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Takeshi Arizono, Hideya Kawamura, Tomotaro Yamaguchi, Hiromasa Miura, ...
1993 Volume 42 Issue 2 Pages
635-638
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We made a retrospective comparison between preoperative ROM of the knee joint and that after one year postoperatively in 82 high tibial osteotomies for the treatment of osteoarthritis of the knee. Average improvement in flexion was 1.3 degrees and 4.4 degrees in extension. Postoperative treatment with continuous passive motion produced no statistical difference in improvement in ROM. The posterior tilting angle, which is the angle between the vertical line of the tibial shaft and the contact line of the tibial plateau on lateral X-P, showed a positive relationship to the loss of knee joint extension but was not related to flexion. It appears reasonable to change the posterior tilting angle slightly in order to improve extension in high tibial osteotomies when the knee has a flexion contracture.
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Tomotato Yamaguchi, Hideya Kawamura, Hiromasa Miura, Yoichi Sugioka, K ...
1993 Volume 42 Issue 2 Pages
639-645
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Loss of correction due to lack of fixation in high tibial osteotomy still remains an important problem. Ogata has developed a new staple that has a bladelike inserting portion and one cortical screw. We radiologically evaluated 106 knees that had an interlocking wedge osteotomy performed for osteoarthritis between 1980 and 1990 at Kyushu University. The average duration of follow-up was 29 months. Patients were divided into five groups by the device used for internal fixation and postoperative rehabilitation. The postoperative recurrence rate of varus deformity when using Ogata's staple was lower than that after using a standard stepped staple. We concluded that Ogata's staple was more useful for High tibial osteotomy than a standard stepped staple.
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Masakatsu Yasunaga, Kousuke Ogata, Hiroshi Nomiyama, Hiroyuki Iida, Yu ...
1993 Volume 42 Issue 2 Pages
646-649
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Data using an accelerometer to measure lateral knee thrust was evaluated in 30 osteoarthritic knees (12 men, 18 women, mean age 62 years [55-72]) and 30 normal knees (18 men, 12 women, mean age 28 years [22-38]) under the following conditions. [(1) flat ground gait, (2) 30° up slope gait, (3) 30° down slope gait, (4) stairs climbing, (5) stairs descending, (6) flat ground gait with 20 kg load.]
Compared with the value for flat ground gait, the peak value of acceleration after heel strike showed a significant increase with a 30° down slope, stairs descending, flat ground gait with 20kg load, all of which were considered factors which exacerbated osteoarthritic knees.
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Hiroomi Ogata, Kazutoshi Nomura, Masanori Yamamura, Mako Hirano, Yasuh ...
1993 Volume 42 Issue 2 Pages
650-652
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Between 1989 and 1991, we performed arthroscopic debridement for 10 patients (12 joints) with lateral type gonarthrosis. Fibrillation of chondral-bone was seen in 7 joints, erosion in 3 joints and large chondral-bone loss in 2 joints. Six of the 12 joints had a degenerative tear of the lateral discoid and the rest had severe degenerative tears of the lateral meniscus. All joints had a partial menisectomy with 2 joints additionally requiring drilling for chondral bone ulceration. Clinical evaluation was made using the Japanese Orthopaedic Assosiation (JOA score) criteria, with good results obtained. (Average score improved from 86.7±5.1 to 97.9±6.9, and the mean follow-up period was 30.0 months)
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Yasuhide Taniguchi, Kunio Tomonaga, Nobuhisa Uematsu, Yoshihiro Yabe, ...
1993 Volume 42 Issue 2 Pages
653-657
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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The result of intraarticular injection of high molecular weight sodium hyaluronate in the knee joint were reviewed. Twelve knees in 12 patients were divided into two groups: Group A consisted of 10 patients with osteoarthritis in the medial compartment of the knee and arthroscopic medial partial meniscectomy had been performed. Group B consisted of 2 patients who had osteoarthritis in the medial compartment of the knee and lateral partial meniscectomy had been performed. After meniscectomy all patients received intraarticular injection of high molecular weight sodium hyaluronate into the knee joint for at least 5 months. After this therapy all knees were arthroscoped again. Improvement was obserbed in both groups.
These results suggest that high molecular weight sodium hyaluronate is effective for improvement of degenerative joint cartilage.
