Out of 35 osteoporotic women studied, 13 presented with vertebral compression fractures, 9 with a femoral neck fracture and 13 with both fractures. osteoporotic women with vertebral compression fracture were younger than those with femoral neck fracture or both fractures. The mean value of serum calcium was lower in the women with both fractures than in vertebral compression fracture group. Two densitometric parameters (GSmin. and Sigma GS/D) which indicated the bone density in the diaphysis of the 2nd metacarpus, showed lower value in the women with both fractures than in the vertebral compression fracture group. In conclusion, these results show that, vertebral compression fracture and femoral neck fracture in senile osteoporosis occur in different age groups with different cortical bone density.
On over 70 years old patients with femoral neck fracture, a report was made of the grade of osteoporosis, complication on admission, extent of risk, etc. Subject cases comprised 14 males and 46 females. Intracapsular and extracapsular fracture concerned 25 and 35 patients respectively. Average period of survey was 20.3 months. 1) Osteoporosis up to grade 3 according to the classification of Singh was observed in 43 of 60 patients (71.3 %). 2) Complications on admission were observed in 59 of 60 patients, and especially heart disease was most frequent (45%). 3) Extent of risk was good in none of the patients, fair in 2, mildly poor in 36 (60%), and poor in 13 (21.7%). And 10 death cases corresponded to the patients who had more than 4 items or risk criteria.
Judet's Screw-plate system is the best osteosynthesis material for fractures and pseudoarthrosis of the proximal and distal ends of the femur. This Screw-plate has been invented by R. Judet in 1969 and ameliorated by E. Letournel in 1980. We bave surgically treated 23 fresh fractures and 8 pseudoarthrosis of distal end of the femur between August 1971 and August 1984, 15 men and 16 wemen. The average age was 52.8 years old and the majority of our cases became the victim of the traffic accident. The consolidation have been obtained in all cases of fresh fractures and end of 8 pseudoarthrosis after osteo-muscular decortication of Judet's technique. With regard to R. O. M. post-operative of the knee, elven cases were very good (130 & plus) ten cases were good (129-100) and 8 cases fair (99-65). Judet's mobilisation of the knne, DESINSERTION DU QUADRICEPS, were performed in eight cases.
Patient with tibial condylar fractures who have been treated in this Hospital since 1977 have been evaluated placing emphasis on the interrelationship between the degree of anatomical reposition and the functional prognosis. The study included 12 males and 3 females, a total being 15 patients. The age of the patients at the time of sustained trauma ranged between 17 and 72 years, with a mean of 51.7 years. The cause of the trauma was traffic accidents in 12 patients and labor associated accidents in 3. According to the classification of fractures by Hohl & Luck, an undisplaced type was seen in one patient, a central depression type in 2 patients and split depression, total depression and comminuted types in 4 patients respectively. The depth of the traumatic depression in the tibial condyle ranged from 0 to 12mm at the time of injury, with a mean of 7.5mm. It varied from 0-8mm during the follow-up period, with a mean of 2.5mm. Conservative treatment was followed in 2 patients, and surgical treatment in 13. Bone transplantation was used as well in 3 of these patients who had severe involvement and a depth of traumatic depression in the tibial condyle of more than 10mm at the time of injury. The postoperative results were excellent in 7 patients (47%), good in 6 (40%) and moderate in 2 (13%), with a satisfactory outcome. Six patients (40%) were unable to function normally, but an unstable knee joint was not seen in any of the patients.
Group I consisting of 53 knees (60 cases) of avulsion fracture of the femorotibial joint treated in the last 9 years was compared Group II consisting of 65 knees of intraligamentous rupture treated in the last 3 years. Average age at the time of Group I was 30 years which was slightly higher than that of Group II whose average age was 26 years. Injury of combined ligaments was 34.0% for Group I and 18.5% for Group II. Cartilage injury was 22.6% for Group I and 40.0% for Group II. Especially many lateral meniscus injuryies in Group I and medial injuries in Group II were observed. Major causes of trauma in Group I were traffic accidents and of Group II were sport injuries. Our conclusion was that avulsion fracture of this joint was caused by high rates of loading combined with sheer force rather than low rates of loading (sprain).
