Twenty-nine fingers of twenty-eight cases which were treated for a mallet finger with fracture at Kyushu Welfare Pension Hospital between 1978 and 1987 were reviewed. Sixteen fingers of fifteen cases were evaluated an average of six years and six months after injury. Surgical treatment did not always produce good functional results, but no patient had disabilty in daily life. The results of conservative treatment with splints varied widely, and of no treatment were poor. A new method of closed reduction for mallet fractures by Ishiguro produces accurate reduction easily. We applied this method to the recent four cases, and favorable results were obtained.
Scaphoid fractures are difficult to diagnose at the early stage because of unclear radiographic findings and slight symptoms. However, if the fractures are left untreated, they will cause carpal instability. In this paper we reported the results of scaphoid fractures in our hospital and pointed out a few important problems. We had 28 fractures (male 23, female 5) for the past 9 years (1979-1988). 12 were managed by conservative treatment and 10 were managed by operative treatment. The patients' mean age was 28.1 years. They were followed-up for an average of 33.9 months. The rate of union was 81.8% and the rate of return to the same job prior to the injury was 72.7%. In this study, we also found that the lunate became to be dorsiflexed following the natural course of the scaphoid fracture, but it was improved after treatment. As a result we had a renewed understanding of the importance of the early and proper treatment of scaphoid fractures.
Ten cases of scaphoid fractures were treated by Herbert screws. Bone union was obtained in nine out often cases. Screw fixation was carried out in a retrograde-manner in the cases which had a proximal half fracture. We used a “scaphoid splint” which restricted radio ulnar motion of the wrist to prevent joint contracture. This splint was used for the patient who showed poor bone formation at the fracture site after cast immobilization.
Four scaphoid non-unions had Hervert screw fixation. One case failed technically and became non-union once more subsequently. But the other three cases had good unions and excellent clinical results. Hervert screw fixation do not require long-term cast immobilization in comparison with Russe grafts. However, as a problem in operative technique, two points are raised. Firstly, DISI deformity should be corrected certainly and sufficiently. Secondly, the tip of the jig should be placed on the proximal pole of the scaphoid and scaphotrapezium joint should be dissected sufficiently. Although the technique is demanding, Hervert screw can achieve excellent results in the management of scaphoid non-unions.
Isolated fractures of the pisiform bone are uncommon. We reported two cases of isolated fracture of the pisiform bone. The first case was a 40-year-old male, and the second case was a 24-year-old female. The second case showed the Guyon canal syndrome. Both cases were treated by open reduction and fixation with microscrew. Bony unions were otained in both cases. A few months after the operation both patients were asymptomatic.
We reported two cases of subcataneous extensor tendon rupture in the finger secondary to kienböck's desease, and studied the anatomic relationship of the lunate and extensor tendons. The two patients were sixty-three-years old and forty-five-years old respectively. Radiographs showed stage IV kienböck desease by Takada's classification. Both ruptures occured in the ring finger. In thirty hands in fifteen cadavers the middle and ring extensor tendons were on the lunate in a high percentage, and the tendency to rupture the tendons in chinical cases was associated with this anotomic relationship.
Six patients with chronic wrist pain were diagnosed with occult dorsal carpal ganglion using sonogram despite the absence of a palpable mass. The four females and two males were aged 19-26 years. Symptoms had been present for an average of 17 months. Tenderness in the scapholunate fossa and pain at the wrist with motion were constant findings. Each was treated with ganglion puncture and the pain was relieved in all six patients and no recurrence was noted at follow up of at least 6 months.
We performed canalography on 15 hands in 15 patients with carpal tunnel syndrome. 14 cases were chronic renal dialysis patients. In 5 cases, we were not able to identify carpal tunnel on the canalography. Those had severe constriction of the median nerve at operation. All of 8 cases, who had constriction on the radiograph, had constriction of the nerve at operation. The clinical findings and the prolonged motor latency of the median nerve had no significant correlation to the radiographic findings. Identification of motor branch was very difficult.
