In order to study the special features of the deformity in the proximal femur resulting from Perthes' disease, measurements of X-ray pictures were carried out. The subjects were 37 cases which had been treated with the weight bearing abduction cast method, and had been followed up for 7 to 12 years. Measurements of X-ray pictures were done in width (a) and hight (b) for the epiphysis, and width (m) and length (n) for the metaphysis. And relationships between “a” and “b”, “m” and “n”, “b/a” and “n/m” were statistically examined. According to this study the flattening of the epiphysis was closely related to the shortening of the metaphysis, and degree of the deformity was dependent on the severity of Perthes' disease.
The experience of Sugioka's rotational osteotomy in three cases, four joints of avascular necrosis, and one case, one joint of slipped epiphysis of the femoral head was reported. Good results were obtained in two cases of idiopathic avascular necrosis and one case of slipped capital femoral epiphysis. In conclusion, we consider the indication of the rotational osteotomy as follows. 1) In idiopathic avascular necrosis, when the lesion is less than two thirds of the femoral head, the rotational osteotomy is indicated, but when the lesion is more than two thirds, the rotational osteotomy with vascular bundle transplantation or vascularized bone graft, is indicated. 2) Vascularized bone graft is performed for the femoral head with no collapse of avascular necrosis caused by caisson disease. Rotational osteotomy with vascularized bone graft is recommended for collapsed head. 3) Three dimensional osteotomy is designed for the moderate degree slipping (30°-60°) of capital femoral epiphysis, and the rotational osteotomy is recommended for severe slipping (>60°).
A thirty-year-old eunuchoid complicated with bilateral slipped femoral capital epiphysis is presented. Endocrinological studies disclosed combined insufficiency of the anterior and posterior lobes of the pituitary gland. Endoprosthetic arthroplasty of both hip joints was the treatment of choice because slipping was severe and late in stage, and the presence of joint contracture precluded treatment by any types of osteotomy.
Multiple epiphyseal dysplasia, first described by Fairbank (1947), is characterised by dwarfism, stubby digits and mottling or irregularity in density and outline of the developing epiphyses on the roentgenograms. We report a 4-year-old female case of multiple epiphyseal dysplasia showing severe slipping of the capital femoral epiphysis.
Results of 11 cases treated with Chiari pelvic osteotomy were reported. Average age of patients at operation were 38 years and follow up periods after surgery were 6 years and 2 months. In all cases, plastic effects for acetabular edge were satisfactory; average CE angle improved to 31° from -7°, Sharp angle to 39° from 49° and acetabular head index to 93% from 50%. Ten of 11 cases have shown successful results, but one case was unsuccessful. Four cases of early stage and another 4 cases of progressive stage have gained excellent results; they have complained of no or very slight hip pain and have gained good ROM and ADL. Two cases of progressive stage have gained good results by combined operation with valgus osteotomy of the femur; they have complained of slight hip pain and of slight limitation of ROM and ADL. One case of progressive stage have shown unsatisfactory result and THR was performed as revision operation after 6 years. In successful 10 cases, pelvic osteotomy were carried out at about 5mm upward from acetabular margin. On the other hand, in the unsuccessful case the osteotomy was carried out at too low level (3mm upward from acetabular margin).
In our clinic, femoral neck fractures are treated by osteosynthesis using Hagie pins or Knowles pins. The pins are inserted in a triangular pattern in the femoral head. Twenty-one postoperative cases were reviewed over a six month period. According to Garden's classification, 11 cases belonged to stage II, 9 cases to stage III and 8 cases to stage IV, but no stage I cases were observed. Bone union was obtained in all but one case. Complications included late segmental collapse, non-union, and irregularity of the surface of the femoral head which were observed in one case respectively.
