Fiftten patients of fracture of the femoral shaft had been treated by closed Ender nailing between 1980 and 1984, and fourteen of them were followed up. Postoperatively, all patients obtained excellent alignment of fracture fragments and started full weight bearing by use of the functional brace from the early stage. All the patients obtained solid union with good functional results. There was no significant complication. Ender nailing can be a useful method for the fracture of the femoral shaft.
Thirty-six comminuted fractures of femoral shaft in 35 patients were treated for the last 3 years, 26 patients being male and 9 female. The follow-up period was 10 months in an average ranging from 6 months to 3 years. The fractures were caused by trafic and labor accidents in 91%. Open fracture was numbered 10 and 29 fractures were complicated with multiple trauma. The fractures were classified into 6 types after Aoyagi in order of severities of comminution. Operative treatments including, intramedullary nailing and their combination should be individualized according to the types of fractures. Clinical history of a patient with multiple trauma treated by external fixation followed by Ender's nailing was reported.
Fractures of the distal end of the femur in adult are not common and not easy to treat because of their sites near to the knee joint and difficulity in getting rigid fixation. Thirty cases of this fracture were treated operatively in our hospital in the last nine years, 26 cases were by A-O condylar plates, 3 cases by Ender's nails, one case by A-O cancellous screws. According to the knee rating scale by Insall et al, the results of treatments were analyzed in this study. The results were as follows; excellent; 34.8%, good; 39.1%, fair; 8.7%, bad; 17.3%, and failure; 0%.
This is a report of two cases of a dislocation of the knee with the compound fracture of the femur and tibia. One, a 28-year-oldman, was thrown from his motor-cycle when trying to avoid a sign post. He sustained a postero-lateral dislocation of the left knee, and a displaced compound fracture of the medial femoral condyle. The other case was a 49-year-old man who sustained a lateral dislocation of the right knee associated with a compound fracture of the proximal end of the tibia. Open reduction and internal fixation were performed on both cases. One patient could perform all daily activities and complained of no pain. But his range of motion of the knee was restricted to 60° of flexion. The other had a peroneal nerve palsy of which the fuction had returned after exploration. He developed osteomyelitis of the proximal end of the tibia three months after surgery. He was treated by a curettage of the wound, and cephalosporin therapy have been continued.
Tibial fracture is the most popular fracture of the long bones. We carried out Ender nailing in 10 patients of tibial shaft fracture. Of the present group of 10 patients, 8 were men and 2 were women, and they were from thirty-three to eighty-three years of age. The 5 cases had open fractures, while the rest of them had closed fractures. It took about one hour on the average to operate on them. We used the method of weight bearing X-P on 7 cases of the patients. As a result, we found that two Ender nails could bear 20kg load and three Ender nails could bear 30kg load. Therefore, we may allow early weight bearing. In the cases of the patients without complications, we start the treatment of walking on cruches without brace at two weeks after operation. Eight of the 9 patients who had the operation three months before showed bone union, while 1 of them showed delayed union.
Fourty-six trochanteric femoral fractures operated with Ender pinnig were reviewed and investigated. The postoperative gait function was relatively good nevertheless some cases suffered radiological deformities. Loss or decrease of gait function is mainly due to high risk and complications of aging, but the technical failure of operators and the essential difficulty of Ender pinnig can not be neglected also.
In our clinic, trochanteric femoral fractures are treated by osteosynthesis using Ender's nails. We have operated on 80 cases using Ender's nails in our clinic during the past 10 years. We studied the degree of reduction, the position of pins, and the impaction of pins during the ope-ration and at discharge. Considering these points, we reported the roentgenographic and clinical results with special reference to unsatisfactory results.
