We have reported upon the roentgenologic changes found in the lower extremities of three typical cases with metaphyseal chondrodysplasia (Schmid Type). These cases had been followed-up, radiologically for an average of 8.8 years since infancy. In the three cases, metaphyseal abnormalities found on the roentgenogram, in order of site of remodelling, were as follows: 1) proximal end of the femur 2) proximal end of tibia, proximal end of fibula and the distal end of the fibula 3) distal end of the tibia 4) distal end of the femur. Metaphyseal abnormalities found on the roentgenogram in case 3 had undergone remodelling earlier than that in cases 1 or 2.
We treated 4 cases of rigid club feet associated with Kniest dysplasia. Cases 1 and 2 had severe bilateral deformities, and talectomy with tendoachilles lengthening and triple arthrodesis were performed. After operation they gained self-ambulation, but forefoot adduction and hindfoot equinovarus remained in both cases. Case 3 had moderate unilateral foot deformity which was surgically treated by lateral wedge osteotomy and tendoachilles lengthening. Ambulatory status improved, although slight forefoot adductus remained. Case 4 had bilateral mild feet deformities which were treated with corrective casts, but this was not effective. When the club foot deformity is severe in Kniest dysplasia, bone surgery is necessary to gain ambulation in infancy. However complete correction is very difficult with only a single operation, and our first two cases will need repeat surgery to correct their residual deformity.
Sjögren-Larsson syndrome is characterized by the triad of congenital ichthyosis, spastic para-plegia, and mental retardation. We report two cases in siblings and discuss the orthopaedic problems. Case 1: A male; his skin findings were diagnosed as congenital ichthyosis at the age of 1. He began to walk at the age of 2-years 6-months and was reported by a pediatric neurologist to have normal tendon reflexes at the age of 6. On examination of the 23-year-old patient, ichthyosis, mental retardation (IQ 19), hyper-reflexia, positive pathological reflexes and flatfeet were observed. Case 2: A younger sister of case 1, who also presented with similar skin findings at the age of 1. At the age of 16 years she developed feet pain while walking. Although at 17 years of age, her tendon reflexes were reported by a neurologist to be normal, hyper-reflexia, positive pathological reflexes and cavus deformity of the feet, together with ichthyosis, and mental retardation (IQ 22) were observed at the age of 20. Since the spastic paraplegia associated with this syndrome is progressive, judging from the above two cases, the foot deformities may increase with age. Indication for surgical treatment for the foot deformities should also give consideration to the progression of the spastic paraplegia.
We have treated lower extremity fratures and deformities resulting from brittle bone cousing diseases using telescoping nails. Since 1985, five coses: 4 osteogenesis imperfecta and 1 Albright syndrome (9 femur, 1 tibia) have been heated, with an average age at insertion of the first nail of 3. 8 years. In seven of the femurs and one tibia, nail was satisfactorily extended. The but in two femurs, the nail was not extendable. A revision of the nail was necessary in four femurs due to bone grouth. There were 4 femoral froctures after fixation of the nail, but all achieved good union without surgery. There were eight complications following insertion of the 14 telescoping nails, including 6 migrations, 1 osteomyelitis and 1 bending of the nail. However the complications can be avoided almost totally by careful surgical technique. Telescoping nails appear to be the best device for use in lower extremity fractures in children with brittle bone causing disease.
Bone mineral density was evaluated by microdensitometmy in 201 hemodialysis patients, with results compared for dialysis duration, serum PTH-C, alkaline phosphatase and aluminium. The average bone mineral density in hemodialysis patients decreased slightly. As the duration of hemodialysis increased, bone mineral density decreased, and serum PTH-C, alkaline phosphatase and aluminium increased.
For the purpose of mass screening of metalolic bone diseases, we evaluated long-term anticonvulsant induced bone atrophic changes. The diameter and osteodensity of the second metacarpal bone in hand films of 46 children in-patients of Beppu Seisien were measured by microdensitometry (MD method). Laboratory findings including gerum Ca, P, ALP were compared with the severity of bone atrophy. The following results were obtained. 16 cases (35%) were normal, 19 cases (41%) were in the initial stage of abnormality, 11 cases (24%) in grade I, no case with grade II or III of abnormality. The severity of bone atrophy correlated with serum Ca and ALP but the duration of anticonvulsant administration did not correlate with the severity of bone atrophy. Sixteen children with noted atrophy were treated with “1α-OH-D3” and after 15 months their bone atrophy was remeasured by the MD method. In almost all cases the bone atrophy was well improved showing the “1α-OH-D3” to be very effective. Baned on there results, it is suggested that roentgenologic and biochemical supervision of patients is required during long-term anticonvulsant therapy.