The healing process of femoral neck fractures of 19 cases treated with osteosynthesis by cancellous screw was studied by serial 99mTc-MDP scintigraphy and scintimetry. Normal fracture healing was achieved in 17 cases. According to time lapse, the count ratio (fracture site/opposite femoral neck) showed a maximal value at about 8 weeks after fracture and then decreased rapidly. In those cases, a similar pattern was observed and no failure of uptake was seen in the femoral head of affected side. However 2 cases of Garden's stage II and III have complained of a severe coxalgia even after the lapse of 15 months postoperatively. The high count ratio of fracture site was prolonged and the femoral head in these cases revealed a deficient uptake. It is suggested that the fracture healing is related to the extent of 99mTc-MDP uptake in fractured femoral head and bone scintigraphy is thought to be a useful method for the investigation of the healing pattern of femoral neck fracture.
101 cases of femoral neck fractures operated in our clinic during past 3 years were reviewed. A comparison study of the X-p results of both Ender method and compression hip screw was reported. About 30% incidence of technical problem was observed with Ender method, however, there was no problem noted with compression hip screw. The compression hip screw was superior to Ender method with regard to the postoperative problem such as varus deformity or rotatory deformity. This study suggested that the compression hip screw method was more suitable in the treatment of unstable lateral fractures.
Prosthetic replacement was carried out in 89 hips since 1974. Fifty-nine hips, including 50 cases of femoral-neck fracture, 5 cases of osteoarthritis and 4 cases of osteonecrosis, were followed up radiologically. Proximal migration occurred in 23 joints (60%) of 38 joints over 3 years after operation. Because of proximal migration, total hip replacement was carried out in 7 joints. Follow up study revealed that proximal migration occurred in the cases with degeneration of acetabular cartilage or bone atrophy of the acetabulum.
Recently we experienced two cases of tuberculous disease: arthritis of right sternoclavicular joint and axillar lymphadenitis. Initially we suspected tuberculous disease, but biopsy showed no tuberculous trait with negative culture. Both cases were diagnosed confirmatively as tuberculous inflammation by postoperative pathological specimen.
Three cases of the tuberculous hip joint aged from fifth to sixth decade were treated. It was reported that the incidence of tuberculosis was increasing in older age groups. Our patients had episodes of arthropathy of the hip but had no treatments for tuberculosis with the results of considerable joint destruction. One of those cases had a fistula between hip joint and rectum which was closed with difficulty.
Five cases of pyogenic spondilitis and discitis were reported. In all cases, destruction of the spinal body was recognized in 4 cases, the other case was already healed and the radiograms showed body fusion when she visited our clinic. Two cases were treated conservatively and in the other two cases, curettage and spinal fusion were carried out because they had neurological manifestations. In all cases, satisfactory results were obtained.
A sixteen-year-old male came to our clinic with complaints of high fever of 39°C, gait disturbance and pain at the symphysis. Blood examination revealed accelerated erythrocyte sedimentation rate, leucocytosis and abnormal CRP. Roentogenographic findings including bone scintigram and CT-scan showed destruction and absorption of the symphysis pubis. Arterial blood culture of the bacterial examination was negative but from the findings of above mentioned, osteomyelitis of the symphysis pubis was diagnosed. Surgical treatment of curettage was made on the seventeenth admission day. Group B streptococcus was cultured from curetted granulation tissue and patho-histological findings was osteomyelitis. Postoperative course was very good and at 5 months after operation there was no abnormal blood findings and no subjective symptoms. He returned to training of the baseball pitcher.
One case report of sacroiliitis with P. P. P. was reported. The patient was a 35-year-old female. She felt severe pain in her right buttock and could not walk and sit on and her palmar and plantar areas showed dirty dermatitis. Blood examination showed inflammatory findings. Pathological findings of sacroiliac joint showed chronic nonspecific and nonsuppurative osteomyeritis. After open biopsy her pain and P. P. P. decreased slowly though we could not understand the cause.
The gas gangrene usually occurs in the limbs after trauma. We have experienced a case of non-traumatic gas gangrene in the low back. The patient was a forty-year-old female suffering from diabetes. When the patient admitted in our clinic, in the lumbar region and left side part of the neck and thorax, interstitial gas was demonstrated radiographically. On the bacteriological examination, L. coli was detected but clostridium was not detected. We diagnosed non-clostridial gas gangrene. The patient was treated with debridment and antibiotics. The wound was closed by skingraft after fresh granulations occurred. The patient made a good recovery.