Ten patients with subcapital fracture of the neck of the femur were treated by multiple pinning. Internal fixation consisted of four or five single-crystal-alumina pins. A single-crystal-alumina pin (diameter, 3.2mm) has exellent biocompatibility and great mechanical strength. Pins were inserted parallel each other with a guide and simultaneously with an inserter. The guide has five parallel tunnels (diameter, 3.2mm) and the inserter has five rods passing through the tunnels in the guide. The method offered the advantages of a short operating time and a little loss of blood. Furthermore, the operating procedure could be performed under local anesthesia in four patients.
The follow-up data of the hip endoprosthesis for femoral neck fractures were evaluated by the questionaire including daily activity. Thirty-two out of sixty-six patients could be evaluated. The cases consists of four males and twenty-eight femsles. The mean age was 73 years old (range, 49-93) and the duration of follow up was from 9 months to ten years (average 3 years). The ratio of the patients who required the cane was 19% before injury and increased to 59% at the time of evaluation. Fifty-two percent of the patients could walk out of doors up to five years after operation. On the other hand it decreased to 29% over five years. Sixty-seven percent of the patients over 80 years old could walk inside of the house. About 80% of the patients had some disability as well as pain at the time of evaluation. The incidence of the patients who could go up down stairs and sit straight was below 50%, but 84% of the patients could sit or squat to evacuate the bowel themselves. In conclusion, it was suggested that the prosthetic procedure was an effective treatment for femoral neck fractures in the aged.
The authors have designed the new pin with long hook for internal fixation of fractures of the proximal femur. On models of the proximal femur with fractures of various types, the stability by M. K. multiple pinning was physically studied and it was confirmed that the fixation of lateral component of the femur was evidently enforced. Clinical experiences revealed that M. K. multiple pinning could be indicated to all types of transcervical and peritrochanteric fracture combinating with palte, if necessary.
The purpose of this paper is to clarify the radiological factors which relate to the development of osteoarhritis (OA) of the hip. For 58 hips which were not treated surgically for at least two years or more, ten radiological parameters (those are CE angle, Sharp angle, Acetabular angle, Weight-bearing articular surface, Head neck quotient, Acetabular quotient, Percentage of femoral head coverage (%FHC), proximal displacement, Lateral displacement, and weight-bearing area) were measured. Comparing a group in which OA change increased with another group in which OA change did not increase, there was statistically significant difference in three parameters: CE angle, %FHC and proximal displacement. It may be possible to anticipate the outcome of OA by measuring these three parameters.
We studied histopathology of the bone which is ischemic. Clinical materials were 6 cases which were amputated due to arterial occulusive diseases such as ASO, TAO and thrombosis. In those limbs the femoral head, the femoral medial condyle and the talus were examined. As the result we would stress that the early changes of the bone are detectable in fat cells or marrow cells in bone marrow, not in bone trabeculae. Especially in fat cells, disappearance of nucleus, irregular or obscure cells contour, various sizes of fat cells and microcyst formation are characteristic findings of ischemic. On the other side, in the bone trabeculae it was not possible to distinguish between living and dead whether the lacuna is empty or not. Ischemic bone changes are conspicuous in subchondral bone rather than in deeper or central part of bone.
Avascular necrosis of the hip joints in hypothyroidism is rare. A 33-year-old woman was admitted to our hospital because of hypothyroidism in May 1983. She had suffered from pain in the right hip joint for about four months. She had no history of steroid therapy, alcholism and caisson disease. Radiographs of the right hip showed diffuse translucencies with sclerosis and irregularity of the joint surface. A Tc-99m diphosphate bone scan showed homogeneously increased up-take in both femoral heads. She was treated with thyroid hormone and skin traction of her legs. We thought that the necrosis was owing mainly to hyperlipidemia and anatomical features of vessels supplying the femoral head.
A case of intraosseous ganglion developed in the acetabulum was reported. The patient was a twenty-three-old woman complaining of mild and localized pain in her hip on weight bearing for about last seven years. The radiographs of the hip joint revealed a cystic lesion (1.5cm in diameter) with sclerotic margin in the roof of the acetabulum. Curettage and autogenous-bone graft was scheduled for the treatment. At the operation, typical ganglionic fluid was found in the cyst. The histological specimen was compatible with intraosseous ganglion. Her symptoms resolved completely three months after operation.
