Monostotic paget's disease involving the entire right pelvis was encountered. The therapeutic effect of EHDP is described together with literature reviews. The patient was a 51-year-old man with an elevated Al-p level and mild dull pain in the right pelvis. Despite treatment with pig calcitonin from Apr, 1981, the Al-p level that had once been controlled began to reelevate. The treatment was changed to eel calcitonin, but as this again resulted in reelevation of Al-p after a temporary reduction, administration of eel calcitonin was suspended. In Feb, 1985, Al-p and urinary hydroxyproline rose to 46.5 (K. A. U.) and 101mg/day respectivery with growth of dull pain in the lesion. As we had access to EHDP, oral administration of 400mg/ day (6.3mg/kg) was begun from Feb, 1985. From 2 months after EHDP therapy, it improved Al-p, normalized urinary hydroxyproline and remitted local pain. Although administration was suspended after 6 months (end of Aug) for fear of its adverse effect on bone metabolism, Al-p showed a tendency of gradual decrease (18.9 K. A. U.) even one month after suspension.
We have already shown that TCA promotes calcification of the thickened growth plate in the healing stage of HEBP-induced rachitic rats respectively. In this experiment female weanling Fisher-344 rats of 4 weeks of age were used and the experiment period was settled to be 2 weeks. Sixty mg/Kg body weight of HEBP was dosed subcutaneously, daily for the former 7 days and then 200, 400 or 600mg/kg body weight of TCA was given to the each rat of TCA group for the latter 7 days. In the result HEBP+TCA group showed prominent mineralization and calcification of newly formed bone and caltilage of the callus in comparison to rats treated with HEBP alone at 14 days after fracture.
Wells et al. (1968) reported that the hypocalcemic action of imidazole was partially prevented by prior administration of isoproterenol and theophylline. And we have reported that imidazole promotes calcification in the widened growth plate of HEBP induced rachitic rats. So, in this time, we report the effect of imidazole on fracture healing in two cases, normal rats and HEBP induced rachitic rats. Rats were female Fisher 344. We examined calcification in early fracture callus. The results suggested that Imidazole promoted calcification in fracture callus of HEBP induced rachitic rats. But we considered that imidazole did not clearly promote calcification in fracture callus of normal rats.
2-Thiophenecarboxylic acid, a hypoglycemic and antilipolitic agent first described by Fang, was subsequently shown to produce hypocalcemic and hypophosphatemic effects in rats. The hypocalcemic effect of 2-TCA is very similar to that observed after treatment of rats with calcitonin. We reported previously that calcitonin enhanced calcification in growth plate of rat in HEBP induced rickets. In attempt to clarify, the effects of 2-TCA on the growth plate in HEBP induced rachitic rats were studied. 2-TCA promoted the calcification in growth plate, which was found on the soft X-ray photos and contact microradiogram. Measuring the mineral content of growth plate with a microdensitometer, ΣGS/D of HEBP treated group was 194μ Aluminium, that of HEBP+2-TCA treated group was 254μ Aluminium. The mode of promotive action of calcification with 2-TCA in the growth cartilage in HEBP induced rachitic rats was similar to that of the calcitonin.
Androstenedione and dehydroepiandrogen-sulfate (DHEA-sulfate) are major adrenal C19 steroids in man. We developed a radioimmunoassay for serum androstenedine and DHEA-sulfate. The present paper describes their levels in normal and osteoporotic cases. In conclusions: 1) Plasma concentrations of androstenedione decreased significantly in male with aging, but not in female. 2) Plasma concentrations of DHEA-sulfate fell significantly with aging. 3) At the age of 50 both hormones levels are higher in males but the common reduction with aging is stronger in males; thereby producing a convergence in the 70's. 4) A positive relation between androstenedione and DHEA-sulfate was noted. 5) Androstenedione concentrations were significantly reduced in osteoporosis group.
Clinical reports clearly show that the presence of biomaterials makes adjacent tissues susceptible infection. The bacteria on biomaterial were examined by electron microscopy 10 days after intraperitoneal administration of stphylococci. This study shows that a large percentage of bacteria adhere to surfaces of biomaterials and form microcolonies surrounded by a biofilm. The bacterial glycocalyx seemed to mediate the formation of microcolonies. These microcolonies may adhere to inert or tissue surface by the interaction of their glycocalyx and their pili with surface components. These demonstration of bacterial adherence to biomaterials in vivo suggests that polysaccharide mucoid peribacterial films (glycocalyx) are among the initial and fundamental factors in infection and are significant factors in the resistance of these types of infections to host defense mechanisms and antibiotic therapy.
