Six cases with the fractures of the humeral neck were surgically treated with a spiral pin in our clinic and four of them were followed. The average follow-up time was about 7 months (ranged from 4 months to 10 months). The average degree of motion of the shoulder joint after operation is as follows-124 degrees of flexion, 123 degrees of abduction, 48 degrees of extension, 48 degrees of external rotation and 92 degrees of internal rotation. All of them were satisfied with the result. Internal fixation with a spiral pin gives rigid fixation and therefore allows early movement of the shoulder joint. It is concluded that the spiral pin is a good fixation device for the humeral neck fracture.
43 patients (Watson-Jones Type I 12, II 4, III 0, IV 6, nondisplacement 3, partial fracture 7) who were treated from 1969 through 1981 at Kyushu Rosai Hospital were analysed. 4 patients had ulner nerve palsy, 1 radius head fracture, 7 avulsion fracture of lateral condyle, 5 fracture in medial joint space. Ten patients were followed. The length of follow up averaged 6 years (range from two to ten years). Almost all patients had solid change or habitual luxation or Tinel-like sign of ulner nerve. Seven of the ten have slight limit of extension. Eight patients have slight elbow instability. A few cases have arthrosis change, sharpness of olecranon tip and narrowness of joint space, because of the damage of joint cartilage and the elbow instability. Ruptured medial collateral ligament should be reconstructed.
Seventy-two children with supracondylar fracture of the humerus were treated during seven years from 1975 to 1981. Forty out of seventy-two cases were treated by vertical traction. Results were evaluated from the motion of the elbow, varus or valgus deformity and nerve palsy to the cases treated by vertical traction. Varus deformity were observed in four patients, valgus deformity were not observed. Most of the patients followed up over one year got normal range of motion of the elbow. Nerve palsy were not observed.
The danger of a concomitant vascular injury is of real concern to the surgeon treating a fracture. Althogh gangrene of the extremity rarely occurs, crippling ischemic myositis and neuritis can follow even a brief interruption of the arterial circulation: In this case report we describe two patients with rare vascular complications of fractures consisting in dislocations of branches of major arteries into fracture sites.
A Weight-bearing ability of the Hoffmann external fixation apparatus was investigated using an experimental model of the fracture of the tibia. When a conventional model fabricated with universal joints was subjected to a compressive load test, the joints of the orthosis were dislocated at approximately 68kgf; suggesting that this method was not suitable to the weight bearing. When the joints were fitted with spring washers to strengthen the joints, the orthosis was strengthened sufficiently enough to bear the body weight. When loads were repeated on the same model several times, however, the spring washers remained flat and inactive with reduced fixing forces. When compressive loads were applied to a model fabricated with vices with rods and articulation couplings, the weight bearing was sufficiently possible. This method, However, also had a few shortcomings.
A Stress fracture of tibial malleolus is rare and only seven cases were reported in the literature. Recently, we encountered a patient who was a seventeen years old boy and had been playing rugby-football. He had a history of pain around his left tibial malleolus for a month, however, he had continued playing rugby. On examination, slight swelling and tenderness were found over the tibial malleolus and pes planovalgus and genu varum were also noticed bilaterally. Radiographs demonstrated oblique fracture line in the left tibial malleolus suggesting the stress fracture and he was kept away from playing rugby for a month. Subsequently, pain was relieved and radiographs showed the sign of recovery. He returned to sports activity without difficulty. In this case, slight deformities of his legs (pes plano-valgus and genu varum) and his role in rugby as right flanker, are considered to cause the stress fracture of the tibial malleolus.