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Ichiro Yoshii
1993 Volume 42 Issue 2 Pages
658-661
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Fifty knees that had arthroscopic surgery for treatment of osteoarthritis were reviewed, and prognosis evaluated corresponding to articular cartilage damage. Surgery was performed including arthroplastic meniscal suture for meniscal tear, or if this was impossible, meniscectomy, articular cartilage smoothing for cartilage loss, osteophyte resection for obstructing osteophytes, enucleation for loose body, lateral release for patellar lateral shift, and synovectomy for hydrops. Preoperative HSS score (p<0.0001) increased in all cages. Only medial articular cartilage loss significantly (p<0.05) influenced post-sugery prognosis. Other factors, such as lateral articular cartilage loss, patello femoral articular cartilage loss, medial and lateral meniscal damage had no significant effect on the postoperative prognosis. There fore, careful attention must be paid to the medial compartment for prediction of osteoarthritis of the knee, when arthroscopically observed.
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Kengo Takayama, Takehiko Torisu, Masahiko Nakamura, Katsuhiro Tada, Sh ...
1993 Volume 42 Issue 2 Pages
662-666
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We carried out a patellectomy in an 80-year old patient who complained of right patello-femoral joint pain when she walked.
She started to walk with partial weight bearing and actively carried out range of motion exeruses 1 week postoperahuely and passively 5 weeks postoperatively. Due to this her gait pain was relieved and the range of motion of her right knee was well preserved.
Loss of strength in her quadriceps muscle was only slightly and she could extend her knee to -10°, with an extension lag of 10°. She had no difficulty in her daily living activities.
Patellectomy therefore appeart to be a good procedure for osteoarthritis localized in the patellofemoral joint in elderly patients.
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Takanobu Abe, Shuji Horibe, Takashi Soejima, Mitsuo Kakizoe, Akio Inou ...
1993 Volume 42 Issue 2 Pages
667-669
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Thirty-six patients with locked knees due to torn menisci were investigated retrospectively. Thirteen patients had medial meniscal tears and twenty-three had lateral meniscal tears (involving 11 torn discoid menisci). Associated anterior cruciate ligament injury was found in seven cases.
Torn discoid menisci were found in a younger age group compared with semilunar type. Discoid menisci were totally resected in all 11 cases. Longitudinal tears were found in 18 semilunar menisci and 11 meniscal tears were sutured. Meniscal repair was performed in most cases without body degeneration. On the contrary, only 44% of the torn menisci with body degeneration could be repaired. We speculate that the longterm locked knee leads to degeneration of torn menisci.
In conclusion:
1) Discoid minisci's tears were found in younger patients.
2) Meniscal repair was performed in 61% of longitudinal tears.
3) Meniscal repair rate with body degeneration was lower than without it.
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Minoru Sato, Tetsu Murao, Hidetoshi Ihara, Shigeharu Nomura
1993 Volume 42 Issue 2 Pages
670-672
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We experienced a rare case of damage to the meniscus and articular cartilage caused by broken glass in the knee. Case: A 9-year-old boy injured his right knee with broken glass, which had previously been incompletely removed. Due to some pieces remaining in his knee, he still had right knee pain. On presentation to our hospital plane roentgenogram demonstrated two pieces of the glasses. Arthroscopic examination showed severe damage to both meniscus and articular cartilage. The glass pieces were removed arthroscopically and the patient returned to normal daily life with in 5 days with no knee complaints. However his damaged knee should be followed carefully. This case suggests the importance of the X-ray check and arthroscopy in cases of glass injury around the knee.
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Hidetoshi Ihara, Yoshihiro Noro, Megumi Miwa, Kiyomi Takayanagi, Keizo ...
1993 Volume 42 Issue 2 Pages
673-676
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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The purpose of this study was to evaluate natural healing of the collateral ligament associated with cruciate ligament injury when treated conservatively by early protective motion. Acute ligamentous injuries of the MCL in 10 patients and of the LCL in another 3 patients, who had concomitant ACL injury in 11 patients and PCL in 2 patients, were the subjects of this study. A Kyuro knee brace with a coil-spring traction system was used to add adequate but not excessive stress to the injured tissues at an early stage. Dynamic joint control training was conducted progressively to improve the muscles ability to protect the joint. All patients were examined before treatment and then re-examined after the 3-month treatment, both radiologically and arthroscopically. Ten patients were also evaluated by MR imaging. Lateral laxity on stress radiographs under anaesthesia decreased from an average of 13.5 to 5.5mm (p<0.01) after treatment. Most of the arthroscopic findings of ruptured ligaments returned to a normal appearance. Results that were rated as “good to excellent” were obtained in 90% of those examined by MRI. Associated ACL healed well, but PCL poorly. We concluded that acute collateral ligament tears can be healed morphologically and mechanically by this non-surgical method, even when complicated with cruciate ligament injuries.
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Eisuke Nakamura, Takehiko Torisu, Masahiko Nakamura, Seiji Yoshida
1993 Volume 42 Issue 2 Pages
677-680
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Patellar tendon rupture may occur spontaneously or after minor trauma in patients with underlying systemic disease. Histopathological findings showed heterotopic ossification and degeneration of collagen fibers at the site of tendon rupture.
