The patients with lumbar disorders were studied by colour thermography of the lower extremities. In the lumbar disc herniation 15 (71.4%) of the 21 patients had the cold area at the affected extremities. Thirteen (86.7%) of the cold area positive group had muscle atrophy at the affected extremities or buttocks. And the positive group had longer duration from onset and were older. Significant difference in the extent of pain was not found between the two groups. In the other disorders, some patients had positive findings and the others had normal thermogram. This study showed, in general, the tendency that the patients without neurological deficit had normal thermogram.
Twenty-nine patients with spinal disorders were examined in order to try to estimate the muscle atrophy of the upper and lower extremities by computed tomography. The main levels of cross-sectional images for measurement were the mid-points of the upper arms and thighs. The results were as follows: 1. A basic study using canine muscle revealed that the optimum window level was 50-100 and window width was 400-500, respectively. 2. Each muscle of the upper arm and thigh can readily be identified, but that of the forearm and the leg can hardly be defined under computed tomography. In conclusion, the mesurements of the muscle atrophy using the computed tomography were available for quantitaive analysis in some spinal disorders.
Fourteen patients with low back pain were studied using MRI (magnetic resonance imaging). The findings being concerned in the operation, myelogram, metrizamide CT and the plain roentgenogram were compared with MRI. Saturation recovery (TR=500msec) and calculated T1 image (T1=200msec, TR=1000msec) were mainly used. The results are as follows. 1) Intervertebral disc herniation seems to be able to be diagnosed. 2) Lumbar canal stenosis was difficult to diagnose because of the low signal intensity of the posterior elements of the vertebrae. 3) Caudal tumor was differentiated from the caudal nerves. 4) MRI will be able to take the place of myelography and CT.
F wave and H wave were elicited from gastrocnemius in 17 children with spastic cerebral palsy. In the comparison of parameters on the greatest responses of both; the persistence, latency, duration and its ratio to M wave in F were approximately equal to H, but H amplitude and its ratio to M were three times as large as those of F wave. It may be concluded that spasticity should be rather diagnosed by analysis of the greatest H wave.
In the vertebral anomalies, congenital synostosis of the cervical vertebrae is not uncommon. In 1912, Klippel and Feil examined a patient with the unusual clinical findings of marked shortening of the neck, low posterior hairline and severely restricted neck motion. Since that time, it has been well known as Klippel and Feil syndrome. During past 3 years, we treated 4 cases surgically which showed cervical disc herniation and cervical spondylotic radiculopathy in the adjacent vertebrae. All cases are male with age range from 45 to 72 years old (average 52). Congenital synostosis of C3-4 vertebrae was seen in 2 cases, C4-5 in 1 case, and synostosis of occipit to CI, C2 in 1 case. Except one case, cevical disc herniation and cervical spondylotic radiculopathy was found in the disc space below the synostosis of cervical vertebrae.
Between April 1976 and March 1985, 94 patients who have myelopathy and radiculopathy with cervical spondylosis were treated by anterior interbody fusion and laminectomy. Postoperatively, six of these patients were identified as another disorders of central nervous system. These disorders were motor neuron disease, multiple sclerosis, intramedullary tumor, metastatic brain tumor and cerebral vascular accident.
Incidence of upper cervical spondylotic myelopathy is quite rare. This is to analyse clinically and roentgenographically 10 cases with C3-4 cervical spondylotic myelopathy in our series, and to discuss the mechanism of occurrence of this disorder. There are 8 males and 2 females, ranging in age from 29 to 63 years (average 46.9-year-old). In general, early diagnosis and treatment was made due to prominent and characteristic symptoms and signs. Queckenstedt' s test in CSF examination showed high rate of positive findings and myelograms confirmed the level of this disorder. X-ray findings revealed that there existed developmental canal stenosis of the cervical spine, and the canal was the most stenotic at the level of C3 and C4. Disc narrowing and retrolisthesis were also found at the level of C3-4. One of the characteristic findings was steep inclination of the facet joints at the level of C2-3 and C3-4. Through this study the mechanism of occurrence of CSM at the level of C3-4, which is quite rare, is suggested to be that on the basis of developmental canal stenosis, especially at C3 and C4, the spinal cord is compressed by degenerative changes of the level of C3-4 such as disc narrowing and retrolisthesis, and that the steep inclination of the facet joints may be one of the factors causing disc degeneration.