The infecting organisms, coagulase-positive Staphylococcus aureus, were injected into the knee joints of the rabbits. They were sacrificed in groups of three rabbits at intervals of 15 and 30 minutes, of 4 and 24 hours and of 3, 7, 14 and 28 days after the intra-articular injections. This study comfirmed that destruction of articular cartilage progressed after the infecting organisms were no longer present and the inflammatory synovitis continued after the absence of infection in experimental pyogenic arthritis.
A 15-year-old boy who had suffered from right upper arm pain was reported. Roentgenograms showed marked sclerosis and thickness of the cortex at proximal and medial site of the right humerus. At first, osteoperiostitis was mostly considered because of clinical course and the radiographic findings. However, histological findings obtained by four times biopsy revealed no inflammatory lesions and seemed to those of osteoid osteoma.
Cryptococcosis is a subacute or chronic infection caused by the fungus Cryptococcus neoformans (torula histolytica). It most commonly infects the brain and meninges, but all parts of body can be involved. Bone involvement is infrequent. The present study describes a 63-year-old man with pathologic fracture of the clavicle by Cryptococcus neoformans. Amphotericin B wet dressing and 5-FC treatment were administered.
It is mandatory to identify the involved knee as infected prior to operation, particularly in an attempt to perform total knee replacement. But, in some cases, we have encountered difficulties to make definite diagnosis of the affected knee as septic because of several factors. In this study, we reported the clinical and operative findings of seven knees which remained preoperatively unidentified as septic inspite of high suspicion of infection. In these cases, laboratory data and results of cultures of aspirated joint fluids taken before the operation were found to be far from diagnostic values. Pathological examination and augmented culture of tissue removed at the time of knee surgery have been elaborated in these seven knees and found to be useful to accurate diagnosis. The findings of pathological examination have shown that three out of seven knees were supprative arthritis and that non-specific inflammatory cells were infiltrated in the removed tissue from other four knee joints. However, the augmented culture of the specimens from all seven knee joints demonstrated the presence of microorganisms including candida species. Three supprative knees were treated with successful arthrodesis and other four knees treated with arthroplasty of total knee replacement have been followed up under meticulous attention.
Nine patients with pyogenic arthritis of the knee were treated by closed irrigation and arthrotomy. The patients average age was 66 years (range, eight to eightyfour years). The infecting organism was staphylococcus aureus in four, staphylococcus cohnii in one, staphylococcus haemolyticus, staphylococcus intermedius in one and unknown in two. At an average follow-up of eight months (range, two to twenty-four months), one patient had a good result, seven a fair result and one had died of multiple organ failure. It was very important that accidental infection should be prevented following intra-articular steroid injection.
A rare case of a twenty-six-year-old man with intraosseous ganglions of the bilateral Lunates and left Scaphoid was reported. His chief complaint was severe localized motion and resting pain at the left wrist once a year since six years ago. The radiographs of his wrists showed round radiolucent defects in the bilateral lunates and left scaphoid with sclerotic borders. Typical ganglionic fluid flowed out at the operation. Only the left cyst was packed with the iliac bone graft. The CT-scan of these ganglions showed the direct communication with the joint cavity. The bone scintigraphy was consentrated at left ganglion. The histological diagnosis was ganglion. His symptoms resolved soon after operation.
It is well known that the nodular involvement of the muscle occurs in patients with a background disease such as sarcoidosis, tuberculosis, lepra and so on. Such nodules are histologically evaluated as non-caseating epithelioid granulomas. We experienced a curious case that had a nodule which was a non-caseating epithelioid granuloma, but without any background disease. It was a sixty-year-old female. She had suffered from a painful nodule for 2 months on the left lower leg. We first suspected a malignant tumor of soft tissue because of the findings in several examinations, but histological examination of the biopsied specimen resulted in noncaseating epithelioid granuloma. The excision was done and two other nodules appeared after 3 months at the right calf and the left thigh, respectively. Those were the same in histological examination as the previous nodule. No background disease could not be found during approximately 2 years of the observation period in spite of our careful examination. We, therefore, diagnosed as muscular sarcoid. It would seem to be a very rare case.