Spontaneous rupture is frequenthy at the site of inset into the quadriceps tendon.
A haenodialysis patient with bilateral simultaneous rupture of the patellar tendon was reported.
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Satoshi Kinjo, Tomomi Uesato, Hiroshi Chinen, Satoshi Mori, Moritaka N ...
1993 Volume 42 Issue 2 Pages
681-685
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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A family in which the son had bilateral habitual patellar dislocation and his father had bilateral permanent dislocation of the patellae was reported. Eleven families in which dislocation of the patellae occurred have been reported in Japan since 1984.
However, the combination of habitual and permanent patellar dislocation in the same family has never been reported in Japan. Permanent dislocation of the patella is usually congenital, and evidence of transition of habitual dislocation to permanent dislocation of the patella has not been reported. Although the father's history was uncertain, his permanent dislocation and the habitual dislocation of the son may suggest possible transition of habitual to permanent patellar dislocation.
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Masao Eto, Nobuyuki Ito, Katsuro Iwasaki, Tsuyoshi Watanabe, Masayuki ...
1993 Volume 42 Issue 2 Pages
686-689
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Rotator cuffs of both shoulders were investigated by ultrasonography in twenty-five postoperative patients with rotator cuff tears.
Aloka SSD-624 (7.5MHz prove) was used for the study. Shoulders were examined bilaterally, with patients sitting upright and the shoulder in a neutral position. Measurements were made in two directions, the transducer being placed in the fiber direction of the supuraspinatus muscle and also perpendicular to this. And the operated side was compared with the sound side.
Six shoulders showed normal sonograms, and nineteen shoulders had abnormal sonograms with irregular echogenecity, echogenic foci, an irregular superficial layer and thinning of the cuff. The average cuff thickness of the operated shoulder was 4.5mm and that of the normal shoulder was 6.4mm. There was a statistically significant difference between the thickness of the cuff in the shoulders. The cuff thickness in patients with large cuff tears was thinner than that of patients with small tears According to the shoulder evaluation sheet of the J. O. A., scores were lower with the reduced thickness of the rotator cuff.
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Yoshihiro Noro, Hidetoshi Ihara
1993 Volume 42 Issue 2 Pages
690-692
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Ultrasonography is convenient for patients because it is non-invasive and mobile. We report two cases of knee disease detected by ultrasonography. Case 1, was a seventeen-year-old girl. She had suffered from increasing right knee pain for one year. Arthroscopy detected a lateral meniscal rupture, but a meniscal cyst was not diagnosed until ultrasonography was performed. The meniscus was resected and the cyst aspirated arthroscopically. Case 2, was a 57-year-old woman. Hemoarthrosis of her left knee appeared with no history of trauma. Ultrasonography detected an anechoic mass, but no abnormalities were detected arthroscopically. After arthroscopy, MRI confirmed a tumor in the region where the ultrasonograph had previously detected it. The tumor was resected and its histological diagnosis was inflammatory granulation. Ultrasonography is a useful screening examination for the knee.
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Syugo Narita, Setsuro Komiya, Kensuke Yamanaka, Akio Inoue
1993 Volume 42 Issue 2 Pages
693-695
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Fifty-one patients with osteoporosis were treated and their bone mineral densities (BMDs) measured serially. BMDs of total bone, L2-L4 vertebrae and femoral necks were measured by dual energy X-ray absorptiometry (DEXA). Patients were followed-up for an average of 9.7 (3-20) months, and treated with Vitamin D
3, Calcitonin, Ipriflavone, combination therapy (including ADFR treatment) or other drugs. After treatment, BMDs were maintained or increased, although not significantly.
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Kazumichi Maekawa, Katsumi Suzuki, Toshitaka Nakamura, Shinichi Nakami ...
1993 Volume 42 Issue 2 Pages
696-699
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed osteoarthritic changes in X-ray films of a normal group from 1983 to 1992. There were 2788 patients without osteopenia, collagen disease, malignant disease and metabolic bone disease in this normal group. Patients comprised 1415 men and 1373 women, ranging in age from ten to seventy. We examined sixteen joints. The number of joints was 8359. We evaluated the following four aspects: bone atrophy, narrowing of the joint space, sclerosis of subchondoral bone and osteophyte formation. Subjects were graded as “0” indicating no radiological change, “1” indicated slight change and “2” was severe change. We investigated the osteoarthritic index, with patients grouped by age, using these scores in each joint. The osteoarthritic index is the total score in each joint divided by toral joints. We discussed the physiological changes seen in osteoarthritis, judged by theses four criteria.
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Keizo Akagi, Kunio Sasaki, Atushi Shimizu, Takuya Tamaru, Kouichi Wata ...