A 89-years-old woman with giant cyst in the left gluteal muscle after the operation of artificial bone head replacement for the femoral neck fracture is reported She found out this tumor at the time of 9-th months after the operation. And we got 200ml fluid by puncture of this tumor everyday for a week. The tumor was removed, and examined biologically and histologically.
We have studied the follow up assesment of seventeen patients treated by endoprosthetic replacement of femoral head. Physical and rentgenographic examination was performed for twelve patients, and telephone interview for five patients. In idiopathic femoral head necrosis, clinical score was high and satisfactory, but it was lower in proximal femoral neck fracture using the Moore type endoprosthesis. No loosening was observed in all patients. In old aged patients group (over eighty years old) and patients with severe complications, clinical score was lower. Five patients died from another complications, two of them died within one years after surgery, we concluded that the main cause of death was attributed to the postoperative disabilities. We would like to recommend that the early surgery for femoral neck fracture or idiopathic osteonecrosis of the femoral head is necessary to avoid the bed-ridden conditions.
We examined the correlation between the size of the femoral head measured on roentgenograms and the size of the prosthesis actually used in the sixty-six operations. Forty operations were performed on the fresh cases of intracapsular fracture of the femoral neck. The size of the prosthesis employed in these cases resided in 97 to 90% of the size measured on roentgenograms. On an average, the size of the prosthesis used in these cases was 1.4mm larger than the size judged on roentgenograms. In the cases whose size of the femoral head judged on roentgenograms was 44mm or less, the prosthetic size actually used was 2.0mm larger than the prospected size.
Eighty-seven of patients were operated on with bipolar hip prosthesis in the last 4 years. 38 of them were followed up for clinical and radiological evaluations. Although postoperative follow-up period is short, all of the patients have had no pain in the hip joint and showed recovery of hip movement. Radiologically, the movility of the inner bearing was lost in nine of the 38 hips, showing one-piece movement. This seems likely to happen in more than two years after surgery, but has no relation with clinical results.
With this method socket wears ware measured in 7 hips of Charnley THR cases. However, the result was not always constant. The principle of this method is that in two radiographs taken over a period of time, displacement of the center of the metal head, in relation to the center of the wire marker's elliptical curve, shows the socket wear over a given period of time. With this method socket wears were measured in 7 hips of Charnley THR cases. However, the result was not always constant. It is possible to know the degree and direction of the socket wear in two-dimentions by using this method. However, there are some problems such as the technical difficulties and the necessity to get two radiographs taken with the same direction. It seems that the inconstancy of the results may be due to those problems.
Clinical and radiological results of the cases of Charnley THR, which were followed up for over ten years, were discussed. Materials consists of 23 hips (21 patients), of which 6 hips were in male and 15 hips in female. Clinical results were evaluated by hip score of Jpn. Orthop. Ass. and radiological results were assessed by the method of Kawauchi et al. 80 points or more of hip score were obtained in 8 hips, 79 to 70 points in 4 hips, and 69 points or less in 11 hips. In comparison between 8 hips of 80 points or more and 11 hips of 60 points or less, the latter had more technical problems such as high inclination of socket angle, over-reming of acetabular bottom and imperfect packing of cement in the femoral shaft, than the former. Another important factor influencing the long term result seemed to be osteoporosis. In conclusion, in order to maintain satisfactory resultsfor long time after THR, it may be necessary to do more perfect procedures technically and to prevent the development of osteoporosis.