239 cases with the cervical spondylotic myelopathy were divided into three groups according to age (less than fifty years old, the fifties, more than sixty years old), and we analyzed the clinical features of the three groups, with special reference to the problem of treatment on the group of more than sixty years old. Following results were obtained. 1. The degree of myelopathy was most severe in the aged group (more than sixty years old). 2. Most cases of the aged group had muscle atrophy of the upper limbs and complained of gait disturbance. 3. In the group of less than fifty years old, spondylotic change was mild and cervical spinal canal was narrower than that in other groups. 4. Post-operative results of the aged patients were not necessarily good in the three groups because duration of the history was longer and improvement potency of the spinal cord was inferior in comparison with other groups.
It is difficult to diagnose a main lesion of cervical spondylosis in consideration of neurological findings when there are several abnormal findings in cervical myelography. We could diagnose 12 cervical disc herniations correctly by CT myelography after cervical myelography and treated them by anterior spinal decompression and fusion. They recovered remarkably. Therefore, we reported 12 cases of cervical disc herniations and utility of CT myelography.
After taking the grafting bone from the iliac crest in the anterior spinal fusion, we sometimes find the bad-looking skin hollow due to the bone defect. Filling up the defect with the alumina ceramic spacer, we find the patient free from the ugly dent and postoperative pain of the ilium at position change.
The causes of senile round back are spinal osteoporosis, disk narrowing, back muscle atrophy and others. We investigated 50 cases of senile round back (male: 13 cases, female: 37 cases, mean age: 73.0 y. o.). They are classified into 2 groups according to the type of round back, namely, 1) the upper group in which the apex of kyphosis is located in the middle thoracic spine, and 2) the lower group in which the apex is in the thoraco-lumbar junction. The cause of round back of the upper group mainly disk narrowings, and that of the lower group is wedged vertebral bodies. Power of the back muscles in the upper group is stronger than that of the lower group.
Twenty-seven patients with complete block in lumbar metrizamide myelography were analysed to ascertain the mechanism of block and the difference of surgical results btween anterior and posterior approaches. The cases of tumor were excluded. The mechanism of complete block was thought to be the combination of various factors including redundant nerve root, adhesion, fibrosis, huge central disc hernia, sequestrated disc hernia, hypertrophy of facets, lamina and yellow ligament dagenanation epnndylnliathnino, and dynanin instability. The results of anterior approach are better than those of posterior approach, and the results of multiple operated back are worse than that of posterior approach. Even though complete block is present in myelography, the anterior approach is recomended, if main lesion consists of anterior portion (disc, displacement, instability) and the case is younger than fifty years old and lesions are less than two intervertebral levels.
The records of thirteen patients were analysed with reference to symptomatology, objective findings on neurological examination. The symptoms with which these patients presented can be divided into four groups; a) intermittent claudication-six cases, b) objective signs of root compression plus a) -five cases, c) unilateral or bilateral pain and numbness in the leg-one case, and d) low back pain only-one case. The facetectomy was unilateral in fifteen facets and bilateral in twelve. Ten patients had unilateral or bilateral decompression at two levels of intervertebral space. The symptoms most frequently relieved were pain in the leg, intermittent claudication and low back pain.
Since 1979 54 patients of lumbar spinal stenosis have been operated on in our clinic. Follow-up study was carried out in 48 cases. The sesults were classified as excellent in 11 cases (22.9%), good in 15 cases (33.3%), fair in 8 cases (16.7%), and poor in 13 (27.1%). On the whole, we couldnot always obtain good results. We considered the causes of poor results as the deficiency of laminectomy levels and width and postoperative instability etc..