Histopathological changes of the lung were studied with transbronchial lung biopsy (TBLB) in 9 patients with definite or classical rheumatoid arthritis (RA). The patients were between 41 to 65 years old (the average age: 57.6 years old). Fibrosis was found in all specimens examined. A mild lymphocytic infiltration in alveolar septa in one case and infiltration of macrophages in alveolar spaces in 4 cases were found. In 4 out of these five cases, rheumatoid factor (RF) and CRP were positive and obstructive type of respiratory dysfuction was observed.
We have examined the efficacy and safety of Auranofin (AF) clinically in 13 patients with Rheumatoid arthritis. Subjects were the female out-patients of our clinic for RA, their ages ranging from 35 to 72. Six and 7 cases were diagnosed as Classical and Definite RA, respectively. AF was administered at 6mg/day continuously. The mean dosing period was 27 weeks (max. 42 weeks and min. 4 weeks). Of all 13 cases, 2 cases were withdrawn from the study and 8 patients showed “effective”. Major improvements were observed in Lansbury index, morning stiffness and ESR. Total 13 side-effects were reported, 6 of rash or itching, 2 of gastric disorder, each one of stomatitis, edema and nitritoid-reactionlike symptom. The present study suggests that AF is easy to administer clinically because it can be administered to the patients where injection is difficult due to adverse reactions or to the patients who have some problems to visit the hospital. Also the gold dose can be adjusted easily by AF.
The operative treatment of pathological fractures of long bone, by the intramedullary nailing combined with bone cement and the prosthetic joint replacement is almost always indicated. The function of the extremity can be regained and patients with fractures are able to walk. All patients are completely relieved of the pain. However, almost all the surgical managements to metastatic spinal tumor except brest and prostatic cancer have no effective result on the relief of pain and the functional improvement. Although the recent therapeutic methods are encouraging to these cancer patients, clearly further improvement is still needed.
One hundred and eighty-nine patients of cancers with bony metastases were examined in our clinic from 1965 to 1981. The average age of the patients was fifty-seven years. Following metastatic tumor types were encountered: breast cancer, 37: lung cancer, 19: gastric cancer, 17: renal cancer 13: uteric cancer, 9: thyroid cancer, 8: and unknown, 41 (21.6%). Only sixteen patients of them had received surgical treatment for the purpose of relieving the preoperative pain and improving activities of daily living (A. D. L.). According to these points, we consider that active surgical treatment was effective. Of the 16 patients, 3 cases with breast cancer, one case with thyroid cancer and one case with gastric cancer had survived longer than other eleven cases. Only one patient (breast cancer) with a metastatic sixth cervical spine who had been treated by preoperative radiation and followed by autografting replacement, has been survived 3 years 9 months after operation.
Thirty patients (31 locations) with pathologic fracture from metastatic cancer were treated with internal fixation supplemented by methylmethacrylate. Primary organs involved were breast (16), lung (6), kidney (3), liver (2), maxillary sinus (1), esophagus (1), and uterus (1). The most frequent location of pathologic fracture was the femoral shaft which occurred in 64.5% of 31 locations. The internal fixation of pathologic fractures offers many advantages. Pain usually disappears within a few days and freed from external fixation. Seventy-three percent had excellent or good results and in only three results were poor. In one patient the postoperative complication (DIC) occurred and two had deterioration of general condition. All but three patients benefited from the procedure in terms of pain relief, improved mobility, and ease of nursing care. The use of methylmethacrylate as an adjuvant in internal fixation of pathologic fractures and postoperative radiation appeared to be the best treatment.
We examined forty-three cases of metastatic bone tumors which were admitted to our hospital during the period of the past twelve years. Fifteen of forty-three patients recieved radiotherapy to twenty-four affected regions of the bone. The dosage was 4000-5000 rads (Liniac X). Thirteen of forty-three patients recirved operative procedures (laminectomy: 3, prosthesis: 4, osteosynthesis: 4, en bloc resection: 3, amputation: 3). Five cases recieved pre- or post-irradiation. In all types of tumors, relief of pain and osteoblastic response were found after irradiation therapy. But in the patients who recieved only surgical reconstruction, the functional good result was palliative. Osteolytic change progressed around the inner fixation device. After irradiation on the affected region of the bone, we observed the osteoplastic change roentgenographycally, decreased up-take of Tc99m on the bone scintigram, degenerative change of the tumor tissue pathologically and relief of pain clinically. Based on these findings, we believe that irradiation therapy is most valuable for the lesion to decrease the activity of the tumor tissue. We recommend irradiation therapy. And if the affected bone needs a reconstructive procedure, it is better to irradiate pre-or post-operatively.
