A rare case of intratendinous ossifications of the bilateral patellar tendons was reported. A fourteen-year-old boy, who was a superior short runner, visited our office, complaining of pain in both knees after running. Physical examination revealed hard masses in bilateral patellar tendons and tenderness of those. No other abnormalities were noted. Roentgenograms of both knees showed ossification in the area of the patellar tendon. Of course, those were extra-articular, arthrographically. Differential diagnosis was made from patella biprtita, Osgood-Schlatter disease and others. Conservative therapies consisting of anti-inflamatory drugs, local injection and others were effective, but the symptom arose repeatedly because he trained hard. We are planning to resect the ossifications after the running seasen.
Various treatments have been reported on RA. Iontophoretic administration was at-tempted to 146 out-patients with RA. As a result, the pain improvement rate of RA was assessed as 100%-70% (excellent), 69%-40% (good), 39%-20% (fair), and below 19% (poor) in 12%, 34%, 42%, and 12% of the patients respectively. The swelling improvement rate of RA was assessed as excellent, good, fair, and poor in 23%, 26%, 38%, and 12%, repectively. When this method was compared with conventional injection to joint, the effectiveness of this method showed less improvement on pain, but the same effectiveness on swelling. This method is easy to be handled and no side effect nor pain has been observed, therefore, it is a useful treatment for RA patients.
A follow-up study of post-operative instability after decompression for lumbar spinal canal stenosis is reported. We operated on 39 patients in our hospital from 1979 to 1985, including degenerative spondylosis; 15 patients, degenerative spondlylolisthesis; 9 patients, and combined; 1 patient. We examined 25 patients personally, 4 patients by questionnaire, and 10 patients were missed. Vertebral slip (3mm or more) occurred postoperatively in 6 out of 25 patients. Abnormal tilting (by Knutsson) in 3 out of 25 patients. The most frequent residual complaint was low back pain and buttock pain. However vertebral slip and abnormal tilting did riot influence the clinical results of the operation.
The total hip replacement was carried out on 15 patients with 15 severe coxarthrosis in 135 cases at a mean follow-up of more than 1 year which were surgically treated on account of hip pain, restricted range of hip motion or activity of daily life. The surgical procedures of transferring the greater trochanter laterally or muscle release were added in only 3 cases on another sides of affected hips. Our results at an average follow-up of 2 years and 2 months were clinically and radiologically evaluated according to JOA score and 4 departments of orthopaedic surgery in Japan. All the patients who were treated with THR were satisfactory to operative results.
The results of 33 total hip arthroplasties in 27 rheumatoid arthritic patients were reviewed one to 5 years (mean, 3.5 years) after operation. We evaluated radiographic analysis of them. The incidence of clear zone was 82% (27 joints), and progression of central migration was revealed in 3 joints (9%). Bone transplantation and mesh implant in the acetabular base were effective in the cases with protrusio acetabuli and thinning of acetabular base.
One would say it is difficult to treat high-riding dislocation of the hip joint at a stretch. There required some special operative techniques: to strip surrounding muscles from the femur to pull-down femoral head to the original position, to dispose the dysplastic small original acetablum, and to insert the stem into a narrow canal of the femur. We performed 31 total hip replacements in 24 cases using these techniques. 23 joints of 18 cases which were followed over one year postoperatively were examined in this study. All the cases could obtain the enough activity in their daily life. As mentioned above, we would emphasize that these troublesome cases could be treated operatively adopting our special techniques.
Bipolar hip arthroplasties with bone grafts in acetabulums were performed in thirteen patients suffering from acetabular protrusion due to rheumatoid arthritis. Roentgenograms revealed sclerosing areas in new acetabulums. The sclerosing area expanded progressively with a thin radiolucent line adjacent to the outer head. Central migration of outer head stopped twelve months after surgery with appearance and spreading of sclerosis in new acetabulum. Until stop of migration, outer head has moved to upper direction by 2.7mm, upper-medial direction by 3.7mm and medial direction by 1.5mm. Finally, the mean width between joint surface and pelvic inner wall was 11.5mm. The sclerosis mey be an evidence of bone formation and incorpolation of grafted bone. Grafted bone exibited increased radionuclide activity. Incorpolation of grafted bone was confirmed by this study.
