In our clinic, we have treated 11 patients of the tibial fractures with consisted of 5 cases of nonunion and malunion, 2 cases of open comminuted fractures and 4 cases of fresh fractures of the distal third of the tibia. In these fractures we used intra-medullary bone grafts (0.5-0.7cm×5-8cm) which were taken from fibula and added neutral plate fixation All cases showed good results.
The anther carried intramedullary nailing combined with plating on 21 cases of the femoral fracture and 2 cases of the Numeral fracture, including 9 non-unions. Especially for non-union, the decortication or Phemister graft was performed and excellent results were obtained.
During the years 1973 and 1982, we treated 92 cases of tibial or femoral fractures by using the Kuntscher medullary nails, which were supplemented by screw fixatisus. The urpose this procedure is to avoid the rotational dislocation of the distal fragment of the fracture without loss of the advantages of the intramedullary nailing. Moreover, this procedure extended the indications for use of medullary nails. We reported the indication and the problems of this procedure.
Nine patients older than 60 years of age with fracture of the surgical neck of the humerus, treated by percutaneous Kirschner pinning, were reported. Manipulation of the fracture, operative technique and postoperative rehabilitation were described. This method has several advantages; simple technique, little blood loss, eary return to ambulation and good course of bone union. Satisfactory results were obtained in 75% of the cases at follow-up examination assessed by Wolfgang's criteria and Takagishi's criteria.
We designed K-U cancellous screw for fixation of fracture of the clavicle. This method using K-U cancellous screw is most suitable for fractures in the outer-middle third curvature of the bone. A type of fractures with rotation of a large intermediate fragment is also an indication for this method. We treated 21 patients during the years from 1976 to 1982 using K-U cancellous screw method. The results of this treatment were satisfactory. In one patient, the bone union was prolonged to occur about 9 months after twice repeated-operation. This prolongation was considered to be due to the damages of soft tissues, stripping ping of periosteum and blood vessels. Our method provides strong fixation for the fracture of clavicle, preventing the rotation of the bones.
Clavicle fracture are usually treated conservatively by bandage or plaster cast. It has also been suggested by some authors that surgical treatment for clavicular fracture sometimes results in non-union. 111 cases out of 720 clavicular fractures which have been treated in our hospital during these five years (1978-1983) were treated by open reduction and internal fixations. 70 cases of these 111 were available for this study. Of these cases 46 were fixed with plate and screws, 15 with Kirschner wire nailing, 7 with Kirschner wire nailing combined with tension band wiring and 2 with others. Obtained results and conclusions were as follows: 1. Plating is a most preferable method in comminuted fracture and non-union at the middle third portion in any ages. 2. Intermedullary Kirschner wire nailing is only preferable in transverse fracture of the middle third portion, especially in adolescent and young adult. 3. Inteamedullary Kirschner wire combined with tension band wiring is only preferable in fracture of the distal third portion.
Long-term review of thirty-eight supracondylar humeral fractures in children demonstrated cubitus varus deformity in ten cases (26.3% of patients). The majority of cubitus varus deformity were noted in the patients treated by plaster cast. The deformity occurred more frequently in the cases with medial displacement (particularly medial tilt) than with lateral displacement. There is no case that the varus deformity occurred due to growth imbalance.
Thirteen elbows (12 patients) were treated with corrective osteotomy from 1974 to 1982. The ages of the patients operated upon for the deformities ranged from three to fourteen years. Ten cases (on case with reoperation) were corrected satisfactorily. Two cases showed poor correction. They had varus deformity resulted from epiphyseal separation fracture. So, the follow-up period after the onset should be observed carefully. The patients should be operated at the ages from four to twelve, or thirteen years.
Twenty-four children between one and thirteen years of age were treated for fracture of the femoral shaft during the years 1976 to 1982 at Yamaguchi Rosai Hospital. Fifteen cases of these were reviewed and checked roentogenologically with regard to difference in limb length and angular deformity. Conservative treatment or external skeletal fixation was done for all cases except two elderly cases. Correction of angular deformity and overgrowth of bone were measured and the results discussed.