1993 Volume 42 Issue 2 Pages
700-702
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Magnetic resonance imaging of 22 Vertebra-fracture patients (3 males, 19 females) were reviewed. Damage to the endplate and rupture of the posterior longitudinal ligament was evaluated in T
1, weighted sagittal images.
Disc damage was indicated by signal intensity, configuration in T
1, and T
2, weighted sagittal images.
MRI was a useful choice of treatment.
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Osamu Mori, Hiroshi Motoshige, Satoru Aoki, Kenshi Takada, Shinya Hori ...
1993 Volume 42 Issue 2 Pages
703-705
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Common MR imaging features in fresh vertebral compression fractures (nontumorous conditions) include lowering of signal intensity on T1-weighted images and elevation of signal intensity on T2-weighted images. These signal changes occur all over the vertebral body in one half and partially in another half. Signal intensity does not change in the lamina, spinal process and intervertebral disc. In 25% of cases, the posterior part of the vertebral body bulges into the lumbar canal in MR imaging (this finding was not observed in plain X-ray). In cases of old fracture, no signal change was observed except for morphologic change. MR imaging was useful in deciding whether this fracture was fresh or not.
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Yuzoh Fukahori, Kosuke Ogata, Hiromi Nishizaki, Masaaki Morooka
1993 Volume 42 Issue 2 Pages
706-709
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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0.2T Magnetic Resonance Imaging was performed on 160 menisci (80 knees). All were operated on using arthroscopy and 59 torn menisci were found. Diagnosis with Magnetic Resonance had a sensitivity of 88.1%, a specificity of 95.0%, and an accuracy of 92.5%. 0.2T Magnetic Resonance exam was shown to be a good method of assessment for meniscal injury. Magnetic Resonance Imaging was the best method for detecting meniscal tears. Magnetic Resonance grading (by Stoller) was an acceptable classification. However, there may be little difference between his grading and our histological findings.
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Shintoku Isa, Fuminori Kanaya, Akira Arakaki, Jun Asato, Noriaki Tazak ...
1993 Volume 42 Issue 2 Pages
710-713
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Four cases of posterior interosseus nerve palsy caused by ganglion were reviewed. Patients were 3 females and one male. Tenderness and tumor at the anterior aspect of the radial head and palsy of the muscles innervated by the posterior interosseous nerve were seen in all cases. In two cases, resting reduced both pain and palsy and exercise worsened the pain and palsy. Duration between onset of pain or palsy to operation ranged from 2 weeks to 3 months. All cases received surgery and showed nearly complete recovery. Two patients who received surgery within three weeks of onset of symptoms recovered within three weeks. Two other cases who received surgery more than two months after the onset required four and five months for recovery. Early diagnosis and surgery will shorten the recovery period of posterior interosseous nerve palsy caused by ganglion.
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Tsuyoshi Watanabe, Kotaro Imamura, Yoshifumi Nagatani, Nobuyuki Ito, T ...
1993 Volume 42 Issue 2 Pages
714-717
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed twelve cases of anterior interosseous nerve palsy and nine cases of posterior interosseous nerve palsy.
In regard to recovery of muscle power, there was no significant difference between conservatively treated anterior interosseous nerve palsy cases and those treated by neurolysis. However conservative treatment posterior interosseous nerve palsy proved to be unsatisfactory.
We consider that anterior interosseous nerve palsy can be treated conservatively, while neurolysis should be carried out immediately for posterior interosseous nerve palsy.
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Kazuo Kaneko, Tatsuo Miyamoto, Yasuo Kainaga, Youichirou Murata
1993 Volume 42 Issue 2 Pages
718-720
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We report on electrophysiological staging in 20 patients (27 hands) with carpal tunnel syndrome (C. T. S.) in subjects ranged in from 33 to 64 years.
In C. T. S. the degree of axonal degeneration relates to the amplitude of the sensory nerve action potential which is recorded distal to the transverse carpal ligament. Segmental demyelination cases have delay in their nerve conduction velosity. Mixedtype cases have a low amplitude action potential recorded from digits after palm stimulation. Axonal degeneration cases are those in which the action potential could not be recorded.
The degree of sensory disturbance relates to the degree of axonal degeneration. Neuropathological findings of entrapment neuropathy are a mixture of some degree of demyelination and axonal degeneration.
The degree of axonal degeneration is important for prognosis in C. T. S.. We emphasize not noly the electrophyiological staging but also the conduction velosity of nerve action potentials.
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Yasunori Fuchigami, Shinya Kawai, Gen Shiraishi, Takashi Itoh, Kazuo K ...
