevent the shoulder problem in cervical spinal cord injured patient.
This paper reviewed 48 cases of tumors of the shoulder girdle treated in our hospital from 1967 to 1981. We could not get any particular results in this series regarding with the sort of tumor, the affected lesion, the age and so on. Two cases of the tumors of the scapula were treated with the simple scapulectomy. The additional reconstructive technique was not applied to this method. However, our simple scapulectomy technique yielded a satisfied result of the function in the activity of daily living.
Nine patients with the glenohumeral arthritis and the rupture of the rotator cuff were operated and histopathologically diagnosed as just nonspecific inflammation of the glenohumeral joint. Mild infection has been doubted in all patients before the operation due to the roentgenoraphical and arthrographical findings, including demineralization, joint space narrowing, osseous destruction of glenoid, synovial irregularty and shadows of lymph channels and nodes. During the operation, we considered that these extra and intraarticular findings in glenohumeral joints were not degenerative in natue and related to septic process, although the repeated cultures of the aspirates were negative and long-standing massive cuff tear and glenohumeral instability causes loss of articular cartilage and secondary synovitis. The problems of the diagnosis and the treatment of nine patients were discussed in detailed.
Ninety-two patients with painful stiff shoulder were examined to find out the relation between affected shoulder and other joint stiffness. The result are as follows: 1. A high incidence of joint stiffness was found in the ipsilateral extremities. 2. Joint stiffness in the ipsilateral extremities would improve after treating the painful stiff shoulder. 3. In the case of joint stiffness in the opposed extremities, treatment of the joint stiffness would relieve the pain of stiff shoulder joint.
The lesions of the shoulder in rheumatoid arthritis were examined in 142 patients clinically and roentgenographically. Seventy-five patients (about 53%) had complaints of 114 shoulders. They were estimated by Takagishi's scoring which included the severity of pain, function, range of motion and roentgenographic appearance. The results were following. 1) Tenderness was located in bicipital groove and quadrilateral space mainly. 2) Pain was severer than we expected. 3) Muscle strength was maintained relatively. 4) The difficulties of ADL appeared to be caused by pain rather than limited ROM. 5) Range of motion was limited especially in abduction, flexion, and horizontal flexion. 6) X-P findings revealed there was a little change comparing with clinical symptoms. 7) In addition, we found elevation of the head of the humerus in 25%, narrowing of the joint space in 32%, erosion of the head of the humerus in 32%, cystic change in 19%, subchondral sclerosis of the head in 21%, and the change of the glenoid in 21%.
Three cases of fracture of the coracoid process associated with acromioclavicular dislocation were reported, furthermore two of them were combined with fracture of the superior border of the scapula. One of them was treated with transfixation of acromioclavicular separation and internal fixation of coracoid process, another one with transfixation of acromiclavicular separation only, and last one with conservative measures. From these results, it was thought that fixation of coracoid process is necessary for the patient to obtain early recovery.
A conservative treatment method for complete dislocation of acromioclavicular joint is presented in the report. Plaster spica was applied with arm abduction 90 degrees and pressed the clavicle downward by elastic band to reduce the dislocation. Ten cases were treated in this method and eight cases were followed over six months. Six cases had no complaint in A. D. L., but on X-ray film, anatomical reduction was obtained in only three cases.
Three shoulders of so called “Loose shoulder” in two cases were reported. The humeral head of each shoulder was loosely dislocated inferiorly from glenoid cavity with enlarged capsule, so that active elevation of the shoulder was impossible. These were rated as the third type by Endo's grading system. Soon after glenoid osteotomy and pectralis major transfer, looseness of the shoulders recured. To obtain strong stabilization of the humeral head in glenoid cavity, we deviced biceps tenodesis of humeral head by simply modified procedure after Nicola. Case 1. 16 years old girl. Glenoid osteotomy and pectralis major transfer were performed on her left shoulder, but looseness was not improved completely. Failing to obtain any stability after pectralis major transfer on her right shoulder, we performed biceps tenodesis and finally obtained stability on her right shoulder. Case 2. 18 years old girl. We performed biceps tenodesis with pectralis major transfer on her left shoulder and obtained sufficient stability. In conclusion, good stability could be obtained by biceps tenodesis combined with the conventional precedure such as glenoid osteotomy or pectralis major transfer on severe loose shoulders.
During the year 1974 and 1981, thirteen shoulders of the anterior recurrent dislocation of the shoulder were treated by modified Bristow operation. These cases consisted of two females and ten males. The age of the patients ranged from 18 to 30 and average age was 23 years. Twelve cases got results. On the other hand, one case got a poor result, with pain and severe disturbance of range of motion.
From February 1981 to April 1982, ten patients with displaced proximal humeral fracture were treated by utilising the Zero-position cast fixation in our hospital. Eight patients were school children and two patients were adults. All the fractures were reduced mannally without anesthesia at the first examination. After the reduction, nine patients were fixed with Zero-position cast brace. The results of eight school children were excellent with criteria for evaluation of results by Neer. The results of 76 years old man and 43 years old woman were satisfactory and failure respectively. The treatment of Zero-position fixation for the fractures has merits as below. 1) There is no functional loss of shoulder and elbow joints. 2) Hospitalization is not necessary. 3) It is possible to walk and sleep at supine position.