A Nineteen patients with tibial plateau fractures treated in our hospital between January, 1972 and April, 1982 were studied in order to detect the causes of gonalgia following these fractures. The fractures were grouped into six types, according to the classification of Hohl. It was concluded that the causes of gonalgia were the depression of tibial plateau, genu varum, instability of the knee, and loss of articular cartilage from degenerative change. Lateral tibial plateau depression of more than 10mm resulted in considerable genu valgum, and the total depression type of medial tibial plateau (Type D and Type F) tended to produce genu varum. Our results suggest that it is important to elevate and maintain the depressed tibial plateau by open reduction, bone grafting, and internal fixation for the former type and to maintain the reduction by medial T-plate fixation to prevent varus defromity for the latter type. If open reduction is difficult, as in cases of comminuted fracture, conservative treatment by means of closed redution, closed pinning, and an ischial weight-bearing brace was found to be useful.
Avulsion fracture of anterior inferior iliac spine is uncommon, and 31 cases have been reported in Japan. A 14-year-old boy sustained fracture of his left anterior inferior iliac spine when he kicked a ball during the soccer game. We replaced the fragment under direct vision and maintained the reduction by internal fixation.
From May, 1975 to April, 1982, fifty patients of pelvic fractures with, primarily pelvic ring disruptions were treated. These fractures were classified according to the direction of force by the method devised by Pennal et al. Five representative cases were described with special reference to their pathologic and therapeutic view points. There included one open-book fracture, one ipsilateral compression fracture, one contralateral compression fracture, and two four-rami fractures of lateral compression. Following results were obtained: 1) 86% of the patients (43) had lateral compression type fractures. 2) Of lateral compression type fractures, the most common pattern was the four-rami fracture with posterior disruption comprising 44% of all fifty patients. 3) Four patients (8% of the total) showed stable open-book fractures requiring pelvic sling therapy. This number was smaller than at first expected. This study suggested that pelvic ring disruptions should be accurately classified and the grade of injury accurately estimated so that an appropriate method of therapy can be determined promptly.
A Two cases of osteochondral fracture of the patella were described in young women. One case was acute, and her knees were affected bilaterally at an interval of 42 months. The other was chronic. In both cases, “sky-line” axial projection of the patella revealed a defect in the medial aspect of the patellar facet. At arthroscopy, a defect in the articular surface of the patella and the loose body were detected. Hypermobility, lateralisation and high riding of the patella were also found. The loose bodies were removed, and advancement of the vastus medialis with section of the lateral alar ligament were performed.
Two cases of osteochondral fracture of the lateral femoral condyle were surgically treated. One patient is a 16-year-old girl who fell during hurdlerace. In this case, this fracture resulted from patellar dislocation. The fragment was surgically removed. Another patient is a 26-year-old man who was forced to overstretch his right knee during baseball. The operative findings suggested that the mechanism of this fracture was a tibiofemoral contact by overstretching the knee. The fragment was removed and the original site was shaved down.
Eleven cases with ruptured posterior cruciate ligament of the knee were followed. We have 3 exellent and 6 good results, but seventy percent of patients had functional insufficiency. We should try to repair surely the tear of posterior cruciate ligament, however, there is no sure technique to suture the tear.
Although external immobilization is often used for six to eight weeks to allow sufficient tissue healing in the treatment of knee ligament injuries, this appears to have considerable disadvantages that can be proven experimentally and clinically. In the last four years at Kyushu University Hospital, early mobilization exercise has been prescribed to the patients with isolated medial collateral ligament injuries. Active knee extension from 45 degress of flexion was started at 4-5 days after primary repair of the ligament, flexion to 90 degrees at 3 weeks and full weight bearing at 6-8 weeks. In cases of non-operative treatment, early mobilization exercise was started at 2-3 days after injury. Preliminary results of the clinical trial of early mobilization have been very satisfactory.
Twenty cases of injured lateral menisci, suspected by fluoroscopic arthrography, were investigated about the problem related to the diagnosis. The following results were obtained. 1) Sixteen cases which can be decided the type of lesion arthrographically coincided with the operative findings with the exception of one case of the incomplete discoid with parrot-beak tear. 2) All case, classified arthrographically as transverse tear, were identified surgically as parrot-beak tear. 3) The cases which were not classified to any type (“unknown” type) involves many problems to be solved.