There are many problems in stabilizing lumbosacral junction posterioly in spite of the progress of spinal instrumentation such as Harrington and Knod rod. Recently we tried to use Luque segmental spinal instrumentation (LSSI) on eight cases to stabilize the lumbosacral junction. LSSI showed remarkable stability, and it reduced the period of postoperative bed rest. We reported these eight cases, and discussed some advantages and problems of the procedure. The eight cases, three males and five females, consisted of seven cases of spondylolisthesis and a case of lumber spinal canal stenosis. These were fused from one segment above the lesion level to sacrum with bone graft to the posterior or posterolateral aspect the spine. The patients were permitted to get out of bed and ambulate in a couple of weeks with soft brace. All cases obtained improvement in pain, claudication and neurological disturbances. Although most cases of spondylolisthesis obtained good correction initially, some cases showed loss of correction gradually.
We have experienced four cases of transpedicular Slot instrumentation for the stabilization of the lumbar spine. Posterior decompression and stabilization are necessary to the stenotic lumbar disorders with instability. This surgery has been performed on two cases of lumbar spinal canal stenosis with degenerative spondylolisthesis, one case of disc herniation with degenerative spondylolisthesis, and one case of pedicular kinking associated with asymmetrical disc collapse.
The authors present a case of intraspinal neoplasm with OPLL in the cervical spine associated with myelopathy, which was identified by myelography, CTM and enhanced CT (axial and saggital reconstruction). The intraspinal tumor was extirpated under the surgical microscope. The literature was reviewed and clinical aspects of these cases were discussed.
A 36-year-old man suffered an injury in the back in an automobile accident in March, 1984. A month thereafter, he complained of numbness in the chest and was admitted in July, 1984. Neurological evaluation revealed hyperreflexias in bilateral lower-limbs. There was hypesthesia distal to the level of T-4. A myelogram showed a block in the region of C-7 through T-2. A laminectomy was performed and the dura was opened. A cyst, 5cm in length and 1cm in width, was found anterior to the cord and removed. Histologically, the cyst wall was lined with colmnar epithelium of intestinal type and PAS staining was positive. After operation, he was discharged with relief of symptoms.
Four cases of giant-sized cauda equina tumor are presented They had had a long history of sciatica before a definite diagnosis was made. We thought it was impossible for complete removal to be done in surgery. Without increasing palsy because of a large-size tumor mass and adhaesion of ne rye roots fiber with and remained in partial resection with decompressive laminectomy. In one case only postero-lateral fusion was done for prevention of spinal column collapse. It can be thought that even only decompressive surgery is beneficial to improve symptoms for a long time in such cases.
Autopsy was performed in 9 patients who had had metastatic lesions in the spinal column, and we examined histologically to study neuropathology of the spinal cord lesion. In those of myelopathy, necrosis and degenerative changes were recognized extensively in the spinal cord. It was found in one case that tumorous tissue invaded into the spinal cord penetrating the dura matter at the involved segment, in those with radicular pain were seen a marked degeneration of the posterior nerve root and demyelinization of the upper tract in the spinal cord.
Primary spinal column and cord tumors, treated in the past 10 years, were listed. There were 23 cases of the former and 23 of the letter. Of these tumors, recurrent or malignant ones were picked up. Especially interesting 5 cases were presented in detail and discussed. Case 1, a 67 years old male; sphenooccipital chordoma, originating from the lower clivus and projecting into the foramen magnum. Case 2, a 79 years old male; sacrococcygeal chordoma, originating from the lower sacrum and projecting into the pelvic cavity. Case 3, a 45 years old male; thoracic giant cell tumor, originating from the 7 & 8th vertebrae and invading into the left thoracic cavity and the spinal canal. Case 4, a 48 years old female, cauda equina neurinoma, which arose multiply like a cluster of grapes. Case 5, a 62 years old male; multiple myeloma, which transformed from solitary cervical myeloma. Case 5 is dead and the others are alive. Case 1, 2, 3 and 5 relasped after excision and radiation. These tumors including that of case 4 became progressively larger in size and more invasive into the adjacent tissue. The method of treatment was searched, however, it was not found.