Bimalleolar fractures of the ankle may cause a marked disturbance in daily life if local instability, pain and motor disturbance occur after treatment. We have treated this disease according to the following therapeutic plan. 1. The ankle is immobilized in cope with its local instability with importance attached to anatomical reduction, particularly accurate reduction of the lateral malleolus. 2. For the prevention of local contracture, traction of the calcaneus is positively carried out prior to reduction and immobilization. We recently treated 26 cases of bimalleolar fractures of the ankle (26 joints) according to the above-mentioned therapeutic Slan at our department and reviewed the results. The mean age of the patients was 48.6 years and the mean duration of follow-up was 3 years and 3 months. The results were poor in many of the patients in whom reduction of the lateral malleolus was inadequate, whereas the prognosis was favorable in patients in whom the lateral malleolus was accurately reduced and immobilized. Traction of the calcaneous appeared to be useful for the prevention of contracture.
A 52-year-old man sustained a severe compound injury of his left leg by traiffic accident. At the involved site, the tibia became and infected skin the over its anterior surface came into necrosis, which required extensive resection. A 25cm long fibula shaft with a 8.5 by 18cm, peroneal skin flap from the sound leg was grafted to the defect part of his involved leg with anastomosis between the donor peroneal vesseles in and the recipient tibialis anterior vesseles. Five months after surgery, the grafted fibula shaft with peroneal flap has successfully untited to the recipient site.
Eleven joints in nine cases of the plafond fracture were treated with open reduction and internal fixation followed by the early exercise of the ankle. These treatments were aimed at the early recovery of the anatomical and physiological conditions of the injured joint. At more than six months follow-up, we evaluated the functional results using a modification of the Weber's method. The satisfactory results were especially obtained in the subjective assessment rather than the objective one.
We have tried manual reduction as the first choice in the treatment of the fractures of the calcaneus. If good reduction cannot be achieved by this method, we reduce the joint surface using the Westhues' method. Then K-wires are used for internal fixation. At two weeks postoperatively the patient is allowed to walk with PTB cast (modified Graffiin's cast). The clinical follow-up 14 patients was obtained. The clinical results were as follows: three excellent, cases (15 percent) eight very good cases (40 percent), one fair case (0.5 percent) and no poor case. This manual reduction is recommended for the initial treatment of the fractures of the calcaneus.
Twenty-four feet in 19 patients with fractures of the calcaneus treated by the modified Westhues' method were reported. Satisfactory results assessed by Furuoka's criteria were obtained in 75% of the cases at follow-up examination. Some cases of fair or poor results showed decreased Bdhler's tuber-joint angle and or comminuted fractures in sagittal plane.
An avulsion fracture of the calcneous is rare, and we have treated two such cases. One case was a 52-year-old man, who had been treated for liver cirrhosis and diabetes mellitus for 4 years. He felt pain in the left heel while walking and was unable to walk. Radiographs showed osteoporosis and an avulsion fracture of the left calcaneus. Three weeks later, this fracture equally occurred in the right side. We have treated both cases conservatively. The other case was a 50-year-old woman, who had been conservatively treated for 3 weeks for the left 5th metatarsal bone fracture. She fell from bicycle in pes equinus position, and felt pain in the left heel and weakness of planter-flexion. Radiographs showed bone atrophy and an avulsion fracture of the calcaneus. At operation, the tendon was found to be entirely attached to the fragment, which was reduced and held by internal fixation. At present, they have no pain and no gait disturbance.
A fifty-five-year-old man with diabetes of sixteen years' duration presented with swelling of the left ankle of insidious onset. He could not recall any specific traumatic event. Roentgenograms of the left ankle revealed an avulsion fracture of the left calcaneus. On the physical examination of this patient, pain sensation and proprioception were markedly depressed.
This paper presents analysis of the results of the treatment of ankle fracture. A follow-up study was performed on 40 of 65 cases of ankle fracture treated surgically between 1977 and 1984. The fractures were grouped into five types according to the classificassion of Lauge-Hansen. The subjective clinical results were good in 38 and fair in 2 and the objective clinical results were good in 34 and fair in 6 according to the Gregory's evaluation. The anatomical reduction affected significantly the clinical results.
