Femoral heads of spontaneously hypertensive rats (SHR) were investigated histologically and radiologically in comparison with those of Wistar Kyoto (WKY) rats as a control.
Incidence of osteonecrosis was much higher in SHR than WKY.
In the 10wks old SHR, the necrotic lesion was first seen without reparative reaction.
In the SHR older than 20wks, many necrotic lesions were seen with reparative reaction.
Radiographs of SHR demonstrated coxa plana and short neck in comparison with WKY.

View full abstract

We reviewed one hundred and five patients greater than 59 years of age who sustained femoral neck fracture and were treated operatively at Fukuoka Red Cross Hospital between 1983 and 1987.
The mean age was 77.4 years (range, 60-98). 80% were women (84/105) and 20% were men (21/105).
49 cases were intracapsular fracture, 56 cases were intertrochanteric fracture, and only 2 were subtrochanteric reversed oblique fracture.
The mean age of the patients with intertrochanteric fracture was 3 years higher than that with intracapsular fracture.
We evaluated the grade of osteoporosis based on Singh's classification and 85% of the patients were evalutated to be osteoporotic.
83% of the patients had one or other complications preoperatively, and only the urinary tract infection was the main postoperative complication (43%).

View full abstract

For the repair of the peripheral nerve injury, it is important to differentiate motor and sensory dominant funiculi.
We investigated the protein composition in the motor and the sensory nerves of the monkey radial nerve and cauda equina by SDS-polyacrylamide gel electrophoresis.
The findings indicated that there is no remarkable difference in protein composition between the motor and the sensory nerves.
Some biochemical techniques have been reported to differentiate peripheral motor and sensory nerve. But they can be used only for fresh nerve injuries. And it is important to find the method to differentiate both nerves in old nerve injury.
We are going to investigate the protein composition of the motor and the sensory nerves in damaged condition.

View full abstract

An experimental study to assess the effectiveness of Piroxicam in the treatment of an acute compression injury of peripheral nerves has been done using seventy-two adult male Sprague-Dawley rats. The degree of nerve injury was assessed using the sciatic functional index, which has been shown to be a reproducible and reliable method of assessing sciatic nerve function in rats. Administration of Piroxicam failed to have any beneficial effect. Previous studies in our laboratory have shown that steroid therapy reduces the functional deficit caused by acute compression injury of peripheral nerves in rats. This study indicates that, to reduce acute compression injury of peripheral nerves, it is not sufficient to inhibit cyclooxygenase only.

View full abstract

Experiments in our laboratory have shown that steroid therapy commenced immediately before the operation prevents the functional deficit caused by silicone cuffs applied to intact sciatic nerves in rats. A further study showed that epineurectomy alone caused no significant functional deficit. In this experiments when compression was applied after removal of the epineurium the same dose of steroid used in our previous experiments proved unable to prevent the functional deficit.
In intact nerves, it is probable that the trauma of cuff application caused edema of the intraneural pressure in the segment under the cuff and thus neuronal injury. The maximum injury and edema would occur in the epineurium, which can be prevented by steroid administration. Following epineurectomy edema of the perineurium and endoneurium resulted in a similar pressure increase that was not prevented by the steroids.

View full abstract

We performed an experimental study to assess the effectiveness of cyclooxygenase and lipoxygenase inhibitor in the treatment of an acute compression injury of peripheral nerve using 48 adult male Sprague-Dawley rats. The degree of nerve injury was assessed using the sciatic functional index, which has been shown to be a reproducible and reliable method for assessment of sciatic nerve function in rats. Administration of Piroxicam (cyclooxygenase inhibitor) and Takeda-AA861 (lipoxygenase inhibitor) failed to have any beneficial effect.
Previous studies in our laboratory have shown that steroid therapy reduces the functional deficit caused by acute compression injury of peripheral nerve in rats. This study indicates that inhibition of cyclooxygenase and/or lipoxygenase is not sufficient to reduce acute compression injury of peripheral nerve.

