In this study the effectivensess of computed tomographic discography (CTD) in diagnosing cervical soft disc hernia was evaluated. Twenty-five intervertebral discs of 15 cases with cervical soft disc hernia were examined with a discography and then a CT scan. Results of the CT scan were as follows: three discs were protruded, 12 discs were prolapsed, 6 discs were extruded, and 4 discs were sequestrated. The findings were helpful in determining the location of soft disc hernians between the median and posterolateral discs. They were also valuable in classifying types of hernians and surgical approaches.
Intraosseous ganglion is a comparatively rare disease. We experienced two cases of intraosseous ganglion, and report with some consideration. The first case was a 31-years-old female, and her chief complaint was left ankle joint pain. Radiograph showed a well defined cystic lesion in the medial malleolus of the left tibia. The second case was a 31-years-old male. His chief complaint was right wrist pain. Radiograph showed a cystic lesion in the right scaphoid bone. Curettage and bone grafting were done in both cases. The cysts contained gelatinous fluid. Microscopically, walls of the cyst were thick and formed mainly by collagenous tissue, which is quite compatible with the wall of ganglion cyst in the soft tissues.
One hundred and sixty-seven cases of supracondylar fractures of the humerus in children were reviewed and discussed concerning rotation of the distal fragment. In most cases the distal fragments showed internal rotation around the lateral axis (78.1%) caused at the time of injury. Care must be taken to prevent redislocation during immobilization in plaster after closed reduction, and correction must be made before the fracture achieves stability in cases where re-dislocation of rotation with medial tilt is visible on X-ray films. An over-head pin traction is an effective method to prevent varus deformity. The authors insist on anatomical reduction of the fracture. Cubitus varus results from incorrected or redislocated rotation which leads to no contact on the medial side between the proximal and distal fragments of the humerus. Consequently the distal fragment may tilt medially. If the fracture line crosses the fossa olecrani, rotation of the distal fragment may result in a narrowing of the space and incongruity of the humerus and ulna. Consequently loss of motion to some degree remains long-Lasting.
A case of Galeazzi equivalent lesion, in a 12-year-old girl, is presented. She was treated with closed reduction and plaster cast immobilization and good results were obtained. Clinical features of Galeazzi equivalent lesions are discussed.
Isolated traumatic dislocation of the radial head is unusual and posterolateral dislocation is exceedingly rare. To our knowledge, only Stelling, F. H. and Heidt, R. S. reported isolated traumatic posterolateral dislocation of the radial head. Recently, we have surgically treated a patient with this disorder. A seven-year-old boy came to our hospital on January 11, 1984 complaining of pain in his left elbow. Upon examination, pain, local heat and swelling were observed in his left elbow. Radiographs showed isolated posterolateral dislocation of the radial head. The dislocation required open reduction, removal of interposition and repair of annular ligament.
Twenty-eight patients with injuries involving the epiphyseal plate were treated during these past seven years in our hospital. Twelve patients out of the twenty-eight were followed-up for one year and their prognosis concerning growth disturbance was studied. The following results were obtained: 1. Twenty patients (71 per cent) were classified as Type II according to the Salter-Harris classification, seven (25 per cent) as Type I and one (4 per cent) as Type IV. 2. The majority of upper extremity injuries were reduced by closed manipulation. Lower extremity injuries almost all required open reduction. 3. The prognoses of upper extremity injuries were clinically good, whether they were treated by close or open reduction. 4. All of the three patients with lower extremity injuries needed open reduction. The patient with distal femoral epiphyseal injury had a length discrepancy of 3.0 centimeters, all three patients had premature cessation of growth plate and two patients had valgus deformity.
We studied the end results following fracture-separations of the epiphyseal plates in fourteen patients. The average follow-up was three years and eleven months. The sites of lesions were classified thus; four phalanges, four distal ends of radius, four capitellums of humerus and one distal end of femur. No patient complained of any severe disadvantage in daily activities. In our study, we concluded that the prognosis was good for those patients on whom an accurate reduction was performed within a few days following injury, but that delayed reduction led to a poorer prognosis.