We experienced 108 patients with facial bone fracture in the last four years. About 50 percent of them had nasal bone fracture, and about 20 percent had malar bone fracture. About 55 percent of them were caused by traffic accident. This time we report four cases of our experiences. In conclusion, the correct diagnosis and adeqbate treatment are important in the case of facial bone fracture.
Sixty-six patients with fractures of the proximal part of the humerus, attended our clinic between 1979 and 1983, were reviewed. The fractures were subgrouped according to Neer's classification. Fifty-five of these cases were treated conservatively, and eleven were treated surgically. The end results were evaluated according to Rowe's criteria. In this series as a rule eighty-six per cent achieved good or exceelent results. All cases in group I had good or excellent results. These cases were usually expected to have satisfactory results with a triangular sling followed by physiotherapy. In group III four cases of unreducible fractures were treated by percutaneous pinning using Kirschner wires. And these cases had better results than the non-operative cases.
We did a retrospective study of radial head and neck fractures in seven patients who had been treated in our hospital from 1972 to 1984. Three of the patients were children and four were adults. All of the children had radial neck fractures and were operatively treated without internal fixation. Of these 3 cases two had good and one had fair results. All adult cases had marginal radial head fractures. They were treated operatively with internal fixation using Kirschner wires or mini-screws. Of these 4 cases three had good and one had fair results.
Ten cases of delayed union and non-union of the forearm were treated in our clinic. Finally in seven of them, intramedullary nails and in another three, plates were used for internal fixation. We found that the Kuntscher nail was a good fixation device for forearm fractures with severe soft tissue injury, segmental fractures, comminuted fractures and multi-operated fractures, because of its less disturbance of regional circulation.
Many rediological investigations of the wrist joint have been performed by Linscheid et al. But difficult problems remain. For example, the positioning of the wrist joint, and determining the axis of each carpal bone. To stabilize the position of the wrist joint, we designed a simple support system and measured the wrist joint roentgenologically from A-P view and lateral view. We examined 38 normal wrists and 69 symptomatic wrists including scaphoid fractures, Colles' fractures, Kienböck's disease and others, and compared the results of normal wrists with those of symptomatic wrists. Consequently we found some interesting differences, for example, “DISI” changes in scaphoid fractures and Colles' fractures, and collapse deformity in Kienböck's disease.
This is a report on the operative treatment of cubital tunnel syndrome. We studied 55 cases which included 39 males and 13 females with 3 dupbications. Upon operating nerves were found to be constricted at Zone III. We found a pseudoneuroma at Zone II. Recovery was generally satisfactory, however, the cases caused by osteoarthritis of the elbow showed unsatisfactory recovery. This ends our discussion of Zone and MCV.
We report twenty cases of posterior interosseous nerve palsy; 6 cases accompanying Monteggia fractures, 3 cases of forearm fractures, one case of neuralgic amyotrophy, postoperation of ganglion, ganglion with epiphyseal osteochondroma of radius head, contusion, open injury, dislocation of radius head, and positioning of forearm respectivery, and 3 cases of unknown origin. The diagnosis of cause and lesion of the palsy requires detail anamnesis, examination, x-ray and EMG studies. Incomplete type showed extention lack of one or two digits only. The palsy accompanying Monteggia fractures should be treated by reduction or neurolysis before irreversible changes occur.
In order to examine the factors which influence the prognosis of the tardy ulnar palsy, the follow-up study was done. Materials consists of 64 cases which were terated with some operative procedures such as anterior transfer, the King's method etc. The postoperative duration of these cases ranged from 6 months to ten years (average; 3 years and one month). Clinical results at the last examination were evaluated by the modified Mizumura and Akahori's method. And the relationship between the results and the age of the patients, period from onset of symptome to operation, the degree of the preoperative palsy and the motor conduction velocity (MCV) were discussed. Good and excellent results were obtained 71.4% of 64 cases. These results were correlated with the age of the patients, period from onset to operation. However, the most important factor which decided the final results was the degree of the preoperative plasy. The statistical analysis showed that the result of cases with more than 41m/sec of MCV was better than that of cases with less than 20m/sec of MCV. But, it was difficult to conjecture the prognosis by using only the value of the preoperative MCV.