We reported two cases of Panner's disease. Case 1: A six year-old boy was seen in June 1982, with a complaint of pain in the right elbow. History revealed that he had no accidental trauma. Physical examination showed that there was no pathological findings about his right elbow. Roentgenograms of his right elbow at this time showed an irregular subcortical bone of rarefaction on the antero-posterior view of the capitulum. The patient and his mother were advised to refrain from strenuous arm activities. Two months after his first visit he was free from subjective symptoms referable to his right elbow. The last roentgenograms were taken in January 1985 and demonstrated excellent healing of the capitulum of the humerus. Case 2: A nine year-old boy was seen in January 1986, with a complaint of pain in his right elbow. He began to play Kenndou in April 1985. He noticed his elbow pain in September 1985. Since then he visited some orthopaedic surgeons. When he visited us, his right arm was immobilised with plaster of Paris splint. Physical examination revealed tenderness over the lateral humeral epiphysis and slight swelling in his right elbow. Roentgenograms at this time showed irregular condensation within the capitulum. The patient and his parents were instructed that the patient should not strain or overexercise the arm in gymnastics or athletics. He was examined every 4-6 months. The last roentgenograms were taken in October 1988, two years from the onset of the illness, and demonstrated excellent healing of the capitulum of the right humerus. We shortly discussed about this disease.
We operated on 27 elbow joints with osteoarthrosis from 1978 to 1988 and compared 12 elbows of the Kashiwagi method with 8 elbows of the anterior approach method. There were no significant differences in subject age or the ROM of the elbow before surgery between the Kashiwagi method and anterior approach method. The flexion angle after surgery improved significantly from before surgery but in two cases there were no significant differences. There were no significant differences of extension angle between the cases before and after surgery. Most patients without pain after surgery had a good flexion angle before surgery and high satisfaction after surgery. The period of admission after surgery and the return to occupation was shorter in the anterior approach method than in the Kashiwagi method. We concluded that the operation for osteoarthrosis of the elbow was more successful in the anterior approach method than in the Kashiwagi method.
Reconstruction of old ruptures of the collateral ligament of the metacarpophalangeal joint of the thumb was performed using the tendinous portion of the adductor pollicis and abductor pollicis brevis keeping the insertion at the base of the proximal phalanx intact. The procedure has been used in four cases, two old radial collateral ligament ruptures and another two ulnar ruptures. Symptoms and instability were corrected in all cases after seven, nine, thirty-two and fourty-three months of follow-up period respectively. Compared with the reported ligamentous reconstruction of long standing ruptures of the collateral ligament, this procedure has four particular merits: First, the procedure is very easy and operative invasion is small. Second, since there is no possibility of harm to the growth plate in children, and there is no fare of loosening of the joint with growth of the patient. Third, the procedure does not require sacrifice of any donor tendons or fasciae. Fourth, the procedure does not disturb any important anatomical structure, allowing other reconstructive procedures to be performed as a second operation.
The latissimus dorsi muscle transfer to restore flexion of the elbow has supplied satisfactory results in the field of reconstructive surgery. This technique was applied to the simultaneous reconstruction of elbow and finger function, combined with multiple nerve transfers, in totally paralysed avulsion type brachial plexus injuries. Our technique consisted of four steps. 1. Exploration of the injured brachial plexus to estimate the available upper cervical roots using the sensory evoked nerve potential, 2. Nerve grafts between the available roots and the median or radial nerve if the injury is postganglionic, and multiple muscle transfers with the latissimus dorsi or rectus femoris muscle to restore finger and elbow flexion, connecting to the FDP tendons at the forearm, 3. After some recovery of finger function, secondary muscle transplantation of the gracilis muscle to provide wrist extension is performed, 4. To control the intrinsic minus deformity of the fingers, a tenodesis is done. This technique had been applied to nine cases with a totally paralysed avulsion type brachial plexus injury. Their range of elbow motion was from minus 30 degrees in extension to 90 degrees in flexion. Their grasping power was between 2 and 4 (by manual muscle testing). Although normal usage still was not restored, this technique appears promising in totally paralysed avulsion type brachial plexus injuries.
An operative method to create interdigital space was described. In this method, a pantaloon flap on the dorsal side and a triangular flap on the palmar or plantar side are designed, and two flaps are inserted to interdigital space from each side. Skin defects of proximal area of both fingers are covered by full-thickness skin graft. It is very important for a triangular flap of the palmar or plantar side that width of the flap is enough to go beyond middle line of the finger and an angle of tip of the flap is less than the right angle.