1993 Volume 42 Issue 2 Pages
721-723
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Latency and wave form of M-responses change in entrapment neuropathy, because of segmental demyelination and axonal degeneration. Normally, latency decreases gradually (0.2ms/cm) as the cathode moves proximally and the wave form does not change due to the phase cancellation having little influence. In entrapment neuropathy a steep latency change occurred across the entrapment point and in many cases the wave form changed across the entrapment point, influenced by the increasing phase cancellaltion.
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Toshinori Nakao, Toshiyuki Tsuruta, Akihiko Asami, Hideo Watanabe
1993 Volume 42 Issue 2 Pages
724-726
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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The double crush syndrome hypothesis was first presented by Upton in 1973. Since then many reports have been made concerning this syndrome. However there are few reports about the double crush syndrome in cubital tunnel syndrome.
We studied cubital tunnel syndromes associated with cervical lesions. Thirty-three patients (thirty-eight hands) with cubital tunnel syndrome, followed for over one year postoperatively, were divided into two groups. Group one had cervical lesions with neurological findings and the other group had no cervical lesions.
Both groups were examined and clinically and electrophysiologically evaluated.
Cervical lesions were recognized in seven hands (five cases). Results in the group with cervical lesions were worse than those without cervical lesions in both clinical and electrophysiological evaluations.
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Tomoo Tsukazaki, Tsukasa Kondo, Kouichi Shiraishi
1993 Volume 42 Issue 2 Pages
727-729
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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One hundred and five patients with unilateral Colles' fracture, treated with closed reduction and cast immobilization, were followed up for a median of 46.8 (12-104) months. At follow-up, 39 patients had some form of persistent ulnar wrist pain. Final dorsal angulation was significantly increased in patients with pain compared to those without pain. However, initial and final radial shortening, fractures involving the distal radio-ulnar joint, ulnar styloid fractures or nonunion and instability of the distal ulna had no effect on ulnar wrist pain. We conclude that ulnar wrist pain is due to incongruity of the distal radio-ulnar joint.
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Tomoo Tsukazaki, Tsukasa Kondo, Kouichi Shiraishi
1993 Volume 42 Issue 2 Pages
730-733
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed 105 consecutive patients with unilateral Colles' fracture to identify factors that are predictive for poor functional outcome. All fractures were treated by closed reduction and cast immobilization, and followed for at least one year. Our results show that only the final dorsal angulation related to loss of flexion. In contrast to other reports, we did not identify a relationship between radial shortening and loss of grip strength or loss of range of motion. In addition, severity of initial displacement, fractures involving the radio-carpal joint or distal radio-ulnal joint and ulnar styloid fracture or its non-union did not affect functional outcome.
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Masataka Goto, Masateru Ijichi, Takuo Yamaguchi, Atushi Funahashi, Tak ...
1993 Volume 42 Issue 2 Pages
734-737
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Fracture of the distal end of the radius is one of the most common fractures, and if comminuted it is difficult to treat with only cast immobilization. Therefore, sometimes it has to be treated with external fixation or open reduction and internal fixation. We reported two cases with Hoffmann external fixation. The first case was an old fracture, the other fresh and communited in the distal end of the radius. According to the point system by Saito, the results were fair and good. Both patients are almost satisfied with their return to the work force, and they can work as before.
*Authors Note:
In this last sentence the meaning needs to be made clearer.
Are the patients almost able to return to work, or do you mean they are satisfied with the functional recovery of their arm?
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Takeyuki Miyazato, Fuminori Kanaya, Akira Arakaki, Noriaki Tazaki, Sat ...
1993 Volume 42 Issue 2 Pages
738-741
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Three volar dislocations of the distal ulna with unusual etiology were reported. The first case was a neglected volar dislocation of the ulna with a malunited fragment avulsed from the volar lip of the distal radio-ulnar joint. Satisfactory stability was achieved by open ulnar reduction with reposition and fixation of the malunited fragment. The second case suffered from volar dislocation of the distal ulna on supination. She had had a malunited Colles fracture with 5mm ulna plus variant and 30 degree dorsal tilt of the distal radius. Closing wedge osteotomy of the radius and shortening osteotomy of the ulna were done in order to realign the distal radio-ulnar joint. She regained painless pronation (60 degrees) and supination (90 degrees). The third case was a 13 year old boy who had a recurrent volar dislocation of the distal ulna which was possibly caused by shortening and angulation of the ulna secondary to growth disturbance of distal ulnar epiphysis due to trauma at 6 years of age. Physiological alignment of the distal radioulnar joint was achieved by opening wedge osteotomy of the ulna.