View full abstract

The purpose of this paper is to describe two things. One is to describe comparison of the structure of the subarachnoid angle in human and monkey spinal nerve roots. The other is to discuss the function of the subarachnoid angle.
Eight monkeys weighing 7-10kg were used. our of them were untreated and experimental nerve root infiltration was performed for the others. Then they were evaluated macroscopically and histologically.
The main results found in this study were as follows:
1) The structure of the connective tissue of the spinal nerve roots in the area of the subarachnoid angle were essentially same in the human and monkeys.
2) Arachnoid villi were found near the subarachnoid angle.
3) We suggest that the subarachnoid angle has a function as a pathway which connects the subarachnoid space and epidural space.

View full abstract

Matrix metalloproteinase (MMP)-2 and MMP-3 were detected in the conditioned medium of human osteosarcoma cells using SDS-polyacrylamide gel electrophoresis (SDS-PAGE) technique. Immunoblotting revealed the activity of MMP-2 with Mr of 72KDa. MMP-3 with Mr of 57KDa was identified when the cells were treated by Interleukin-1 (IL-1). Analysis by SDS-PAGE containing gelatin revieled two gelatinolytic activities with Mr of 72KDa and 66KDa. Treatment of the cells by IL-1 induced a wide spectrum of gelatinolytic activities with Mrs ranging from 40KDa to 57KDa. These collagenolytic activities especially for type IV collagen seem to relate the metastatic potentiality of osteosarcoma cells.

View full abstract

An osteosarcoma cell line was established and characterized with respect to several metabolic parameters. The cells were originated from a case with osteosarcoma of the femur of a 14-year-old girl. The surgical specimen of the tumor showed histologically that the tumor comprised anaplastic cells, osteoblasts, tumorous osteoid and chondrocytes. The cultured cells revealed biologic properties of osteoblasts and preosteoblasts. Alkaline phosphatase activity was identified on the cytoplasmic membrane of the cells. Deposition of calcium around the cells and production of Type I collagen were identified. Injection of the cells into nude mice gave rise to the tumor histologically similar to the original. The cells are useful as a model for the study of mechanism of bone metabolism in vitro, as well as for the study of the treatment of osteosarcoma.

View full abstract

A human rhabdomyosarcoma cell line was established from a calf tumor found in a 19-year-old woman. The diagnosis of rhabdomyosarcoma depended on the ultrastructural features of the presence of abundant intermediate filaments and the aggregation of glycogen granules.
The cultured cell were oval with granular cytoplasm, with a population doubling time of 32 hours. Myogenic markers were clearly shown in the cytoplasm of the cultured cells by enzymeimmunohistochemistry.
This cell line seems to be useful as a model for the study on the muscle metabolism and chemotherapy.

View full abstract

The effects of cyclic AMP (cAMP) analogues and cholera toxin which increase intracellular cAMP levels on the growth and the invasiveness of HT 1080 human fibrosarcoma cells were investigated. Both the number of cells and the invasive activity were reduced after three days exposure to each agent as compared with untreated controls. On the contrary, TPA, the potent activater of protein kinase C (PKC), promoted the growth and the invasive activity of HT 1080 cells. These results suggest that the mechanism of the reduction of the growth and the invasiveness of HT 1080 cells by cAMP analogues may be the inhibitory effect to the PKC.

View full abstract

It has been recognized that irradiation causes damage to the growth of osseous and cartilagenous tissue. In this study, the effect of irradiation on chondrocytes in culture was investigated. Chondrocytes derived from 21-day-old rabbit cartilage were cultured in Ham F-12 medium supplemented with 10% FCS. The culture dishes were irradiated with a single dose of 200 rads, 1, 000 rails, and 5, 000 rads by gamma cell 40. The synthesis of DNA was inhibited for 2 days after irradiation of 200 rad, and thereafter it recovered. With irradiation of 1, 000 rails, synthesis of DNA was inhibited completely and did not recovered. Synthesis of proteoglycan was not significantly inhibited with the irradiation in this experiment.