Membranous lipodystrophy is a rare disease that is characterized by peculiar membranocystic degeneration of fat tissues of bone marrow in the long bones of the extremities as well as that of fat tissues of other visceral organs and leucodystrophy of the brain. In Japan, about 55 cases have been reported. A forty-year-old female visited our clinic because of the left elbow joint pain. Roentgenographic findings revealed irregular cystic translucent areas in the left distal humerus and olecranon. Curettage and auto-iliac-bone grafting were performed. Histopathological diagnosis was membranous lipodystrophy. Lesions of the right distal humerus, and the right proximal tibia were curetted, and packed with hydroxy-apatite.
A 75-year-old male was admitted to the Kumamoto University Hospital on December 12, 1985, because of the tumors on bilateral subscapular region. He noticed the tumor about 6 months before admission. And there was no symptoms. On admission, the tumors were palpated at bilateral subscapular regions. They were elastic-hard and 4.7×4.2cm, 4.5×4.0cm in size. The tumors were both resected. The pathological study revealed elastfib-roma. Elastfibroma is uncommon and about 300 cases have been reported in the world so far. Over two-thirds of these were from Okinawa Prefecture, in Japan. It occurs predominantly in the subscapular region of aged females. Occasionally the tumors are found bilaterally.
A rare case of epithelioid sarcoma was presented. To our knowledge this is the 25th case reported in Japan. A 36-year-old man was admitted to our hospital complaining of diffuse swelling with pain in the right upper arm. Although at 30 years of age the patient had been aware of painless nodule about 1.0cm in diameter on his right forearm, he hadn't sought medical advice for 5 years. At 35 years he underwent wide excision of the tumor in other hospital, but local recurrence was found 6 months after the operation. He had eventually agreed to reoperation, but died of metastatic pleural effusion 11 months after forequarter amputation.
We experienced two cases of leiomyosarcoma of the subcutaneous tissue. First case was a seventy-two-year-old male. He had a nodule in his left buttock that was histologically revealed leiomyosarcoma of the subcutaneous tissue. A wide excision and postoperative chemotherapy were done. The local recurrence, however, occurred and finally he died with the pulmonary metastasis. Second case was a thirty-four-year-old male. He suffered with an ulcerated nodule of his right dorsal foot. That was histologically evaluated as subcutaneous leiomyosarcoma. Syme amputation was performed. He is alive at 4 months after operation without chemotherapy.
Eosinophilic granuloma, so called Kimura's disease, is a benign chronic granuloma that appears chiefly in subcutaneous soft tissue or lymphonodus and sometimes other regions such as elbow presented in this case. The case is a 37 years old man who complained of severe swelling on the right elbow region in the last 3 years. The labolatory date, angiogram, CT-scan and Ga-cintigram were checked before resection operation was done. The differential of WBC showed a high grade increase of the percentage of the eosinophil and the serum IgE also showed increase to abnormal high level. The pathological finding showed a characteristic lymphofollicular structure and infiltration of eosinophils. Depending on the clinicall findings, the abnormalities of the labolatory data and the characteristic findings pathologically, it was considered to be a case of the eosinophilic granuloma, so called Kimura's disease.
This paper reports a case of granular cell tumor with histological and electron microscopic findings. The patient was a 44-year-old female with a painless tumor in her left thigh. The tumor was a 6×9cm in size without tenderness. Histological studies showed “granular cell tumor” and S-100 protein immunoreactivity was demonstrated in the tumor cells. After surgical excision of the tumor malignant behavior was observed.
We experienced 4 cases of multiple myeloma with low back pain during the last 2 years. Their X-rays showed severe osteoporosis at the spinal column and punched out lesion at their skulls. Their serum and urinary protein were analyzed. M-protein was present in 3 cases' serum and Bence-Jones protein was proved in 2 cases' urine. We diagnosed these cases as multiple myeloma. These cases were treated with cyclophosphamide, prednisolone and calcitonin. We adopted calcitonin for these cases based on the opinion of Bataille et al that calcitonin was of use in multiple myeloma to treat hypercalcemia as initial therapy. In cases that X-ray shows osteoporosis and routine examinations show abnormality (for example, acceleration of ESR, anemia, abnormality of serum protein, abnormality of bone X-ray etc.), further examinations for multiple myeloma should be made.