Biomechanical effects of the Chiari pelvic osteotomy with femoral osteotomies were evaluated using two dimensional computer simulation by Kawai's rigid body-spring model. The author made three models of the pelvis; normal, acetabular dysplasia and after Chiari, and four femoral models; normal, after varus osteotomy, after curved varus osteotomy and after valgus osteotomy. Both group of models were combined respectively. Their biomechanical effects were evaluated. The results were as follows. 1) The resultant force on the femoral head after Chiari osteotomy was less than that of the normal pelvis. 2) The Biomechanical condition of acetabular dysplasia with a valgus osteotomy was the worst in these 12 hip joint models. 3) Chiari pelvic osteotomy alternated the biomechanical condition of acetabular dysplasia with valgus osteotomy. 4) The biomechanical effects were different between varus osteotomy and curved varus osteotomy.
A Chiari pelvic osteotomy was performed in 376 hip joints, and a Chiari with femoral osteotomies was performed in 148 hip joints in our hospital. The abduction power of the hip was measured by Cybex and was analyzed using computer simulation. The results were as follows. 1) The abduction power of the hip was decreased temporally after the operation, but gradually increased to the preoperative level in 6 to 9 months. 2) In the valgus group, the abduction power was increased in the early period, but in the varus group, there continued a decreased period of abduction power in the long term. 3) The isometric torque curve of hip abduction in the healthy young male was decresed with hip abduction. 4) The vector direction of the abductor muscles was changed medially with hip abduction by simulation.
To clarify the cause of osteonecrosis in the femoral heads of spontaneously hypertensive rats (SHRs), we observed the growth plate and trabecular bone in the proximal femoral metaphysis, histologically. Bone morphometry was also carried out to measure trabecular bone volume and trabecular thickness. The growth plate in SHRs showed abnormalities such as decreased thickness, discontinuity and clustering of chondrocytes, etc. Bone morphometry disclosed that metaphyseal bone trabeculae in SHRs was significantly hypertrophic in contrast to those of control rats. In addition, 14 femoral heads with osteonecrosis in SHRs had a tendency towards more increased trabecular bone volume and trabecular thickness than those which had no osteonecrosis. It seemed that abnormalities in the growth plate and metaphyseal bone trabeculae plays a part in the occurrence of osteonecrosis of the femoral heads of SHRs.
Recently, some reports demonstrate the usefullness of the magnetic resonance imaging (MRI) for early diagnosis of the avascular necrosis of the femoral head (ANF). In this report we analysed 64 hips in 40 cases using preoperative plain radiographs, tomography and MRI affected by ANF. And we gained following three conclusions. 1. When rotational osteotomy of the femoral head is to be carried out, two plain views of MRI, parallel and contrary to the axis of the femoral neck, were useful for evaluation of postoperative weight bearing area. 2. In 58 hips with strinct the former two plain views of MRI, atrophy of posterior area of the femoral head was recognized in 54 hips by tomography, and of them abnormal signal in posterior was revealed in 32 hips by MRI. 3. In 28 hips performed anterior rotational osteotomy, atrophy of posterior area of the femoral head was recognized in 26 hips by tomography, and of them abnormal signal in posterior was revealed in 6 hips by MRI. In such cases careful follow-up should be required.
21 Revisions of THR because of aseptic loosening were performed requiring replacement and recementing of one or both components. The results were poor in a significant number of patients. Revision of THR with recementing, results in a high rate of failure. The use of an alternative method and technique must be explored for revision surgery.
The clinical and radiological results of Charnley THR, which were performed on 32 hips in 26 cases suffering from rheumatoid arthritis (RA), were examined and the problems were discussed. At 3 years after THR, the average score of Jpn. Orthop. Ass, was 56.7 points. Postoperative complications were observed in 4 cases, 3 cases had a dislocation of the hip joint with a non-union of the greater trochanter. The mortality rate of patienst after THR was 15.4%. In zone I, IV (acetabulum) and zone 1, 7 (femur), the incidence of the clear zone was higher than the other zones. THR for RA had various clinical and radiological problems, thus we thought that a suitable procedure for THR and careful postoperative management were important.