One staged anterior-posterior decompression and fusion for the old traumatic deformity of cervical spine are evaluated. Ten cases of the old traumatic deformity of cervical spine were operated on. Nine are male and one is female. The type of injuries are as follows; six fracture-dislocations, three burst fractures, and one subluxation. Average length for operation is about 4 months. Operative methods are as follows; one staged anterior-posterior decompression and fusion in eight cases, anterior decompression and fusion in two cases (Hallo brace was used in one, and A. O. cervical plate were used in the other). The following results are obtained; pre-operative kyphotic angle ranged from -4.5° to 43.5° (average; 22.9°), post-operative kyphotic angle ranged from 2° to -5°(average -1.95°), pre-operative translation ranged from 0mm to 5mm (average 1.0mm). None of the cases deteriorated neurologically following the operation. Indications for our treatment to the old traumatic deformity of cervical spine are; 1) pain which causes ADL disturbances, 2) deformity, local kyphosis, locked facet, and 3) neurological deficit. The authors recommend that one staged anterior-posterior decompression and fusion is useful for the treatmentof old traumatic deformity of cervical spine.
Cephalohematoma is common, but spinal cord transsection is rare in the newborn. Breech position with hyperextension of the fetal head is called “star gazing fetus”. If such a fetus is delivered vaginally, spinal cord transsection occurs frequently. Recently we have experienced a case of “star gazing fetus” which was discovered by prepartum roentogenogram. This case was delivered vaginally. Because spontaneous breathing did not occur, intubation and IPPB were started, and upper cervical spinal cord transsection was diagnosed. This case is still alive on an IPPB, and is now one year and 9 months old.
We studied the consequenses of the patients, who had the stable thoracolumbar fractures treated without reduction, and who were not older than 60 years when they were injured, and were not accompanied with neurological deficits or severe complications. The number of the patients were 23, (male: 15, female: 8, average age: 40 years). The periods of follow up are 4 to 8 years (average: 5 years). The results showed that 19 of 23 patients have no symptom. Four patients who have mild lumbago seem to be related to secondary spinal kyphosis. We are impressed that the stable thoraco-lumbar fractures need not necessarily be reduced, but that we should pay deliberate attention to spinal alignment.
Chance fracture was described in 1948, consisting of the line of disruption passed entirely through bone, a horizontal fracture line extending across the vertebral body and continuining posteriorly through the pedicles, transverse process laminae, and spinous process. This fracture commonly occurs in the first lumbar vertebra to the forth lumbar vertebra, and neurological complication is unfrequent. Our case occurred in the twelfth thoracic vertebra, and there was no neurological complication. Our patient stayed in bed for two months after which he was mobilized, wearing thoracolumbar cast. He was discharged about three months after odmission with instructions to remove the cast after eight weeks. At five months radiographs showed consolidation of the fracture, in spite of kyphosis of about 20°. Now seven months later the patient is free of symptoms and he comebacks business.
Our purpose of surgical treatment for injured spine is reduction, decompression, and stabilization. And this method is effective in early rehabilitation and nursing care of injured patients. From June 1979 to December 1985, 138 injured patients were operated on by use of Harrington instrumentation. Among them, 134 patients were followed up for 6 months after the operation. We studied instrumentation failure (dislodgement or loosening of hook, etc.) in roentgenography. 30 patients operated by distraction rods, mainly two distraction rods, showed failure. Frequency of failure was 32% in the round ended type and 24% in the square ended type. 9 patients by compression rods showed failure (52%). Harrington instrumentation of double distraction rods with segmental spinous process wiring was effective in patients with spinal injury to perform early rehabilitation with a light brace. Failure of instrumentation in this method didn't bring remarkable loss of correction to require reoperation.
We examined the shoulder function of the 458 aged (50-80) and 1264 children (6-12) who had no complaint about their shoulders. The purpose of this study is to determine the normal limit of ROM, muscle power and instability for criteria of shoulder functions. Holding the dumbbell in 90° elevation, serial elevation of the shoulder, and ROM were evaluated in each age group. In addition, inferior instability of the shoulders were examined in children. Shoulder function of the aged seemed to be dependent on personality rather than their ages. All the children have had full ROM, but muscle power was influenced by their age. 4.7% of children has inferior instability of the shoulder.