View full abstract

Isosorbide dinitrate tape (ISDN tape) applied on random pattern flaps in rats resulted in effective prevention of flap necrosis. ISDN tape is clinically available and its long-lasting vasodilating action has been proved. So, when a flap is in trouble, simple application of ISDN tape might help its salvage.

View full abstract

To investigate the cause of osteonecrosis in the femoral head of spontaneously hypertensive rats (SHRs), the articular and growth cartilage in the femoral head was observed microscopically in 50 SHRs at the age of 5-9 weeks after birth. For histochemical examination, thin coronal sections of the femoral heads were stained with hematoxylin-eosin, toluidine blue, Alcian blue and safraninO.
Osteonecrosis of the femoral head was found after 7 weeks of age. In the period of 5-7 weeks after birth, abnormal findings of the cartilage, such as subsidence of the articular cartilage, distortion and nodular proliferation of chondrocytes in the growth plate, appeared in the outer part of the femoral head where toluidine blue stain disclosed the decreased stainability. So, it suggests that abnormalities of the cartilage in the femoral head may take part in the occurrence of osteonecrosis of the femoral head in SHRs.

View full abstract

The effect of calcitonin on the growth cartilage of rats with HEBP induced rickets was studied. In the hypertrophic zone, calcification by T3 occurred in the maturing zone. On the other hand, calcification induced by calcitonin occurred in the calcifying zone in which calcification takes place in natural course.

View full abstract

IL-1 and IL-6 producing cells in synovial tissues obtained from patients with Rheumatoid Arthritis (RA), Osteoarthritis (OA), Avascular Necrosis of the Femoral Head (ANF) and Rapidly Destructive Coxarthrosis (RDC) were observed by immunohistochemical method. Positive staining of IL-1 and IL-6 was seen in the synovial lining cells, vascular endothelial cells and fibroblasts in OA, ANF and RDC synovial tissues as well as RA synovial tissues. The results of immunohistochemistry found necessity to select the area taken from the synovial tissues.

View full abstract

We investigated bone and joint symptoms of 68 cases of leukemia admitted to our department. Twenty-six cases complained of symptoms which did not relate to leukemia. This group mainly consisted of elderly males and degenerative diseases predominated on diagnosis. Twenty-nine cases complained of symptoms relating to leukemia, and 11 of these cases displayed symptoms originating from bone involvement of leukemia. In 4 of these 11 cases, bone and joint symptoms were the initial symptoms of leukemia.

View full abstract

Three cases of multiple enchondromatosis including an Ollier's disease were reviewed in this report. Clinical featurees of multiple enchondromatosis were variable and subclassifications were thought to be necessary.
Case 1: a 59-year-old man with his onset of tumor formation of both hands at 23 years old. Deformity or shortening of long bones were not seen. The pathohistological examination revealed no malignancy.
It was subclassified as a neoplastic type in multiple enchondromatosis.
Case 2: a 11-year-old girl with her onset at 8 years old. The tumors were localized in the right fingers and both toes. Clinical features showed both neoplasma and developmental anomaly, and is was subclassified as an intermediate type.
Case 3: a 8-year-old boy wiht his onset of limping due to limb discrepancy at 5 years old. Roentgenographically the tibia showed shortening deformity and cartilage nests which were charactaristic in Ollier's disease. It was caused by failure of normal enchondral ossification and subclassified as a developmental anomaly.

View full abstract

A case of periosteal chondroma of the tibia was reported. An 8-year-old girl complained of swelling and pain of the left tibia. The mass measuring 4×3cm was hard and slightly tender. Radiography showed a weakly radiopaque mass with some calcifications. Microscopic examination showed lobulated hyaline cartilage without malignant cells. Marginal excision of the tumor and autologous bone grafting was performed. During 13 months after the operation, the tumor has not recurred.