The subjects were 81 cases of metastatic spinal tumor in our clinic between 1960 and 1982. Age at admission ranged from 6 to 79, with an average of 53 years old. Conservative therapy was carried out on 62 patients, and surgical decompression on 19 patients. Recently, spinal instrumentation for posterior approach, and alumina ceramic for anterior approach have been used to support the spinal structure.
Sixty patients with metastatic or invasive disease of bone had undergone chemotherapy, hormone-therapy, radiation-therapy and/or operative treatment. Diagnosis of the lesion by computed tomography was useful to select the therapeutic procedure. This study appears to clearly indicate that methylmethacrylate enhances the stability and controls regression of the pathological fracture. Patients with metastatic lesions involving the spine had been improved neurologically with the use of steroid hormone before and after the operative procedure. A harmonious cooperation between the oncologist, orthopedist and radiotherapist can result in more comfortable, more functional, and in some instance, longer life for the patient.
Since 1975, Fourteen cases of metastatic bone tumors arising in extremities have been operated as palliative treatment. The procedures are divided as resection, curettage and bone packing, bone cement and internal fixation, prosthetic replacement (including four cases of proximal femur replacement) and amputaion. Proximal femur was the most prevalent place for the operation. An average postoperative survival period was 16 months and it was mostly influenced by the primary souces of the tumor. In contrast with the short survival of liver and lung cancer, breast, thyroid, prostate and kidney cancers have survived relatively long. Primary sounce research and whole body studies are essential to establish the operative indication for metastatic bone tumor and adjuvant therapies for the primary tumor are necessary to obtain good results.
One hundred and sixty-three cases of metastatic bone tumor, in which the primary lesions were recognized, were investigated statistically. Fourty-four patients received surgical treatments, e i. internal fixation with or without bone cement, external fixation to the patients whose general status was poor, laminectomy or spondylodesis to the patients showing a rapidly progressive paralysis, femoral head replacement to the patients with metastatic lesion of the femoral head and the neck, and amputation or disarticulation in cases with extraskeletal invasion of tumor cells showing no indication of surgical intervention. The majority of patients were relieved from pain, however most of them died within a year after surgical therapies. The survival period did not seem to depend on the methods of therapy but chiefly on the biological characteristics of the tumors. Reconstructive surgical treatment was thought to be indicated to the patients with metastatic lesions from prostatic or mammary cancer who had showed relatively long survival period.
Since the first discription of carcinoma arising from chronic osteomyelitis by Hawking in 1835, many cases have been reported, in which the malignancy has mostly developed in the lower extremity. We report a case with squamous-cell carciroma occurring from chronic otteomyelitis of the ilium with a history of 60 years. Curettage of the lesion was performed, and the patient was followed with administration of Pepleomycin (total: 160mg) and Bleomycin ointment. The patient died 6 months after the operation. The findnges of the post-mortem dissection were as follows; 1) the left ilium, left sacroiliacal joint and left his joint were markedly destroyed by carcinomatous invasion. 2) tumor cells infiltrated into the vertebral bodies of the fifth lumbar, first and second sacral spines; and the extradural spaces below the L5 level. 3) no invasion was recognized in the retroperitoneal region.
The term “desmoplastic fibroma” was used by Jaffe to describe an intraosseous fibrous tumor which is distinct from fibrosarcoma and various benign fibrous lesions such as non-ossifying fibroma, fibrous dysplasia, and chondromyxoid fibroma. Recently we have treated 4 cases of tumor of clavicle. Two of which were operated by curettage and bone graft. On the basis of the sum of the clinical, roentogenographic, histological and operative findings, we diagnosed it as “Desmoplastic fibroma”.