The treatment of complete dislocation of the acromioclavicular joint (Tossy Type III) has been the subject of continued controversy, as indicated by the large number of both surgical and nonsurgical modalities. Eight cases of arcomioclavicular dislocations were treated by modified Dewar's procedure and followed up for more than 6 months. They included 6 males and 2 females who fell on the point of the shoulder. The age at injury ranged from 15 to 51 years with an average of 29.1 years, and the follow-up period ranged from 6 months to 1 year and 8 months with an average of 1 year. In all patients the range of motion of the treated shoulders was not limited, and they did not complain of pain on motion. All patients experienced no problem on ADL and obtained complete return to previous activities. This study showed that the modified Dewar's procedure was widely indicated for the complete dislocation of the acromioclavicular joint.
Four patients were operated following Boytchev's procedure between 1984-1985. There were 4 males, whose ages ranged from 18 to 39. All cases were affected on one side. One patient had recurrent dislocation after the operation and the mean value of limitation in external rotation was 15 degrees compared with the unaffected side. One patient had a joint mouse in the gleno-humeral joint. We immobilized the affected shoulder for 3 weeks by Desault bandage after the operation. We experienced the temporary musculo-cutaneous nerve paresis in two patients. We could follow up three cases, who had no disturbance in ADL.
Recurrence after primary traumatic anterior dislocation of the shoulder is common. The rate of recurrence is generally thought to be about 20%, and to be related to factors of age, force and situation of injury, length of immobilization complications of primary dislocations, and instability of the shoulder joint. However, a case of recurrence is still a matter of speculation and few reports to be concerned with the rate of recurrence of primary dislocation have yet been in Japan. About 170 cases were assesed at our University and neighboring hospitals, and the relation between primary dislocation and recurrence were investigated. We studied and examined 104 cases of traumatic dislocation, age, force and situation of injury, length of immobilization, complication of dislocation, and of 66 cases of recurrence, we studied the situation of primary injury and interval of recurrence.
The frequency of deterioration toward Recurrent dislocation of the shoulder is approximately 20%. Recurrent dislocation is likely to occur in the patients with joint laxity and especially in youth who had unproperly short length of immobilization, however, as for the aged, recurrent dislocation is rarely seen. The research is performed this time on the cases of over 50-year-old to find the relationships between traumatic dislocation and recurrent dislocation of the shoulder. The items of research are as follows; condition of injury, length of immobilization, the number of times of dislocation, joint laxity, Hill-Sacks lesion, and Bankart lesion. As the results, the cause of recurrence in our five cases seems to be by Hill-Sachs lesion rather than joint laxity.
Peroneal compartment syndrome secondary to rupture of the peroneus longus muscle is very rare, with only two previously reported cases. We recently experienced a case suffered from peroneal compartment syndrome secondary to rupture of the peroneus longus muscle in the volleyball game. A twenty-six-year-old male sustained an inversion injury to his left ankle when he was about to jump for spiking in playing volleyball. He complained of severe pain and numbness along the lateral aspect of the left leg, ankle and dorsum of the left foot. The ankle was immobilized with a plaster splint and he was given sedativa, but we saw no effect. An energency operation was done approximately twenty hours after the injury. After the tensed fascia was incised, abundant clot and hemorrhagic debris were evacuated from the lateral compartment. Further inspection revealed complete rupture of the peroneus longus muscle. End to end suture of the muscle was performed. Eleven months postoperatively the peroneus longus muscle power is rated as fair and his sensation has fully returned. He is again working.
A case of a 20-year-old distance runner who had iliotibial band friction syndrome is reported. The patient was treated conservatively for six months, but his symptom continued. Therefore, we performed operative treatment, which is the open-window method of iliotibial band at the site of lateral femoral epicondyl. He has returned to full sports activity as a distance runner.
Soccer is a dynamic contact and collision sport that exposes players to many dengerous situations and possible injuries. We investigated soccer injuries of Nippon Steel Corporation's soccer team and Recreational games. Contact play, tackling and kicking are most dangerous.