Alcaptonuria is a rare hereditary metabolic disorder caused by deficiency of enzyme Homogentisic Acid. We hava experienced 2 surgical cases of ochronotic coxarthosis. The first case was a 64-year-old woman who had typical ochronotic spondilitis and arthropathy. Coxarthrosis of the both sides was treated with T. H. R. in five years interval. The second case was a 71-year-old man who had had a considerable pain in the left hip for four to five years. The radiological findings of the femoral head showed irregular density and collapse, but those of acetablum were normal. We carried out replacement with the fomoral head. endoprosthesis.
Metastatic tumors of the phalange of the thumb are uncommon. We describe two cases which appear to be very particularly rare: those from broncogenic carcinoma and from renal cell carcinoma. In our one case from the bronchogenic carcinoma, digital metastasis was the first sign of the presence of a malignant tumor, and amputation was perfomed with chemotherapy thereafter. However, this patient died three months later. The other case had multiple metastases involving lung and skin. No surgical treatment was sustained because of a poor general condition and the patient died two months later. We describe these two cases and discuss about the metastases to the phalanges of the hand.
A rare case of malignant hemangiopericytoma of the thumb in a 69-year-old female was described. The tumor was found to arise at proximal phalanx area of volar side of her right thumb and the range of motion of the MP joint of the thumb was restricted. Radiographically, the proximal phalanx was not affected by the tumor, and the resection of the tumor was performed. However, histological findings showed malignant hemangiopericytoma such as the tumor possessed a rich vascular component of blood vessels with epitheloid cells (pericytes) closely packed between and around the vessels. Fortunately, one year after surgery, the reccurence of the tumor was not observed in the thumb.
Generally, the classification of rhabdomyosarcomas of WHO is used today and these rhabdomyosarcomas are distinguished by the difference between the form of the histological character. The case of an 85-year-old woman who developed right hip swelling is reported. The tumor of this case is less pleomorphic than pleomorphic type of the rhabdomyosarcoma and relatively immature myoblasts are predominant. We recognize this tumor arising form muscle cells form those originating in the skeletal muscle by electrone and light microscopy. According to the fact that was mentioned earlir and also to the examination of the literature, we may diagnose this case as the malignant tumor in soft tissue which shows the form of so called malignant blastoma.
We had a case of multiple malignant fibrous histiocytoma of bone (MFH) with no pulmonary metastasis. It was a fifty-three-year-old female. In her past history, she had had myastenia gravis. She complained of left coxalgia since November, 1983 and bilateral anterior chest pain since March, 1984. In the first radiological examination in May, 1985, we found four radiolucent areas including in the lesser trochanter, the left sixth rib, the right fifth rib and the skull, but no pulmonary metastasis was noted. In histopathological examination, the tumor of the left trochanter was MFH. Between October, 1984 and June, 1985 multiple metastases of bones (bilateral iliums, the right femoral shaft, the right tibial shaft and the right fibulal shaft) and of soft part tissues (the nape, the low back, bilateral upper arms, the right side chest and the right thenar) have be found. The tumors of the nape and the low back examined histopathologically were MFH. We concluded that it might have had a multicentric synchronous origin because no primary lesion could be determined from the clinical course and affected areas.
This brief paper presents a 2-year-old girl with a tumor in the left buttock. The histological findings showed those of yolk sac tumor. This tumor has been rarely managed in orthopedic surgery. In this case, the value of serum α-Fetoprotein was extremly high on admission and it was fluctuated with therapy. A survival period over one year has been obtained due to chemotherapy, chiefly with cis-platinum.
A follow-up study of 33 cases of glomus tumors which were treated at Hiroshima University is reported. All cases were operated and diagnosis was confirmed pathologically. We mainly discussed clinical features of glomus tumors, especially X-P changes and correlation between distribution of glomus bodies and glomus tumors.
Various problems were discussed in the treatment of benign aggressive tumors about joints such as giant cell tumor of bone (GCT), benign chondroblastoma (CB), desmoplastic fibroma and extraabdominal desmoid. A singnificant correlation between the therapeutic procedures and recurrence of GCT was found, but no pathological features were significantly correlated. Local recurrence could not be predicted on the basis of histological grading. Excision or block resection should be performed as the initial treatment. Other tumors but CB similaly should be treated by resection.