Pathological fractures in osteoporosis were evaludted using magnetic resonance imaging (MRI). MRI were obtained of 2 cases with intracapsular fractures of the femoral neck and 20 cases with Spinal compression fractures. All cases showed low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, even in the early stage when no lesion was detected on the plain radiograph. Metastatic spinal tumor lesions appeared the same as compression fractures with osteoporsis. But in osteoporosis, many cases show old compressive lesions of other vertral bodies, and after 1 or 2 weeks they are certain to show characteristic compression fracture lesions plain radiographs.
Twenty two femaies with osteoarthritis (OA) and eleven females with rheumatoid arthritis (RA), had the their iliac bone investigated histomorphometrically and the bone mineral density (BMD) of their radius and lumbar spine measured. Bone volume in OA and RA patients decreased with inaeasing age. Bone volume, osteoid surface, osteoid volume and trabecular thickness were lower in RA patienst than in thore with OA. RA paterts had more eroded surface area than those with OA. The relation between osteoid and eroded surface might lead to the lower trabecular thickness found in RA compored to OA patients. BMD in both patients decreased with increasing age, while radial and lumbar spine BMD in RA patients were lower than in OA. BMD of the distal third of the radius in RA paherts decreased with age more rapidly than that of the distal 1/6 of the radius. Therefore, osteoporsis in RA might be parhally caused by cortical bone loss. The lumbar spine BMD in some OA patients aged greate than 65 years was lower than normal, and it was postulated that these patients might suffer from osteoporosis.
Bone turn-over of Paget's disease was examined by biochemical and histomorphometric analysis in one female and two male patients, aged 72, 48 and 68, respectively. All patients had polyostotic lesions involving the tibia, femur, pelvis, spine and skull. Elevations in serum alkaline phosphatase reflecting bone formation were demonstrated in all patients, and a high level of serum BGP was found in one patient. Increases in the urinary excretion of calcium and hydroxyproline were also noted, as a result of excessive bone resorption. Histomorphometric data indicated that bone resorption and subsequent bone formation were highly excessive in Pagetic bone. Approximately 36% of bone surfaces were eroded, and 21% were osteoid in the 68-year-old male. In this specimen, the so-called mosaic pattern and woven bone pattern were also seen, reflecting rapid bone turn-over. Calcitonin and etidronate disodium, or EHDP, were administered to each patient. EHDP was associated with a decrease in serum alkaline phosphatase levels, and urinary excretion of calcium and hydroxyproline, much as was observed with calcitonin.
The purpose of this study was to investigate the cause of acromegalic arthropathy by examining two cases of acromegaly. Case 1 was a 54 year-old male, who complained of shoulder pain. Osteoarthritic change with osteophyte formation on the medial side of the humeral head were shown radiographically. Osteophyte resection and shaving of the articular surface were carried out. Growth hormone level at the time of surgery was 31.5ng/ml. Histological examination of the osteophyte showed thickening of the cartilage on the articular surface and accelerated enchondral ossification. Case 2, a 56 year-old female, presented with right hip pain. On X-ray examination, excessive osteophyte formation was observed on the edge of the acetabulum and femoral head, however, joint space narrowing was not seen. Right total hip replacement was performed. Growth hormone level at the time of THR was normal (2.9ng/ml), as she had had a pituitary adenomectomy 5 years previously. Histological examination of the femoral head, showed cluster formation on the articular cartilage, however, enchondral ossification was not observed in the cartilage of the osteophyte surface. Acromegalic arthropathy probably occurs by incongruence of articular surfaces due to hypertrophy of the articular cartilage and osteophyte formation.
We report three cases of coracoid fracture with acromioclavicular dislocation. One case was a 14-year-old with an epiphyseal lesion of the coracoid process. As this fracture is not readily visualized by anteroposterior x-ray, both an axillary and anteroposterior cephalic tilt view of 30 degrees are needed. Operative therapy was performed in all cases and the coracoclavicular ligament was intact. We believe this fracture with acromioclavicular dislocation occurs with an avulsion force of the coracoclavicular ligament.
The treatment of acromoclavicular subluxation (Tossy's type I and II) is not controversial, but there is, no consensus as to whether Tossy's type III should be treated conservatively or surgically. Since 1979, we have treated 40 cases of acromioclavicular dislocation and have evaluated 29 of these patients, with a follow-up of over 1 year. There were 8 cases of type I, r cases of type II, and 13 cases of type III. All type I and II cases were treated conservative and achieved excellent results. Of the patients with a type III dislocation, the following results were achieved: Using conservative treatment, 1 case was excellent, 2 were good, 1 was fair and 2 were poor. The outcome for the 7 who received surgical treatment, was 5 cases were excellent and 2 were good.