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Kensuke Takashima
1993 Volume 42 Issue 2 Pages
742-745
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Carpometacarpal dislocation other than thumb is uncommon. Four patients with dorsal fracture dislocations of the fourth and fifth carpometacarpal joints were treated. Direct trauma, such as from a fall or blow was the principal mode of injury. Two cases were first diagnosed as fractures of the fourth metacarpal by first aid doctors. Three cases had fractures of the fourth metacarpal base, with dorsal displacement of the distal fragment that accompanied a fragment of hamate fracture and dorsal dislocation of the fifth metacarpal. The other case only had dorsal and proximal dislocation of the fourth metacarpal with a fragment of hamate fracture. Three cases were treated operatively and one case conservatively.
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Masaru Nezu, Mochiru Kamihira, Hikaru Ikeuchi
1993 Volume 42 Issue 2 Pages
746-748
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We operated on 7 patients with fresh complete dislocations of the acromioclavicular joint (Tossy's grade III) by transference of coracoacromial ligament. Patients comprised 6 males and 1 female, ranging in age from 18 to 61 years with an average of 43.1 years. Follow-up ranged from 3 to 43 months with an average of 12 months. The postoperative results were evaluated according to J. O. A. and Kawabe's scores. The J. O. A. score ranged from 88 to 100 with an average of 97.3 and from 78 to 100 with an average of 94.0 according to Kawabe's scores (6 exellent and 1 fair).
We concluded that this operative method was very useful for fresh complete dislocations of the acromioclavicular joint.
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Koichi Koyama, Fumitoshi Ihara, Shigeharu Nomura, Yoji Kamo, Hirofumi ...
1993 Volume 42 Issue 2 Pages
749-751
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We surgically treated twenty one patients for acromio-clavicular dislocations (Tossy III). The modified Phemister's method was performed in eleven and Dacron reconstruction of the coraco-clavicular ligament in ten. The mean age at the time of surgery was 37.3 years. The mean period of follow up was 5 years and 8 months. We evaluated and compared the results of both methods with Kawabe's criteria.
Clinical results in all cases were safisfactory with the average total score by Kawabe's criteria of 93.0 points. No statistical differences were found between the two methods. The modified Phemister's method was provided a good clinical results if the coraco-clavicular ligament was able to be sutured, but reconstruction of the coraco-clavicular ligament should be performed if suturing is not possible.
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Koichi Ieiri, Kiyotsugu Maekawa, Hiroaki Sakata, Keiichiro Okajima, Ak ...
1993 Volume 42 Issue 2 Pages
752-754
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed seven patients who underwent operative treatment for clavicular fractures using Mennen plates. Six of seven fractures were accompanied with three or more fragments and one of these was a case of non-union after plate fixation.
It is suggested that this plating system is especially useful for these kinds of fractures.
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Hirotaka Arima, Akihiko Sonoda, Kiyoshi Uchino, Nobuo Origuchi
1993 Volume 42 Issue 2 Pages
755-757
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We investigated the results of surgical treatment of 41 intertrochanteric femoral fractures using the CHS method over the past 6 years.
Subjects included 9 males and 32 females, with an average age at operation of 76.2 years.
According to the classification of Evance, 20 cases were stable and 21 were unstable.
At follow-up, 63% of these cases could walk, 17% could not walk and 20% had already died.
In the radiographic findings, both the stable and unstable type showed remarkable changes in collodiaphyseal angle and telescoping.
Post-operative complications occurred in 3 cases, 1 case cut out, 1 case of penetration and 1 case of necrosis of the fenemoral head.
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Jun Ueda, Tatsuo Kutsuna, Jun Itou, Takako Ishii
1993 Volume 42 Issue 2 Pages
758-762
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed the clinical results of 26 cases (19 female, 7 male) with comminuted trochanteric femoral fractures. 22 cases can be classified into type I-group 4 (17 cases) and type II (5 cases) according to Evans' classification. Remaining 4 cases were unclassified. The age range at time of injuny was 36-91 years, with average age of 74.
Four out of 26 cases (15%) had a poor or impossible gait after treatment. Stress experienced during surgery was large and postoperative treatment took a long time. This tendency showed up stronger in the plate group (9 cases) compared to that of the CHS group (12 cases). Deformity on X-p postoperatively was seen in 5 cases (20%) of which 4 belonged to the CHS group. These results suggested the importance of selection of operative methods and the need for combination of materials for internal fixation in each of the cases presented.
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Seikei Miyagi
1993 Volume 42 Issue 2 Pages
763-769
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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The main current method for internal fixation of pertrochanteric fractures is compression hip screwing (CHS). Contrary to rigid physical fixation with CHS, complications have recently been reported, which are thought to be due to breakdown of the biomechanical pattern of the proximal femur.
The author emphasizes that in these high geriarthritic plays efforts should be made for achieving biomechanical fixation of the pertrochanteric fracture with a small surgical intervention.