Children with fractures of the femoral shaft have been treated in our hospital for the past eight years; twenty-one children returned for our follow-up study. Fourteen of them were bodys and seven were girls and they injured between two and ten years of age and the term of one to seven years passed since their injury. Nineteen of them were treated conservatively and two operatively. Particular attention was paid to the overgrowth, alignment of femur, joint motion, gait pattern and complication of pain. Following conclusions were made: a) Shortening of about 10mm on average is an allowed extent. b) Lateral flexion angle of over 10 degrees and anterior-posterior flexion over 20 degrees should he avoided. c) Rotation must be avoided.
From January 1977 to June 1982, Cast-Brace method was applied to 9 cases of fractures in the distal part of the femur. In this study the result of the treatment is reported. The bone union was accomplished in all of the cases, but angulation ranging from 5 degrees to 14 degrees was seen in the last X-ray films in all cases. The range of motion of the knee was from 110 degrees to 160 degrees.
In IO cases of femoral neck fracture treated with prosthetic replacement, the preo perative 99mTc-MDP scintigraphs were investigated and then compared with each histological findings of the extracted femoral head. The appearances of the scintigraphs were classified into following 3 patterns; increased activity pattern of 99mTc-MDP uptake in the overall femoral head (type I) in 4 cases, deficient activity pattern at the lateral side correspond to weight-bearing area (type II) in 2 cases and considerably deficient activity pattern in the whole femoral head (type III) in remaining 4 cases. Histological examination of the extracted femoral heads revealed the narrow part of ischemic necrosis in type I. However type II showed extensive necrosis in the portion of deficient activity by scintigraphs and in type III, the femoral heads except articular cartilage were entirely necrotic. This classification of 99mTc-MDP scintigraphy is correlated with the degree of femoral head necrosis and it can be emphasized that the preoperative scintigraphy is a useful method to select osteosynthesis or prosthetic replacement treatment, etc.
For the femoral neck fracture of the old patients, we have positively carried out the prosthetic replacement. But the old patients have more complications, and the results of the prosthesis were not so satisfied. We carried out 82 cases of the prosthetic replacement from 1974 to 1982, but only 38 cases could be investigated. The results of 38 cases were: 7 excellent, : 26, good; 4, fair and one poor. In one case of the traumatic femoral neck fracture which developed the central migration, the total hip replacement was performed subsequently. The distal migration occurred in 3 cases with severe osteoporosis. To prevent the distal migration the bone-cement is useful.
Eighty-one cases of femoral neck fracture were studied with type II of the Hayashi's quantification analysis for a prediction of late segmental collapse. These cases in which the follow-up results were known were used and the age at the onset was 58 years in an average renging from 12 to 79 years. For factors, ten items without Garden's stages have been used, becases the late segmental collapse was observed in 32.5% of the cases with stage I & II including 29 old fractures. The results show that the most correlative factor with a late segmental collapse was a fracture angle of Pauwels and the prediction of the wllapse was possible with a misdiagnosis rate of 28.5%, however, if an analysis was performed with limited conditions to fresh and old age fractures, it was considered that Garden's stages ware problay one of the most essential factors in this fracture.
Traumatic dislocation of the hip is an uncommon injury. Traumatic anterior dislocation of the hip is even less frequent. A case of this rare lesion is presented here. A 32-year-old male had fallen from 60m slope forcing both lower limbs into abduction. Examination of the patient revealed that the left leg was fixed in 60° of flexion in 30° of abduction, and in 50° of external rotation. The femoral head could be palpated under the adductor muscles. After X-ray confirmation of an obturator dislocation, manipulation was performed, under general anaesthesia with good relaxation. By applying gentle traction in the line of the body with the limb extended, the dislocation was reduced. The patient was kept in skin traction in bed for 4 weeks. He began to hear weight 12 weeks later. Functionally and radiologically, he has fully recovered and has been working normally without complication.