The first report of postirradiation sarcoma was by Beck in 1922. Since then sarcoma arising in previously irradiated bone and soft tissue has been well recognized, but the incidence is low. We report a case of postirradiation osteosarcoma of sacrum. A fifty-eight-year old female was admitted to Kitakyushu Municipal Kokura Hospital in March 1985 because of severe sacral pain. In 1966, the patient underwent radical hysterectomy and radiation therapy for carcinoma of the cervix, after which she remained asymptomatic. In December 1984, she was admitted to Kokura Memorial Hospital for sacral pain. X-rays revealed massive osteoblastic changes of sacrum. Open biopsy was performed and the diagnosis of osteogenic sarcoma was established. Corresponding to Arlen's criteria, we thought this tumor was postirradiation osteosarcoma.
A rare case of chondrosarcoma at the left scapula was reported. About 13cm×12cm size mass was palpable in his lateral side of the scapula, however, the range of motion of the left shoulder was not restricted. Roentgenorams showed the huge mass of the scapula and the partial calcification of the surface was noted. To confirm the diagnosis, complete excision of the mass was performed, and histological findings revealed secondary chondrosarcoma arising in osteochondroma of the scapula.
This paper describes 4 cases of secondary chondrosarcoma in hereditary multiple exostosis. The incidence of malignant change in hereditary multiple exostosis was estimated to be about 8.7%. These tumors arised from the pelvis and the proximal end of the femur. All of these tumors were giant but microscopic findings were those of well differentiated chondrosarcoma.
Metastatic bone tumor is a very important disease clinically. Sometimes we have been at a loss for diagnosis and treatment of metastatic bone tumor. In this time, we have investigated metastatic bone tumor in our hospital for the past seven years. We have got 49 cases. In thses cases, liver was the most frequent as primary lesion. The purpose of this paper is to report the clinical course of these cases which visited our department of orthopaedic surgery in spite of affected with hepatoma. In the metastatic bone tumor with hepatoma, the metastasis to the lung was very rare, but metastasis to the bone was more frequent at the first visiting. The location of the metastasis was much more in shoulder girdle than upper or lower extremities and spine. The sites of the metastasis were in rib, clavicle, sternum and scapula. On the first visiting to our department, there were no symptom of hepatoma. The vertebral venous plexus will be concerned with bone metastasis of hepatoma in some references. In the case of bone metastasis with unknown origin, it should be examined for primary liver as same as pancreas or kidney.
Epithelioid sarcoma is an unusual soft tissue neoplasm with distinct morphologic and clinical evolution, but has been confused with a variety of other benign and malignant lesions. Epithelioid sarcoma is most often found in young adult males as a subfascial or subcutaneous lesion originating on the limbs. At an early stage of the tumor, it appears as a solitary nodular lesion (nodular type), however, in longstanding cases, it is manifested as a firm area of induration or a multinodular lumpy mass (invasive type). The age of the patients at the time of initial surgery were 8, 18, 21, 26, 35 and 61 years respectively, with a median of 28 years. There were four males and two females. The patients had had symptoms for five months to six years before the initial treatment. Four cases were invasive type and two nodular type. In two of these patients the tumor was removed initially by wide local excision, but the involved limb was subsequently amputated because of local recurrences. Three cases were treated solely by wide local excision. One case was treated by disarticulation of the affected thumb at the initial surgery. Only one case (nodular type) treated by wide local excision is free of disease for nine years and six months. Five had metastases to the skin of the more proximal portions of the same extremity and or the draining lymph nodes. In conclusion, the case of invasive type should be treated by amputation from the beginning, because of difficulty of evaluation of curative surgical margin, and wide local excision may be effective in case of nodular type.