14 cases of spinal injury caused by sports are reported. They are all addmitted to our hospital and underwent medical treatments from June in 1978 to April in 1985. 13 cases are cervical injuries and only a case is thracolumbar injury caused by gymnastic exercises. The causes of injury depend on those kinds of sports as follows; 6 cases by diving into shallow water, 3 cases by “back drop” which is a trick of wrestling, 2 cases by gymnastic exercises, and one case each by rugby, football, skating and hangglider respectively. Types of fracture are as follows; 9 cases of fracture-dislocation, 3 cases of burst fracture, and one case each of compression fracture, tear-drop fracture, and disc injure respectively. Mechanisms of injury are considered as follows; 10 cases of flexion injury, 2 cases of extension injury, and one case each of vertical compression and unknown. On all cases were performed operations.
Fracture of the clavicle is a common injury, although, simultaneous fracture of outer and inner ends of the same side is thought to be rare. We experienced such a rare case. A 48-year-old man fell down and contused the head and the right shoulder under the druken condition. On admission, one day after the injury, he was diagnosed roentgenologically and clinically as having fracture of the right occipital bone with epidural hematoma and the fracture of outer and inner sides of the right calvicle. Eight days after injury, osteosynthesis; plating for outer end and tension band wiring for inner end, were carried out with favourable results. Brief discussion on the fracture mechanism was made.
We reported a case of voluntary posterior dislocation of the elbow which occurred after simple traumatic dislocation. A 10 years old boy, who had had the traumatic dislocation due to a fall, visited us at Goto Chuo Hospital complaining of dislocation of the left elbow. On examination, he could voluntarily dislocate his elbow at the position of 30° flexion and pronation of the forearm. Stress roentgenogram suggested the laxity of lateral collateral ligament. In electromyogram, discharge of the brachioradialis and triceps muscles was observed at the time of voluntary dislocation. On this patient, we performed transplant of biceps tendon to the coronoid process and release of brachioradialis muscle at its origin. Five months after operation, instability of the elbow joint has disappeared. It may be considered that this voluntary dislocation of the elbow occurred by the activity of brachioradialis muscle under existence of the lateral collateral ligment laxity.
In a 5-year period, 45 children were admitted to our hospital with supracondylar fractures of the humerus. Twenty-nine cases were followed postoperatively for an average of 29 months. In most of the cases, closed reduction was tried under general anesthesia. If satisfactory reduction and stability were obtained, the fracture was immobilized in a plaster with the elbow in an acute angle of flexion and the forearm in supination. If a stable reduction could not be obtained, the fractures were fixed with percutaneous K-wire pinning and a plaster with the elbow in a right angle. The end result was considerably better than previously reported results.
Seventeen cases with fracture of the medial epicondyle of the humerus were treated during seven years from 1978 to 1985. Out of 11 cases which were followed up over 2 months, 4 cases had slight limit of extension. Radiological findings revealed that 3 cases had change on epicondylar groove and 2 cases had pseudarthorosis which was caused by imperfect reduction at operation.
Stable distal radial fracture of the Coles type are, as a rule, easily reduced by traction and manipulation. However, maintenance of reduced position of severely comminuted fracture (Gartland type III) in a plaster cast alone is quite difficult. We reported the results of 16cases of comminuted fracture of the distal end of the radius, which were treated with Hoffmann-C type external fixation. According to the point system of Saito and Sibata, 88.9% of 16 cases had good or excellent results. Applying the method to assess the anatomical result by Sheck, 75% of the patients showed excellent results, 25% good results. In conclusion, Hoffmann-C type external fixation is recommended for comminuted fractures of the distal end of the radius.
In order to clarify roentgenographical diagnosis of ankle instability resulting from lateral ligament injury of the ankle, morphological measurements of the anterior talofibular (ATF) ligament and the calcaneofibular (CF) ligament were performed utilizing thirty-three cadaver ankles and six amputated ankles. The ATF ligaments of sixteen ankles were cut and changes in ankle instability which were influenced by the application of force and the position of the ankle were observed. Then the CF ligament was also cut and changes in ankle instability were again noted. In taking stress roentgenograms of the anterior drawer test and the varus stress test, it may be desirable to keep the ankle in a neutral position and apply manually a force of more than 10kg. In the above mentioned situation, it is suggested that the anterior drawer test is mainly related to the condition of the ATF ligament and the varus stress test to that of the CF ligament.