A clinicopathologic study of 36 cases of malignant fibrous histiocytoma (MFH) of the soft tissues is reported. Of the 36 patients, 21 were males and 15 were females. The age of patients ranged from 37 to 93 years with the mean age of 63.4 years. The tumors occurred predominantly as a mass in proximal portions of the extremities (thigh: 11 cases, upper arm: 9 cases). Hand and foot were affected in none of the cases. Overall five-year survival is 44%. The prognosis of the patients was correlated with a few clinical and histologic features. The depth and the size of the tumor are correlated with the prognosis. The five-year survival rate, as estimated by Kaplan-Meier method, was 35% in the tumors involving the skeletal muscles, while 67% in the superficially located tumor. The patients with tumors, measured less than 5cm in the greatest diameter, carried a five-year survival of 68.6%, while 17.1% in patients with tumors measured more than 10cm in diameter. The patients with the tumors of myxoid type had better prognosis (63% five-year survival) than those with the tumor of pleomorphic subtype (35%). Other predominant histologic features, such as storiform pattern, herringbone pattern, low cellularity, dense collagenization, ect., seem to be good prognostic factors. In contrast, marked pleomorphism suggests poor prognosis.
We studied MTX plasma pharmacokinetics in 102 occasions of high dose (200-350mg/kg) infusion for 6 hours followed by CV factor rescue for 15 cases with osteosarcoma and 1 case with chondrosarcoma. Serum MTX concentrations were measured at 0-hour, 24-hour, 48-hour and 72-hour after MTX infusion was terminated. We investigated several factors determining the terminal level of serum MTX. And using the two compartment models of pharmacokinetic theory, we tried to simulate the clearance curve of serum MTX. Only these analyses could predict the conditions of rescue and evaluate the effectiveness of this therapy for each case accurately.
We reviewed the thermogram of 8 cases of soft part tumors after water cooling (4°C, 1min). Malignant tumors and hemangioma rapidly recovered temperatures on their tumor surfaces compared with normal opposite part. On the lipoma, schwannoma and fibroma, the recovery was delayed. Cooling Thermography was supposed to be a diagnostic aid of soft part tumors.
Tumor of the rib is a rare condition and the incidence of this tumor is two percent of all bone tumors. The authors reported the diagnosis and treatment of twenty-three cases of tumors of the ribs which had been treated in our clinic. In primary bone tumors there were four cases of osteo-chondroma and one case of chonarosarcoma. In secondary bone tumors there were thirteen cases of metastatic tumors and two cases of invasive tumors. In tumorous condition there were two cases of fibrous dysplasia snd one case of solitary bone cyst. Preoperative bone scintigram and CT were very useful to confirm the expansion of the tumor. Unless the diagnosis is clearly benign, wide excision or radical resection should be performed. Because thee functional disturbance after rid resection is rare and treatment of the recurrent case is very difficult.
We presented the follow-up results of 19 patients with unrepaired rupture of the posterior cruciate ligament. It showed that the function of the knee was dependent on the degree of posterior instability, occupation and athletic activity in large. Satisfactory results was obtained conservatively in less than 5mm posterior instability in all the patients, while muscular labors and athletes showed unsatisfactory results if the instability was 5 to 9mm. And none was satisfactory in more than 10mm, in which surgical repair, we think, is mandantory.
Repair of a longitudinal peripheral meniscal tear permits salvage of its function. We performed arthroscopic meniscal repairs in 15 cases of longitudinal peripheral meniscal tears and 2 cases of lateral hypermobile menisci. 15cases were reexamined by arthroscopy six weeks after arthroscopic surgery. Three of them were unsuccessful in repairing by the first operation, but two of these were successfully repaired by the reoperation. The other case was of lateral hypermobile meniscus and the second openation was not done. The potential risks of this surgical procedure are damages of the peroneal nerve, the tibial nerve, the popliteal vascular structures, but we have not experienced any neuro-vascular complications.