We have been perfoming Bateman prosthesis replacement for the osteoarthritis of the hip joint since 1980. In the present study, 13 cases with 15 joints were examined directly, and 4 cases with 5 joints were examined by questionnaire after follow-up of more than 5 years post-operative course. The age range was from 43 to 75 with an average of 55.4 years. 13 cases with 15 joints were evaluated by roentgenograms. The clinical results showed that preoperative total average score of 47.7 points was improved to 80.2 points postoperatively by Japanese Orthopedic Association Hip Score System. Roentgenographic results showed that central migration stopped in 10 cases, loosening and sinking of the prosthesis occurred in no case, clear zone around the prosthesis occurred in 10 cases, and ectopic bone formation occurred in 3 cases postoperatively.
Bipolar endoprosthesis was used for primary treatment of coxarthroses. Fifty-nine patients with 66 hips were radiologically and clinically followed. At surgery the acetabulum was deepened in 63 hips and additional acetabuloplasty was done in 13 hips out of them. Postoperative partial weight-bearing with one crutch started at an average of 5 weeks after surgery, regardless of with or without acetabular reaming. Central migration of the head was observed in 5 hips (7.6%) and superior one in 4 (6%). About forty per cent of the cases with non-cemented stem showed the sclerotic bone formation at the tip of the stem, which had no correlation to the postoperative thigh pain. Clinical evaluation was satisfactory which encouraged to use bipolar endoprosthesis for primary treatment of coxarthrosis.
Recently we treated two cases of infected hip prosthesis. At the first stage, surgical treatment consisted of removal of prosthesis, debridement and curettage, irrigation with saline solution and antibiotics, changing operative clothes and tube dilution method. At the second stage, we used bone graft for severe bone loss and cementless hip prosthetic implantation. Our cases have been asymptomatic.
A few years have passed since the introduction of the Bateman type prosthesis to Japan. Its peculiarity is that the range of motion of the inner head is up to 50°, and when the angle exceeds 50°, the outer head finally moves. But in our experience, the outer head actually moves first, so we postoperatively examined and evaluated 38 hip joints in 35 patients with the Bateman type prosthesis. Following results were obtained. 1. The outer head movement was over 60% of total range of motion of the hip joint in abduction and flexion. 2. The longer the postoperative period, the lower the flexibility of the outer head, and the higher the J. O. A. hip-joint score, the lower the flexibility of the outer head. 3. The better the outer head matches the acetabular cavity, the higher the flexibility of the inner head, and overall the J. O. A. hip-joint score. In conclusion, the size of the outer head should well match the size of the acetabulum.
In order to know the indicence, development and prognosis of the clear zone in the acetabular side, radiological examination was done on 104 hip which were followed up for 5 years or more after Charnley THR. The acetabular side in each x-ray picture was divided into four zones. The width of the clear zone in serial x-ray pictures was measured in each acetabular zone and compared among four zones. The incidence of the clear zone 1 year after THR was almost 100% in Zone I, 55% in Zone II, 60% in Zone III and 82% in Zone IV, and 5 years after THR 100% in Zone I, 74% in Zone II, 76% in Zone III and 90% in Zone IV. In 24 hips with less than 1mm width of the clear zone at 5 years after THR, 18 hips did not show further development, however, in 27 hips with 1mm or more 19 hips showed increase of the width and 16 hips had loosening of the socket. It may be concluded that the prognosis of the clear zone within 1mm at 5 years after THR is good.