Primary repair is possible, because usually Cruciate ligment shows atrophy in about two weeks after injury, but, Posterior Cruciate injury with avulsion fracture of the tibia does not show atrophy even after several months. Primary repair of chronic posterior crusiate ligment injury leads good results. Case 1: 69 years old, male The patient was injured during riding on a motorcycle. He had not recieved any surgical treatment for his knee. Two moths later, he complained of continuous knee pain. Posterior drawer sign was found on his knee. Avulsion fracture of the tibia was found in X-ray film. Primary repair was done in 75 days. After the operation, pain was releaved. Stability has been gained and R. O. M. is in the normal range. We rate the result excellent according to the Solonen's criteria. Case 2: 57 years old, female The patient was injured during riding on a motorcycle. She had not recieved any surgical treatment for her knee. Two months later, she complained of continuous knee pain. Posterior drawer sign was found on her knee. Avulsion fracture of the tibia was found in X-ray film. Primary repair was done in 117 days. After the operation, pain was releaved. Stability has been gained and R. O. M. is in the normal range. We rate the results excellent according to the Solonen's criteria.
Fracture of the ankle joints is frequently encountered in clinical practice. For its therapy it is necessary not only to repair the joints anatomically but also to stabilize the joints on loading the body. In 1977 Isadire described in his report that through various experiments and tests followed, the fibula contributed greatly to the repair of such fracture. In 28 cases that we have recently experienced, examination was conducted for restoration of fracture of the ankle joints. In cases that restoration of the lateral malleolus was not favorable, displacement of the astragalus occurred and instability of the joints was caused when loaded. This unfavorable results were encountered. Our therapeutic methods for this disease include elimination of the pressure on the cartilage of the injured joints by the skeletal traction, maintenance of the cracked portion of the joints in an early stage after injury, followed by correct resoration of the external malleolus placing an importance on stabilization of the ankles.
Calcaneal stress fracture is uncommon and it has been rerely reported in Japan. We are reporting a very rare case of bilateral calcaneal stress fractures. The patient was a 27-year-old man, who noticed pain and swelling in the region of the bilateral heels after running. Roentgenogram showed a dense line of increased bone reaction running anterior and parallrl to the posterior margin of the bilateral calcaneus, and the diagnosis of calcaneal stress fracture was suggested. The patient was placed on light duty with diminished weight bearing. After two weeks pain and swelling diminished.
Osteochondral fracture of the talus is a relatively rare injury. Recently, we have experienced two cases of osteochondral fracture of the talus. Both cases were treated conservatively. Now, they have no pain and no disturbance of activity of daily living.
A 42 years old male, who had trained for Golf-Swing for 4 months, suffered from the spinous process fracture of the seventh cervical vertebra. For analysis of this condition, experiments were performed on 8 adult men. Superfi3ial-electrodes for recording of EMG were placed around the nucha during Golf-Swing and Baseball-Swing. One of the mechanisms of the fracture was suppdsed to be in the unbalances of the muscle activities, which were introduced with the superficial electrodes around the spinous process of the seventh cervical vertebra.
We reported a case of a 28-year-old woman with stress fracture of pubic arch who was a jogger; the pre-fracture daily running distance was six to seven kilometerr. She pained in the thigh, groin and hip in running, but she continued jogging. A stress fracture was clinically suspected, but overlooked in the initial radiographic examination. Three months later in radiographic examination she was diagnosed a stress fracture of the inferior pubic ramus near the symphysis pubis. This fracture is usually diagnosed on the radiographic examination of the pelvis, but when the radiograph fails to reveal the lesion, a radionuclide bone scan may be diagnostic. The pubec strrss fracture is relatively rare, and occurs especially in a woman does long-distance or marathon running.