Total hip arthroplasty with bone graft to the medial acetabular wall was performed on 21 hips in 19 patients with rheumatoid arthritis. Thin slices or block from the femoral head were used as bone graft. Cemented acetabular cup was used in 4 hips and cementless in 17 hips. Ages at operation ranged from 37 to 74 years (mean, 54.1). The postoperative follow-up was done at 3 to 18 months (mean, 9.1). All grafts appeared to have united roentgenographically and the protrusion did not progress. Invasion of cement between the grafted bone and acetabular wall was seen in a patient with cemented acetabular cup. Although non-progressive radiolucent line less than 1mm in width occurred around acetabular cup in 13 hips, no complication has been clinically encountered in a follow-up period. The results of this study suggest that bone graft with cementless cup provides the sufficient medial wall and there is no need for cementing in acetabular cup.
The purpose of this paper is to discuss the following problems in Perthes' disease: (1) a method for the evaluation of the radiographical results, (2) the relationship between the age at onset and the end results, and (3) the relationship between Catterall's classification and the end results. Twenty-seven patients (twenty-eight affected hips) with Perthes' disease were reviewed and studied. All of them were evaluated radiographically by the original classification of our hospital. This is a simple and practical four-group classification. It can be applied not only in the short-term follow-up study but also in the long-term one of the disease. In our study, the radiographical results surely depended on the age at onset, but not on the Catterall's classification.
Fifty-three hips of Perthes'disease treated in our hospital from 1975 to 1984 were reviewed. The patients were classified into two groups, the early-admission group (within 6 months from the onset) and the later-admission group (after 6 months from the onset), and the results of these were compared. In terms of the risk sign of the femoral head, subluxation, metaphyseal cyst, and lateral ossification were examined. The results were as follows: 1) the result of the early-admission group was better; 2) the results of the cases that had two or more risk signs were worse, especially in the later-admission group; and 3) The adequate treatment at the initial stage is important.
The results of treating 87 hips of 83 children (average follow-up of 11.3±4.3 years) with Perthes' disease were analyzed. The patients were classified according to the Stulbergs' classification. The cases of class I and II of the all had a good congruous hip joint. Fifty-six percent of the cases of class III and IV had an aspherical congruous hip joint. However, forty-four percent in cases III and IV had an aspherical incongruous hip joint with pain in the hip. We concluded that hip joint congruity is one of the most important factors affecting the development of osteoarthritis.
We evaluated the radiological results of 113 hips in 109 patients with Perthes disease using the modified method of Jikei University and graded them as excellent, good, fair, or poor. The average age at diagnosis was 7.6 years. The average follow-up period was 5.2 years. 22.1% of the cases were excellent, 30.8% were good, 30.8% were fair, and 15.9% were poor. Then we analyzed the secondary changes of the acetabulum in 25 long term follow up cases above 15 years by acetabular roof angle (ARA) and the extent of lateral femoral subluxation (EOS). Patients with a poor result showed a steep angle of the acetabular roof at the time of primary healing. However, some patients graded as fair improved their ARA at the time of follow-up. In conclusion, it is important to include the ARA into analysis of X-ray evaluation for a more exact prognosis in Perthes disease.
Nineteen patients with Perthes' disease treated conservatively and eleven patients with osteoarthritic changes after Perthes' disease were evaluated clinicaly and radiologicaly at the age of fifteen years old. The clinical results were good. The radiological results at the follow-up period depended on the Catterall's group, the head at risk sign, and the maladaptation between femoral head and acetabulum. In conclusion acetabular roof angle on poor result cases was especialy steep, and subluxation of the femoral head at the first stage was the most critical cause of osteoarthritis.