Fourteen cases with a fracture of the middle third of the clavicle were treated by percutaneous pin fixation. In all cases, satisfactory results were obtained with bone fusion and normal function of the shoulder joint. We concluded that percutaneous pin fixation was more promising than operative or conservative therapy as it prouided good cosmetic result and allawed preservation of the potential for bone fusion.
We reviewed sixteen cases using the modified Bristow procedure for treatment of recurrent anterior shoulder dislocation. Twelve patients were male and four were female. All patients had the procedure performed laterally. Ten shoulders were on the right and eleven shoulders were on the dominant side. The follow-up period ranged from one to 11yaers and one month (mean, 5 years and 5 months). Postoperatively, one patient had subluxation on one occasion but none had redislocation. Evaluation using the shoulder evaluation sheet of the Japan Orthopedic Association resulted in an average point score of 94.4, and 15 patients were subjectively satisfied with this procedure. The mean loss of external rotation was 12.2 degrees with the arm at the side and 7.5 degrees with the arm at 90 degrees of abduction. Roentgenograms at the final follow-up did not show any problems with the screw or non-union.
Three cases of snapping scapulae which were surgically treated are reported. Casel was a 34-year-old woman, who had an abnormal shadow on her chest X-ray. A bony prominence from the lower part of the costal face of the scapula was found on the scapular-Y-view and tomography. The resected bony mass was consistent with the findings of exostosis and local recurrence has not seen for six years. Case2 was a 14-year-old girl, who complained of shoulder pain and dorsal projection of her scapula. A bony projection from the medial edge of the costal face of the scapula was verified by tomography and computed tomography. After exostosectomy, the patients complaints disappeared, with no recurrence within three years. Case3 was a 23-year-old woman, who presented with a grating sound on shoulder motion. Although no abnormality in her roentgenograms and other pictures was detected a snapping between the inferior angle of the scapula and costal bone was observed through a fluoroscope. After resection of the lower angle of scapula, the snapping sound disappeared. It is usually possible to clarify the cause of a snapping scapula by roentgenograms, tomography, computed tomography and fluoroscopy. Surgery is an effective procedure for treatment of the snapping scapula.
Os acromiale is non-union of one or more ossification centers of the acromion to the rest of the scapula. Among 70 cases with rotater cuff tear who we operated on, two were found to have a rotator cuff tear with os acromiale. We report these 2 cases and discuss the relationship between the occurrence of rotator cuff tear and os acromiale. The two patients were aged 56 and 70-years-old respectively. They consulted our hospital due to shoulder joint pain and limitation in range of movement without any episode of injury. Roentgenograms showed the existence of the os acromiale and osteophyte formation on the undersurface of the acromion and an arthrogram confirmed rotator cuff tear. As abnormal movement of os acromiale was recognised during surgery, it was removed and the torn rotator cuff repaired. As abnormal mobility of os acromiale and ostephyte formation are consistent with the site of rotator cuff tears, these two factors may possibly contribute to the occurrence of rotator cuff tear injury.
MRI was used to inveshgate 15 patients (16 shoulders) with shoulder pain. Seven cases of rotator cuff tears and two cases each of inpingement syndrone and frozen shoulder were diagnosed. MRI findings of complete rotator cuff tear included the loss of the subdeltoidal fat plane and tendon discontinuity in T1-weighted oblique coronal images. In the discontinuily identified in the tendon, a high intensity area consistent with fluid was identified within the area of disruption in T2-weighted images. On the bases of these findings we could diagnose all cases of complete rotator cuff tears, but, no identifying features for other diseases were found. MIR was especially useful for demonstrating complete rotator cuff tears in our study.
Eighteen patients with known tears of the rotator cuff and three patients with suspected impingement syndrome of the rotator cuff which were diagnosed by arthrography underwent MR imaging. The results of the imaging studies were then compared with arthographic and operative findings. MR imaging was performed with a 1.5T superconductive system with shoulder surface coil. T1-weighted images and MPGR T2*-weighted images were performed in the coronal oblique plane and the sagittal oblique plane. Out of twenty-one patients, the operative findings confirmed complete tear in fifteen patients, partial tear in three patients and tendinitis in three patients. Arthrography showed complete tear in fifteen patients, partial tear in two patients and no abnormality in four patients. MR imaging showed complete tear in thirteen patients, partial tear in three patients and tendinitis in five patients. In the thirteen complete tears diagnosed by MR imaging, no false results were found. But of the three cases diagnosed as having a partial tear, one had a key hole tear. Out of five tendinitis cases, one had a pin hole tear and another had a small partial tear. We conclude that MR imaging is accurate for the diagnosis of impingement syndrome and rotator cuff tear except for very small defects such as pin hole tears.