An experimental effort to determine the degenerative effects in the articular cartilage of the joint caused by meniscectomy was performed by doing total meniscectomy on the medial compartment of dogs' knees. At intervals of 1 to 9 months dogs were sacrificed and osteoarthritic changes of the knee joint were observed roentagenologically, macroscopically and histologically. Electron microscopic pathological changes in the articular cartilage were also studied. Results indicated that removal of the meniscus in itself can lead to degenerative changes in the knee joint and the meniscus plays an important role in protecting articular cartilage from degenerative changes. Therefore in care of the human knee, the meniscus should be removed only when it is abnormal and interfering with normal knee joint function.
Since 1976, the Knee mobilization procedures have been performed upon 12 cases of stiff knees due to fractures of the femur and patella. Operative method was Thompson's quadricepsplasty or Kono's method. The average of flexion of the stiff Knees was 52 degrees pre-operatively, and 97 degrees post-operatively, so that the range of 45 degrees was obtained. The best improvement of flexion of the stiff knees was obtained by six weeks post-operatively suggesting importance of early physiotherapy. The post-operative follow-up examination showed that only two patients were able to squat and sit in Japanese style, but almost all patients were satisfied with improvement of the activity of daily living.
Total knee arthroplasty by the I/B total condylar type 1 or Kinematic stabilizer was undertaken on thirteen severely damaged knees of 7 patients with rheumatoid arthritis or osteoarthrosis. The short term results from 4 to 18 months after the operations were satisfactory as following: 1) The total knee score has improved on the average, from 25 points preoperatively to 83 points at follow up time. 2) Significant relief of pain and improvement of walking ability were obtained postoperatively. 3) Preoperative flexion contracture or flexion deformity could be corrected postoperatively, on the average from 27° to 6°. Increase of range of motion was 14 degrees on the average. 4) Valgus/varus instability could be satisfactorily aligned and stabilised. Postoperative femoro-tibial angle was 176° on the average. 5) The complications included a fracture of femoral condyle and transient peroneal nerve palsy.
A clinical findings were analyzed in 45 cases of thoracic outlet syndrome operated with first rib resection. Furthermore, the result of the anatomical examination in 254 cadavers were analyzed. Fifty-eight percent of the operated cases showed good-toexcellent results, and postoperative improvement of backache was less than that of numbness and weakness. The cases which the Wright's test became negative after the first rib resection had gained a good operative result. In the cases which showed 3+ or 2+ of the Morley's test, the improvement of the test had relation to the postoperative result, but the cases with 1+ or - showed not so good improvement. The cases in which the 3 minute test became negative after the first rib resection had gained good relief of symptomes. In the examination of 254 cadavers, abnormal bands were found at 62 sides (24.4%), 63% of them being Type 5 and 16% being Type 4 by Roos's definition.
The shoulder X-ray films in ninety-eight patients with idiopathic avascular necrosis (AVN) of the femoral head were taken to determine the incidence of AVN of the shoulder in AVN of the hip. In addition, the roentgenographic findings of AVN of the humeral head were studied. Ten patients-10.2% of 98 patients- who revealed the shoulder lesion were deviled into the following causes: two of 38 patients associated with alcoholism (5.3%); six of thirty-five corticosteroid-treated patients (17.1%); two of twenty-five patients without any causes (8%). The incidence of the shoulder lesion in steroid-treated patients was two to three times higher than that in other causes. Six steroid-treated patients were suffering from the following diseases: two of 14 SLE patients (14.3%); three of eleven patients with nephrotic syndrome (27.1%); one patients with aortitis syndrome. As an initial roentgenographic change, subchondral translucent line, band-like areas of sclerosis, and radiolucent area around the anatomical neck of the humerus were found in the steroid-induced group. The site of area of the collapse was first seen at the supero-medial portion of the humeral head. Severe incongruity of the joint surface would be reduced to osteoarthritis in the late stage.