There are many differences as to the postoperative regimen following meniscectomy. This study analyzed early knee function following meniscectyomy. Sixty-five simple meniscectomies in 64 patients were evaluated by means of patients' complaints and clinical examination. These cases were classified into two groups according to the methods of aftertreatment following meniscectomy. Group 1 consisted of immobillization and delayed weight bearing. Group 2 consisted of partial immobillization and early weight bearing. There was no significant difference between the two groups.
Sixty-three cases of discoid lateral meniscus were classified into four types by double contrast arthrography; 23 complete type, 19 intermediate type, 17 incomplete type, 4 grossly torn. Incomplete type had more tears than complete and intermediate types. Longitudinal and peripheral buckethandle tears were popular in any type of discoid.
An 11-Year-old boy, previously asymptomatic, sustained a twisting injury to the left knee while playing baseball in December 1983. After ten months, he still had pain and was unable to extend the knee fully. He was admitted to our hospital on October 8, 1984. Physical examination reveaiea the knee to be locked in 10 degrees of flexion and medial joint-line tenderness and a click of the McMurray maneuver. Arthrogram revealed a tear of a medial meniscus and a lateral discoid meniscus. Arthroscopy and Arthrotomy were done on November 5, 1984. Arthroscopy revealed a medial discoid meniscus and a lateral discoid meniscus, but there were no tears on the lateral meniscus. Arthrotomy comfirmed that there was a horizontal tear of a medial discoid meniscus. The medial meniscetomy was performed and the patient had a complete recovery after 3 months.
Arthroscopic surgeries for 20 shelf disorders (19 patients) were performed from April 1982 to April 1985. Release operation was done on 6 knees, partial resection on 13 knees and total resection on one knee. The average follow up was seven months (range, one to seventeen months). Postoparatively, excellent results (completely free from pain) were obtained in 2 cases and good results (improved, but pain remained solely on heavy activities) in 17 cases. Histological examination revealed that inflammatory cellular infiltration and other abnormal findings were seen on seven out of eleven shelves. Our results suggest that if the abnormal shelf is evident through arthroscopic observation, release operation or small resection will be the choice for treatment.
We treated operatively bilateral patellar dislocations in Down syndrome. We lengthened quadriceps lemons muscle except for vastus medialis in the right knee, but not in the left knee. The right kee has got good extension power, but the left knee hasn't. This suggests that shortening of the quadriceps is one of the causes of patellar dislocation.
Although patella alta is commonplace in cerebral palsy, detailed analyses have been reported only rarely. It is the purpose of this paper to evaluate patella position and configuration in cerebral palsy. Of 138 knees (69 patients, three to twenty-two years old), 74 knees (53.6%) had roentgenographic evidence of patella alta, using Insall-Salvati method and Sugimoto's method. Using Blumensaat line, we found patella alta in 98 of 132 knees (74.2%). Patella alta was not significantly different between spastic patients and non-spastic ones. However, in patients with contracture there was a significant increase of patella alta as compared with ones without it. In addition we used Wiberg's type and found an increase of II & III types in patients who can not walk alone.
In 65 cases of the hemarthrosis of the knee during the last three years, 59 cases of which had a history a prior trauma with immediate hemarthrosis. In six cases, however, the occurrence of bleeding into the joint was not initiated by an incident of trauma noticeable to the patients. Clinical diagnosis of these six cases included; pigmented villonodular synovitis (one case), hemangioma (one case), idiopathic hemorrhage (two cases), vascular injury by torn meniscus (one case), perforation into the subchondral bone by torn meniscus (one case). Last case was interesting, because caltification of the popliteus muscle shown on radiograms indicated functional disturbance of that muscle which seems to protect the lateral meniscus from injury. Attension is called to the fact that some meniscal rupture could be a cause of the non-traumatic hemarthrosis.