A fifty-six years old man suffered from a left hemiplegia. Three months after the onset of paralysis, he complained of pain in the left groin. A swelling was found on the anteromedial aspect of the upper part of the left thigh. Radiographs showed immature new bone around the hemiplegic hip joint. Range of motion exercise was stopped. Gradually heterotopic bone had grown, and solid ankylosis of the left hip joint had occured. Ankylosis of the hip resulted in severe disability and required him to be in supine position. Six months after the ossification, to confirm the maturation of heterotopic bone around the hip joint, a partial resection of it was performed. Eight months after surgery, the recurrence of heterotopic ossification was not observed, and he could be able to sit in a wheel chair.
Lateral capsular shadow and iliopsoas sign in A-P view and fatty radiolucent line anterior to the femoral neck in lateral view were studied retrospectively between normal adult hips and cases of avascular necrosis of the femoral head frequently associated with hydrops. The visible radiolucent line was seen in 93%, 77.5% and 77% respectively of the normal hips with any shape of variations. The collapse type of avascular necrosis (stage 3) had clear radiolucent shadow in 61.5%, 69% and 85.1% respectively. The involved hip showed the expansion over 5mm in comparison with normal side or any displacement in 80%, 20% and 77% respectively. It was concluded that lateral capsular shadow lateral to the head in A-P view and radiolucent layer anterior to the hip in lateral view (90 degree of flexion and 45 degree of abduction) are useful as a radiological sign for the diagnosis of intracapsular swelling.
Natural histories of 23 patients (28 hips) with primary osteoarthritis were radiologically examined and its etiology was discussed. There were two types in radiological development of the process, according to the direction of the displacement of the femoral head; (1) supero-lateral type (22 hips), which had a female prevalance, a fast development of the stage and osteophyte formation, (2) medial type (6 hips), which had a slow development of the stage and no osteophyte formation. In the cases of early stage in the supero-lateral type, their displaced femoral heads were reduced by hip abduction. Radiological findings in the medial type were similar to those of inflammation disorders such as ankylosing spondylitis and arthritic of the hip In conclusion, there is close relationship between the medial type and inflammation of the hip joint. However, the etiology of the supero-medial type is considered as the muscle imbalance around the hip, which induces supero-lateral displacement of the head.
The limb shortening as a result of congenital hip dislocation or Legg-Calve-Perthes disease often causes limping. Six patients of acetabular displasia with limb shortening had been treated by Chiari's pelvic osteotomy with femoral lengthening, who were followed up over a year after operation. The following results were obtained: 1) coxalgia decreased; 2) range of motion of the hip improved; 3) disappearence of limping needs a long-term exercise; 4) two of these six cases sustained femoral fracture.
Several parameters in the anteroposterior and lateral views on the plain roentgenograms were compared between 17 cases of the discoid lateral meniscus and 19 cases of the semilunar lateral meniscus in order to find whether the plain roentgenogram could discriminate between the discoid and semilunar menisci. These parameters wereas follows: the distance between the anterior notches of both femoral condyles, and the posterior inclination of the tibial plateau in the lateral view; the ratio of the lateral femoral condyle to the medial femoral condyle, the ratio of the lateral joint space to the medial femorotibial joint space, and the concavity of the lateral tibial plateau in anteroposterior view. Any significant difference was not found in these parameters. Morphology including articular cartilage and meniscus should be investigated further in regard to the difference of the both types of the meniscus.
Eleven patients (14 joints) of hypermobile meniscus were treated in our hospital in the last 6 years approximately. Their mean age was 16 years with a range from 13 to 22 years, and 4 patients were male and 7 patients were female. An affected side of meniscus was all lateral. Only 3 patients had traumatic episode on the knee joint. Giving way was seen in all patients but locking was seen in only one patient. McMurray test was positive in the majority of patients, but Apley test was positive in only one patient. The tendency of general joint laxity was seen in 6 patients (3 patients showed involvement in bilateral knee joints). These were considered to be characteristic findings and one of the geneses of hypermobile meniscus. Arthroscopic partial meniscectomy was performed in 6 patients (8 joints) and arthroscopic meniscoresis in 5 patients (5 joints). These results were more satisfactory in the cases of arthroscopic meniscoresis than the cases of arthroscopic meniscectomy. So, arthroscopic meniscoresis should be chosen in the case of hypermobile meniscus requiring surgery.