The results of the treatment of six children with fractures of the neck of the femur are reviewed. Three cases were Type-II fractures and three were Type-III fractures. Four of the six cases had displaced fractures and from these, two cases with displaced Type-II fractures underwent an operation for open reduction and internal fixation. The other four cases were treated with skeletal traction or plaster spica casts. Four cases achieved good results, one fair, but the other one was por. This poor result was due to other traumatic injuries. One Type-II fracture had avrscular necrosis and premature epiphyseal closure. Coxa vara was found in two of the cases with displaced fractures. We think, undisplaced Type-II and Type-III fractures are best treated with conservative therapy.
Stress fracture of the metatarsal bone, though common in adults, seems to be extremely rare in children, according to published reports. We report, the case of a 8-year-old child with a stress fracture of the 3rd and 4th metatarsal bone without any noticable trauma and still physically active. When we suspect a stress fracture in children, great attention must be directed towards obtaining a detailed history and serial X-rays must be obtained over a short time period. Bone scintigraphy shows a predictable superiority over radiography in early diagnosis.
Twenty-seven patients with 28 comminuted Colles' fractures were treated with a cast-brace. According to the classification by Gartland, these comminuted fractures were classified into group 11 (14 cases) and group III (14 cases). And then group III had been divided into group IIIa (10 cases) in which the displaced fragments of radial articular surface could been reduced and group IIIb (4 cases) in which these could not be reduced by closed manipulation. The results were assesses both anatomically and functionally. The functional results were very commendable in comparison with the anatomical results, and then there were hardly any differences between group IIIa and group IIIb in the functional results. The results of this series reveal that cast-bracing is a useful method for Colles' fractures, especially in the group IIIb.
Ten cases of severely injured open fractures of the forearm were treated in our clinic. In six of them, internal fixation using intramedullary nail was undertaken. In two, plate, and in further two, a combination of plate and intramedulary nail was used. Internal fixation and tendon and nerve repair was performed primarily. Skin coverage was delayed. After removal of fixators, refractures occured in the group using a combination of plate and intramedullary nail. One nonunion was observed in the plate fixation group. In all but one case, solid union was obtained. We had no experience of deep infection in this series.
After reviewing the methods of fixation for fracture of the olacranon, the authors designed a new method of crossed double 8-figure tension band fixation (CD 8 tension band fixition), which was confirmed to be superior to the conventional methods. The results of physical examination on stress and strain following various methods of wire fixation for the fracture and the operative procedure of CD 8 tension fixation are presented together with 2 case reports.
Twenty-three cases of fracture of the humerus were treated by open reduction and internal-fixation. Ten cases healed primarily, but thirteen did not. They were salvaged by bone grafting and internal-fixation. Theree of them were added mobilization of the elbow or neurolysis of the radial nerve futhermore. The results of the surgery were not so satisfactory in the cases of open fracture and compound fracture.
A fracture of the clavicle is a common injury around the shoulder girdle. A figure of-eight bandage is the generally accepted treatment for such lesions during childhood. However, the choice of treatment for this injury in adults is still controversial. It is the purpose of this paper to study ten cases of nonunion of the clavicle occuring at our hospital from 1977 to the present time. We investigated them with special regard to factors predisposing them to pseudoarthrosis and the surgical treatment employed. Wesuggest that the chief reasons for development of nonunion would be insufficient reduction and/or inadequate fixation in non-operative treatment and insufficient fixation in operative treatment. Two patients required operative treatment with plate fixation, iliac bone on-lay graft and cancellous bone graft. Their results were classified as excellent.