Etiology of the ossification of the posterior longitudinal ligament (OPLL) is still obscure. This is to report the long-term follow-up study of OPLL cases at least for about 17 years. A 65-year-old man had a laminectomy of C3 and C4 because of dysesthesia and motor dysfunction of the both upper extremities at the age of 36 and his postoperative course had been satisfactory. However about 1 year ago, development of dysesthesia and motor dysfunctions in the upper and lower extremities and blader disturbance was recognized. In this paper, his roentgenological changes are discussed accompanied with the findings of myelography and CT scan. More over the family history gave a possibility of heredity of OPLL.
Crutchfield traction was employed in the treatment of 40 cases of cervical spondylosis and 9 cases of OPLL. The treat ment was very effective in the radiculpathy group in cervical spondylosis, especially in those cases which showed a stenosis of the intervertebral foramen with less than 50 percent of its normal diameter in an oblique X-ray view, In the group of myelopathy in cervical spondylosis, its effect was related to the antero-posterior diameter of the cervical spinal canal. In the group of OPLL, its effect was not related to the rate of stenosis, but to the type of ossification.
Fifty-three patients who were operated on for the myelopathy due to OPLL in our clinic from 1973 to 1982 were analysed in this paper. Postoperative recovery rate (criteria by Japanese Orthopedic Association) were poor or worse in 9 patients (19%): 4 with severe, 5 with moderate and none with mild myelopathy before operation. Among the patients with severe myelopathy preoperatively, the causative factors for the poor prognosis were thought to be the age at operation and the hyperostosis in another level of the spinal canal. On the other hand, 5 cases with moderate myelopathy showed marked complications complications such as hepatic myelopathy, brain embolism, meningitis and so on. We concluded that the patients with myelopathy due to OPLL should be operated on before the moderate stage unless the conservative treatment showed any effective recovery.
We have recently trcated two cases of ossifications of the ligamentum flavum with disc herniation in a same level. The first case was a 43-year-old woman with disc herniation in L2-3, and the second case was a 42-year-old man in T10-11. They were treated by posterior and anterior incision.
Our brace is designed to control a head by the frontal bone, occipital bone and the both zygomatic bones. The mandibular bone is free. Then, the patient can speak and eat comfortably, cozy brace can limit the movement of the cervical spine in all the directions, including the rotation of the upper cervical spine. It can fix the every level of the cervical spine. Our brace has been used for cervical injury in acute stage and as an immobilizer following cervical spine surgery. We treated 48 cases of the cervical disorders. We can start rehabilitation in eary time. Complication with this brace was not experienced in this series.
A 34-year-old man with cretinism complained of motor and sensory distrubance of the extremities. The neurological examination revealed spastic paralysis. Roentgenograms of the cervical spine showed an atlanto-axial dislocation with os odontoideum. The transoral anterior atlanto-axial fusion described by Thuyama was recommended. Reduction and fusion is satisfactly at 10 months after surgery. We did not find any other case of atlanto-axial dislocation with cretinism, in the literature.
Cervical myelopathy is often associated with lesions of other levels in the spine such as lumbar canal stenosis and thoracic myelopathy. In case three are difficulties in preoperative diagnosis to determine which level is most involved, postoperative recovery of myelopathy will be poor because of multiple lesions. Seven cases of cervical myelopathy who had such a lesion are presented and the postoperative results are evaluated. Six out of them had lumbar canal stenosis, whereas one had thoracic myelopathy due to OPLL. They all underwent decompressive surgeries of two stages in each level, while they showed no satisfactory results compared with those of cervical myelopathy only.
Enlargement of the cervical spinal canal without laminectomy has been applied to one hundred cases with cervical myelopathy since 1971. A 58-year-old man, operated with this method 11 years ago, visited our clinic with acute paraplegia on Nov. 15, 1982. He died after two weeks and autopsy was performed. Multiple metastases of adenocarcinoma was diagnosed. At the autopsy the cervical spine was also examined. The enlarged spinal canal was still maintained and the laminae were very hard. Histologically, epidural connective tissue was loose compared with dorsal side of the laminae. Through this autopsied case it was confirmed that this operative method was effective for not only sufficient posterior decompression of the cord but also reconstruction of the posterior elements of the cervical spine.