Arthroscopic findings of the shoulder joints in 7 cadaveras and 10 clinical cases were presented. In cadaveras, almost anterior part of the joint constructions were observed by anterior approach, and arthroscopic findings were enssured by dissection. In clinical cases, anterior, posterior and lateral approach were used according to the locations of lesions. Anterior approach was used as the regular method, and was effective in diagnosing reccurent anterior dislocation with Bankart's lesion and enlargement of anterior capsule. Lateral approach to the subacromial bursa was useful for the rotator cuff rupture. Arthroscopy for the frozen shoulder showed little value because of constriction of the capsule. Arthroscopic examination has considerable value in diagnosis of some shoulder lesions.
Sprengel's deformity is a rare anomaly chracterized by congenitally elevated scapula and is often accompanied by restriction of shoulder abduction and flexion. We reviewed the cases of six patients with Sprengel's deformity who were treated by the Green's procedure. The age of these patients ranged from two to six years. Female to male ratio was 4:2, and right to left ratio was 1:5. Omovertebral bone was presented in four patients. The average postoperative increase in shoulder abduction in the six patients was 33 degrees. However, except for one case with normal preoperative abduction, the average increase was 39 degrees. The cosmetic result was evaluated according to Cavendish's cosmetic grades. Of the six patients, one had Grade-2 deformity and five had Grade-3 deformity preoperatively. Postoperatively, four patients attained to Grade-1, one to Grade-2, and one remained Grade-3. There was no brachial plexus palsy or wound infection. However, the severe keloid was seen in one patient. A patient who had omovertebral bone received Computerized Tomography (CT) scan, which served to clarity the spatial relation between cervical vertebrae and the omovertebral bone. It is recommended to use CT scan as one of the preoperative evaluations of this deformity.
We treated two cases of deltoid muscle contracture in adult. The first case was a 21-year-old female who complained of abduction deformity of her left shoulder associated with pain. The deformity was first noticed at about the age of fourteen years. There was no history of injection or trauma to the shoulder. The second case was a 26-year-old female with slight abduction deformity of her left shoulder. The deformity was first noticed at about the age of twelve years. She had a history of injection to the shoulder at the age of four. After injection, she developed a pyogenic myositis. She had a past history of the first operation to the left shoulder at the age seventeen. Operations were performed on both cases consisting of excision of the fibrous band and release of posterior fiber of deltoid muscle. After the operation the deformity and pain of shoulder disappeared. The postoperative course was good.
17 cases with cervical lesions were investigated by cervical Amipaque myelography through cisternal puncture in prone position. Early side effects were observed in 11 cases out of 17 cases (64.7%). No serious complications were seen except one case who developed transient disorientation and speech disturbances. The advantages of this method include low frequency of side effects, high quality myelograms with minimum dilution of the contrast medium, and easy technique. This approach was considered to be useful as Cl-2 lateral puncture for cervical myelography.
An assistant chest respirator consisting of three parts (brace, pressure convertor and vacuum pump) was developed. This respirator was applied to a patient with dyspnea after extirpation of an intramedullary tumor of the cervical spinal cord. Long term respiration control using a Bennett MA-1 respirator frequently results in hazards of tracheal infection and tracheal necrosis induced by compression of the cuff of tracheotomy tube. Our assistant chest respirator was found to be helpful in preventing such hazards.
We think that injured spine with neurological involvement is unstable in acute phase. From June in 1979 to June in 1982, we treated 75 patients with injured spine by several operative methods within 1 month after trauma. We compared their operative findings with radiographic appearances. The results indicated that (1) Simultaneous anterior and posterior decompression and fusion was necessary in all cases of fracture-dislocations and some of flexion teardrop fractures. (2) Anterior decompression and fusion was indicated for cases of no significant radiographic appearance of injury because of their usual disc damage.