Masuda city suffered heavy damage from flooding after the concentrated heavy rain on 23, July, 1983. In the two weeks following the disaster 302 patients, 207 males and 95 females, aging from first decade to eighth decade, visited our outpatients clinic. About half of them had injuries to their feet from glass fragments and nails suffered when they were seeking refugee or removing wood and mud. We were afraid of an outbreak of an outbreak of tetanus, but fortunately neither tetanus nor dysentery broke out. Power failure restricted the use of elevators and roentogenographic examinations. We ran short of gauze, drapes and gowns, Medical staff also suffered and some of them were absent from the hospital. It was rumored that tetanus and dysentery were going around. We keenly felt the necessity of a wireless-telephone between the hospital and administrative organs an temporary facilities which accommodated injured patients who had lost their houses. Typhoons and concentrated heavy rain will occur again in the future. We must seriously take up the problems of preparing for a possible flood.
Sixty-four lateral fractures of the femoral neck have been treated by Ender nailing in our hospital between 1980 and 1984, and 57 cases have been followed up. Fifty-six fractures (98.2%) have achieved union. Thirty-five cases had resumed their pre-injury gait per formance at the time of discharge. Thirty-three of them (88.6%) have maintained their gait performance following discharge. In contrast, of the 22 cases who hadn't resumed their pre-injury gait performance at the time of discharge, 11 (50%) died following discharge. Postoperative complications caused deterioration in gait performance, but neither deformity of femoral neck, nor migration of the nail caused deterioration in gait perfor mance. Resumption of pre-injury gait performance before discharge is a very important factor especially concering aged patients life expectancy after discharge, for which an early operation soon followed by rehabilitation is strongly recommended.
The purpose of this article is to report three cases of fracture of the middle third of lateral tibial condyle, the so-called Segond fracture. Case 1. A 31-year-old male landed on his left foot with the knee adducted while playing volleyball. Initial examination revealed an instability to valgus stress at 30° of flexion. Radiographic examination of the left knee demonstrated avulsion of the lateral tibial condyle. The patient was treated with a cast. Case 2. A 50-year-old male injured left knee in a traffic accident. Upon examination the left knee was remarkably swollen. Plain roentgenography of the left knee showed fracture of the lateral tibial condyle with transverse fracture of the proximal region of the tibia. The patient was treated surgically. Case 3. A 21-year-old male landed on his left foot with the knee abducted with external rotation while playing volleyball. Initial examination revealed anterolateral rotatory instability with lateral meniscal sign. Roentgenography revealed a chip fracture of the lateral tibial condyle. Lateral partial meniscectomy was performed.
We experienced a typical case of fat embolism syndrome. Few such cases are reported. A twenty-year-old woman recieved head contusion and open fracture of the right tibia in a traffic accident. Three days later, she was admitted to our hospital with loss of conciousness. We began treatment for fat embolism syndrome same day, and she was discharged without any disturbance.
We performed Judet's mobilisation in three cases of stiff knee following various knee injuries: supra-condylar fracture of the femur, femoral condylar fracture and fracture-dislocation of the knee joint. In all cases we obtained successful functional results without any complications during the post-operative year. The satisfactory results obtained in this series may indicatethat this procedure is a useful method for joint contracture following peri- and intra-articular fractures of the knee as well as fractures of the femoral shaft.
Thirty five cases with uni-, bi-, and tri-malleolar fractures of the ankle were treated by open reduction and internal fixation. Screws were used for most of the fractures. These cases consisted of 29 males and 6 females. The age of the patients ranged from 15 to 74 years and the average age was 42 years. The subjective results were good in 22 cases, fair in 7 cases and poor in 6 cases.
During the year March 1983 to February 1984 we experienced 63 cases of ligament injuries to the ankle. 6 of these cases were treated surgically. Pre-operative stress X-rays revealed that the talar tilt angles ranged from 7 to 20 degrees and the anterior displacements of the talus ranged from 6 to 14mm. The increased rate of talar tilt angle was 5 degrees or more compared to the sound side. Primary repairs were carried out in 4 cases during the acute phase and reconstructions with modified Watson-Jones method were carried out in 2 cases who had disabling instability due to chronic lesions. Complete tear of the anterior talofibular ligament was found in all cases. Complete or partial tear of the calcaneofibular ligament were each found in 3 cases. All cases improved anatomically and clinically during the follow up time of between 3 and 14 months after the operation. From our experience we conclude that surgical repair is the first choice of treatment in a suspected case of severe lesion of the lateral ligament of the ankle.