We reported three patients with a tumorlike lesion that has been diagnosed as ossifying fibroma pathologically. The lesions in our patients developed in childhood and were located in the diaphysis of the tibia. In two patients the lesion recurred after a curettage or subperiosteal resection with bone graft. In three patients, the radiographic appearance of the lesions suggested fibrous dysplasia, but histopathologic evaluation demonstrated findings similar to ossifying fibroma or osteofibrous dysplasia. Radiologic and pathologic recognition of this entity is necessary for proper treatment.
We treated a case of giant cavernous hemangioma which had been developing in the subcutaneous and intramuscular tissue of the buttock for 30 years. The patient was a 43-year-old male with a painless tumor in his left buttock. The tumor was 14×14cm in size without tenderness but with brownish skin color and local heat. Roentgenograms revealed the presence of several phlebolithes. Angiogram and CT scan showed the visual situation of the tumor Because of these findings, surgical excision of the tumor, which existed in the subcutaneous tissue, was done. Histological studies showed “cavernous hemangioma”.
This paper reports a case of pseudomalignant osseous tumor which was appeared at the origin of right major pectorius muscle. The patient was diagnosed as P. M. O. by zone phenomena and histological examination. We could not deny osteogenic sarcoma of solft tissue by histological examination at first. Then we used Co-irradiation and A. D. M. We think that following considerations are important to avoid overtreatment; 1) Knowledge of P. M. O. 2) Suspection of P. M. O. by clinical course, radiograms and diagnosis with zone phenomena.
A 44-year-old female with foramen magnum menigioma was discussed which was clearly revealed by preoperative contrast enhanuced CT. This technique was very helpful to determine extirpation procedure or detect postoperative recurrence. Its availability should be stressed.
The authors present two cases of malignant lymphoma involving the cervical and thoracic spinal cord, which were treated by surgical decompression. The literature was reviewed and clinical, radiological, and surgical aspects of these cases were discussed.
A case of malignant schwannoma with sciatic nerve paralysis was reported. A case was a 26-year-old female. She complained of pain of right lower extremity since August, 1980, and showed drop foot on December, 1981. She was admitted to our hospital on January, 1982. She had pigmentation (so called Cafe-au-lait spots) all over the body, and left convex lumbar scoliosis, but showed no nodule on her skin nor fibromatosis. She had a large mass in the posterior aspect of the right thigh. Labolatory data obtained on admission was normal except for LDH; 759IU/1 and CPP (+). Angiography and scintigraphy showed malignant findings. The treatment consisted of local excision (three times), radiation therapy (60Co) and chemotheraphy (high dose methotrexate). She showed rapid recurrence and died 8 months after first operation.
Two cases of synovial sarcoma were reported. The first case was developed in the anterior aspect of the hip joint in a 32-year-old-male. It adhered to the joint capsule and was removed marginally. Regional radiotherapy was employed, but the patient died by the metastasis 11 months after surgery. The tumor measured 5×5×4.5cm and was classified as group C histologically (MacKenzie). Second case was developed in the distal end of the upper arm in a 61-year-old-male. A marginal excision was performed, but local recurrence developed 2 years later. A disarticulation of the shoulder joint was carried out and postoperatively, 0.4-0.6mg/kg of Adriamycin was administered for two days in every four weaks. Six months after surgery, the patient is free of disease. The primary tumor measured 5×4×3.5cm and classified as group B. The recurrent tumor extensively invaded the humerus and was classified as group C.
We report a patient with a metastatic osteosarcoma of the gingival region, which was treated with chemotherapy and additional interferon therapy. The patient was a 13-year-old boy with an osteosarocoma of the left proximal humerus. After amputation, he was treated with high-dose MTX therapy as an adjuvant chemotherapy. Two years later, the patient had the gingival metastasis. Rapid growth of the tumor prevented him from receiving surgical treatment. After admission, he underwent the treatment with i. m. injections of HLBI (human lymphoblast interferon), and also with ADM chemotherapy. At first, the dose of HLBI was 3×106 IU per day, and gradually increased. Finally, the total dosage of HLBI reached 760.5×106 IU. A transient suppressive effect for tumor growth was seen in the first period of this treatment. However, the metastatic mass had increased in size during the treatment until death, three month after admission. The pathological diagnosis of the primary lesion was chondroblastic osteosarcoma, but histologic examination of the metastatic lesion showed chondrosarcomatous change after this treatment.