View full abstract

The clinical utilities of magnetic resonance imaging (MRI) in the diagnosis of osteogenic and soft part tumors are recently recognized. We investigated the significances and some problems of MRI of the cartilaginous tumors. Ten patients were examined with the Signa 1.5-Tesla superconducting magnet. The following results were obtained.
1) Calcificating lesions, which are the symptoms of cartilaginous tumors, were unclear on MRI. 2) In one case of benign tumor, tumor extent was more clearly demonstrated on MRI than that of plain X-ray. 3) As cortical invasions by tumors were poorly identified by MRI, we need both CT and MRI. 4) In the cases of chondrosarcoma, some have broad reactive zone, but others have little reactive zone. 5) Intramedullary extent and extraosseous extent were clearly demonstrated on T₁ and T₂ weighed images, respectively. We have to pay attention, however, to the unclear border of extraosseous extent shared with the reactive zones. 6) In the cases of chondrosarcoma, the tumor intensity on T₂ weighed image tended to be higher than that of fat tissue around the tumor.

View full abstract

We reported three cases of chondrosarcoma in the femoral condyle which was difficult to be diagnosed, showing no typical X-ray findings of chondrosarcoma.
Two of them were diagnosed pathologocally as chondromyxoid fibroma on the first examination.
We would like to emphasize the close histological investigation with suspicion of chondrosarcoma if the tumor shows to be of cartilaginous tissue.

View full abstract

For malignant bone tumors of the proximal humerus, limb-saving surgery by resection alone is likely to discard the shoulder function. Resection of the proximal and diaphyseal humerus was performed in a 14-year-old girl with osteosarcoma, whose shoulder and elbow became totally useless. For another osteosarcoma case (a 19-year-old boy), vascularized fibular graft was performed after failed endprosthetic replacement. However, the grafted fibula proximally underwent avascular necrosis. Finally, shoulder arthrodesis was successfully performed by additional vascularized fibular graft and a long plate. For Ewing's sarcoma in a 5-year-old boy, vascularized fibular graft preserving epiphyseal plate was performed. However, pseudarthrodesis and closure of the epiphysis were evidenced in one year.
Arthrodesis of the shoulder probably provides more stability and useful motion than other limbsaving procedures.

View full abstract

Correlation between the dosage of preoperative irradiation and the successful methods of bone graft were observed radiologically in nine patients with limb salvage procedures for malignant bone tumors. As radiotherapy, four patients were treated with around 30 Gy of irradiation and the other with more than 60 Gy of irradiation. For reconstruction of the skeletal defect following the resection of tumors, conventional or vascularized bone grafts were performed in six and three patients, respectively.
All of four patients who received around 30 Gy of irradiation got successful bone grafts. In contrast, three out of five patients who underwent more than 60 Gy of irradiation failed in bone grafts, except for two successful results obtained by vascularized bone grafts.It is suggested that the optimal dose of preoperative irradiation to get successful bone graft is around 30 Gy for limb salvage procedure.

View full abstract

Four patients who had a metastatic tumor in the pelvis were treated with a combination of external irradiation of 20-30 Gy and intraoperative irradiation of 15-20 Gy. Intraoperative irradiation was done using Liniac electron beams (Mevatron 77DX67, Siemens Co., Ltd.) during surgery which retracted the bowels out of the radiation field.
Severe hip pain disappeared in all the patients after the radiotherapy. A follow-up study by radiography disclosed findings indicating the effectiveness, such as perifocal sclerosis of the lesion and interruption of the progress of bone destruction, in three patients. No patients complained of radiation complications of the bowels.
So, it seems that a combination of external and intraoperative irradiation was useful for the treatment of metastatic tumors in the pelvis.