Two cases of meniscal cyst were reported in a 53-year-old female and a 49-year-old male. Total meniscectomies were carried out in both patients, and good results were obtained. Histological findings revealed cystic structures with lining epitherial cells. The incidence of meniscal cyst seems to be rare in Japan, compared to that of other countries. Clinical relevance is, however, very important in the differential diagnosis and treatment of meniscal cyst.
Forty patients who were more than forty years old when meniscectomy was performed were reviewed. Fifteen of twenty-three patients who were more than 5 years postoperatively returned for follow up evaluation. Although mild pain was present in 40per cent of the patients, satisfactory clinical results were obtained in all cases. The roentgenographic findings of postmeniscectomy degenerative changes were more severe on the side operated but not correlated with the clinical results. The femoro-tibial angle was in relatively more varus angulation in post medial meniscectomy and more valgus in lateral one on the involved side than on the uninvolved side.
A 63-year-old woman had a locking of the knee joint without a past history of trauma and gonalgia. Radiographic examination revealed a slightly osteoarthrotic change, but no radiopaque loose body. The loose body was observed in the lateral intercondylar notch and removed under arthroscopic control. It was showed histologically the degenerated and torn meniscus, and was considered to be derived from the posterior segment of medial meniscus.
The clinical results and problems of anterior criciate ligament reconstruction using the Leeds-Keio artificial ligament in a series of 28 patients who desired to participate in sports and vigorous labor were reviewed a mean of sixteen months after surgery. Nineteen (68%) of the 28 could almost completely return to their desired activities after surgery. Lachman's test was positive in ten cases even after surgery. Although we placed the substitute at the isometric point with a special instrument (isometric positioner), Lachman's test changed into positive in eight cases with further flexion beyond 130 degrees. The cause of failure was suspected to be the lack of the elasticity of the substitute. This procedure should be done with the correct knowledge about the problems of the artificial ligament.
Posterior cruciate ligament injury has been increased mainly due to traffic accidents. There are many problems concerning the treatment. Someone supports an operative treatment and someone does conservative. Though we have adopted Kennedy's or Insall's methods, stability and range of motion have riot been sufficient. We think that extra-articular reconstruction will be also necessary, because many cases of PCL injury are associated with postero-lateral rotatory instability. So we have been taking the modified Lipscomb's method for extra-aricular reconstruction. The instruments of Aesculap are useful for accurate and safe drilling and putting a guide wire quickly through the bone tunnel. The Leeds-Keio augmeritative mesh was used as a material. As for the isometric points, we adopt the theory described by Sidles. Postoperatively, the Don-Joy 4 points brace was applied after four weeks' cast fixation.
We studied arthroscopically chondral lesions of 56 knees in 55 patients under 40 years of age with anterior cruciate ligament injuries. Chondral lesions were found in 23 knees. With the passage of time after injury, the frequency of chondral lesions increased and extent and grade of chondral lesions developed. In a group examined more than 3 months after injury, chondral lesions were not present in 4 knees with intact menisci. A presence of chondral lesions in femoral coridyle correlated with a presence of meniscal tear or meniscectomy on the same side. The higher activity after injury or reinjury made frequency with chondral lesions higher.
Four patients (five joints) of patella dislocation were treated by semitendinosus tenodesis including lateral release and medial application of the patella. Two cases were recurrent dislocation. We obtained almost good results. Symptoms and signs were almost improved. About 6 months after operation, patients gained full range of motion, and were able to do Japanese sitting. The technique of this operation is simple and easy. The particular application of this procedure is in the young patients before epiphyseal closure, but it can give good results in the older patients. But, in the case with advanced osteoarthritis of the patello-femoral joint, we don't recommend this procedure.