In this paper, the late results of epiphyseal injuries of the ankle were reported and the factors influencing the results were discussed. Twenty epiphyseal injuries were treated at Nagasaki Rosai Hospital from 1959 to 1984. Sixteen of the series of them were followed up for one to fourteen years. On examination, the clinical results such as pain, walking ability, range of motion and the radiological results such as malleolar hypertrophy, length discrepancy of the tibia were evaluated. According to the Salter-Harris' classification, the patients were devided into Type I: two cases, Type II: seven, Type III: seven, and there was no relationship between the types of injuries and the clinical late results. Radiologically, however, malleolar hyper-trophy was observed in all of the five cases of Type III (adduction type), and length discrepancy of the tibia was seen in low-aged patients, but these radiological abnormarities had no clinical significance. In conclusion, the satisfactory prognosis in this series may be due to the facts that there was no case of Type IV and V injuries, most cases were in adolescence (10-15 years of age), and the good reduction was achieved in all of the cases.
Juvenile Tillaux fracture is rare. It is an isolated fracture of the lateral portion of distal tibial physes and is a Salter-Harris type III fracture. The fragment is pulled by the anterior inferior tibiofibular ligament when the foot is externally rotated. We reported a case of a 12-year-old female who required open reduction of the fracture after closed manipulation failed.
Talus fracture is an unusual injury. But the treatment of the fracture is difficult and it is said that the prognosis is poor, because of the complication of avascular necrosis and osteoarthritis of the ankle and subtalar joints. We have reviewed 27 tales fractures which were treated during the year 1970 to 1984 at Kyushu Rosai Hospital. From our results, we recommend that the fracture-dislocation of the talus be treated by anatomical reduction and internal fixation. Following good anatomical reduction of a fracture-dislocation of the talus associated with avascular necrosis, a result is not necessarily poor, if a collapse is prevented by a regular check of X-ray view.
103 cases (106 joints) of malleolar fracture of the ankle were treated during past nine years in our hospital. 67 cases (70 joints) were followed-up for more than six months and their prognosis was studied. The results were good in 49 joints, fair in 14 joints and poor in 7 joints. We conclude that anatomical reduction, rigid internal fixation and eary joint movement are the principal points of treatment to prevent secondary osteoarthritis.
18 patients who had Sudeck's atrophy of the foot, were treated with intravenous injections of a solution of 1% xylocaine and solu-medrol followed by standard physical therapy. The results were excellent or good in 14 extremities (77.8%) and poor in 4 (22.2%). The causes of Sudeck's atrophy were femur fr. in 1 case, lower leg fr. in 6, foot fr. in 9 and foot trauma in 2. 14 cases had clinical findings only, while 4 had clinical findings with radiographic changes. Clinical findings appeared at ave. 5.8ws. after trauma and radiographic findings appeared at ave. 8.4ws. after trauma. We reported both clinical and radiographic findings.
On the treatment of soft tissue injuries of the face, the correct orientation is important in primary repair. Especially, in eyelid, nose, and lip injuries, it is more difficult to repair old cases than fresh cases. In this paper we report five cases of our experiences.
We report 6 cases of hyperbaric oxgen therapy for crush wounds. Although it has long been recognized that wounds are hypoxic, the critical role of oxgen in healing has only recently been appreciated. Tissue PO2 level in wound can be raised by inhalation of 100%O2 at 2 A. T. A. and increased tissue PO2 accelerats wounds healing by correcting tissue hypoxia. We think that hyperbaric oxygen therapy is effective as one of the supportable treatment for the crush wounds.
Ruptures of both quadriceps tendons are relatively rare injuries. Especially, spontaneous and simulataneous rupture of the both quadriceps tendons is a rare condition. The presented case is a patient with chronic renal failure treated by hemodialysis and secondary hyperparathyroidism with spontaneous and simulataneous rupture of both quadriceps tendons. The patient was treated by surgical repair of the both tendon ruptures with a satisfactory return of function. Hyperparathyroidism may be a predisposing condition for the rupture.
A thirty-four-year-old man with bilateral simultaneous rupture of the quadriceps tendon is presented. On the review of the literatures the authors suggest that the rupture seen in patients on chronic haemodialysis should be separately discussed from that with other predispositions.