Hereditary trait of OPLL was studied radiographycally in twenty-two patients suffering from this disorder in the cervical spine. This study included ninety-nine persons of twenty-two families. The familial incidence of OPLL was found in nine families of twelve persons. Other vertebral hyperostotic changes such as ossification of the anterior longitudinal ligament (more than Stage III) or the yellow ligaments were prominent in the family members in whom the familial traits were recognized.
Postoperative evaluations were performed on eleven patients with the ossification of the posterior longitudinal ligament associated with myelopathy after decompression laminectomy (in nine patients), subtotal spondylectomy (in one patient), and anterior wide spondylectomy (in one patient). Anterior wide spondylectomy was designed to extend subtotal spondylectomy exposing vertebral arteries and to remove ossified posterior longitudinal ligament and dura mata radically. Poor results in two patients were caused by incomplete decompression or traumatic cervical cord injury after laminectomy. Fair results were obtained in three of nine laminectomized patients. Other six patients, including two of anteriorly spondylectomized patients, were evaluated as good. It is concluded that anterior wide spondlectomy was a better procedure for compression myelopathy due to ossification of the posterior longitudinal ligament, because total removal of the ossified ligament became possible with wide exposure of spinal canal.
We have recently experienced one rare case of the cord symptom caused by acupuncture needles having migrated into the cervical spinal cord. The patient was a 61-year-old woman with her main complaints of numbness and pain in the left upper limb and the motor paresis in the left upper and lower limbs. As her history, she had occasionally had back pain since 1965 and received acupuncture treatments in 1973, with no apparent discomfort symptome thererafter for about two years until December, 1975, when she began to feel numbness and acute pain in the left upper limb. She has developed neurological symptoms in her left foot since January, 1976. X-ray examinations revealed the presence of many acupuncture needles around the cervical spine and cervical CT scanning confirmed the migration of the needles into the cervical spinal cord.
In order to examine the spinal canal after enlargement of the cervical canal, eighteen cases were studied on computed tomograpy. In all cases, configuration of the cervical canal was normal or further enlarged after surgery. Thinned laminae became thicker by bone formation at the dorsal side as time passed. Cervical canal were enlarged by 3.3mm in sagittal diameter and by 47% in the area.
A Modified Robinson's method was performed after Laminectomy in 7 patients, of whom 4 were male and 3 female. The cases for our method were cervical spondylosis in 3, ossification of the posterior longitudinal ligament in 2, cervical spondylosis with ossification of the posterior longitudinal ligament in 1, trauma with ossification of the posterior longitudinal ligament in 1. 6 patients had been followed for more than 4 months after the operation. Excellent stability was presented in 5 out of 6 patients. Excellent alignment was presented in 5 out of 7 patients. 2 patients did not have excellent alignment; 1 patient had previous anterior interbody fusion and foraminotomy, and angular changes were already made before our fusion. The other patient had breakage of grafts and wire during operation. Decompression and fusion by this method was considered effective in selected cases.
A follow-up study of 41 cases with anterior decompressive interbody fusion of cervical spine was done. We analysed relationships of results to many factors. (term of illness, age, Hattori's classification, developmental Canal stenosis, Pseudoarthrosis and so on.) We found significant relationships of results to term of illness and Hattori's classification.
Postoperative long-term follow-up studies were conducted on patients with cervical myelopathy. In this report the authors described the clinical and radiographic observations on 91 cases who were followed for more than 5 years. Results at the time of final follow-up were excellent in 57%, good in 28%, fair in 9%, unchanged in 3%, and worsened in 3%, indicating that satisfactory results were maintained for long period in most cases. Long-term results were influenced by the factors of the age, duration of the history, results at the time of discharge, spinal canal stenosis and operative methods. Results were deteriorated in 19% of the cases and the deterioration tended to occur nearly 3 to 7 years after surgery. Radiographic examination indicated that nonunion at the level of fusion and spondylotic change at the adjacent levels of fusion appeared in some cases. However, these findings varely influenced the clinical results, except in cases with severe spinal canal stenosis.