View full abstract

Recently, the F. C. R (Fuji-Computed-Radiography) system was developed and its clinical applications were reported. This time, we investigated the usefulness of this method in orthopedic surgery. We widely applied the F. C. R to the daily x-ray film method for a year (from March 1988 to July 1989) and we compared the F. C. R system with standard x-ray system. Results: the advantages of the F. C. R system are: 1. X-ray films of F. C. R system demonstrate more clearly than those of standard x-ray system; particularly on films of the portions that have extremely different transparency of x-ray. 2. The margin of the soft tissue appears sharper. 3. Once the x-rays are taken, they can be saved in a laser disc and that picture can be consulted anytime. The disadvantages of the F. C. R are: 1. When there is a metal, the edge effect appears, and it is difficult to judge if there is a loosening or bone atrophy. 2. The price is expensive. 3. Some subjects appear reduced in size.

View full abstract

We reported a case of lung cancer with multiple metastases to the right vastus medialis, inguinal lymph nodes and brain.
A39-year-old man visited our clinic on the 9th of July, 1988, because of painful and tender mass localized in the vastus medialis muscle accompanied with painful swelling of inguinal lymph nodes and bloody sputum. Clinicopathological analysis from imaging techniques and pathological examinations for these lesions revealed multiple metastases in the vastus medialis and inguinal lymph nodes from poorly differentiated adenocarcinoma of the left upper pulmonary lobe. Three weeks after resection of primary tumor, while he was under chemotherapy (CDDP 140mg, VDS 3mg and MMC 6mg), brain metastasis was detected with CT. After that, he returned to his home on the 22nd of September this year and died of tumor 4months after surgery.

View full abstract

Spindle cell hemangioendothelioma is a new entity defined by Weiss and Enzinger in 1986, as a low-grade malignant vascular tumor. Although the neoplasm has involved in the dermis and subcutaneous fatty tissues, no case has occurred in the muscle. The first case of spindle cell hemangioendothelioma originated from the muscle is reported. A 48-year-old female had a tumor which occurred in the extensor digiti minimi of right forearm.
CT scan demonstaratetd multinodules in an isodensity region within the skeltal muscle.
MRI showed multinodules in a high signal intensity region on both T1-and T2-weighted images.
The patient was treated with wide excision and had no evidence of local recurrence or metastasis 5 months later.

View full abstract

A case of extraskeletal chondrosarcoma was reported. Immunohistological and electron microscopic observations were performed for the differential diagnosis with other mixoid tumors.
A 56-year-old man was referred to our hospital, who had ever received a surgical resection of a tumor in the left arm. The tumor had been diagnosed as an extraskeletal myxoid chondrosarcoma in 1983. The tumor recurred in the same portion in 1986 and the size increased gradually when he was admitted to our hospital in 1989. The tumor was 5×8cm in size, and no metastatic lesion was found. Wide resection of the tumor was performed and the histological findings in HE staining were the same as before.

View full abstract

The schwannoma characteristically arises from only one location, seldom in multiple locations. We have recently experienced a case, 56-year-old woman with the complaint of lumbago, of multiple schwannoma with cystic degeneration in the retroperitoneal space.
The case is reported because of the rarity of the condition.

View full abstract

Ten patients with the soft tissue sarcomas were analyzed with respect to the correlation between the local control and the surgical margin by the JOA Musculo-skeletal Tumor Commitee. Although seven patients were operated on with the wide surgical margin and three with the curative margin, with regard of transverse section eight tumors were removed with a surrounding cuff of normal tissue beyond the fascial septa. All ten patients had no local recurrence during the follow-up period ranging from one year to 6 years and 7 months, and eight were alive with no evidence of disease.

View full abstract

We examined twenty-four patients with idiopathic hemihypertrophy at Fukuoka Children's Hospital and Medical Center from 1980 to 1989. All cases showed the leg-length discrepancy. The leg length was measured by scanogram from the top of the femoral head to the inferior articular surface of the tibia. We also evaluated the percentage discrepancy which expressed the leg-length discrepancy as a percentage of the longer limb.
The leg-length discrepancy of all cases increased as growing, gradually or rapidly, continuously or irregularly. We found great difference in the growing pattern of discrepancy in each case. The percentage discrepancy of most cases tended to show to be fixed and stable after four or five years old. The results suggest that the leg-length discrepancy after growth of the idiopathic hemihypertrophy can be prospected even in the younger children, if the percentage discrepancy is invariable in the growth period.