This study was undertaken to elucidate the relationship between degenerative changes of the acromion and the anatomical size of the second joint of the shoulder. We used 41 bleached skeletal bones, 78 shoulder joints (37 right, 41 left) which had been stored in the Department of Anatomy Section 2, Nagasaki University. The aveage age was 59.1 years (range, 20-79) in 18 males, 61.5 years (range, 31-77) in 23 females. Osteophytes in the anterior portion of the acromion and wear on the undersurface were observed macroscopically, and we measured the anatomical size of the scapula and humerus with slide calipers. Scapular Y-view radiographs were then obtained to carry out measurements which included the acromial angle, and the coraco-acromial triangle area. There were 25 joints (32.1%) with osteophytes and 13 joints (16.7%) had a worn undersurface of the acromion. The incidence of right shoulder's osteophyte formation was statistically higher than on the left. The average age of the large osteophyte group and that of the non-osteophyte group was 71.8 and 59.3 years, respectively. This showed that the degree of osteophyte formation increased with increasing age. We could find no statistical relationship between degenerative changes of the acromion and the anatomical size of the second joint of the shoulder. The average inclination of the acromial angle was 56.7 in the large osteophyte group and 49.3 of the non-osteophyte group. This showed that osteophyte formation accelerated with iscreasing acromial angle, that is, as the slope of the acromion became flat. These results may be useful in solving pathogenesis of degenerative disease of the second shoulder joint and it's therapy.
Rotator cuff tears associated with fractures or dislocations around the shoulder girdle region are uncommon. Dislocation of the glenohumeral joint and fracture of the tuberosity are thought to be factors associated with rotator cuff tears, while acromial, coracoid, or distal clavicular fractures and acromioclavicular separation are not generally thought to cause rotator pathology. In this paper, we report seven patients with rotator cuff tears who had dislocation of the glenohumeral joint (three cases), acromial fracture (one case), acromiclavicular separation (one case) distal clavicular fracture (one case) and greater tuberosity fracture (one case). These seven patients continued to complain of pain during active shoulder movement after injury and achieved little pain relief by conservative treatment. For this reason, we performed shoulder arthrography and found abnomal leakage of contrast material into the subacromial bursa. Surgical repair was carried out in seven cases and the postoperative results were excellent. Thus, arthrography is helpful in managing patients with fractures or dislocations of the shoulder.
Five stiff elbow with primary osteoarthritis were examined. Arthroplasty of the elbow joints was achieved by the posteroateral approach accordig to Tsuge's method. From three days postoperatively a continuous passive motion (CPM) unit was used for a penod of 15 days. We tried to achieve the widest setting angle of the CPM, without causing any patient motion painh The average range of motion was 60 degrees preoperatively, increasing to 113.6 degrees after operation. All patients were graded excellent according to Knight's criteria. From these results, although the mean follow up period was only 8 monthe, the aggressive usage of a CPM unit is thought to be useful for Successful results following arthroplasty for primary osteoarthritis of the elbow.
With the increase in the number of people playing sports such as baseball, tennis, and golf the incidece of Osteochondritis dissecans of the elbow has also increased recently. We report two cases of this disease who had large defects of the capitulum. The size of articular surface defect was 1.5×1.2cm and 1.7×1.3cm after removing the free bodies. If we simply remove the free bodies, the elbow joint will degenerate or the patient grown up. We therefore tramsplant an osteochondral homograft using the iliac crest growth plate to the defect. The clinical result was excellent.
We studied the results of corrective osteotomy for varus deformity in 16 patients 17 elbows. Of these 17 elbows, the varus deformity resulted from supracondylar fracture in 5, diacondylar fracture in 11, and unclear in one. Follow up results showed that correction of the deformities in all 5 elbows which had resulted from supracondylar fractures was satisfactory. Howeit, of the 11 deformities which resulted from diacondylar fractures, a decrease in their corrected angle was seen in 5 that had been treated under the age of 11 years. I have assuned that this sentence you mean treatment was done on young children, under the age of 11. (Rathe than cess than 11 yies follow-up duoatron) This suggests that corrective osteomy for varus deformity resulting from diacondylar fracture should be done at the age of 12 or 13 years.
We camed out an experimental study which was modeled on Lundborg's studies in which he investigated the healing process of rabbit extensor tendons in the synoxial pouch of the knee joint. We histologically studied the influence of the intrinsic vascular system of pedicle sutured tendons placed in the rabbit knee joint and removed after four, five and six weeks. We did not clearly confirm any influence from the intrinsic vascular when conpanng freesutured with pedicle sutured tendons.
We report 3 cases of extensor tendon rupture secondary to Kienböck's disease. Three patients, one male and two females in their 60's and 70's had a history of long term wrist pain. Radiographi cally they were asserssed as Lichtman stage IV, Kienböck's disease. All ruptured tendons were limited to the 4th dorsal compartment. Treatment required the resection of dorsal fragments of the collapsed lunate, and a tendon-graft or tendon-transfer operation to repair the ruptured tendons.