This report presents twelve cases concerning knees of which two cases are male and ten female. An average age of the patients was 15 years old. They rangeed from 11 to 17 one case who was a 37-year-old man. Among the twelve cases of displaced fractures five cases showed simple fractures and seven cases were associated with the fracture of the lateral condyle of the femur. All underwent operation consisting of medial plication and lateral release. Two cases were performed in the manner of tibial tubercle plasty of anteromedial advancement. Two females had a recurrence of symptoms after the operation; however, reoperation was done with good clinical results. Nine cases corresponded to our follow-up investigation, of which two cases were male and seven were female. Accordingly from an objective viewpoint most of the patients progressed very well except for subjective complaints of anxiety in three cases and patella baja in three other cases.
Many conditions influencing the range of flexion after total knee arthroplasty have been suggested, but mnst of these have not been evaluated critically. The purpose of this study was to examine some factors that influence the range of flexion after Miller/Galante total knee arthroplasty. We attempted to evaluate how the flexion of the knee was affected by the diagnosis, the preoperative flexion, the prosthetic alignment and the anterior-posterior deviation of the tibial component.
We reported a comparative study of bone mineral density (BMD) of the proximal tibia with age, sex, weight and height. We measured the BMD of the proximal tibia of 74 healthy men and 76 women from the 2nd to 8th decades, with dual photon absorptiometer, LUNAR DP3, using gadolinium 153. BMD of the proximal tibia decreased according to age particularly in women. Age-related decreases of BMD of the femoral neck and lumbar supine were also recognized. The linear regression coefficient of the proximal tibia on age was greater than that of other skeletal sites. The most relative factor of BMD of the proximal tibia was age in women and weight in men. And BMD at medial and lateral sides of the proximal tibia, which were the weight bearing area, was higher than that of central side, non-weight bearing area. The value of the BMD of the proximal tibia may be influenced by physical activity other than aging.
In 10 knees with valgus deformity, corrective osteotomy was performed from 1981 to 1987. Their osteotomies were done in 3 cases at the tibial portion and in 7 cases at the supracoridylar region of the femur. To obtain good stability of the knee, it is most important to avoid medial tilting of the tibial plateau after the operation when making the final decision of whether to do an osteotomy of the proximal part of the tibia or of the supracoridylar region of the femur.
A very rare case of bilateral naviculo-first cuneiform coalition was reported. Only 9 cases with 12 feet of this coalition has been reported in the literature. The patient was an 11-year-old girl who complained of pain in the medial aspect of both feet. Radiographs showed the cystic change surrounded by the sclerotic shadow at the naviculo-first cuneiform joint. Computed tomography (CT) was useful for recognizing the size and shape of the lesion. A 99m-Tc bone scintigraph showed localized increase in tracer concentration at the lesion. Conservative treatment with the arch support produced no relief of pain, and we carried out the operative arthrodesis of the naviculo-first cuneiform joint. Operative findings revealed that the coalition was incomplete and consisted of cartilaginous tissue. We considered that the pain might be produced by the mobility of this incomplete coalition. After the operation, she had relief of pain.
Congenital tarsal coalition is a fibrous, cartilaginous or osseous union of two or more tarsal bones and its origin is congenital. Recently we treated such 4 cases. Two cases were talo-calcaneal coalition, one was calcaneo-navicular coalition, and one was naviculo-1st cuneiform coalition. Two patients were male and the others were female. All their foot pain appeared in adolescence (10-16 years of age). They all belonged to sports club and their foot pain was caused by vigorous trainings. We treated them conservatively. Now, their foot pain has reduced or disappeared. We should keep this diagnosis in mind when we see the patients who complain of foot pain.