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Ryuji Okazaki, Yoshinori Nagata, Masayuki Murase, Yoshiaki Sasashige, ...
1993 Volume 42 Issue 2 Pages
770-773
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Fractures of the femoral neck in children are rare. Various complictions such as avascular necrosis, non union, premature closure of the epiphysis and coxa vara deformity worsen hip joint function. Avascular necrosis of the femoral head is the most important factor which influences the endresult.
We retrospectively studied seven cases of femoral neck fractures in five boys and two girls. The mean age was 10.4 years (range, 5-15 years). The seven cases were classified according to the four types described by Delbet and popularised by Colonna, type II in 2 cases, type III in 3 cases, and type IV in 2 cases. All cases were treated by skeletal or skin traction. In the case of non-acceptable reduction, we desided to reduce it operatively. Results were good in four, fair in two, and poor in one by the Ratliff's assessment.
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Cases with Severe Dementia
Kimiaki Kawano, Nario Ihara, Yasuyuki Iguchi, Yasunobu Isozaki, Yukihi ...
1993 Volume 42 Issue 2 Pages
774-777
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We have operated on 30 patients over the age of 70 years for intertrochanteric fractures since May 1989. They have been divided into Group A, those with dementia (n=14) and Group B those without dementia (n=16).
We present the following results:
1) The recovery rate of Group A was 74.8%.
2) The recovery rate of Group B was 92%.
3) There was only one postoperative death in Group A.
4) It is recommended that surgery is done as soon as possible and that complications such as decubitus, pneumonia, and so on are prevented, allowing the patient to regain their preinjury activity of daily living.
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Hitoshi Hatanaka, Yasurou Kuga, Toshiyuki Andou, Bin Haga, Harutaka Ya ...
1993 Volume 42 Issue 2 Pages
778-781
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Generally patients with femoral neck fractures should be treated surgically. However, it is not well known whether surgery is recommended in patients who may additionally suffer from mental disorders. A retrospective study was performed to determine the effect of mental disorders on clinical outcome in 13 patients who had been treated surgically for femoral neck fractures while under psychiatric treatment. In comparision with 65 patients free of such disorders, psychiatric patients demonstrated significantly longer periods between the time of injury and surgery. However, no significant difference was found in preoperative complications, postoperative period in bed, hospital stay, or functional prognosis.
We conclude that patients with mental disorders should be treated for femoral neck fractures surgically while under psychiatric treatment.
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Kazuo Konishi, Tatsuo Kutsuna, Toshimitsu Koga, Miho Aoyagi, Kazuhiro ...
1993 Volume 42 Issue 2 Pages
782-785
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Nine cases of spontaneous fracture of the femoral neck were reviewed. Eight were complete fractures and one was an incomplete fracture. The eight complete fracture cases ranged in age from 58 to 87 years (mean, 78.0). Of these, three were accompanied by rheumatoid arthritis, and one case also had CRST syndrome. Average age at diagnosis of the fracture was 72.3 years in these cases, and 83.8 years in the four cases without associated diseases.
We suspect the differences were caused by steroid.
Diagnosis of spontaneous fracture of the femoral neck can be easily missed, with no roentgenographic findings except bone atrophy when the patients first complained of hip pain. We need to consider this fracture when diagnosing hip pain in elderly patients without a history of significant trauma.
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Tetsuo Nakano, Kazuki Miyazono, Juji Nishi, Hideo Nishikawa, Satoshi K ...
1993 Volume 42 Issue 2 Pages
786-790
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Ten coxae of nine patients with intracapsular fractures of the femoral neck were examined by magnetic resonance imaging (MRI). In five of the ten, specimens were obtained by needle biopsy and examined microscopically. Cases were staged into four groups: according to Garden's classification Stage I, II, III and IV. In some cases of Stage I and II, partial bone necrosis was detected by MRI. Even cases of Stage I or II with bone necrosis rarely suffered from the complication of late segmental collapse. In Stage III or IV cases, extensive bone necrosis was detected by MRI, and in these cases consideration had to be given to the possible occurrence of late segmental collapse. The low signal area surrounded by a zone of non-signal area (so called “band pattern”) demonstrated on MRI corresponded to bone necrosis seen microscopically.
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Takuya Ikuta, Makoto Tamai, Yuichi Nagano, Kei Hirakawa, Yoshifumi Shi ...
1993 Volume 42 Issue 2 Pages
791-795
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Fourty-one cases with femoral shaft fractures were treated with an intramedullary nail. Of the fourty-one cases, twenty-one were treated with the interlocking nail and twenty, with only a Küntscher nail.
The mean time until full-weight bearing was 46 days. Thirty nine of fourty-one fractures had good bone union but there was one refracture with breakage of nail and one with delayed union.