Among several factors which many cause tardy palsy of ulnar neve cubitus valgus following humeral fractures and arthrosis of the elbow are most common. On the other hand, Cubitus varus rarely induces tardy ulnar palsy. A male patient complaining of left tardy ulnar palsy visited our clinic, but on examination it was found that he had cubitus varus in both arms. In such a case, we believe that instead of dysplasia of the trochlea dysplasia of the humero ulnar joint should be diagnosed.
We restored the elbow extension power by posterior deltoid to triceps transfer (Moberg's method). Eight extremities in five functional C6 quadriplegic patients were operated by this procedure. According to the grading system of 0 to 5 points the average preoperative elbow extension power was 0.37. After surgery the average point increased to 3.6 at follow-up. One extremity showed deep wound infection and rupture of the grafted tendon with poor results. But most patients were satisfied and improved in their activities of daily living.
Thirty-one children with fractures of the lateral humeral condyle were reviewed. The age the time of injury varied from one to thirteen years and the follow-up period from eight months to eight years. Bone union was achieved in all cases. Clinically all patients had normal elbows, with a full range of motion and a carrying angle almost equal to that of the other arm. Radiologically mild fish-tail deformity was observed in sixty-five percent of the patients and this deformity occurred due to incomplete reduction of the displaced fractures. Those fractures with an initial displacement of the distal fragment of three millimeters or more is recommended surgical intervention.
We had experiences of operative cases of lateral condyle fracture of the humerus in children during the past 13 years. Our series consisted of 38 patients, in which 29 cases were boys and 9 were girls. Their ages ranged from 2 years to 11 years with the average of 6.1 years old. The fracture type was subdivided according to the Wadsworth (type I: 3 cases, type II: 12 cases, type III: 18 cases, unknown: 5 cases.). The Kirschner wire and/or Fencing nail (Pro. Yamoto's special divice) were used as the fixation materials. The satisfactory results were obtained in our all cases without any complications such as varus or valgus deformity, ulnar nerve irritation and the pseudarthrosis at the time of follow-up.
Dislocation of the extensor tendon in the hand was often found in rheumatoid arthritis. But traumatic, congenital or idiopathic dislocations were rare. A case of a 51-year-old patient with this legion who had no previous history of trauma and rheumatoid arthritis was reported. At operation, injuries of radial intertendinous fascia and sagittal band at the metacarpophalangeal joint were observed. The operation was successful.
out of 73 extensor tendon injuries in 44 cases, who were operated on during ten years period from 1975 to 1984, 47 tendons in 30 cases (20 males, 10 females) were evaluated. The mean age of these cases was 33.7 year-old, renged from 2 to 67-year-old. The average follow-up period was 3 years and 7 months, with the range from 7 moths to 9 years and 3 months. The evaluation was made according to Tsuji's method for zone 1 and zone 2, and for the region from zone 3 to zone 8, Doi's method was used. The results were as follows. In zone 1 and zone 2, excellent results were obtained in 7 of 12 cases, but the cases which underwent end to end suture at the time more than 2 months after injury showed poor results. In the region from zone 3 to zone 8, excellent results were obtained in 13 out of 18 cases. The results of the cases involved in zone 3 were poorer than those in the other zones, the cause of which was thought to depend on the P. I. P. joint injury and double lacerations of the extensor tendon.
Ninety-five cases (154 tendons) with the digital flexor tendon laceration were treated in our clinic from 1979 to 1984. Among these cases, there were 4 cases (4 tendons) of rupture after repairing of the tendon. All cases were adult. All tendons (one was in zone I, two in zone II, and one in zone III), were lacerated sharply and were repaired by the Tsuge's method (using a looped nylon suture) within 2 days after injury. Two tendons were ruptured during the period of the early motion therapy by the Kleinert's method, one during immobilization, and one after immobilization. Active flexion of the finger during the period of immobilization (2 cases), accidental powerful grasping (1 case), and passive extension of the finger (1 case), were the proximate causes of rupture. Loss of cooperation for the therapy on the side of the patient, and unadjustable cast were also to be considered as a cause, especially in the cases of early motion therapy.