We have reconstructed three cases of the amputed thumb using an iliac bone graft and a free neurovascular wrap-around flap from the big toe. This operative technique was reported by Wayne A. Morrioson in 1980. Postoperative course in our clinic was good in the short term follow up study. We think this method is very useful for the thumb reconstruction.
A Few authors have reported these latency studies till now. The measurement of these latencies will help our neurological approach to palsy of brachial plexus injury, entrapment neuropathy of upper extremity etc. We studied motor nerve latencies of suprascapular, clorsal scapular, axillary and musculocutaneus nerves in 33 patients with stiff and painful shoulder. These latencies were measured between Erb's point (stimulation electrode) and the mid point of the muscle belly innervated by these nerves (needle electrode). The average times of latencies were as follows; suprascapularn.: 2.85 msec in M. Supraspinatus and 3.56 msec in M. Infraspinatus, dorsal secapular n.: 3.53 msec in M Rhomboid, axillar n.: 3.89 msec in M. Deltoid, musculocutaneus n.: 4.46 msec in M. Biceps.
We replanted 25 fingers and a toe (18 cases) in our clinic for the past four years. Although the average survival rate was 65%, it was increased year by year. This increase might be due to the application of vein graft, wide-spread information of cooling of amputated fingers and shortening of ischemic time. We confirmed that the operation by replantation team was essential for gaining a more success rate of survival.
From 1973 to 1982, twenty-nine cases (thirty-one digits) of flexor tendon injuries in the zone II, commonly called no man's land, were treated by free tendon grafting at our department, of which twenty-six cases (twenty-eight digits) were reviewed and reexamined. There were twenty-four males and two females. The average age of patients at operation was twenty-one 1/3 years with a range from two to fifty-eight years. The average period of follow-up was three 1/3 years with a range from ten months to eight 11/12 years. Primary free tendon grafting was performed in twenty-three cases (twenty-five digits) and secondary grafting in six cases (six digits) after transient use of Hunter rod in five cases and Silicon rod in one. According to the Boyes-White's criterion, forty-three percent of patients obtained excellent and good results. In the cases of primary free tendon grafting, the patients treated with ten months after injury obviously showed better results than the cases treated over ten months. The cases operated on in their childhood do not get worse with their growth.
During the period from 1979 to 1982, we have performed 33 operations (involving 30 cases) of the direct tendon suture for the treatment of flexor tendon lacerations in the hand. There were 19 males and 11 females. The average age of patients was twenty-one years old. According to the Verdan's Zone Classification, Zone 1 was seen in 7 digits Zone 2 in 20 digits, Zone 4 in 1 didit and Zone 5 in 5 digits. The operative method was as follows. Skin incision was made using Bruner's zigzag incision and tendon suture was applied by Tsuge's intratendinous tendon suture method in the majority of the cases. Postoperative care was early mobilization of Kleinert's method in 13 cases and plaster fixation for 3 weeks in 20 digits. The evaluation was made according to Boyes- White's method and the results were classified as follows. Eighteen digits were excellent, eight good, three fair and four poor. Of all cases, 78.8% showed excellent or good results. According to the zone, 70% were excellent or good for Zone 2, 92.3% were excellent or good for Zone 1, 4 and 5. We studied the relationship of the results to age, time of operation, causes of injury, operative method (FDS suture or not) and postoperive treatment in those cases.
Five free vasuclarized autogenous 2nd toe joint transfers were applied to reconstruction of four traumatized joints and one congenital defect of CM joint of the thumb. Three PIP joints involved in two patients, followed up for 3 to 12 months, have some extension lag ranging 14 to 35 degrees. MP joint was involved in only one patient, but we tried a new method of toe joint transfer to gain a further mobility. One of three transferred PIP joints, in which anastomosed artery was obstructed at an early course of 2nd toe PIP joint transfer, developed degenerative changes.