Three cases of talus fractures are reported. Case 1. A 20-year-old-male suffured a fracture-dislocation of the neck and body of his right talus (Type 3). Dislocation was reduced, fracture was fixed with bone screw and staple, and weight bearing was not allowed until 9 months after operation. The results were excellent. Case 2. A 31-year-old-female suffered a fracture of the neck of her right talus (Type 1). Fracture was fixed with two staples, and weight bearing was not allowed until 7.5 months after operation. The results were good. Case 3. A 24-year-old-female suffered a fracture-subluxation of the neck and body of her right talus (Type 2). Fracture was fixed with a staple, and weight bearing was allowed 4.5 months after operation. Osteoarthritic change was seen roentogenographically. The results were good. So we conclude that sufficient reduction, stable fixation and no weight bearing are the principle points of treatment to prevent avascular necrosis and osteoarthritis of the ankle joint.
For the last eight years, fifty-two calcaneal fractures were treated in our hospital and forty-one of them are reviewed in this report. We made a valuation on the treatment of calcaneal fractures. We studied the interrelation between our valuation, the type of fracture, Böhler's angle and our treatment. Also, we studied the interrelation between our valuation and patients' mental factors which were checked by means of Y-G test and CMI test.
Fourteen patients with fifteen intra-articular fractures of the calcaneus were investigated. The results are as follows: 1) Patients had relief of symptoms after three years. 2) Westhues method was the most effective treatment for ‘tongue type’ fractures. 3) Prognosis of ‘depression type’ fractures was good, even though we did not reduce them. 4) Precise antomical reduction and subsequent functional restoration of the talo-calcaneal joint lead to good prognosis.
Recently we experienced a case of an avulsion fracture of the calcaneus. In this case, a so-called beak type fracture with avulsion fracture of the insertion of achilles tendon was seen. Acute contracture of achilles tendon by forced dorsifl exion of ankle joint and mild osteoporosis of the calcaneus were considered to be the causes of this rare fracture. Surgery was performed and satisfctory results were obtained.
The etiology of tendon ossification may be trauma, surgery or one of a wide variety systemic, metabolic, or inflammatory diseases. Ossification of achilles tendon is not a common condition. We report a rare case of the fracture of ossified achilles tendon, which occured in a 34-year-old man.
Four cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All cases were males and involved the dominant side. The age at surgery ranged from 14 to 16 years. Follow-up period ranged from 8 months to 3 years, 1 month. All cases belonged to children's baseball teams. Two of them continue to play even now. In addition to curettage or drilling etc, shortening of the radius was performed in all cases. All had good results. There was no instability after surgery. It seemed that shortening of the radius decreased the pressure in the radio-humeral joint.
Apophysitis of the Olecranon ocurring in two boys is described: Case 1: 14-year-old right-handed boy who has been practising kendo since he was 11 years old. The symptoms were pain and tenderness over the tip of his left olecranon and radiography showed fragmentation. Case 2: 13-year-old right-harded boy who had been practising kendo since he was 8-years-old. The symptoms were pain and tenderness over the tip of his left olecranon and bone scintigram showed high uptake on his left elbow. The symptoms disappeared following rest.
We report two cases of stress fracture. Case 1; The patient was a 10-year-old boy who had swum or playedbaseb all three times a week. He felt a pain in the distal part of left thigh in October 1983. Radiological examination of femur showed periosteal reaction and cystic lesion and tomograph showed fracture line. We diagnosed it as stress fracture situated in the fibrous cortical defect. Case 2; The patient was a 9-year-old boy. He suddenly felt a pain in the right clavicula whilst running with Kendo bamboo sword in January 1983. Radiological examination of right claviclua showed linear radiolucency. Stress fracture was diagnosed.