Since 1981, we have performed to measure the skin temprature by the thermography for over a thousand patients in our O. P. D. In this report we discuss the continuous change of the thermogram in twenty-seven cases, including 8 bone tumors, 10 soft part tumors and 9 inflammatory diseases which have been examined since their first visit. The mean value of the thermal difference between the focus side and the control side of malignant bone or soft part tumors was about 1.3°C before the chemotherapy etc. After the treatment the difference of temprature became about 0.3°C. In benign bone or soft part tumors, the thermogram of the lesions were contaminated by the operative scars. And in the cases of inflammatory diseases, the hot area in the thermogram disappeared rapidly after the conservative or surgical treatment.
Eight patients with bone sarcoma and fifteen patients with soft part sarcoma were treated with combination chemotherapy (VACA therapy) consisting of Vincristin, Actinomycin D, Cyclophosphamide and Adriamycin. Cumulative five years survival rate by Kaplan-Meyer method was about 62% in soft part sarcoma. In bone tumors, only 2 cases have survived in the long period. VACA therapy is considered to be a useful combination chemotherapy for soft part sarcoma.
It is well known that the knee muscle strength decreases in the patients with internal derangement of the knee. But it is difficult to evaluate the muscle strength adequately. In this paper, we quantified the quadriceps and hamstrings strength of 27 patients by using Cybex II machine. We discussed the usefulness of the Cybex II macine to evaluate muscle strength in the patients with internal derangement of the knee.
Twenty cadaver distal femora were x-rayed laterally and those anterior cruciate ligament (ACL) attachments were studied by authors' original measurement technique. Authors believe that application of this technique to ACL reconstruction surgeries helps to create femoral tunnels exactly at the sweet spot.
The anterior/posterior displacement in cruciate insufficient knee joint was measured. Both drawer tests were performed at 30 degrees of flexion in addition to 90 degrees of flexion, and the deta were statistically analyzed. The methods of loading a quantitative stress on the knee joint and a roentgenographic measurement were previously reported. In anterior cruciate insufficient knee, the anterior displacement was larger at 30 degrees of flexion than at 90 degrees. In posterior cruciate insufficient knee, on the contrary, the posterior displacement was larger at 90 degrees of flexion. The mean difference between complete and partial tear of each cruciate ligament was not statistically significant.
Ossification of meniscus of the knee is relatively uncommon and the cause is unknown. Recently we experience a case of ossification of lateral meniscus of the Knee. The patient is a 26 years old male. In January 1984, he inverted and from that time he recognized right gonalgia. In july 1985, radiographs revealed a free body in the lateral joint space of the right knee. In august 1985, arthroscopy and operation of the right knee was performed. The excised specimen showed a discoid meniscus in which the anterior horn had a hard osseous tissue. Radiological examination of the specimen clearly disclosed, the trabeculae. The ossification of meniscus is classified to a primary type and a secondary type (posttraumatic).
Midsubstance tears of the cruciate ligament in children are rare, because the ligaments are stronger than the bone and physis. The most common injury that occurs when the cruciate ligaments in children are stressed is avulsion fracture or open physis. We saw two young children with midsubstance tears of the cruciate ligaments which were presentel with a review of the literature.
Six cases of meniscus ganglion who visited our clinic during past 15 years were reported. The age range was 11-54 yr. Meniscus ganglion was found at medial meniscus in five cases and at lateral meniscus in one case. All patients complained of knee joint pain. Three cases represented click sign and two cases represented locking sign. All patients were treated by meniscectomy and tumor resection. Horizontal meniscal tear was found during operation in five cases. The postoperative course of all patients were good.
We reviewed cases who had meniscus tears combined with ACL deficient knees. The cases who had ACL reconstruction and meniscectomy can almost return to sports activity. The growp who had meniscectomy or meniscus suture without ACL reconstruction complain no giving way, but instability feelings in sports activity.Two of four patients who had only meniscus suture were found to have rupture. We think young patients who take part in sports activity should be treated with meniscus operation and ACL reconstruction.
The common method for arthroscopy gives less accurate diagnosis of the tear of medial meniscus, mainly because of the difficulties encountered in examining the posterior compartment. The authors attempted the modified Giliquist's technique to examine the posterior portion of medial meniscus in 42 consecutive patients. The findings at arthroscopy were compared with the arthrogram in all cases. In five of them the findings at arthroscopy differed from the arthrograms. These differences are caused by the tecnique of arthrography and the interpretation of normal variants of arthrograms. Arthroscopy with this technique gives high diagnostic accuracy and details of posterior portion of medial meniscus.