Sixty-six of patients seventy-two of hip joints with Perthes disease who had been treated in our clinic were reviewed radiologically and clinically. The follow-up period after the onset of disease was from three to thirteen years. Non-weight bearing or abduction cast treatment was carried out in fifty-eight hip joints, while surgical treatments, varus osteotomy and bone-peg grafting in fourteen. The study shows no difference in their results between the conservative treatments and surgeries. This may be because surgery was performed to the severe cases.
Three comparable groups of patients with fractures of the femoral neck were studied. Three groups consists of Ender's nails, Y-nails, and Moore prosthesis. We had an impression that Ender's nails gave good results in the treatment of old patients with stable intertrochanteric fractures.
Middle term results, over 5 years after surgery, were reported in 8 hips treated by Pelvic Osteotomy (Chiari). Ages of cases at operation were 15 years old in average. Plastic effects for dysplasial acetabular edge were satisfactory in all cases; in radiogram at follow-up time, CE angle became to 34.1° from minus 11.0° at pre-operation, Sharp angle became to 39.8° from 54.6° and Acetabular Head Index became to 97.6% from 41.0% in average. All patients showed normal range of motion and good activities of daily living. Only one case showed slightly Trendelenburg limping and another one case complained of slight pain of the hip after long gait.
Seventeen cases with heightening of the greater trochanter in congenital dislocation of the hip were treated by transplantation of the greater trochanter. Of those cases, ten cases with acetabular dysplasia combined with Chiari's medial displacement osteotomy. The age at operation ranged from 9 to 33 years. Observation periods averaged 3.4 years. These cases were evaluated clinically and roentgenologically. The following roentgenological measurements were performed; 1) the CE angle 2) articulo-trochanteric-distance (ATD) 3) lever arm ratio. The clinical assessemt was made using Colton's point-soring system. The clinical assessment correlated with the postoperative CE angle and lever arm ratio except two cases but did not with ATD. Fourteen cases had good results but two cases poor because of weakness of the abductor muscle. In this report, trying to assess the quantitative fatigue of the abductors (m. gluteus medius) by means of dynamic spectrum analysis (frequency analysis) of EMG was introduced.
Complications of trochanteric osteotomy in the total hip replacement include wire breakage, delayed union, nonunion, central migration and bursitis. Complete painless union of the detached greater trochanter will be achieved by prevention of forward and backward shearing force acting on the fragment. For this purpose staple clamp device was introduced by Charnley (1979). Twenty-one hips undergoing Charnley low friction arthroplasty between 1979 and early 1982 were reviewed. The detached trochanter was fixed with three wires in 11 hips, of which proximal migration following wire breakage was seen in three. Using staple clamp with wire fixation, complete union of the detached trochanter was obtained in all ten hips.
This paper reports the results of Charnley total hip replacement in 49 hips of 40 patients with a follow-up of five to ten years. Satisfactory results were obtained in 33 hips. But loosening of the socket and stem occured in 8 hips, and unknown pain of the hip region were seen in 8 hips of the remaining 16 hips. Loosening of the stem and socket was attributable to the technique of operation such as poor packing of cement and improper anchoring holles, and to the occurence of osteoporosis.
We experienced a miserable case of postirradiation femoral head necrosis. Osteomyelitis due to a screw penetration into the cecum was followed by total hip replacement. The patient is a sixty seven years old woman. As she was injured by inoperable uterus cancer at fifty one years old, 60Co irradiation therapy was done. As postirradiation necrosis occured 5 years after irradiation, total hip replacement (Mckee-Farrar type) was done. However, bone necrosis area in iliac bone due to irradiation progressed gradually, and anchoring screw migrated proximally into the cecum. Then the fistel formed at the region of rt. major trochanter. In fistelography, contrast medium leaked out into the cecum. So after iliocecectomy and anastomosis of colon, removal of prosthesis and local continuous suction irrigation was done twice. Since then, there has been no recurrence.
In order to study experimental polyarthritis in mice caused by Mycoplasma pulmonis, four introduction methods of mycoplasma cells to mice were employed; i. e. intravenous, intraperitoneal, intra-foot-pad. The results obtained indication that (I) polyarthritis took place in 80% and 53.3% of mice, by i. v. and i. p. injection, respectively. (2) By intra-foot-pad inoculation, severe arthritis was observed only at the inoculation site, finally. (3) No effect of adjuvant was demonstrated in the case of i. v. inoculation with mycoplasma cells.
The effect of Latex and Silica Particles, macrophage suppressive agents, on the incidence of collagen-induced arthritis was examined. Latex and Silica significantly depressed the incidence of arthritis. Antibody levels mesured by passive hemagglutination parralleled the clical course of arthritis.