Tenosynovitis in hand and finger is exudative or proliferative inflammation of tenosynovium. Clinically, it shows the symptom of local swelling, palpable tumors, motion disturbance of fingers in spite of its different causes. And it sometimes causes tendon rupture or nerve palsy. Diagnosis is made by clinical symptoms, laboratory data, bacterial and fungal culture and histopathology. We presented three cases of tenosynovitis associated with rupture of extensor pollicis longus tendon (Case No. 1) and carpal tunnel syndrome (Case No. 2). One case out of three was caused by tuberculosis. But in other two cases, clear diagnosis was not estabilshed even after such thorough examinations. In this paper, we discussed some problems of diagnostic process, and emphasized that tenosynovitis in hand fingers had possibility of causing tendon rupture and in carpal canal causing carpal tunnel syndrome regardless of its etiology.
Sixteen cases of complete rupture of the collateral ligament of the proximal interphaingeal joint of the fingers and metacarpophalangeal joint of the thumb, treated surgically, were reviewed. Twelve acute and two chronic cases were repaired by the pull-out method, one acute case was sutured at the middle of the ligament and one chronic case of thmetacarpophalangeal joint of the thumb was reconstructed by rerouting the extensor pollicis brevis tendon after Strandell. The results of the operation were satisfactory in 80% of all cases. No instability was seen by stress test, but range of motion was limited slightly in some cases. The factors influencing the results were considered to be age, complicated injury and the interval between injury and operation.
Eleven patients of Bennett's fracture-subluxation have been treated by operative method from 1969 to 1984. Seven of these patients were reviewed at the post-operative period from 15 years to 7 months. All except one had achieved full working capacity and did not complain of pain. Especially, two showed good clinical results in spite of incomplete reductions at the time of operation. Only one has been complaining of severe pain on motion due to severe destructions of articular surfaces of the 1st metacarpal bone and trapezium bone at onset.
We reported an extremely rare case with closed dorsal dislocation of the trapezium and the trapezoid, treated successfuly with open reduction and Kirschner wire fixa6ion. Clinical result was favorable at 6 months after operation.
Wrist arthrography can be helpful in the evaluation of the chronically painful wrist including rheumatoid arthritis and injury and more by visualization of the integrity of the triangular fibrocartilage and interosseous ligaments. This study was designed to demonstrate the pathomechanics of the rheumatoid wrist joint by showing the early synovial and cartilage changes one visible on plain film roentgenograms and by demonstrating how inflammatory changes progress with advancement of the rheumatoid process. Arthrography for the traumatic wrist pain, especially following sprain and Colles' fracture with avulsion of ulnar styloid, has suggested that these symptoms have been due to ulnar prestyloid synovitis and disfunction of carpal rotation.
Using Highet's criterion and Zachary's criterion for usefulness, postoperative therapeutic results were examined for 36 cases of median and ulnar nerve injuries (43 nerves) at the forearms. Operative procedures comprised epineural suture under microscopy (24 cases), sural nerve garfting (1 case) and epineural suture under macroscopy (11 cases). Results: In terms of microscopy or otherwise, definitery better results were obtained in the microscopic cases. From the viewpoint of primary or secondary suture, for incised wounds secondary suture can be expected to obtain as good a result as primary suture when performed within 6 months, and from the viewpoint of age and nervous recovery of the patient, very good results were obtained in all of the cases less than 10 years, while cases more than 40 years remarkably showed poor results.
Three patients (5 wrists) with severe rheumatoid arthritis have had arthoplasty of the wrist with Swanson's flexible hinge implant sine August of 1979. The review of the results of 5 wrists with 2 years and 9 months follow-up showed all of them to be remarkably free from pain, with improvement of the average arc of motion by 43° (before operation: 35°, after operation: 78°) and improvement of grip strength by 5.8kg on the average (preoperative grip strength: 2.6, after operation: 8.4kg). All the patients noted an improvement in ability to carry out and perineal care. We feel that wrist arthroplasty with silicone implant is preferable to wrist fusion for severe rheumatioid patients.