Eight patients who were treated by the release of intraarticular adhesions under arthroscopic control for knee contracture following various causes and who were over 1 year postsurgery were reviewed. At follow-up, six patients gained satisfactory motion of the knee joint, while in the remaining two patients results were unsatisfactory. The patient who has extension contracture owing to intraarticular adhesion formation has a good indication of this procedure. It is our impression that best results are obtained in patients with rapidly occurred knee contracture.
In a past year, we have experienced 9 cases of arthroscopic substitution of the anterior cruciate ligament. In this paper, we present the techniques of arthroscopic ACL reconstraction and the short term results. The most important point of this operation is to make the bone tunnel on the isometric point which is anatomical origine of anterior cruciate ligament. On this purpose ACL guide is available. Follow-up ranged from 2 months to 14 months, and averaged 7 months. Although all patients show positive Lackman's test and N-test preoperatively, Lackman's test is positive in only two patients at the follow-up. An average of range of motion was 5° to 144°.
Hip arthrodesis has been performed for coxitis tuberculosa and a part of osteoarthritis of the hip. It is an excellent procedure which results in a durable, painless, stable hip. But, after operation, the patient will be influenced on his contralateral hip joint, ipsilateral knee joint and lumbar spine. Then we placed femoral head prosthesis for hip joint. Next we performed high tibial osteotomy for his knee joint. The patient was a 49 years all female. At 19 years she was diagnosed coxitis tuberculosa. At 26 years, she underwent arthrodesis of right hip joint. In June of 1982, she underwent femoral head prosthesis (Bateman type). After about a month, she underwent high tibial osteotomy. At present she had a restricted motion of the involved hip and a slight discrepancy of leg length. But, she returned to light work and is satisfied with the operation.
The rotation and tibial torsion of the leg in osteoarthritis (15 cases) were investigated using the computed tomography, and the results of osteoarthritis (O. A.) group were compared with those of the Intact group (8 cases). The different angles of the rotation of the leg measured in three positions (rest, neutral and quadriceps setling) were especially investigated. The results are as follows: 1) The O. A. group showed slight internal rotation and tibial internal torsion in all three positions, however, there was no statistically significant difference comparing with the Intact group. 2) The O. A. group without flexion contracture showed significantly different angles between three positions. 3) It is suggested that the rotational instability of the knee joint has to be considered for planning the programs of therapeutic exercise for the osteoarthritic knee.
The investigation presented here is intended to outline changes of lateral joint opening angle (LJOA) of the knee in twenty-seven patients measured pre and postoperatively in connection with high tibial osteotomy. LJOA is the angle which is made between the line connecting bilateral femoral condyles and the line connecting bilateral tibial plateaus in antero-posterior roentgenogram. The results indicate that LJOA of postoperative standing position is almost equal to that of preoperative supine position and is 3.0 degrees smaller than that of postoperative standing position. This suggests that the correct angle in high tibial osteotomy had better be determined in the preoperative X-ray film of supine position.
Fourty-one cases (fifty-three knees) treated by high tibial osteotomy between 1975 and 1984 were revieued. A comparison study of both staple fixation and compression clamps was reported. Average age of patients at operation was 64.1 years (50-82 years) and follow up period after surgery was four years and two months. Staple fixation and compression fixation showed almost same results. But range of motion was better in compression fixation than in staple fixation.
Eight cases of congenital dislocation of the hip were treated in our hospital with functional cast. Two cases failed in reduction by the Palvic Harness, and 6 cases were not treated before one year old. They were treated with our cast for 8 weeks after manual reduction. This cast enables the patients to move legs cephalad and caudal a little in axillar position. All cases obtained good results.
Results of the congenital dislocation of the hip in children with the age of three years were examined radiologically, and the significance of premanipulative traction and of reconstruction operation for residual deformity were discussed. Of 44 hips which were reviewed in the paper, anatomical healing was obtained in nine. There are 23 hips in which satisfactory results are expected if appropriate reconstruction operations might have been performed. The results of the cases in which position of the femoral head was lowered by premanipulative traction were favorable. Consequently, there are two main problems in the treatment of high dislocation of older children; lowering the femoral head and correcting the deformity in acetabulum and proximal femur.