A fifteen-year-old girl with Ewing's sarcoma of the right twelfth rib is reported. En bloc resection combined with chemotherapy resulted in recurrence in the pleural cavity. Although the tumor responded well to irradiation, it recurred outside the field of irradiation to cause respiratory insufficiency. She died one year and four months after surgery. Several problems about treatment is discussed.
A 47-year-old woman with extraskeletal Ewing's sarcoma is reported. On September, 1980, she was aware of the mass in the right thigh, but had no pain or tenderness. Her general condition had been very good. One month later, the tumor was completely resected. There was no visible bone involvement at that time. On April, 1982, she was hospitalized because of recurrence. Physical examination on admission disclosed no abnormality. Radiographs of the right thigh revealed no involvement of bone. Laboratory data for blood is not remarkable. A biopsy revealed a small round cell malignant tumor, very similar histologically to Ewing's sarcoma.
We encountered 31 cases of metastatic bone tumors from Sep, 1979 to Aug. 1982. In many of our cases, ESR, CRP, LDH, Al-p and CEA-Z indicated abnormal ranges. Bone scintigraphy was a sensitive diagnostic aid available for detection bony metastases. Our management of metastatic bone tumors were to reduce intractable pain and to get better ADL of the patients, but these were found very difficult. And we reported 6 cases of bone metastases.: Case 1. A. I. A 48 years old male, who was operated with removal of the clavicle which had bone metastasis from hepato-cellular carcinoma. Case 2. S. M. A 74 years old femal, who had pathological fracture of the femoral shaft, was treated using an intramedullar device and bone cement. Case 3. J. M. A 80 years old male, who had compression fracture of the thoracic vertebrae, was suffered from metastasis of malignant melanoma. Case 4. Y. Y. A 53 years old female had leiomyosarcoma of the left knee and metastatic bone tumors. She was medicated HuINF-β. Case 5. T. I. A 41 years old male, who died 46 days after entering, with stomach cancer and bony metastases. Case 6. M. Y. A 63 years old male, who was diagnosed by computed tomography on the extent of spinal metastatic tumor. These clinical findings and management were reported and discussed.
Autopsy was performed on seven cases of malignant tumors and metastasis of the tumors in bone was studied. Five cases out of them were of cancer and the others of sarcoma. The patients ranged in age from nine to sixty-seven years. The metastatic lesion of bone was more extensive than that of found on the radiograms and bone scanning is more reliable for the early detection of the metastatic lesions in bone.
Our recent experiences in treating metastatic bone tumors surgically are presented in this paper. We treated four patients surgically. Laminectomy was done on two patients simultaneously with Harrinton Instrumentation. One patient under went amputation of shoulder joint and another had Leinbach-type Bateman UPF in which the femoral resection was modified because of the extent of the tumor. The Osteotomy of the femur was required below the lesser trochanter. This caused the patient to limb.
A 32-year-old woman was admitted with the lumber pathological fracture (L4) by falling down on the road. This pathological fracure was caused by a metastatic spinal tumor from the medullary thyroidcarcinoma and the bone scintigraphy showed hot spot in the thoracic spine. We performed the posterior fusion with Harrington rods from 12 to S1 for the purpese of early uhalitation. Two rods were placed as lateral as possible in order to provide future decompression. Bone chips from iliac bone were transplanted in the interlaminal spaces. Six months after operation the patient has come back home and enjoyed a daily life without any help. Plasma levels of carcinoembrionic antigen (CEA) and calcitonin (CT) which are closely related to the medullary thyroid carcinoma were still elevated.