Clinical data of 255 cases (1869 examinations) of definite or classical RA were analysed statistically and discussed on the correlation between with titers of RF (LATEX, RAHA and Waaler-Rose test) and with clinical findings. Titers of RF tend to increase in cases with high activities of general and joint symptoms in the following clinical data; general symptom index, ESR, painful and contractured joint score, acute phase reactants in serum protein and immunoglobulin (IgA, G. M.) Titers of LATEX and RAHA test showed a relative good correlation with clinical findings, but waaler-Rose test showed litle correlation.
Peripheral blood lymphocytes from healthy donors and thirty one RA patients were cultured in the presence or in the absence of Phytohemagglutinine (PHA) for three days. Supernatant containig lymphotoxin (LT) was added to L cells, and LT activities were assessed. Although LT activities in 100-fold diluted supernatant from non stimulated lymphocytes were hardly detected in healthy donors, significantly high level of LT release was found in RA patients. There was no significant difference of LT release from PHA-stimulated lymphocytes of both groups. LT activities in 10-fold diluted supernatant from non-stimulated lymphocytes in seropositive RA patients were significantly higher than those in seronegative RA patients. These findings suggest that LT could involve in the pathogenesis and the condition of RA.
Two Cases of the psoriatic arthritis were reported. Case 1: A 33-year-old woman was typical psoriatic arthritis, in which deterioration and improvement of psoriasis synchronized with those of arthritis. In roentgenogram, joints of finger and toe were highly destructed, and partially revealed pencil-in-cup deformity. In laboratory data, RA factors were negative in course of all duration. Case 2: A 57-year-old man was atypical psoriatic arthritis which was seropositive, and did not synchronized with skin lesion. Moreover, the clinical features of psoriatic arthritis and differencial diagnosis of psoriatic arthritis, were discussed.
We experienced 4 cases of ochronotic arthropathy. The chief complaints of the cases were knee pain, intermittent claudication, pain of the left hip joint and low back. These cases were treated by arthrodesis of the knee, laminectomy, total hip replacement and spondylodesis. One of them was died of pulmonary cancer. Radiological examination of the three cases except a young case, showed narrowing and wafers-like calcification of the discs and bamboo spine. Histological examination showed degenerative change of the cartilage and ligament.
Articular chondrocalcinosis with both arthritis and abnormal calcium deposition in hyaline and fibrocartilage was first described as a clinical entity in 1958 by Zitnan and Sitaj (9). Subsquently McCarty et al. (3) identified calcium pyrophosphate dihydrate (CPPD) crystals from both synovial fluid and cartilaginous tissues using compensated polarized light microscopy, x-ray diffraction and infrared spectrophotometry in patients with articular chondrocalcinosis and termed CPPD deposition disease or pseudogout. Although a considerable variation of clinical features has been described (1, 4), pseudogout without radiographic evidence of chondrocalcinosis seems to be very rare and also difficult to determine a correct diagnosis. In this paper, a case of pseudogout without radiographic evidence in either involved or distant joints is presented.
Four kinds of plastic casts: Pliton 80, Hexcelite, Scotch Cast, Cutter Cast are used as corrective cast materials. Characteristic features of plastic casts are lightness, water-proofness, skin-tightness and quick hardening. We have found that plastic casts have many merits used in congenital club foot treatment.
We reported a rare case of the stress fracture of femoral shaft, which occurred in a 34-year-old man running about 20 kilometer every day. He felt a knee pain during running at 10 September. We examined his knee at 14 Oct., but it was normal. But X-p of distal third of femur showed periosteal reaction and tomograph of lateral view showed linear radiolucency of posterior cortex. Stress fracture was diagnosed. Running was stopped for three months and then he began to run because X-p showed spindle-shaped enlargement of cortex.
A case of fracture of the neck of the talus with dislocation from both the ankle and subtalar joint was reported. The patient was 36 years old male. A heavy thing fell on his left thigh and his left ankle joint was dorsiflexed. Closed reduction was performed and the foot immobilized in plaster for 11 weeks. Full weight bearing was started 6 months after the injury. Although he complains limping and slight pain after fatigue 19 months after the injury, there is no collapse of the body and no arthritic change roentgenographically.
Twenty-nine cases of fracture of the humeral shaft were treated for the past 11 years (between 1971 and 1981). Eighteen cases of those were observed clinically and roentogenologically. Conservative treatment was done for 9 cases. Hanging cast was used for 4 cases of spiral and oblique fractures, traction and shoulder spica cast for 4 cases and shoulder spica cast for 1 case. All cases showed good result. Surgical treatment was done for 9 cases. Five cases of those were transverse fractures. Two cases resulted in psudoarthorosis. From our result, we suggest that the majority of cases should be treated conservatively except for the cases of transverse, open fracture or the case with radial nerve injury.
K. U. compression plate was produced by the fracture research group of department of orthopedic surgery of Kumamoto University in 1967, which is a compression plate using no accessory device. The plate has a sliding groove, which plays a role of compression device to create compression force bring each fragment closer. The result of animal and clinical studies suggested the K. U. compression plate might be most effective one and also it has the effect of conventional contact plate.