We reported 4 patients with traumatic desruption of the extensor mechanism of knee joint. All patients were treated operatively and good results were obtained in all cases. All of them returned to their sport activities after surgical operation. The mechanisms of injuries of each patient were discussed in this paper.
A 25-year-old female visited to our clinic complaining of numbness in the sole and all toes of her right foot. She mentioned that this symptom had developed after tightening her ski boot. Clinical examination revealed that she had sensory disturbance in the corresponding area and there was tenderness behind and inferior to the medial malleolus. A positive Tinel's sign was also present over the tarsal tunnel. Motor weakness of the foot was not present. Measurements of the conduction velocity suggested a interruption of the posterior tibial nerve at the tarsal tunnel. We diagnosed her as suffering from tarsal tunnel syndrome caused by ski boot pressure. This was based on the above findings and her history. The numbness resolved gradually and she was completely free from symptoms and signs 3 months later.
There are an increasing number of reports of traumatic dislocation of peroneal tendones, formerly believed to be rare, as a result of sports accidents. Most of them are diagnosed late and treated surgically. Although conservative treatment for acute cases is described in standard orthopedic textbooks, few successful cases have actually been reported. There is no established theory as for how old injuries could be managed conservatively, as for the method and duration of immobilization and as for the necessity of non-weight-bearing. A case of traumatic dislocation of the peroneal tendons is presented in which immobilization was started on the twelfth day following injury and continued for 31/2 moths permitting weight-bearing. The patient, a 24 year-old dental student, who sustained a dorsiflexioninversion injury from skiing, returned to sports activities such as water skiing at 5 1/2 months and regained full ROM at 8 months. He was assymptomatic in the 16th month of follow-up. Several problems about conservative tratment of this condition are discussed.
Three cases of traumatic dislocation of the peroneal tendons are reported. Two cases were treated surgically. One case was operted on using the Duvries with the addition of the König technique. In the other case, suvgery using only the Duvries was performed. Of the two patients operated on and followed up for four months or longer, the peroneal tendons did not redislocat. In both cases, there was no rupture or laxity of the peronal retinaculum. To the contrary, the grooves in the lateral malleolus were shallow and the medial borders were round.
Five cases of traumatic dislocation of the peroneal tendon which were treated surgically are discussed. The ages ranged from 14 to 26 years with an average age of 18.2 years. All injuries resulted from athletic traumas. In case 1, the DuVries' technique was used, however, dislocation persisted. In case 2, in addition to the DuVries' technique, three holes were drilled into the posterolateral surface of the lateral malleolus and sutures in the retinaculum were pulled through the holes. The retinaculum was firmly attached to the fibula. No dislocation was recognisable. In the other 3 cases (cases 3, 4 and 5), only drilling and attachment were performed and all the patients have since resumed their athletic activities.
A case of acute traumatic retrosternal dislocation of the right clavicle in a 16-year-old male Judo player is presented. A depression at the medial part of the clavicle was noticed, and diagnosis was made by X-rays and computed tomographic scan. Closed reduction under general anesthesia was attempted, the arm being hyper-abducted and extended, but was not achieved. Open reduction was carried out through transverse incision. Large tears of posterior part of the capsule, the sternoclaviclar and costoclaviclular ligament were found, and the medial part of the clavicle was displaced under the sternum. Type I epiphyseal injury according to Salter-Harris classification was found. Following reduction, the sternoclavicular joint was fixed with K-wires. Plaster cast was applied for 4 weeks, and 4 months following reduction, the patient had recovered full ROM without pain and returned to his previous activities.