View full abstract

Arthrogryposis multiplex congenita (AMC) is a syndrome characterized by multiple joint contractures present at birth. It needs a long-term habilitation or performing surgical treatments several times. In this study, the experience in eight cases with AMC was reported.
1) In terms of distribution of contracture, in general joints, 4 of 8 cases belonged to “upper and lower limbs type”, whereas in major joints except hands and feet, most cases were divided into “upper limbs type” and “lower limbs type”.
2) Multiple surgical treatments were performed in 5 of 8 cases.
3) Four of 8 cases had an episode of fracture, mainly in the upper limb.
4) Some cases had abnormal delivery or malformation.
5) Every case showed normal mentality, except for one case with mental retardation.
In AMC, the functional prognosises on ADL were expected to be improving, though long-term treatment and habilitation were needed.

View full abstract

The multiple pterygium syndrome is a rare condition which consists of pterygia of neck, antecubital, digital, popliteal, and intercrual areas, growth retardation, peculiar facies, foot deformities, multiple joint contractures, vertebral anomalies.
Here we report a 9-year-old boy with multiple pterygium syndrome.
This case is a sporadic type because of mild symptom and no evidence in his family history.
We emphasize that it is important to have in mind multiple pterygium syndrome in clinical examination.

View full abstract

Spondylo-epiphyseal dysplasia (SED) is classified broadly into congenita type and tarda (late onset) type. Both types of SED were characterized by dwarfism of short trunk type, platyspondyly and coxopathy, but some differences between them were found.
In this study, each one case of SED congenita and tarda was reported and compared each other.
Case 1: A 14-year-old boy, diagnosed as SED congenita, showed dwarfism of short trunk at birth. X-rays showed platyspondyly with irregularity of end-plate, the disappearance of femoral head, odontoidal hypoplasia of axis and atlanta-axial dislocation. Severe scoliosis was noted and treated with brace. Serum concentration of testosteron was decreased and the gonadotropin treatment was done.
Case 2: A 14-year-old girl, diagnosed as SED tarda, developed dwarfism of short trunk type after infant. X-rays showed platyspondyly with irregularity of end-plate and the small femoral head with the irregular surface.
The excretion of keratansulfate in the urine showed normal range in both cases.

View full abstract

For the treatment of deformity and fragility of long bones with osteogenesis imperfecta (O. I.), Sofield reported the procedure of segmental and rodding osteotomy. Compared with conventional rodding procedure which required frequent operations, an internal fixation with telescoping nail produced by Bailey in 1963 has reduced the incidence of fractures and prevented the bone deformities for a longer duration.
We reported 3 cases of O. I. which were treated by this procedure. Two of them, 7-year-old girl and 4-year-old boy have not had fractures for 2.5 years. All of them can walk with or without cane.

View full abstract

During the period from April 1986 to March 1989, 15 cases of the femoral fracture except for the femoral neck fractures were repaired with the Ender nailing procedure. There were 7 males and 8 females, and their ages ranged from 16 to 81 years (average, 47.9). The sites of fracture were 1 case of subtrochanter, 12 femoral shafts and 2 supracondyles.
The purpose of this article is to find out the advantages and disadvantages of the Ender nailing procedure for the femoral fracture.
Result: Good bone union was obtained in all of our cases. The advantages of this procedure are as follows: (1) The surgical invasion is quite less than the other procedures; (2) The indication of this procedure is wide for the femoral fracture; and (3) The callus formation is rapid because of the external periosteal membrane is not injured during the opetation. The disadvantages of this procedure are as follows: (1) Shortening or deformity may occur in the cases of oblique or comminuted fractures; and (2) Pain or contracture at the site of nail insertion may also found.