We reported a case with epiphyseal separation of the distal ulna which could not be reduced by nonsurgical manipulation due to interposition of the ext. carpi ulnaris tendon. The case was a 13-year-old boy who injured by falling clown from a running motorbike. X-ray findings showed markedly separated distal epiphysis of the bilateral ulna with fracture of the distal radius. In spite of manipulation under anesthesia, the epiphyseal separations were irreducible. Operative findings showed that the ext. carpi ulnaris tendons were interposed between the separated ulnar fragments. Each radius and ulna were fixed by Kirschner wires following surgical reduction.
Volar Barton's Fracture is an unusual injury. Satisfactory closed reduction is difficult to achieve and even if manipulation is successful, redislocation occurs frequently. We have treated seven cases of volar Barton's fracture, one by closed reduction; one by percutneous kirschner wire fixation, and five by open reduction and internal fixation with T-plate. In the case treated by kirschner wire fixation, range of movement of the wrist was limited. On the other hand, the results with internal fixation were good. We believe that internal fixation with T-plate is one of the good methods for treatment of volar Barton's fracture.
We experienced 2 cases of the fracture of the hook of the hamate by a golf swing striking the ground. Both cases had been misdiagnosed as tenosynovitis, wrist sprain or Guyon's canal syndrome. Correct diagnosis was made 4 months (Case 1) and 2 months (Case 2) after injury by carpal tunnel X-ray view. Both fractures were seen at the base of the hook and showed no union on X-ray examination. They were treated by removal of the fragment by volar approach in the first case and lateral approach in the second case. In lateral approach, dissecting between the 5th metacarpal and the abductor digiti minimi muscle and retracting the deep branch of the ulnar nerve volarly with the opponens digiti minimi muscle, it is easy to approach the hook of the hamate and to expose the base of the fragment. Besides we stress in this paper that lateral approach is safer to ulnar nerve than volar one and operative scar is not left in the palm.
This study is a 13 to 75 months (mean, 45 months) follow-up of patients with two or three stages of Kienböck's disease treated by radial shortening procedure. In five of six patients, the roentogenograms at the follow-up examination showed the remodeling in the lunate bone. Compared with the pre-operative status, the mean range of the wrist motion improved by 32.5 degrees and the mean grip strength increased by about 1.41 times. Four of six patients were satisfied with their treatment and showed functional improvement. The other two patients complained of some wrist pain with strenuous activity. All patients returned to normal activity.
There are diagnostically and therapeutically difficult problems in post-traumatic contracture in the hand. We have treated surgically 5 cases with post-traumatic contracture in the hand that consist of a variety of pathogenesis: adhesion of the extensor apparatus on the dorsum of the PIP joint, ischemic intrinsic plus contracture, flexor adhesion in the carpal tunnel and others. The therapeutic problems are as follows; 1. strict diagnosis of pathogenesis, 2. adequate exercise using dynamic splint, 3. atraumatic technique, and 4. reconstructive surgery according to patient's needs.
We have treated a patient with hand injury caused by the injection of paint from a high pressure spray gun. The patient was a seventeen-year-old right handed painter, who was injured to the base of the left thenar, and admitted 7 clays after the injury. On admission, lacal findings showed wide spreading swelling and necrosis of the subcutaneous tissue of the whole hand, and partial necrosis of the skin. Wide debridement and decompression incision were carried out and, moreover, he was treated with hyperbaric oxygen therapy four times during the following 7 days. Swelling was promptly subsided and he was discharged 8 weeks after the operation leaving the small granulated wound at the thenar. At one year and four months after the operation, he had no functional disturbance of the hand except for mild restriction of extention of the IP joint of the thumb. We discussed the mechanism of effects of hyperbaric oxygen therapy for the spray gun injury.
Seven cases with giant cell tumor of tendon sheath arising from the finger were reported. The age of patients was ranged from 4 to 60 gears and 3 cases were below 20 years, of which 2 were below 10 years. The sites of the tumor were the thumb in one, the index finger in 3 and the ring finger in 3 cases. In 5 cases, the tumor was found at dorsal site of the finger. Radiograph showed a soft tissue shadow in all cases and the pressure atrophy of the cortex of the phalanx was found in 6 cases. The tumor was treated with surgical excision and was not related with the joint or flexor tendon sheath. Histological findings revealed the proliferation of giant cells and histiocyte-like cells in the collagen fiber band (alveolar structure) in the typical cases.