Eight patients with complete acromio-clavicular dislocation treated between 1976 and 1983 were reviewed with a follow-up time of from 7 months to 8 years, the average being 3 years and 8 months. They were treated by arthrodesis of the acromio-clavicular joints with bone graff. The results were evaluated according to the Takagish's method with 100 percent excellent results. Two showed complete arthrodesis, whereas Six showed pseudo-arthrodesis.
Three patients are presented, who were diagnoded as having complete acromiocravicular separation. They were operated on using knitted Dacron vascular prostesis for the pupose of reconstruction of torn coracoclavicular ligaments and are satisfactory now. We think the method of utilising the Dacron prosthesis is more physiological and more anatomical than any other method of reconstruction. The Dacron vascular prosthesis is soft, elastic and very strong. Therefore, their rehabilitation was begun two weeks following operation and they were able to return to thei pre-injury functional levels of shoulder joint.
Traumatic posterior (sub) luxation of the shoulder is not well understood because it is an uncommon condition. This disease may be classified into two groups: habitual and voluntary. We treated six cases of the habitual (sub) luxation, who had no history of trauma initiating the (sub) luxation. Diagnosis was made by clinical observations and radiographs. The routine radiographs and arthrograms showed no abnomalities. Stress radiographs were made and these demonstrated posterior (sub) luxation. The operative procedure consisted of posterior glenoid osteotomy and capsulorraphy. Five shoulders that were followed up for one year or more after the operation were graded excellent.
We consider that prevention of contracture of the shoulders in quadriplegic patients is important usual for daily activity. Previously we positioned the shoulder in the case of 90 degrees abduction and reported those results at this 63rd congress. Recently we made a new shoulder positioning device (for cases of 90 degrees abduction with 20 degrees horizontal adduction and slightly external rotation). Such a device was applied to 18 guadriplegic patients who were operated on 3.7 days following injury. This procedure was continued for 4 weeks after the operation. We compared their results 17 patients on whom we did not use. Results showed former group complained less of pain in shoulder and maintain good R. O. M., Our treatment was beneficial for patients in the acute phase to prevent problems in shoulders.
A sixteen-year-old female complained of disturbance of the left shoulder elevation and numbness in the left arm. A roentgenogram of the left humerous showed a 7.3cm shortening in its length, deformity of humeral head and the early closure of the proximal growth plate. These findings were presumed to result from a fracture of the proximal humeral epiphyseal plate, which she suffered at the age of ten. The ranges of active motion in the left shoulder were: abduction 80 degrees and flexion 80 degrees. Passively, both ranges of abductuon and flexion were 160 degrees. Neurological abnormalities of the shoulder girdle muscles were not detected in the electromyogram. Because it was concluded that disturbance of shoulder elevation was caused by dysfunction of deltoid muscle due to shortening of the humerus, the left humerus was lengethened by an iliac bone graft with bone block (16mm in length) and a plate fixation at the diaphysis proximal to deltioid insertion. As a result of analysing the effect of humeral lengtening in a simplified simulation of shoulder joint, an increase of 46 degress in shoulder elevation was predicted. One and a half months after operation, the ranges of active motion were: abduction 150 degrees and flexion 150 degrees.
The purpose of the paper was to investigate the natural course of the hip in sixtytwo patients with cerebral palsy. We evaluated the postoperative results of the dislocated or subluxated hips in twelve patients. The results were as follows; i) non-operative cases 1) Dislocated or subluxated hips were found in nineteen percents of 124 aips. 2) Most of the hips in cerebral palsy had the abnormal neck-shaft angle, anteversion angle, CE and Sharp angle. 3) Five patients of twenty-three that followed-up more than three years, progressed to dislocation or subluxation. ii) operative cases 1) Reposition of the dislocated hip was not achieved in one case and recurrence of the dislocation occured in two cases.
Pinning in situ with Knowles pins was performed on one patient with moderately slipped capital femoral epiphysis of which the slippage was 35 degrees. Three Southwick 3-dimensional osteotomies were performed on another three patients with severe-chronically slipped capital femoral epiphysis. We concluded that Southwick osteotomy gives good correction of the hip deformity and great improvement of the hip movement and activity.