View full abstract

A retrospective study of 37 intercapsular femoral neck fracture treated with osteosynthesis is presented, with an average follow-up of five years and one month. There were 4 males and 33 females, their mean age being 67 years. The fractures were classified according to Garden.
There were re-displacement in 4 cases, non-union in 2 cases and avascular necrosis in 7 cases. The patients under 70 years of age developed avascular necrosis more frequently than the patients over 70 years, and the treatment for many patients with dementia or mental disturbance failed.

View full abstract

We clinically investigated complications of femoral neck fractures in elderly patiens of over 60 years of age during the last two years. They were formed of 67 patients and divided into extracapsular fracture type and intracapsular type. The former were formed of 37 patients 10 males and 27 females. The latter were 30 patients 8 males and 22 females. In their complications, the first was the abnormal ECG, the second was hypertension, the third was pulmonary dysfunction. The control of complication is important in addition to treatment of fracture.

View full abstract

Osteosynthsis for the intracapusular fracture of the femoral neck with Rheumatoid Arthritis (RA) was performed in 5 cases. All of them were females and their ages were from 49 to 74 years old; the average age at the time of fracture was 64.2. They were suffering from RA for 1 to 35 years and had stage II to IV, class 3, 4 of RA. All cases were treated by multiple pinning, including the fracture types of Garden's stage II, III and IV. Non-union was seen in one patient who developed osteonecrosis, though the others showed favorable bone union.
Osteosynthesis for the femoral neck fracture is recommended for RA patients in dependent of Garden's stage.

View full abstract

We report a case of the trochanteric fracture of the femur with the subluxation caused by the proximal migration of a pin after the Ender's method in a female aged 78 years. The penetration of a pin occurred within one week after the operation. This pin grinded the antero-lateral part of the acetabulum, and the hip joint became subluxated. The friction between the femoral head with subluxation and destroyed acetabulum grinded the postero-medial portion of the femoral head. This case was treated by the acetabular plasty with bone graft and cartilage bone graft.

View full abstract

S tress fracture of the femoral shaft is not common, and especially it seems to be extremely rare in children. We report the cace of a 6-year-old child with a stress fracture of the left femoral shaft. His chief complaint was left gonalgia and claudication after running.
Radiographs showed periosteal reaction arround distal third portion of his femur. Stress fracture was most suspected, but bone tumor could not be excluded. We examined bone scan and angiograph. Bone scan was positive, but angiograph was negative. We diagnosed this case as a stress fracture of the left femoral shaft. In many cases stress fracture is easily diagnosed, but in some cases bone biopsy is needed for its differential diagnosis. In our case angiographic study was useful for its differential diagnosis.
We managed this case conservatively. Callus formation was good by radiographic study.
We think that the number of young patients of stress fracture will increase because the number of children doing sports is increasing.

View full abstract

We treated ninety-seven fractures of the tibia from 1986 through 1989. Sixty-five cases were treated with Ender nails, twenty-three cases with Küntscher nail, five cases with plates and other cases conservatively. Sixty-one patients were examined in sixty-five with Ender nails. All the fractures except two showed excellent results. Two cases developed pseudarthrosis. This method was easy to use and effective.

View full abstract

Between October 1, 1982, (when this department of Orthopedic Surgery was opened, ) and March 31, 1989, 30 patients with 32 tibial shaft fractures were subjected to invasive treatment. Of these patients, 27 with 29 fractures that could be followed up to synostosis are discussed in detail in this report.
The reported 27 patients are predominantly male in sex, consisting of 23 males including 2 afflicted with bilateral fractures, and 4 females; and in age predominantly below 60 years old with 21 cases against 6 cases above 61, with the mean of 39.3 years old, indicating a higher percentage of occurrence in the age group of greater physical activity. The causes of injury are largely traffic accidents, involving particularly motorbikes in recent years. Treatment included 8 cases of plate system, 4 cases of Küntscher nailing system, 1 case of screw system, and 16 cases fo Ender nailing system. There were 3 intractable cases (one case each of plate system fracture, Küntscher nailing system fracture, and Ender nailing system fracture) which required a second surgery such as bone grafting.