The prevalence of carpal tunnel syndrome (CTS) was studied in 270 patients on intermittent hemodialysis. The results were as follows; 1) Twelve (4.4%) of 270 patients had clinical signs and symptoms of CTS. 2) No notable difference in the prevalence of CTS was found between male and female. 3) There was no correlation between the time on dialysis and the incidence of CTS.
A case of electrical burn injury was reported. After coming into contact with high tension electrical current (20, 000 volt), severe electrical burns of bilateral forearms and lower extremity were evoked. Immediately, débridement of the wounds was made, however, circulation distrubance of the blood vessels arose, which enhanced degeneration and necrosis of the soft tissue. Within a month, three limbs amputations were done, and he was survived and recovered fortunately. The patient is doing training of prosthesis exercise at present.
Twenty cases of traumatic dislocation of the hip joint were followed up for six months to seven years. Of twenty cases, 8 were simple dislocations, 6 were fracture-dislocations, and 6 were central dislocations. The clinical results were satisfactory in 18 cases (90%). In simple dislocations, early closed reduction was acceptable. But in fracture-dislocations, the satisfactory results were obtained by additional operation, such as the removal of loose fragments or the internal fixation of the fragment of acetabulum, soon after the closed reduction. In our study, the traumatic osteoarthritis occurred mostly due to a loose fragment in the joint space. At the time of follow up study, aseptic necrosis of the femoral head was not seen.
The dorsal dislocation of the metatarsopharangeal joint is rare. Recently we have experienced a case of this dislocation at 3rd and 4th metatarsopharangeal joints. These dislocations could not be reduced by manipulation 3 days after injury, therefore, we performed open reduction.
We experienced nine cases of the distal tibiofibular ligament injury. The patients comprised of four fresh cases who visited our clinic within seven days after the injury and other five cases visited us later than a month after the injury. Among them, four cases were treated by operative procedure with tibia bolts, and other four cases by conservative treatment with plaster cast. One case refused our treatment. The result was as follows: All of four operated cases showed good results with very little discomfort, but no limitation in their activity of daily living. Three of conservatively treated cases showed excellent results without any complaints, and another one showed good results. The last one who refused our treatment showed poor results with limitation of ankle motions.
Operative findings and clinical course in a 79-year-old male patient with proximal dislocation of the talus without fracture of the fibula were reported with special reference to a new method of fixation of the tibio-fibular joint. The method is a wire loop fixation of the fibula to the tibia, which is considered to be preferred to a screw fixation.
Injuries to Lisfranc's joint are not common, but seem to be increasing gradually. We have recently experienced four cases of Lisfranc's fracture-dislocations. One of them was a rare case whose reduction had been prevented by the interposition of the anterior tibial tendon and surgical treatment had been necessary. The results of treatment were fair in 1. and good in 3. cases We discussed the mechanism, classification, and treatment of this injury.
We have experienced one case of voluntary dislocation of the head of the radius after traumatic dislocation. The patient was 14 years old. When the elbow was flexed and the forearm was supinated the anterior dislocation of the head of the radious was produced by contraction of the biceps. Annular ligament was reconstructed surgically, and a Kirschner wire was passed through the capitulum to enter the proximal radius with the elbow flexed, and a plaster was applied. The plaster was retained for five weeks, after which the wire was removed. Five months later, the patient was free of symptoms and the elbow was stable with a full range of movement.
Intensive use of the muscles in the anterior or lateral compartments of the leg may increase the pressure within these spaces. A significant increases in intracompartmental pressure may lead to disturbances in the circulation of the enclosed muscles. In these instances, an objective measure of intracompartmental pressure may assist the physician in the evaluation of a possible chronic compartment syndrome. Intracompartmental pressure in the leg was measured continuously during running in five patients who had an anterior chronic compartment syndrome using the wick catheter technique. All of the patients were athletes and had pain with exercise. The average pre-exercise pressure in the anterior compartment was ten millimeters of mercury. However, the intracompartmental pressure was increased during running to sixty-three millimeters of mercury on the average. After fasciotomy complete relief of pain has been obtained in all of the patients.