In this study, the usefulness of Mose's criteria for the radiological assessment of Perthes' disease was examined. 22 patients with unilateral Perthes' disease providing 22 affected as well as 22 control femoral heads were reviewed radiologically at five and ten years from the onset of the condition. The sphericity of the heads were evaluated with Mose's criteria at both times and comparised to their chronological change. Two radiological parameters, Epiphyseal quotient (EQ) and Radius quotient (RQ), of each affected head were measured to show the relationship between Mose's rating and epiphyseal flattening as well as enlargement of the femoral head. It was found that the Mose's rating of both affected and control heads changed in several cases prior to ten years. A significant number of control heads exhibited less than a good result with the Mose's rating at the five year evaluation, however, almost all control heads at ten years were judged good, which suggested that this criteria should only be used after ten years from the onset of the disease. There was a correlation between Mose's rating and the values of EQ and RQ, however, Mose's rating could vary according to the definition of the range of the radiographic head to which the Mose's ring was applied. It was concluded that Mose's criteria was useful as an assessment method for the rediological result of Perthes' disease, however, it also had some problems in it's timing of assessment and measurment of details.
For orthopedists, the radial end fracture is a very common injury. The optimism that the prognosis of the fracture is good, has been echoed by several authors. Sometimes, however, we see patients whose wrists and hands are suffering, from a probable malunion. The authors have performed open reduction, and internal fixation by AO/ASIF T-plates for reduction and stabalization of the intraarticural fragments in 9 cases. We concluded that the important points of the procedure are (1) anatomical reduction, especially volar angle, (2) rigid fixation and maintainance of reduction, (3) ROM exercise, immediately after, the operation. Carpal instability in the cases of dorsal malunion is noted.
Fifteen patients with bilateral distal end fractures of the radius were treated from August 1984 to March 1989. There were 11 males and 4 females. The mean age was 24.9 years with a range from 9 to 83 years. The types of fractures were 17 Colles' fractures, 11 Smith's fractures and 2 Chauffeur's fractures. The mechanism of injury was high energy trauma in most cases. Before 1986 treatment by fixation with a plaster cast after manipulation was performed in our hospital, but percutaneous pinning has been prefered since 1986. The results of percutaneous pinning were satisfactory.
Isolated fracture-dislocation of the radial head without fracture of the ulna is extremely rare. A 15-year-old girl with such an injury came to our hospital on May 13, 1988, having fallen on her hand with the elbow outstreched. Examination revealed marked tenderness over the head of the radius, and pain on all motion. X-rays revealed an anterior dislocation-fracture of the radial head without fracture of the ulna. Closed reduction under general anesthsia was achieved. 12 months later, she had a little loss of rotation, however, had no functional complaint.
We report the results of Monteggia fractures in fifteen cases during past ten years. The age at fracture ranged from three to sixty years with an average of seventeen years. Five of fifteen were treated by closed reduction, and others were treated surgically. According to Wheeler's evaluation, ten cases were excellent, one was good, three were fair, and one was poor.
Seven patients who had undergone osteosynthesis three weeks or more after injury were evaluated at a mean of 3 years and 8 months following surgery. Pain, lateral instability, elbow motion, carrying angle, ulnar nerve palay, and roentgenographic stature and measurements were determined for both the normal and the involved extremities. Functional results were satisfactory in all cases except for one patient with avascular necrosis and another patient whose preoperative elbow motion was extremely limited. Cubitus varus deformity caused by reduction was the most common complication. Avascular necrosis was thought to be caused by stripping of the all common extensor tendons. Early epiphyseal arrest occurred in a patient who had undergone surgery 1 year and 4 months after injury. Osteosynthesis within 5 months after injury is successful with no significant complications. Early epiphyseal arrest may occur if a patient undergoes osteosynthesis one year or more after injury, but osteosynthesis should be done considering the bad result of non-treated fractures of the lateral humeral condyle.
84 cases of fractures of the distal end of the humerus in children were followed-up from 1 to 16 years with an average of 3 years and 9 months. We studied the Baumann angle, the carrying angle and the tilting angle. In the normal arm, there was no significant difference between age and sex in the carrying angle and tilting angle. There was no significant difference in the carrying angle of the fracture of the distal end of the humerus in the follow-up period. The Baumann angle was measured after the reduction of the fracture and was found to correlate well with the final carrying angle measured at follow-up. We suggested that if the Baumann angle after reduction of a supracondylar fractures is 17°, the final carrying angle will be the same angle as in the normal arm, and if the Baumann angle after reduction of a intracondylar fracture is 22°, the final carrying angle will be the same angle as in the normal arm. With the tilting angle of the supracondylar fracture, there was a significant difference between the follow-up period which was under 1 year and that over 1 year. It is suggested that the supracondylar fracture has a remodeling capacity.