Postmortem examination were carried out on eight cases of the metastatic bone tumor of the spine. Their average age was 52.9 years. Six cases were men and two were women. The original tumors were found to be Pancreas cancer in 2, thymic cancer in 1, multiple myeloma in 1, lung cancer in 1, hypernephroma in 1 and unknown in 1. In half of the cases, multiple metastasis of spine were found. These cases hardly had the indication for surgical treatment. On the case of lung cancer, replacement of the cervical vertebral bodies was carried out using the bone cement. He had been relieved from pain for ten months, but there was no relief from paralysis.
Snapping elbow in an extremely rare disorder. We have recently treated two cases with characteristic snapping phenomenon of the elbow. Roentgenograms of the elbows were normal. At the time of operation, thickened fold of synovial tissue was noticed in the radiohumeral articulation as a cause of snapping in one case. Thickened node of synovial tissue in the olecranon fossa was disclosed as a cause of snapping in the second case. Excision of these synovial folds abolished the snapping. No other abnormility of the joint was observed.
A case of ankylosing elbow with unusual ossification was reported. The patient was a twenty-seven years old female who had an episode of inflammatory sign over the arm about three years ago. On X-ray examination, the ossification was extraarticular and localized only in the fan-like part of medial collateral ligament of the elbow. The abnormal ossification was thought to be attributed to the fibrositis ossificans circumscripta. After resection-arthroplasty of the ossified bony bridge, the patient recovered satisfactory range of motion of the elbow.
In three patients with arthrogryposis multiplex congenita, arthroplasty of the elbow joint was performed using tricepsplasty or Steindler flexorplasty. All patients, have gained greater elbow joint motion and power postoperatively.
Three cases of free flap transfers of dorsalis pedis flap were employed for secondary reconstruction of the mutilated hands. Case 1. A 22-year-old male sustained a heat press injury to his right hand, resulting in defect of skin and subcutaneous tissue of dorsum of the hand. The defect was grafted initially with split skin. The painful scar was developed on the dorsum of the hand after initial operation. Seven months after initial operation, free flap transfer was performed. Case 2. A 34-year-old male sustained a imcomplete amputation of his right hand involving the second to fifth finger at the mid palm with bone and soft tissue defect. All digids were successfully replanted, but severe flexion deformity was developed postoperatively. Six months after initial operation, free flap transfer with iliac bone grafting was performed. Case 3. A 35-year-old male sustained a roller injury to his right hand, resulting in degloving of the thumb and mid palm. The degloved segments were primarily replanted with microsurgical technique. All digids were successfully replanted, but the skin and soft tissue of the dorsum of the hand was defected. Four months after initial operation free flap transfer including long extenser of the foot in the flap was performed. In spite of the bad condition of the recipint beds, all of the transferred flaps were stable postoperatively and the hands were considerably relieved of the preoperative deformity.
Musculocutaneous flap of the gluteus maximus with its abundant and constant blood supply is most useful in the surgical management of lumbosacral pressure sore. Recently, we used this musculocutaneous flap for coverage of these soft-tissue defects in four cases and satisfactory results were obtained.
Clinical usefullness of the bone-scintigraphy with 99mTc-MDP was evaluated. Of 131 patients studied from 1979 to 1982, a high percentage of positive uptake was observed in cases of primary malignant bone tumor, metastatic bone tumor, tumor-like bone lesion, fracture, osteomyelitis and aseptic osteonecrosis. As to primary malignant bone tumor, an extent of the local involvement may be better defined. In metastatic bone tumor, distribution of the tumor may be observed cleary. As to bone infection, early bone involvement can be demonstrated before roentgenographic changes are detected. In bone necrosis, living area may be detected.
A sixteen years old boy with hemophilia A was admitted in August 1981 with history of spontaneous pain in groin, paresthesia of the anterior and medial aspect of the thigh and paralyzed quadriceps muscle on the right side. On examination the hip joint was held in 35 degrees of flexion, the knee joint was held in 50 degrees of flexion and a small mass was felt in the right iliac fossa. Under use of antihemophilic factor, curettage of the pseudotumor in the iliopsoas muscle was carried out. The flexion contracture of the hip and knee joint was treated by conservative measures. On examination at ten months after the operation, the paralyzed femoral nerve recovered almost completely with improved range of motion of the hip and knee joint. The patient has been satisfied with little disturbance.