Radiograms of the hand were studied in 247 patients undhemodialysis. Among the 247 patients 143 were maie and 104 wrer female, with a mean age of 53.3 years (range: 23 to 88 years). Cystic lesions of wrist joints carer found in 41 patients (16.5%). Cyst positive patients were significantly older and had been receiving hemodialysis for longer periods than cyst negative patients. More cyst positive patients (22%) had carpal tunnel syndrome, which was statisfically significant. In 7 cases of cyst positive patients carpal collapse was found.
We report on a case of carpal tunnel syndrome due to tuberculosis tenosynovitis, a syndrome which is relatively rare in the literatire. This case had no remarkable symptoms except painless tumor and a trigger finger of the 4th finger before sensory disturbance clerelopde. We must consider and reat tuberculosis tenosynovitis when we diagnose carpal tunnel syndrome.
We studied thirteen hands of ten patients with carpal tunnel syndrome to elucidate the relationship between the degree of median nerve compression and distal motor latency. All patients underwent ultrasonographic and electrodiagnostic studies prior to operation. Intracarpal thickness of two portions of median nerve, proximal (A) and distal (B) to the position of carpal transverse ligament, were measured by ultrasonography, and the median nerve compression ratio was given by B/A. It was demonstrated that, in proportion to the degree of median nerve compression, there was a significant increase in distal motor latency of the damaged nerve.
Ten patients with severe unilateral carpal tunnel syndrome treated with carpal tunnel release surgery and external neurolysis of the median nerve were reviewed. Subjects comprised 2 males and 8 females ranging in age from 42 to 71 years (mean 53.4). All patients had thenar muscle atrophy and no reaction to electrophysiologic testing of the median nerve including distal motor latencies preoperatively. various tests including the two-point discrimination, Semmes-Weinstein sensory test, muscle test of abductor pollicis brevis and opponens pollicis, measurement of distal motor latencies and test of ADL were done pre-and post-operatively. All patients regained some degree of useful hand function post-operatively despite the severity of the syndrome. We therefore concluded that we could achieve satisfactory results using external neurolysis for severe carpal tunnel syndrome without simultaneous opponoplasty.
This paper reports a rare case of fracture-dislocation of the hamatometacarpal joint. A 25-year-old right-handed man was involved in a fistfight and struck a wall with his left fist. He was examined at our hospital 5 days after injury and found to have swelling and tenderness in the vicinity of the fourth and fifth CM joints. Radiographs of the hand revealed dorsal dislocations of the bases of the fourth and fifth metacarpal accompanied by a dorsal oblique intra-articular fracture of the distal hamate and an avulsion fracture of the base of the fourth metacarpal. Treatment consisted of closed reduction and percutaneous fixation with Kirschner wires. Three years after his injury, the patient is asymptomatic, working at his previous job, with a full ROM of all joints of his left hand wrist and normal grip strength.
In this paper, we reviewed our patients with Kienböck's disease who had had radial shortening osteotomy and radial wedge osteotomy, and compared the two procedures. Since 1981 we have performed radial osteotomy on 40 patients, 32 males and 8 females, with an average age of 40.3 years (range: 15-63). Radial shortening osteotomy (RS group) was carried out in 17 patients with ulnar minus variance and radial wedge osteotomy (RW group) for 23 patients with ulnar zero and plus variance. According to Lichtman's classification, two of the 17 patients in the RS group were at stage II, 12 at stage III and 3 at srage IV. One of 23 patients in the RW group was at stage II, 20 at stsge III and 2 at stage IV. We reviewed the clinical symptoms and radiological findings and evaluated the results according to Nakamura's scoring system. Ulnar variance, radial inclination and ulnar shift ratio were measured in P-A roentgenograms and the correlation between these factors and the clinical results was investigated. Average follow-up time was 4.1 years in the RS group and 3.2 years in the RW group. Six of 17 cases in the RS group were rated excellent, 6 good, 2 fair and 3 poor. Five of 23 cases in the RW group were rated excellent, 6 good and 12 fair. There was no significant difference between two procedures regarding clinical results. The average postoperative radial inclination was 23.1° in the RS group. The average postoperative radial inclination in the RW group was 17.0° in consequence of the 9° wedge osteotomy. There was no significant correlation between postoperative radial inclination and clinical results in both groups, however, the radial inclination in cases rated excellent and good ranged from 10° to 20°. The average preoperative ulnar variance was minus 1.2mm in the RS group and minus 0.6mm in the RW group. The average postoperative ulnar variance was plus 0.4mm in the RS group and minus 0.5mm in the RW group. There was no statistical correlation between preoperative, postoperative ulnar variance, the amount of shortening and clinical results. The average ulnar shift ratio was 0.16 preoperatively and 0.15 postoperatively in the RS group. In the RW group, the average ulnar shift ratio was 0.13 preoperatively and 0.08 postoperatively, which indicated the radial shift of the lunate. There was significant correlation between radial inclination and ulnar shift ratio indicating that radial inclination was smaller, the lunate moved more radially. In the RW group, there was significant correlation between ulnar shift ratio and clinical results, that is, radial wedge osteotomy with the lunate shifted radially achieved satisfactory results.