There are many young patients with hip pain of unknown origin. We have performed hip arthroscopy in nine patients. Under epidural anesthesia, patients are placed in a supine position on the traction table, and the hip joint is abducted slightly and pulled distally. After injecting physiologic saline into the joint, the arthroscope (Storz ∅5mm, 0°, 30°, 70°, 120° degrees) is inserted from just proximal to the greater trochanter with the aid of the image intensifier. In 6 cases, we found acetabular labral tears in posterosuperior portion, which seemed to be the cause of the hip pain. They had pain both with passive flexion and with passive internal rotation of the hip joint in physical examination. In one case, many cartilagenous loose bodies were found in the acetabular fossa, which enabled us to make a diagnosis of synovial chondromatosis. Accordingly, the hip arthroscopy can clarify thecause of hip pain in such young patients whose X-ray findings are normal.
The purpose of this paper is to clarify the difference between less than four-year-old patients and more than nine-year-old patients. Materials consist of 30 patients (33 hips) in less than four-year-old patients (group 1) and 14 patients (16 hips) in more than nine-year-old patients (group 2). Epiphyseal quotient (E. Q.), articulo-trochanteric distance (A. T. D.) and length of the neck were measured in each patient. Radiological results were assessed by Mose's method. The value of the E. Q. clearly showed difference after 42 months of onset. E. Q. of less than four-year-old patients increased gradually after 40 months of onset, while that of more than nine-year-old patients decreased after onset. The position of the greater trochanter of more than nine-year-old patients is higher than less than four-year-old patients. The growth of neck length was more disturbed in more than nine-year-old patients. Good radiological results were obtained in 12 patients, fair in 18 patients, poor in 3 patients, in group 1, while in group 2, good; 1, fair; 3, and poor; 12. In conclusion the most significant difference of two groups was the ability, rate of repair and speed of repair process.
Three cases with slipped femoral capital epiphysis were reported. Case 1: A 18-year-old man with femoral capital epiphysis slipped bilaterally had been operated on by arthrodesis of the right hip joint and epiphyseal arrest by multiple pinning in the other hip. In admittance he complained of left coxalgia, and his left femoral capital epiphysis was displaced 75 degrees posteriorly. Bumpectomy and O'Malley's muscle release operation were selected for his left hip joint. After surgery, his activity of daily living improved remarkably. Case 2: A 13-year-old boy with right femoral capital epiphysis slipped 63 degrees posteriorly was treated by Fish's cuneiform osteotomy. Preventively, the other femoral capital epiphysis was arrested in situ by multiple pinning. In our evaluation at five months after surgery, he had no complaints about his bilateral hip joints. Case 3: a 16-year-old boy with bilateral mild slipped femoral capital epiphysis had been treated by epiphyseal arrest. Multiple pinning in situ was done for the right hip at the age of 9 years and the left at 13 years. His activity of daily living was not disturbed at the time of postoperative evaluation.
The dynamic bone scans consisted of sixty-one-second images of both femoral heads, recorded immediately after the injections of technetium 99-labeled methylene diphosphonate. The counts per second were plotted against time to give time-activity curves for each of the femoral heads. The time-activity curves were integrated and then divided by the time-span to give average total counts per unit of time. In order to determine whether the blood flow to the diseased femoral head was decreased or increased, ratios were calculated using the values from the regions of interest on the affected side as the numerator and the values from the analogous regions of interest on the non-affected side as the denominator. The value for the ratios was less than 0.91 in a group of patients, with the following clinical diagnoses: three with femoral prosthesis of the hip, four with femoral neck fracture (Garden Stage IV), and three patients with avascular necrosis of the femoral heads. This non-invasive technique is suggested to evaluate the vascularity of a bone lesion.
A 28-year-old female underwent Chiari's pelvic osteotomy and a 46-year-old female total hip replacement. Two weeks after the operation both cases complained of sudden onset of chest pain and dyspnea. They were transferred to ICU and were diagnosed as pulmonary embolism. They were saved by emergency operation. The first case took oral contraceptive one week before operation, and the second case was a obese female. They may be risk factors of pulmonary embolism. We must pay a great attention to pulmonary embolism that would be the severest complication after orthopaedic surgery.