A 59-year-old male was noted to have a tumor at the fifth finger tip. Roentogenologically, the distal phalanx had osteolytic change, and amputation was performed with chemotherapy thereafter. The metastasis in the phalanx was relatively rare. However, this case was histologically a metastasis of the clear cell type-renal cell carcinoma. Four months later the patient died as a result of general metastasis.
Juxtacortical chondroma is an uncommon benign cartilaginous tumor that arises under or in the periosteum on the surface of the cortical bone. The term “Juxtacortical Chondroma” was coined by Jaffe in 1956. Recently we have exprienced a 10-year-old male with juxtacortical chondroma in the fourth proximal phalanx. In addition, this case had an enchondroma in the same phalanx. This time, we reported this case and gave consideration to the clinical and pathological findings of this case.
From 1967 to 1982, 44 cases of enchondroma have been treated in our hospital by curratage and bone-grafting. 28 cases have been reviewed after 6 months to 15 years, the average length of follow-up being 4 years and 7 months, The overall results which included the subjective symptom such as pain, deformity, radiographic finding and R. O. M, were as follows: good in 22 patients (73%), fair in 2 (7%), and poor in 4 (20%). It was concluded that the functional result was not related to the existence of pathological fracture but the location of tumor and age at the time of surgical treatment.
In comparison with soft tissue ganglia, the intraosseous ganglion is relatively rare. Although cases of intraosseous ganglia were described in the literature, their occurrence in the carpal bones is indeed rare. We have encountered a patient with an intraosseous ganglion of the scaphoid bone of the wrist. A 63-year-old woman complained of some pain in her left wrist. There was limitation of motion but not inoammition. Roentgenographic study demonstrated a round-to-oval, radio lucent cystic lesion in the scaphid bone of the wrist. Operation was carried out for the purpose of both diagnosis and treatment. The scaphoid bone consisted of yellow fibrous cystic material, and this was removed and curettaged of the cavity, and then the defect was packed with banked bone. Histologically the wall of the cyst is composed of fibrous tissue without lining cells, and we finally made a diagnosis of intrasseous ganglion.
The results of treatment of 7 transcervical and 2 extracapsular fractures of the femoral neck in patients with rheumatoid arthritis were compraed with the results in those of 62 fractures without rheumatoid arthritis. The results were as follows. 1) The patients in rheumatoid group were younger than those of the non-rheumatoid group, and the rate of female in rheumatoid group was considerably greater than that of male. 2) The transcervical fracture were more frequent than the extracapsular fractures in rheumatoid group. 3) The results of treatment of the femoral neck fractures in rheumatoid group were poorer than non-rheumatoid group, because of the high rate of redisplacement after the treatment of reduction and fixation. Therefore, we should consider that the most appropriate treatment of the femoral neck fractures with severe osteoporosis and/or rheumatoid changes is hemiarthroplasty or total hip replacement.
The effect of Cyclosporin-A, suppressant agent to helper T cell, on developing type II collagen induced polyarthritis was examined in rats. Cyclosporin-A treatment (15 and 25mg/kg/d) for 14 days suppressed the arthritis perfectly and decreased the antibody titers and DTH skin test to type II collagen.
In crystallographic study of tophaceous substances and deposits in gouty synovial fluids using differential-interference microscopy, polarized light microscopy and X-ray diffraction method, the following results were obtained. 1) Substances of subcutaneous tophi and deposits in gouty synovial fluids were found to be needle-like crystals. By polarized-light microscopy, they were negatively birefringent with extinction on the long axis. 2) The needle-like crystals obtained from subcutaneous tophi and/or synovial fluids in gouty patients have been positively confirmed as monosodium urate monohydrate (NaC5H3N4O3·H2O) by X-ray diffraction technics.