We report 5 cases of the posterior dislocation of the elbow joint accompanied with the fracture of the coronoid process. In case 1, as the coronoid process had been crushed, a piece of bone was extracted. However, the redislocation occurred, so the iliac bone was transplanted to the lost coronoid process, and the medial collateral ligament was replanted after transferring the triceps tendon. After the operation, there has been no redislocation. ROM remains between 20 and 125 degrees. In both case 2 and 5, the bone was reduced and fixed. Then, neither redislocation nor ROM limitation has been seen. Satisfactory prognosis has been seen. In both case 3 and 4, the fracture of the radial head had been associated and the radial head was excised from 2 cases. In the field of the coronoid process, the internal fixation was conducted in case 3, and in case 4, medical treatment was conducted conservatively. After the operation, in case 3 ROM was restricted between 20 and 125 to a slight degree. But, in case 4, no ROM limitation has been observed.
A 61-year-old woman complaing of swelling and pain in her right foot was seen in our clinic in June 1986. Fifteen years before she dropped an ice block on her right foot. Swelling and pain subsided spontaneously. One month later she suffered acute pain and swelling in dorsum of her right foot, she was diagnosed as gout and was treated with local injection and anti-inflammatory drugs. Since then she had reccurrent attacks of swelling and pain in the same place. In June 1986 she had attack of swelling and severe pain and visited our clinic. Physical findings revealed redness and swelling in dorsum of her right foot and severe tenderness on the center of the swelling. Roentgenograms showed a calcium deposit about 3.5×2.0×1.0cm on the dorsal side of the 2nd and 3rd MP Joints. There was no calcified area of the articular cartilage of the joints. Laboratory findings were normal except for ESR and CRP. The calcification was excised. X-ray diffraction revealed that the chorky mass was hydroxyapatite. Postoperative course was uneventful. One year after the operation she again visited us with complain of swelling and pain of the planter side of her right foot. Radiograms showed a big calcification about 4.0×2.0×1.0cm on the planter side of the 2nd and 3rd MP joints. Conservative treatment was ineffective and surgical exstirpation was performed again.
A rare case of the osteochondritis dissecans of the talus associated with giant cyst was reported. A 17-year-old girl, who had severe pain and swelling because of sprain of recurrent planterflexion and inversion force of the ankle in playing handball games, was seen. The antero-posterior, lateral and mortise roentgenography, and lateral tomography were taken, which revealed osteochondritis disscans of the talus with giant cyst in the body, as Stage III according to the Berndt and Hartys classiffication, including mild osteoarthrotic changes. The osteochondral fragment was excised with drilling after curettage by transmalleolar approach. The aetiology, diagnosis and treatment of this case compared with some references was discussed.
The radiographic Changes of the femorotibial angle, the proximal tibial metaphyseal diaphyseal angle, the distal tibial metaphyseal diaphyseal angle and the tibial metaphyseal metaphyseal angle were measured on serial radiograms in twenty children with physiological bowleg (group A) and in six patients with infantile type of Blount's disease (group B). The average of the distal tibial metaphyseal diaphyseal angle in group A was 8.5 degrees, compared with 9.2 degrees in group B. There was no statistical difference for the two groups. The average of tibial metaphyseal metaphyseal angle in the group A was 17.1 degrees, compared with 24.1 degrees in group B. The two groups were statistically different (p<0.01), the results suggested that the tibial metaphyseal metaphyseal angle is a useful marker for the early diagnosis of the infantile type of Blount's disease.
We have reported the short term follow-up of reconstruction of the lateral ligaments in 7 patients (8 ankles) who were followed-up for 12 to 45 months (Age. 27.6 months) after surgery. Three of the patients were male and four were female, whose ages were 16 to 54 yrs. (Age. 29.4 years). Operative procedures included 3 cases of Kaplan, 4 cases of autograft, and 1 case of (artificial) graft. Radiographically, almost all cases had normal values of anterior talar displacement (ATD, 3.4±1.0mm) and talar tilt angle (TTA, 5.2±2.6 degrees). Objectively, we obtained 87.5% good results, and in subjectively, we obtained 87.5% above S2. There were several complications which included limitation of motion in 3, nerve entrapment in 2, hypertrophic scar in 1, and tendinitis in 1. Based on the findings in this study, we seemed to obtain a much better result when an anatomical and functional reconstruction with a correct procedure was performed.