Blood transfusions are necessary in scoliosis surgery in many cases. But they are not innocuous because they introduce the risk of serum hepatitis and various immune reactions. Autotransfusions can minimize this risk. In our hospital, scoliosis surgery was performed in 13 children participating in an autotransfusion program from 1981. Preoperatively, collection volume was 25-30g/kg weight blood early but recently 40-45g/kg is collected. There are no complication apart from transient dizziness. It is able to draw as much blood as 40g/kg/3wks. Bleeding volume was 200g per vertebral body in anterior procedure and 150g per vertebral body in posterior procedure. So we consider that the upper limit of a number of fused bodies is 10 in posterior procedure and 7 or 8 in anterior procedure. The results of this study show that autotrasfusions are a satisfactory method in elective scoliosis surgery.
We reported early results of the new derotation orthosis for the idiopatic scoliosis (Cheneau, 1976), which is used recently in Europe. The purpose of this orthosis is to obtain an active and passive correction. Derotating pressure is applied transversolaterally, and fenestration on the concave side allows to correct the rotational deformity. Respiratory movement of the chest can be available as the correcting power in this orthosis. Early results in four patients were demonstrated. They all had thoracolumbar curvature and showed primary correction of 47.9% in average.
This is a report on four cases of delayed myelopathy following compression fractures of the thoraco-lumbar spine. Cases 1, 2, and 3 developed myelopathy in a relatively short period of time of 6, 2 and 3 months following the fractures respectively. Although these three cases showed stable fractures on radiographs immediately after the injury, there were bulging features on the posterior margin of the vertebral body. Correction of kyphotic deformity, decompression and anterior fusion were indicated for the cases with destruction of anterior stabilizing mechanism. We obtained excellent result in these three cases through this method. Case 4. showed compression myelopathy caused by ossification of yellow ligament (OYL) with occurred at the site of compression fracture. In this case, the kyphotic deformity after fracture secondarily caused the neurological symptoms due to OYL.
In 1948, Chance had described three cases of fracture of the lumbar spine in which there was a holizontal splitting of the vertebral body and neural arches through the pedicles. It is suggested that tension stress is primarily responsible for this kind of fracture. We have experienced eight cases of this unusual fractures. The theoretical pathomechanics of these fractures are discussed, and surgical treatment with Harrington system are described.
The advantage of discography has been shown by many authors and many analytic studies has been performed on the discographic findings. We classified our discographic findings into 4 types: full type, partial type, hair line type and negative type. Full and partial types were indicated for conservative treatment. These types were often seen at L4-5 level. Hair line type was mostly seen at L5-S1 level. The posterior tear of the anulus was found at the upper end of the vertebrae in half of our cases.
Measurements were performed on lateral lumbar myelograms taken at flexion and extension of the spine on the x-ray table. The average A-P diameter of the spinal canal increased more markedly at the L5-S1 level than at the L3-4, and L4-5 levels, and the anterior epidural space was usually much deeper at L5-S1 than at the higher levels. The average A-P diameter of the dural sac was slightly larger in flexion than in extension but decreased considerably at the L3-4 and L4-5 interspaces, but at L5-S1, there is a small increase in diameter. The false negative findings on the myelogram can be explained by the width of the spinal canal and the anterior epidural space at the intervertebral L5-S1 level. The forward bulging of the ducal surface follows the compression of the anterior epidural vein.
During 1968 to 1981, 120 cases of lumbar spinal canal stenosis treated operatively were reviewed clinically and radiologically. The basic disorders were degenerative spondylolisthesis (32 cases), degenerative spondylosis (29 cases), combined stenosis (22 cases), spondylolytic spondylolisthesis (17 cases), post-operative stenosis (13 cases) and others (7 cases). The disease was thought to be a syndrome complex, not a clinical entity, and the myelogram was most useful for understanding the syndrome.