Over 18 months have passed since we experienced 7 cases of neurovascular injuries in the upper arm during the past 12 years. An account is given of their follow-up. A ges of the patients at injury vanged from 13 to 52 years, averaging 31.9. Injuries were induced by contusion in 4 cases and by clean cut in 3 cases. Injured vessels and nerves consisted of brachial artery and vein, median nerve, ulnar nerve and radial nerve in 3 cases and of brachial artery and vein, median nerve and ulnar nerin 4 cases. Time of flow inhibition was from 2 to 9 hours, averaging 4 hours and 42 minutes. All cases received neurovacular primary repair. Neurorrhaphy was always epineural and 2 cases of vascular suture needed vein graft. Examination of the results led to the following tendency: the lower the age at injury was, the more favorable the nervous recovery was and the longer the time of blood flow inhibition was, the worse the result was, and especially those cases with such time over 6 hours and great local damages such as incomplete amputation showed poor prognosis with Volkmanns contracture. As various authors described, in terms of injuried condition, cases of clean cut showed better results than those of contusion, and the former cases ours showed more than S3M3.
From January 1971 to July 1984, 224 cases of Charnley's THR were performed in our department, of which 4 showed deep infection. The purpose of this report is to discuss about the findings of the early signs of the infection and its medical management. The first clinical symptom of the infection is pain at rest and the characteristic laboratory finding is a high E. S. R. level. The X-ray and bone scintillation diagnosis are of effective help in the early discovery of the disease. The first step in its medical treatment is complete curettage at the first opportunity of surgical operation. Removal of prosthesis and of bone cement are important and should be included in its treatment.
Five femoral shaft fractures occurred in 221 hips after Charnley total hip replacement. Four of five fractures were fixed with the K-U plate; of three fractures bone grafts were added. It was possible to insert screws into the bone in the presence of cement and stem, and to get rigid fixation of the fracture site. Bone union was completely achieved in all of the cases. Altyough a lot of methods have been reported in their management, we considered that fixation with the plate is more useful than other methods.
The Bateman Universal Proximal Femur is a unique dual bearing femoral head prosthesis. Primary articulation theoretically occurs at the inner bearing and secondary articulation occurs at the outer bearing. So we evaluated clinically the movement of the inner and outer bearing at abduction without bearing weight, using the A-P roentgenogram. Results: 1. In most cases, the average degrees of the inner bearing motion is slightly more than that of the outer bearing motion, but the inner bearing motion is less than the outer bearing motion in the following cases: old patients, patients with clinically bad findings and short post-operative durations. 2. Outer head motion occurs at 10 degrees abduction under the theoretical limits of the inner bearing motion.
Twenty-six cases (15 cases with osteoarthritis of the Knee and 11 cases with the knee of rhematoid arthritis) were treated by Okayama knee prosthesis (Mark II), In this review, tibial components were tilted medially by 3 degrees on the average and Femoral Tibial Angle was 174 degrees on the average in our cases. Clinically the cases within the limits of 0-7 degrees for medial tilting angle of tibial component and 169-176 degrees for Fomoral Tibial angle were good and excellent. The cases retaining the anterior cruiate ligament were stabilized more than a the cases sacrificing the cruciate ligament in a short term.
We already studied the effects of concomitant administration of 1, 25(OH)2)D3 and (Asu1.7)-eel calcitonin (Elcatonin) to rats treated with EHDP on the healing process of non-immobilized fractures of tibia and reported the promotion of calcification by 1, 25(OH)2D3 and Elcatonin in that fracture callus. In this experiment, we also found that various patterns of injective time of 1, 25(OH)2D3 or Elcationin with EHDP resulted in the promotion of mineralization and calcification of newly formed bone and caltilage of the callus in comparison to rats treated with EHDP alone at 14 days after fracture. However the pattern of calcification by 1, 25(OH)2D3 was different from that by Elcatonin. And these phenomena suggested the different mechanism of their promotion of calcification in fracture callus of rats treated with EHDP.