Anatomical and roentgenographic studies of TFC were performed using 24 cadaver's wrist joints. Perfortion of TFC was observed in 11 cases (46%) consisting of 3 cases with ulnar plus variance, 5 cases with neutral variance, and 3 cases with minus variance. In spite of ulnar minus or neutral variance, if radial inclination is high, the carpal bone gets ulnar translocation, so TFC perforation results from ulnar abutment. Cartilaginous changes were most frequently seen on the lunate in cases where the TFC had perforated, but roentgenographic changes were not observed. If radiographic changes are observed, they are signs of TFC perforation.
We reviewed the clinical symptoms and the radiographical findings of patients complaing of ulnar wrist pain and evaluated the results of ulnar shortening osteotomy for this disorder. Since 1988 10 patients had ulnar shortening osteotomy, nine male and one female, with an average age of 30.2 years (range: 14-66). These patients complained of severe pain in the ulnar side of the wrist in spite of conservative treatment. On preoperative roentgenograms, the average ulnar variance was +2.5mm ranging from -2.0mm to +6.0mm. Arthrography was performed on all 11 wrists and MRI in 3 wrists. These examinations indicated perforation of the Triangular Fibrous Cartilage Complex in 7 wrists. The average duration of follow-up was 12.4 months, ranging from 7 to 20 months. Using Cooney's clinical scoring system, the average clinical score was 89, ranging from 53 to 59 (full mark 100 points). No one complained of pain. All patients returned to their original occupation. In two patients with disorder of the distal radioulnar joint, the range of pronation and supination was restricted. Postoperative roentgenograms showed the average ulnar variance to be +0.2mm ranging from -4.0mm to 2.0mm. The average amount of ulnar shortening was +2.5mm ranging from 1.5mm to 6.0mm. No significant correlation was found between the postoperative ulnar variance, the amount of ulnar shortening and clinical results. Ulnar shortening osteotomy is considerd a useful procedure for patients with ulnar wrist pain.
The purpose of this article is to determine the strength of trunk flexor and extensor muscles at several isokinetic test speeds (60deg/sec, 120deg/sec, 150deg/sec) in normal subjects by using the Cybex TEF unit (Back Systems Trunk Extension/Flexion Rehabilitation Unit). Ninety-five subjects (56 males and 39 females) with ages ranging from 14 to 71 years (mean: 35.5 years) were tested. There were many differences in peak torque and total work between males and females. Peak torque, total work and torque acceleration energy (TAE) in male subjects exceeded respective strengths for female subjects at all isokinetic speeds tested. Peak torque, total work and TAE gradually decreased in older subjects. Peak torque and total work decreased as isokinetic speed increased. Conversely TAE increased as isokinetic speed increased.
The purpose of this article is to determine the strength of trunk rotator muscles at several isokinetic test speeds (60deg/sec, 120deg/sec, 154deg/sec) in normal subjects by using the Cybex TR unit (Back Systems Torso Rotation Rehabilitation Unit). Ninety-five subjects (56 males and 39 females) ranging in age from 14 to 71 years with a mean of 35.7 years were tested. There were many differences in peak torque and total work between males and females. Peak torque, total work and torque acceleration energy (TAE) in male subjects exceeded respective strengths for female subjects at all isokinetic speeds tested. Peak torque, total work and TAE gradually decreased in older subjects. Peak torque and total work decreased as isokinetic speed increased. Conversely TAE increased as isokinetic speed increased. There were no differences found between right and left rotator muscle strength.
This study analyzed the effect of exercise on dynamic foot pressure. Subjects compnsed 15 feet of 8 normal adult males and dynamic foot pressure was measured 50 times per one foot used by MP-4800 (Anima products). α is the distance from the medial margin divided by the width of foot. We divided the amount of α to 5 trial groups. The mean and standard deviation of α were not significantly different the 5 groups. We concluded that there was no effect of exercise on dynamic foot pressure.