We studied the characteristic findings of lumbar canal stenosis associated with the entire spinal canal stenosis. They are as follows; 1) They have generally severe symptoms. 2) They tend to have various neurological deficits. 3) They show many intervertebral lesions in myelogram. 4) They tend to have urinary-fecal disturbance. 5) They sometimes complicate with cervical or thoracic lesions. 6) Their recovery are poor. In this report, we made the radiological standard for the entire spinal canal stenosis; C5≤14mm, T11≤13mm, and L4≤17mm in sagittal diameter. Filmfocus distance was 1.5m at C5, 1m at T11 and L4. According to the standard, 51% of lumbar canal stenosis were regarded as the entire spinal canal stenosis.
A follow-up study was performed on thirty of forty-six cases of spinal canal stenosis treated surgically in the past five years (1977-1981), from the viewpoint of the international standard of grading. The results of all the cases of the developmental type and combined type were satisfactory, but those of 6% of cases belonging to the degenerative type were unsatisfactory. The results of cases of the spondylolytic spondylolisthesis type and postoperative type were unsatisfactory. Although intermittent claudication disappeared in almost all the cases, lumbago, pain or numbness of the legs still remained in many cases.
The special technique for lumber intervertebral body fusion by disc excision by lateral approach and transverse bone grafts has been presented. The advantages of this technique were that solid early stabilization and early fusion were expected by large amounts of bone grafts, which occupied intervertebral space more widely, and the integrity of anterior longitudinal ligament. Of the 24 patients of several degenrated disk diseases, all of them became asymptomatic and solid fusions occurred within 3-4 months after surgery.
We have treated 14 cases of perilunate dislocations. Twelve cases (3 perilunate dislocations, 5 transscaphoid perilunate dislocations and 4 lunate dislocations) were reexamined clinically and radiographically. All were males aged from 22 to 49 years. Two cases were reduced manually, and seven were reduced surgically. Proximal-raw carpectomy and arthrodesis were performed in one case respectively. Arthrodesis was attempted in one. The results of the treatment were as follows: seven good, four fair, and one poor results. Fresh cases, in which correct reduction was carried out, obtained good results.
22 cases of the carpal navicular fracture were classified into 3 types of group; operative, conservative and non-treatment groups. These group were followed from one-half month to 10 years, and analysed by radiological and clinical findings. In 12 operative cases, which were all pseudoarthrosis, good bone union was obtained. In 10 conservative cases, clinical and radiological results were excellent because these were fresh fractures. All non-treatment cases resulted in non-union, but they experienced mild pain only after hard work.
The treatment of the severely injured hand involves many difficult problems. Here we show several cases and discuss its problems. In this paper, we especially stressed the importance of the reconstruction of the finger tip.
The authors reported a 4-year-old girl showing multiple caltilaginous exostoses with severe shortening of the forearms and lower legs. Her height was 85cm. Radiological measurements of her long bones revealed a marked shortening of the middle and distal segments of the extremities compared with those of the same aged girl who was 97cm in height with multiple cartilaginous exostoses.
Hereditary multiple exostosis is an autosomal dominant disease with complete penetrance, characterized by numerous exostosis capped with cartilage involving the juxtaepiphyseal areas of long tubular bones of the limbs, the ribs, the pelvis and the scapulae. Recently, we have experienced four cases of hereditary multiple exostosis in the same family.
We confirmed it by angiographic, lymphographic and histologic examination that overgrowth of leg consisted of hypertrophy of normal tissue. In cases with overgrowth of both femur and tibia, leg length discrepancy tended to increase in short term. We have corrected leg length discrepancy by epiphyseal stapling in children with leg length discrepancy more than 3.0 centimetres.
Senile patients with low back pain and radiolucency in the same lesion are usually diagnosed as osteoporosis. Some of them should be diagnosed as osteomalacia. We reported two cases of senile osteomalacia with pseudo-arthrosis of pelvis and ribs, whose laboratory findings were as follows; the serum alkaline phosphatase was elevated, and the 25-OH vitamin D was decreased. They were treated with 1α-OH-D3.