Five patients with osteochondritis dissecans were encountered in the last three years, in which three cases showing normal-like appearance of the cartilage with radiological subchondral changes. A method of subchondral drilling from the side of the medial condyle against the lesion without interfering with the articular cartilage was made in these three cases. All lesions were healed on the radiograms at 4 months later. A follow-up was performed 18-36 months postoperatively. All three patients were symptom-free at that time. We concluded that early drilling can prevent the lesion from developing detached fragment.
The curvature of the human femoral condyle can be represented by the Archimedean spiral. The center of the Archimedean spiral was found to be situated in the attachment of P. C. L., M. C. L. and L. C. L. of the femoral condyle.
Kinematics of the human knee joint consist of flexion-extension and “screw home”, some passive varus-valgus and rotation movements during flexion. Two conflicting factors must be satisfied: not only a wide range of movement but also a large load bearing capacity. To evaluate the kinematics quantitatively and mathematically, it is necessary to know the anatomical configuration, structure and mechnics. Few related studies have been done in the past, except for Menscik's descriptive work. In this paper, we described a two-dimensional kinematical knee joint model, which treats both articular surface configurations in the sagittal plane and ligaments, as a single functional unit: a four bar mechanism. Using this model, calculation was made for sectional configurations of femoral condyles and some specific sliding ratios at the contact points. Some of the local regional characteristics were examined.
An operative technique for mobilization of the stiff knee after knee surgical treatment is described. This technique had been performed on eight patients. The average total range of knee motion was improved by 64 degrees after surgery. An important advantage of this operation is its short skin incision.
We treated seven cases of the spontaneous osteonecrosis of the knee by High Tibial Osteotomy (HTO) in our clinic in the last three years. The effects of HTO is significant in Pain (p<0.05). Now we report the effects of HTO on the spontaneous osteonecrosis of the knee comparing with those on osteoarthritis of the knee treated by HTO.
This is a follow-up study of the total knee arthroplasties performed in our department on the patients with rheumatoid arthritis in the past ten years. 29 arthroplasties of 20 patients were investigated and assessed. Applied prostheses were 11 Geomedic Arthroplasties, 16 Total Condylar, one Guepar and one Shiers. It seems that great pain relief can be made with total knee arthroplasty regardless of its type. On the other hand, functional improvement is not so easily achieved, because other joints are usually affected in most of the patients. We could not find any obvious differences between the result of Geomedic knees and that of Total Condylar knees in this survey. There were no severe postoperative complications except one unfortunate case of deep infection.
Though tuberculous spondylitis is decreasing, it is not rare. This is to report on a case of muitiple spinal bodies affected with tuberculosis accompanying high grade kyphosis and Pott's paraplegia. The case was a 56-years-old female. Since she was affected at 10 years old, kyphosis had increased, In June 1983 paraplegia occurred. When hospitalized on 4 June 1984, she was unable to walk alone due to paraplegia. Roentgenogram showed destruction of the 5th thoracic to the 4th lumbal vertebral bodies. Kyphosis angle was 125 degrees. On 6 July 1984, curettage of the TH-4 to L-4 vertebral bodies and vascularized fibular bone graft was undertaken. Bleeding amount was 17, 000 grams, and operation time, 2 hours. After operation, paraplegia resolved gradully, 20 weeks later the patient began to walk. By scintigram, uptake was not seen in the grafted bone but nine weeks later coalescence between the grafted bone and the vertera was found by roentgenograms.
We analyzed 29 patients with osteomyelitis of the spine. Clinico-pathological investigation showed that histological changes had more reliability according to the activity of the disease than serological and radiological features. Biopsy was the most important examination, even if it had high rate of faulse negative. We thought that operative procedure should be considered for the cases with difficult differentiation, recurrence and persistent activity.