A case of aseptic necrosis of the first metatarsal sesamoid in the both feet was reported and the differentiation between aseptic necrosis and fracture of the sesamoid was briefly discussed. A 36-year-old woman complained of pain on the first metatarsal head of her left foot without episode of injury. The lateral sesamoid was excised. Pain at this site subsided after operation, but the second operation was performed because of pain on the first metatarsal head of the opposite foot. X-ray of both feet showed irregularity, fragmentation and mottled appearance of those fractured sesamoids. Histological examinations revealed both types of lesion: fracture and aseptic necrosis. This case, however, had all characteristic findings of aseptic necrosis of the sesamoid described by Muller, but a deformity of the feet. Then, it seemed that in both sesamoids of this case, aspect necrosis was a primary lesion and the fracture followed.
Dislocation of the Chopart joint is uncommon and only a few reports have appeared in the literature. We are reporting a very rare case of planter dislocation of the Chopart joint without fracture. The patient was forty-eight years old, who was injured by traffic accident. Roentgenogram showed plantar dislocation of the Chopart joint. Reduction was done by manual closed method. There are slight osteoarthritic changes now.
1) 86 cases of congenital vertebral anomalies were reviewed with regared to the associated congenital anomalies. 28% of these cases had cardiac anomalies, 24% had intestinal anomalies and 14% had genito-urinary anomalies. Only 14% of them had no associated anomalies. Thoracic spine anomalies were highly associated with cardiac anomalies. Sacral anomalies were highly associated with imperforated anus. 2) 965 cases of cardiac anomalies, 248 cases of intestinal anomalies and 444 cases of genito-urinary anomalies were studied for associated vertebral anomalies. 2.5% cases with cardiac anomalies, 8.5% cases with intestinal anomalies and 2.7% cases with genito-urinary anomalies had vertebral anomalies. The cases with imperforated anus, omphalocele, kidney anomalies and bladder anomalies were highly associated with vertebral anomalies.
Scapular osteotomy followed by the procedure of Wilkinson & Campbell (1980) was performed in four cases of Sprengel's deformity. Three cases were female and one case was male. All cases were assosiated with skeletal anomalies including spina bifida occulta, scoliosis, synostosis of the upper ribs, funnel chest, etc. Three patients of our cases had omovertebral bones, and all cases had fibrous bands in the rhomboideus muscles, etc. The operations were performed at the age of four to six years old. Posterior fusion of vertebrae was added for a case with the scoliosis of the upper thoracic vertebrae. Post-operative follow-up periods were from four months to six years. All patients were improved cosmetically and functionally by this method.
We make reference to the revascularisation of avascular necrosis after fracture of the neck of the femur in children. The ages of the patients were 12, 4, and 6 at the time of fracture. We studied the circulation with intraosseous venography and bone scintigram. The circulatory disturbance in the epiphysis and the venous congestion in the metaphysis had continued for about 1 year from 6 months after the injury. We think that the repaire of the avascular necrosis are delayed by the retardation of revascularisation caused by microf racture.
169 infants with limited abduction of the hip (bilateral 141, unilateral 28) were radiologically analyzed. Acetabular dysplasia was seen in 34.5% of the bilateral infants and in 57.1% of unilateral ones. 5% of the bilateral and 7.1% of the unilateral cases had a convex type of acetabulum. Retardation of ossification of the femoral capital epiphysis existed in 22.7% of all of the infants with limited abduction of the hip. We believe that it is important to do radiological examination to infants with limited abduction of the hip, because they might have retardation of acetabular development and of ossification in the femoral head.