View full abstract

Twenty-nine cases (age range from 16 to 85 years; mean, 44. 1 years) of the femoral and tibial diaphyseal fractures treated with K-U compression plate were investigated in terms of progress of bone union, especially remodeling of bone cortex. Progress of bone union was divided into four periods on x-ray films. It took 28 and 36 weeks for disappearance of fracture line and remodeling, respectively. After using K-U compression plate, bone atrophy at the fracture line was identified in some cases. Especially, bone atrophy was conspicuous from 1 to 3 months after removal of the plate. So we must pay strict attention to patients during this period.

View full abstract

Nineteen cases of twenty-one fractures of the upper end of the tibia have been treated in the last five years in our clinic.
The 12 patients, (13 fractures) were male and 7 patients, (8 fractures) were female.
The ages ranged from seventeen to seventy-six years old. The follow-up ranged from three months to four years and seven months.
Fractures were classified by Hohl's classification: undisplaced type in 4 cases, local depression type in 6 cases, total depression type in 3 cases. and comminuted type in 8 cases.
The methods of treatment were as follows external fixation was performed in four cases, open internal fixation in seventeen cases. and bone grafting was necessary in four cases.
The results showed that fifeteen cases were excellent or good by Hohl evaluation. Six cases were poor or fair and most of them were comminuted-type fractures.

View full abstract

We used May plates in eleven cases of the fracture around the Knee joint. Seven were the proximal side of the tibia and four were the distal side of the femur.
The results were excellent in seven, good in two, and fair in two cases. May plates are made along with the contour of the condyles of the femur and tibia, so they fit satisfactorily to this portion and their fixation is stable.
We recommend CPM after this opration.

View full abstract

We report a rare case of the stress fracture of the distal tibia and fibula after total knee replacement.
We know that stress fractures of the pubis, femoral neck, patella and proximal tibia are often seen after TKR, but stress fracture of the distal tibia is not known.
Seven months after TKR, a 70 year-old-femal complained of rt. ankle joint pain. Three weeks after onset, the distal tibia and fibula were fractured and varus displaced. And tibial compornent of the total knee system was fixed in 7 degrees varus position.

View full abstract

Eleven severely physically handicapped children who had cerebral palsy, spina bifida, congenital or developmental muscular dystrophy and so on, and whose records were reviewed, had sustained bone injuries and were treated at our hospital. More severely handicapped patients were susceptible to bone injury in spite of their poor daily activities.
Most injuries were caused by trifling forces or by undetermined ones. Two supracondyle fractures occurred during stretching exercise of the hamstrings. One fracture of the femoral shaft occurred when a lower limb was just trapped between the side-bars of the bed at transfer.
Injuries were sometimes detected by nurses or other attendants because the suffered limbs had swelling and heatness without complaints of children.
We treated them conservatively except one patient.
All the injuries healed satifactorily without complications such as decubitus, contracture, or pneumonia. To protect the bone injury in handicapped children, we must take care of them gently.

View full abstract

We report a rare case of spontaneous rupture of the extensor tendon due to Kienböck's disease.
The patient was a 60-year-old man and consulted us with pain in the right wrist and extension disturbance.
At operation, the fragmented Iunate was removed, and a tendon ball using the fascia lata was packed into semilunar space.
The extensor indicis proprius was transferred to the extensor of the ring finger. At two years after operation, the result was successful.

View full abstract

Functioning free muscle transplantation is available for the reconstruction of the missed function.
We report a case of severe volkmann's contracture treated by free muscle transplantation to reconstruct the finger flexion.
A patient, 19-year-old male, crushed his forearm by a pressor and lost the function of the finger flexion due to Volkmann's contracture with radial nerve palsy.
As the tendon-transfer was impossible, because of radial nerve palsy, we transplanted the semitendinous muscle for the musculature of the finger flexor by microneurovascular anastomoses.
An electromyographic tracing of the muscle transplanted showed the interference pattern 5 months after operation.
His grip strength reached to 12kg, and he returned to the heavy labor 4 years after operation.

View full abstract