The purpose of this study is to dofine the indications for a modified Mitchell's procedure in hallux valgus. 42 feet corrected with this procedure were followed up for an avarage 2 years and 10 months. We reviewed each patient's postoperative result individually and measured the hallux valgus angle, the intermetatarsal angle and the tibial sesamoid position from the radiographs. We obtained good subjective results when the hallux valgus angle before surgery was less than 45 degrees. There was a correlation between the hallux valgus angle before surgery and at follow up. As mentioned above, a good indication for the modified Mitchell's procedure is less than 45 degrees of hallux valgus before surgery.
We present 5 cases of compartment syndromes which we recently treated during the period from July to November 1988. Three cases out of five were acute compartment syndromes of the lower legs. The last case was a chronic compartment syndrome of the lower leg, and the fourth was a flexor compartment syndrome of the upper arm which, we believe, was conspicuously rare. The diagnosis was determined by tissue pressure measurements and clinical symptoms, such as neurological symptoms, circulation disturbance, increasing pain, and swelling. Also, as a mean of supporting diagnosis, muscular pressure measurements was conducted in accordance with the needle manometer by Whitesides et al. Finally, fasciotomy was performed in all cases. We report here the above five cases about the compartment sydromes with our literatural comments which we have studied these days.
In this literature, we report the measurement of static pressure under the foot of 38 healthy adult females. The systems we used was Electric Baropodometer PEL-38 (Medi Capture). Data analysis was done with IBM PS/2 Model-130.
Isokinetic knee extension, flexion, ankle dorsi and plantar flexion strength was evaluated in 20 patients with ankle joint injury (patient group) and 10 normal volunteers (normal group). Using the Cybex 340, the test was performed at 60 deg/sec (knee) and 30 deg/sec (ankle). Knee flexion/extension for peak torque is about 1/2 and ankle dorsi flexion/plantar flexion for peak torque is about 1/4-5 when comparing the patient group to the normal group. Ankle dorsi flexion for peak torque is significantly lower on the injured side. Ankle dorsi flexion for peak torque is significantly lower in average power, after 4 weeks immobilization and in males. Quadriceps and Hamstrings muscle strength is not significantly lower in the patient group.
We investigated ankle, foot and toe sports injuries. Four hundred and forty-four patients who had orthopedic injuries, related to sports activity were treated in our hospital between August 1988 and January 1989. Of these patients, 97 cases (21.8%) had injuries in their ankles, feet and toes. There were 48 men and 49 women, aged 9 to 50 years. Seventy-one percent of the patients were in their teens. The most common causal sports were volleyball, soccer and field and track events. Of the injuries, 41 (42%) were ankle sprains (involving lateral ligament rupture), 7 were Achilles tendon rupture, 6 were fracture and there were various other injuries. As ankle sprain, the most common injury in this investigation, may lead to further problems (e. g. unstable ankle, pain, repeated aprain) if appropriate treatment is not given, we should pay careful attention to its therapy and prevention.
Two hundred and nineteen patients who had ankle and foot injuries related to sports activities consulted in our orthopedic department between October 1986 and October 1988. The sports which cause the injury included 52, track-and-field, 45 basketball and 29 volleyball injuries. Treatment was necessary to 60 in which 34 had a conservative therapy, and 26 had a operative intervention. Eighty-seven % of the patients who were treated made a comeback to their former sport. To prevent sports injuries, it is necessary that doctors have a good communication with coaches particularly those who teach young people.
We reported two cases of neglected rupture of the Achilles tendon treated with peroneus brevis tendon that was reported by Hepp. Case 1 fell down and sustained neglected rupture of the Achilles tendon by misdiagnosis. Four years after operation, the patient has no symptom and can stand on tiptoe of the injured foot. In case 2, operative wound was infected after surgery of the Achilles tendon suture. One year after reconstruction of the Achilles tendon, patients is in good condition and can stand on tiptoe.