Using a floor reaction force plate system, gait studies were performed on 25 unilateral osteoarthritic hip patients and compared with 5 normal healthy adults. Four parameters of gait analysis, that is, “weight off” effect ratio, deceleration effect ratio, stance phase duration ratio and stance phase impulse ratio, were evaluated by force plate data. The “weight off” effect ratio was shown to be the most reliable parameter and correlated to the JOA score. All parameters, except for the “weight off” effect ratio, showed that there was no statistical significance between the gait of normal adults and that of post-operative patients whose JOA score was over 80 points.
We investigated the distribution of spinal motoneurons corresponding to cervical nerve roots using the HRP (horseradish peroxidase) method as well as assessing the anatomical levels of anterior and posterior filaments, and discs. Eighteen forelimbs of Wistar rats were used, and 250I. U. (3μl) HRP solusion was injected into their cervical nerve roots. The levels of anterior and posterior filaments and discs on the corsd were noted microscopically, and motoneurons in the anterior horn at each levels were labelled, then compared to the levels of anterior and posterior filaments and discs. Motoneurons corresponding to the C5 nerve root were distributed from the middle of the C4 segment to upper part of the C6 segment with 92.3% of motoneuros located in the C5 segment. Motoneurons corresponding to the C6 nerve root were distributed from the middle of the C5 segment to the upper part of the C7 segment with 95.8% of motoneurons located in the C6 segment. Motoneurons corresponding to the C7 nerve root were distributed from the upper part of the C7 segment to the middle of the C8 segment with 95.5% of motoneurons located in the C7 segment. Anterior and posterior filament levels were almost the same from C5 to C7 and C4/5, C5/6, C6/7 disc levels were almost the same C5/6, C6/7, C7/8 spinal segments.
In a previons study we found that the motor nerve conduction velocity in humans was delayed in a low pressure environment (510mmHg). We have how investigated the nerve blood flow of anesthetized rabbits in a low pressure environment. Rabbits were anesthetized by intramuscular administration of ketamine (80ng/kg) and xylazine (8mg/kg) and then the sciatic nerve blood flow was measured using the laser doppler flowmeter and systolic blood pressure in the femoral artery measured. Systolic blood pressure and even more notably, the of rabbits were significantly reduced in the low pressure environment. There was significant correlation in both measured values. These results suggest that reduction of nerve blood flow possibly causes the delay of motor nerve conduction velocity.
We tried to quantitatively evaluate the function of the intrinsic muscles in patients with cubital tunnel syndrome. The index-little finger distance (ILD) was measured from the tip of the index finger to that of the little finger at maximum finger extension and abduction. The difference of ILDs between affected and unaffected hands was studied and compared with the MCV. Of 38 patients with an average age of 52.5 years, the difference of ILDs was 12.0±12.6mm (average±SD), whereas 34 normal subjects with an average age of 31.6 years had an ILD difference of 3.7±2.4mm. The difference of ILDs in patients were significantly greater than those in normal controls and showed a high correlation with their MCV (r=-0.70). The difference of ILDs provided a good indication of the degree of dysfunction of the intrinsic muscles in cubital tunnel syndrome, and could be a useful parameter for observing the functional recovery of the intrinsic muscles after surgery.
The authors report a case of common peroneal mononeuropathy caused by an intraneural ganglion which presented acutely in a 58-year-old man. On admission, the patient had drop foot and numbness in the lateral leg and dorsal foot. At exploration, the peroneal nerve was found to be enlarged by cystic formation intimately related to the nerve trunk. A pedicle was found connecting the ganglion with the posterior aspect of the knee joint. One year three months after the cyst resection operation, done using a surgical microscope, there was almost complete return of function in the nerve. In this case the intraneural ganglion may have arisen from the neighbouring joint.
Two cases of atypical incomplete median nerve palsy are reported. A 33 and a 26 year-old male had severe pain around the radial forearm and elbow joints. Several weeks later, they found they could not flex the IP joint of their thumbs. On physical examination FPL, FCR, pronator teres and pronator quadratus were not functioning but there was no sensory change in the median nerve region. The patients did not show any signs of recovery and were operated on within 6 months of onset. Surgical exploration revealed no entrapment points along the median nerve, however, some of the median nerve fasciculus was semitransparent along its entire length. Histological examination of the terminal branch of the anterior interosseus nerve revealed Wallerlian degeneration without inflammatory changes. The FPL was reconstructed with tendon transfer using PL or BR with both patients regaining early function of the thumb.