In order to assess the usefulness of open replacement of the femoral head for slipped capital femoral epiphysis, the results of seven cases are presented. Of the four cases with acute-on-chronic slip, one had avascular necrosis of the femoral head and another had radiological irregularity of the contour of the head. Two other cases with acute-on-chronic slip and three cases with chronic slip had good clinical and radiological results. As Dunn has reported, this open replacement operation should be indicated for cases of severe chronic slip. From the above experiences it seems that the capital blood supply is not at great risk because the hip is exposed by elevation of the trochanter, and intra-articular procedures can be done under direct vision of the retinaculum which contains the blood vessels to the femoral head.
Sixty-one cases of Perthes' Disease were treated in our hospital from 1974 to 1982. All of them were treated conservatively. Eight cases were bilateral. We examined directly seven bilateral cases. Average age of onset in bilateral cases was four years and two months. Present X-ray findings are concerned with extension of disease and age of onset.
One case of synovial chondromatosis and 2 cases of osteochondromatosis of the hip are reported. As diagnosis of synovial chondromatosis is difficult by a plain X-ray, arthrography should be actively indicated for the patient complaing of chronic and unspecific disorders with limited ROM of the hip joint. According to clinical and histological findinges, osteochondromatosis and synovial chondromatosis may be considered to be entirely different entities.
The case of a 29-year-old male, with non-specific coxarthritis is reported. In this case, clinical findings of right hip pain were observed over a long period of time. Laboratory findings were normal except for positive CRP and elevated ESR. Roentogenographic findings showed bone atrophy, osteosclerotic change, erosion and narrowing of joint space in right hip joint. Arthrodesis was performed on the right hip. Microscopic pathology showed infiltration of lymphocytes and plasma cells in synovial tissue. Post operative course was uneventful.
This study provides histological findings as to the pathogenesis of rapidly destructive coxarthrosis (RDC). Materials consisted of six femoral heads of RDC and several femoral heads of osteoarthritis and idiopathic avascular necrosis. According to histological findings, there were no changes in articular cartilage as in the cases of osteoarthritis or chondrolysis, but the most important findings were osteonecrosis of trabecular bone and invasion of synovia into the subchondral space of the femoral head. We suggest that the etiology of RDC is that the osteonecrosis may be intiated first and the absorption by synovia extended to the osteoporotic femoral head.
Rheumtoid arthritis (RA) is one of the many etiologic agents in bone necrosis of femoral head (FHN). Practically most cases of FHN in RA have received corticosteroid therapy, but a few cases occur independently of corticosteroids. We encountered a rare case of FHN associated with RA. This case was a 54-year-old male with an eight-year history of RA, and he had been treated with an anti-inflammatory drug for three months. The drug contained about 15mg of corticosteroid as total dosage. He had had increasing joint pain, loss of motion and limping gait in left hip for one year. X-rays revealed collapse of his left femoral head. A total dosage of 15mg of corticosteroids is very small to bring about steroid-induced necrosis. So it is thought that our case occured independently of corticosteroids.
We researched the influence of the peripheral vascular occulusion upon the femoral head. Fifty cases of occulusive vascular diseases which contains 42 cases of arteriosclerosis obliterance, one case of thromboangitis obliterance, 6 cases of embolism and one case of arteriothrombosis were reviewed. Those occulusive sites were limited from aorta to common femoral artery. Those cases were examined by plain radiograms of the hip joints, pelvic arteriograms and physical examination. As the result osteonecrosis of the femoral head was seen in none of the cases. We saw only one case of localized sclerosis within the head (1.3%) and one case of joint space narrowing (1.3%). All the cases had the rich network of the collateral circulation around the hip. It seems to be doubtful that occulusive vascular disease accompanies the osteonecrosis of the femoral head as reported by Millet in 1974.