128 hips in 100 patients with congenital dislocation and subluxation of the hip were reviewed to discuss the clinical problems. All of them were initially treated with the Pavlik harness. Following conclusions were obtained through this study. (1) All but 8 acetabulums developed into normal shape within 4 months after fitting the harness, so that 4 months is thought to be enough time to wear the Pavlik harness. (2) Wearing the harness more than 3 weeks without any reduction may be not only useless but also harmful, so that are recommended other methods including refitting the harness after short waiting period. (3) It is difficult to know the incidence of avascular necrosis of the femoral head clinically, however, apparent swelling around the inguinal region may indicate the occurrence of avascular necrosis of the femoral head. It may be one of the important steps for preventing this serious complication to decrease the abduction in flexion position after onset of this clinical sign.
Thirty-three cases with Perthes' disease who had been treated in our clinic were evaluated radiologically and clinically. The follow-up period after the beginning of treatment was from 5.6 to 32 years (average, 13.5 years). Conservative treatment was carried out in nine cases, and operative treatment in twenty-four cases. Chiari pelvic osteotomy was performed for fourteen cases that had coxa magna. The results were dependent on the method of treatment and those of Chiari group were favourable clinically and radiologically.
Little League Shoulder is a syndrome involving the proximal humeral epiphyseal plate. It is characterized by pain when pitching and is associated with specific changes. An 11-year-old male of little league shoulder was reported. He got a pain in the right shoulder when throwing a baseball. X-ray films of right shoulder showed a marked uniform widening of the proximal epiphysis of the humerus without fragmentation or significant osteoporosis adjacent to the epiphyseal plate area. The patient was seen 1 month later at follow-up and he denied having any pain in his right shoulder. An X-ray film of the right shoulder after 3 months showed healing of epiphysis.
We reviewed 19 cases of so called “little league's shoulder” treated from 1981 to 1987. Follow-up period ranged from 5 months to 71 months (average, 26). Those cases were all boys and their age ranged from 10 to 15 years old (average, 12.2). Physical examination revealed no characteristic signs, but radiographic findings are important to make a diagnosis. Widening of the anterior and lateral physis is essential for this disease. In addition reactive bone formation such as bony spur and demineralization of the lateral half of the epiphysis are seen. Rest for 2 or 3 months led to rapid healing on X-ray examination and no pain on hard throwing is present at the final examination. We consider that the pathological feature of the little league's shoulder is separation of the proximal humeral physis, Very early diagnosis and treatment is stressed in this paper.
The aim of our study was to demonstrate the ratio and the management of shoulder pain in high school athletes by questionnaires and interviews. In our study, we asked 2, 209 athletes (1, 299 male, 910 female) about their shoulder pain by questionnaires. And we asked the managers how many athletes who had complained of their shoulder pain and how to deal with their shoulder pain in interviews. 42.2% of male and 32.3% of female, 38.1% of the athletes in total had experienced shoulder pain in their sport lives. Among the athletes who had complained of shoulder pain in questionnaires, only a few really complained of their shoulder pain to their managers. Most of the managers ordered their players to refrain from training, but a few of them left it to the player's measure. Both the players and their managers tend to make light of shoulder pain, therefore, the degree of the shoulder disorders had become worse at the time of the treatment. So, we must make the appropriate prophy-lactics to prevent the incidence of sever shoulder disorders.
Stress fractures are not uncommon among athletes, but pelvic stress fractures are relatively infrequent. We experienced two cases of pelvic stress fractures. Both patients were wemen and fractures occurred at the junction of the inferior pubic ramus and ischial ramus. It was considered that strain caused by muscular pulling and weight stress led to pelvic stress fracture. When a stress fracture of the pubic arch is clinically suspected but the radiographs are normal, follow-up examination in 2-3 weeks and radionuclide bone scan are usefull. After identification of the fracture, training had to be curtailed until the symptoms disappeared in order for healing to occur.
Avulsion fractures of the anterior iliac spine were observed in 6 adolescents. The patients, 5 boys and 1 girl, were between 12 and 15 years old. All the fractures occurred while the patients were engaged in vigorous sports, such as short-distance running and soccer. The avulsion fractures were of the anterior superior iliac spine in 4 cases and of the anterior inferior iliac spine in 2 cases. Open reduction was necessary in 5 patients in whom displacement of the superior or inferior iliac spine was more than 3cm. One patient was treated by cast immobilization. We consider that suitable treatment should be given as soon as possible after careful clinical and radiological assessment of avulsion fracture.