Reconstruction of brachial plexus palsy (BPP) involves many difficult factors. We had 35 patients with BPP of whom 23 were surgically treated. The BPP palsy was total in 16 patients, upper in 6 and lower in 1. Ages at injury ranged from 15 to 39 years (mean 20.4). Motor cycle accidents caused the injury in 24 cases, while are cases was caused by a motor car and another after being caught in a rolling machine. Cerical roots were explored first and avulsion of the root confirmed by SEP. In post-ganglionic lesions, a nerve graft was carved out, and in pre-ganglionic lesions, the following operations performed. The inter costal nerve (C3, C4) was transfered to the musculocutaneous nerve in 15 patients; the accessory nerve was transferred to the musculo cutaneous nerve in 3 cases; the accessory nerve was transferred to the thoracodorsalis nerve in 1 cases; the intercostal nerve (C5, C6) was transferred to the thoracodorsalis nerve in 4 cases. The following results were obtained evaluation using manual muscle testing in the years after the operation: 7 cases good, 1 case Fair, 3 cases Fain Fair. Are both categories Fair a if so, why are they not written as 4 cases Fair, and 1 case zero. Nine cases (69.2%) regained flexion of the elbow joint against gravity. The intercostal or accessory nerve transfer to the thoracodersalis nerve produced wrist flexion and inter constalnerve transfer to the ulnar nerve had wrist flexion.
Operative methods and surgical results for brachial plexus palsy are influenced by the paralytic status of the patient. From 1971 to 1990, we operated on 29 elbow (27 cases: flexoplasty, 2 cases extensor plasty) and 21 shoulder plasties. The methods for elbow flexoplasties included intercostal nerve transfer (16 cases), Steindler's method (7 cases) and latissimus dorsi transplantation (3 cases). The extensor plasties involved transplantation of latissimus dorsi and biceps brachii. For shoulder reconstruction, we used trapezius and levator scapulae transfer (13 cases), arthrodesis (4 cases), rotation osteotomy of the humerus (3 cases), glenoid plasty (1 case) and pectoralis major transfer with elongation of latissimus dorsi (1 case). The results of intercostal nerve transfer were influenced by the patient's age at operation and duration after the injury, with flexor power of the elbow increasing to three or four one year after surgery. All except two patients, operated on by Steindler's method or Latissimus dorsi transfer achieved good power of elbow flexion. For shoulder reconstruction with root avulsion, we believe that the results achieved with trapezius and latissimus dorsi transfer are better than those of arthrodesis.
Prehension is a basic human function. The surgical procedure for reconstruction in complete brachial plexus injuries of all five nerve roots should take into account how to regain the grip function. There are several approaches to restore this basic hand function, however, powerful grip should be greately appreciated more than weak key pinch which is used to be reconstructed based on the Moberg's rationale. Simultaneous reconstruction of elbow and finger function with free muscle and nerve transfers and its long-term results are described.
From January, 1985, to July, 1991, 228 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to Okinawa Chubu Hospital. Thirty-one patients (13.6%) had gross hematuria, 93 patients (40.8%) had micro hematuria, and 90 patients (39.5%) had no hematuria. There were 14 patients (6.1%) who had lower urinary tract injuries; 12 men and two women. One man who had multiple injuries was dead. An intraperitoneal bladder rupture was treated by operative repair of the defect. One extraperitoneal bladder rupture was operated under diagnosis of intraperitoneal rupture, and the others were treated with urethral catheter alone. None of the patients had any complications. Emergency cystostomy was done for two patients with urethral injuries. The lower urinary tract injuries were associated with severe pelvic fracture irrelevant to the classiffication of pelvic fracture.
Hemorrhage remains the leading cause of mortality in patients with severe pelvic fractures. To elucidate efficacy of emergency pelvic angiography and transcatheter arterial embolization, of 228 patients with pelvic fracture from January 1985 to July 1991, we reviewed 64 consecutive patients who underwent pelvic angiography for intractable pelvic hemorrhage. Their ages ranged from 6 to 85 years with an average of 44.7 years. In these 64 patients, 47 had active bleeding vessels and 53 underwent transcatheter arterial embolization. Of the 45 patients whose systolic blood pressure was less than 100mmHg at the time of their arrival to the emergency room, pelvic angiography was performed in 37 patients within 6 hours of their injuries, and 33 patients underwent arterial embolization. We conclude that pelvic angiography should be performed when pelvic fracture is diagnosed as the primary source of intractable hemorrhage, moreover, transfusion and/or fluid therapy alone is not effective. To manage severe pelvic fracture, cooperation between the departments of surgery, orthopedics and radiology is important.
We analyzed 10 hips of 9 patents with posterior dislocation and femoral head fracture. The patients ranged in age from 19 to 62 years (mean: 27), and were evaluated on average 2.4 years after the injury. Hips classified as Pipkin type I had better clinical results than Pipkin type II, because type II hips had larger fracture fragments including weight bearing surfaces of the femoral head. Malposition of the femoral head fragments in Pipin type II needs to be correctly reduced and fixed by operative intervention. Computed tomography derived before and after closed manual reduction may be necessary for treatment of posterior dislocation of the hip with femoral head fracture.