Solitary myeloma is a rare disease as compared with multiple myeloma, and becomes multiple myeloma if followed for long time. The present report describes a 64-year-old female. Her chief complaint was pain at the left clavicle. Roentgenoographic findings revealed osteolytic areas. Histopathological diagnosis was plasmacytoma. Surgical excision was done. This tumor recurred 2 years after operation. She underwent total excision of her clavicle. Next year, same osteolytic change occurred in her left radius. It was the same in histological examination as the previous tumor.
We presented two cases of aneurysmal bone cyst; one case in the second lumbar vertebra and the other case in the second cervical vertebra. Case 1: a 15-year-old man His chief complaint was low back pain. CT showed a expanded and destructive mass lesion from the transverse process to body of L2. After curettage of the lesion and bone grafting in the involved area of the vertebral body, a posteroeateral fusion was done. At 5 months following the operation, the patient had no recurrence showing a solid bony fusion on the roentgenograms. Case 2: a 20-year-old woman Her chief complaint was swelling of the posterior region of neck and severe pain referred to the left shoulder. Roentgenograms revealed a spherical tumor surrounded with a thin bone-shell. The tumor was resected and a left laminectomy of C2 was performed. Roentgenograms and CT showed no recurrence at 15 year after the operation. She was free of complaints.
Solitary bone cyst of the humerus treated by trepanation was reported. The technique consisted of drainage of the cyst fluid and multiple drilling with a kirschner wire. Four cases with the disease were treated by this method. Three of them were completely healed on follow up, and one case necessitated another treatment because of recurrence of the lesion. Biochemical analysis of the cyst fluid revealed an existence of bone resorption factors of prostaglandin E2 and Interleukin 1. Therefore, drainage seemed to be useful both for the reduction of the internal pressure of cysts and for the removal of the bone resorption factors.
Osteosarcoma is generally believed to originate from a single lesion. Rarely, however, there are cases presenting with bone lesions involving multiple bones. Such a condition is called multicentric osteosarcoma and is regarded as representing a unique entity among osteosarcomas. This particular condition of bone malignancy may be classified into two types, i. e. synchronous type in which multiple lesions occur at the same time and metachronous type which is characterized by the occurrence of multiple lesions at a certain interval after that of the primary. This paper reports 2 cases of osteosarcoma probably of the metachronous type experienced by us recently, with comment of relevant literature.
The accurate assessment of extent of tumor is necessary to evaluate the propriety of limb sparing surgery, amputation level or resection width when we consider surgical treatment of the patients with osteosarcoma of an extremity. Therefore, we investigated the clinical utilities and problems of the magnetic resonance imaging (MRI) in the diagnosis of the patient with osteosarcoma as compared with plane radiography, computed tomography (CT). Seven patients were examined with a Signa 1.5-Tesla superconducting magnet. The results were as follows. 1) Intramedullary extent and extraosseous extent were clearly demonstrated on T1 and T2 weighted image, respectively. 2) Destructions of growth plate were actually displayed in all patients whose tumor had extended to the growth plate. 3) Cortical invasions by tumor could be seen on MRI as well as on CT. 4) Reactive zone was demonstrated in five of seven patients, and could be descriminated from the tumor except one patient. 5) The periosteal reaction was poorly identified with MRI. 6) In one case, skip metastasis was suspected on MRI, but it was excluded because of no evidence of malignancy in the pathological specimen and no reccurrence at the amputated femur postoperatively. We should be careful in making a diagnosis upon the skip metastasis.
We have studied the prognostic factors affecting the survival rate in 11 patients with chondrosarcoma. Of those, six died of multiple pulmonary metastases and the overall 5-year survival rate was 38.4%. The most significant prognostic factor was the histologic grade, and the 5-year survival rates in grade 1, 2, 3 were 100%, 0%, 25%, respectively. The location of the chondrosarcoma, and whether it was a peripheral or a central type, also seemed to be a good prognostic factor. The 5-year survival rate of the peripheral type was 66.7% as compared with 21.4% for the central type. Adjuvant therapy such as chemotherapy and irradiation had no effect on the survival rate.