Fracture of the processus posterior tali is rare. But it is very significant in the sport injury and included in the “footballer's ankle”. Recently, we experienced three cases of this fracture. Two of them were footballers and the other was a Judo player. They had an episode of the posterior ankle contusion, and complained of pain in the area of the posterior ankle joint. In all cases, Flexor Hallucis Longus test (FHL test) was positive. We resected the bone fragments, and had good results. After surgery, pain disappeared, and FHL test became all negative. We considered that the resection of fragments was effective for early recovery to sports. Then, we will report two cases of them.
We encountered a patient with osteocartilaginous fracture of the talus considered to have been caused by sports activities. Osteocartilaginous fracture, stage III by Berndt' s radiographic classification, was noted on plain radiography and CT posteriorly to the upper medial margin of the pulley of the talus in a 16-year-old male. The injury had occurred about a year before our initial examination. Considering that the patient was active in sports, we treated this 1-year-old stage III fracture by percutaneous retrograde bone perforation, to avoid damage to the articular cartilage, followed by 2-month application of PTB braces. At present, 5 months after the operation, no marked changes have been observed in CT, but the patient is asymptomatic, and the results are clinically safisfactory. This case is presented with a review of the literature and a discussion.
The case was a 29-year-old male who had experienced several episodes of atraumatic subluxation of his right shoulder. In March 1986, the right shoulder pain increased and he was admitted to our hospital on April 30, 1986. Debridement was performed on May 6, 1986. After the operation, he obtained relief of pain but suffered from 2 or 3 times subluxation of the right shoulder without trauma. Roentgenographic findings showed joint space narrowing and destructive change of the head and glenoid. Arthrographic findings showed severe synovitis. In July 1987, the pain increased and arthroscopy and open synovectomy were performed. Findings on the arthroscopy and operation, showed severe synovitis and defect of articular cartilage. The infecting organism was streptococcus. After the operation, he obtained relief of pain and good range of motion transiently but now motion pain reappears. It is considered that the destructive change of the shoulder joint by subluxation and the damage of articular cartilage and jiont components by pyogenic arthritis caused severe osteoarthritic changes.
We treated three cases of septic arthritis of the knee with loss of articular cartilage in medial compartment of the femoro-tibial joint. One case underwent arthrodesis due to bone loss from medial tibial plateau and unstabl knee. Other two cases had synovectomy, debridement, closed irrigation-suction treatment. They had flexion of 100 degrees or more and no recurrence. Synovectomy, debridement, closed irrigation-suction treatment is effective for septic arthritis of the knee with stability and intact articular cartilage in one compartment even if articular cartilage in another compartment is defected.
Chronic osteomyelitis still remains problems despite advances in medicine. Chronic and located osteomyelitis is difficult in diagnosis for that reason of it's non-specific clinical apperances. We reported five caces of osteomyelitis that was located in the femoral bone. In two caces surgical debridement and grafting of autologous cortical cancellous bone was performed, which seems to be a valuable method of treatment for chronic osteomyelitis.
A 48-year-old woman developed lumbago in 1973 and pustulosis palmaris et plantaris (PPP) in 1976. In 1977, with curettage of right iliosacral joint, her lumbago and PPP were treated successfully. In May 1987, she was admitted to our hospital because of recurrence of lumbago, pain of the right hip and PPP. X-ray showed sclerotic and destructive changes of the joint in right iliosacrum and lumbar vertebral. 99mTc scintigraphy showed abnormal accumulation in cervical vertebral, sterno-clavicular joint, ribs, lumbar vertebral and iliosacrum. Histological examination of the right acetabulum showed the thickening of trabecular bone and the proliferation of lymphocyte.