All patients had almost full range of motion at the knee joint, but one had myositis ossificans.
Intramedullary nailing is a useful method for treatment of femoral shaft fractures allowing early joint motion and weight bearing.
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Michiya Hara, Kouji Yano, Yasushi Soejima, Yoshitake Yokokura, Hisashi ...
1993 Volume 42 Issue 2 Pages
796-800
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Five femoral shaft fractures in five patients were followed after treatment with the Interlocking Titanium Alloy nail (ACE intramedullary Rod System). Two fracture were transverse, three were comminuted. The age range was from 17 to 66 years. All patients achieved union with good functional results.
Titanium Alloy has more strength than Stainless Steel and this small nail can be used with less reaming.
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Tetsuya Kuga, Mahito Kawashima, Hiroaki Tamura, Nobuyuki Akimoto, Haru ...
1993 Volume 42 Issue 2 Pages
801-804
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Because internal fixation of femoral Supracondylar fractures is difficult, conservative treatment with traction or casts has been recommended. But there are some surgical indications such as displaced intra-articular fractures, failure to maintain acceptable alignment with traction or casts, and fractures in elderly patients who cannot be confined to bed.
The Zickel supracondylar system is an intramedullary fixation device for femoral supracondylar fractures and can be performed as a closed method. Between 1986 and 1991, ten patients whose ages ranged from 20 to 86 years old were operated and successfully treated in our hospital by this method. This method is useful especially for elderly patients who can have some general complications because it is technically easy and non-invasive.
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Hiroshi Maeda, Masao Noguchi, Masatsugu Suehiro, Eiichi Mihara, Zuitou ...
1993 Volume 42 Issue 2 Pages
805-809
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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we evaluated the results of surgical treatment in 18 patients with tibial plateau fractures to define the prognostic factors. Overall, 15 patients (83.3%) achieved an excellent or good result. There was no significant association between the end result of surgical treatment and the fracture type, the absence of bone graft, the time of mobilization or coexistent ligamentous injuries. Three patients with a fair result had residual depression of greater than 7mm on the joint surface and angulation deformity.
The most important factor influencing the outcome in patients with tibial plateau fracture was adequacy of reduction.
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Ichiro Itonaga, Takehiko Torisu, Kazuhisa Nanamori, Katsuhiro Tada, Yu ...
1993 Volume 42 Issue 2 Pages
810-814
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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The formation of a genu recurvatum after partial growth arrest of the proximal tibial physis is uncommon. We report the case of a 16 years old male patient with a genu recurvatum of 30 degrees. He sustained a femoral fracture in a traffic accident when he was 9 years old, and we believe that he incurred a physeal injury at the same time. He was managed successfully by an open wedge osteotomy and bone-grafting.
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Yasushi Mashima, Hideharu Ono
1993 Volume 42 Issue 2 Pages
815-820
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Eleven tibial fractures were treated surgically from January 1989 to December 1991. Three tibial plateau fractures, 7 diaphyseal fractures (1 proximal, 6 distal), and 1 tibial plafond fracture were included in the series. Treatment options included internal fixation with buttress plating in 5, screws or a tibial bolt in 5, and lagscrew with external fixator in one case. Autogenous bone grafting of subchondral or metaphyseal defects was performed in 5 cases. Arthroscopic knee manipulation was required in one tibial plateau fracture at 10 weeks postoperatively. All fractures united between 2.5 and 9 months with a mean of 6 months. The results were graded excellent, adequate, poor according to Kellam's criteria. Nine were excellent and 2 were adequate. We reported an intraoperative view of a step-off less than 5mm which was smoothly covered with fibrous cartilage, the poor prognosis of Type B tibial plafond fractures and its surgical treatment, and the problem of buttress plating and refracture.
Note to Author:
What do you mean by plafond? Please check this word.
I would like to explain this word.
Tibial plafond means distal intraarticular epiphysis of tibia. “Plafond” means something like a dome. The ferminology is used in Bibliography no 4.
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Kazuki Miyazono, Tetsuo Nakano, Juji Nishi, Hideo Nishikawa, Satoshi K ...
1993 Volume 42 Issue 2 Pages
821-824
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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We reviewed the prognosis of 66 ankle fractures. Patients ages ranged from 12 to 76 years with an average of 45 years. The prognostic factors were evaluated in these cases. It was found that the type and the stage of Lauge-Hansen's classification, etiology of the injury, degree of reduction, age of patient, presence or absence of compression deformity and other injuries were related factors. Evaluation of these factors would enable us to estimate to some degree the clinical result.
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Yoshito Shiba, Naoto Satou, Mitsuo Kakizoe, Masahiro Shirahama, Akio I ...
1993 Volume 42 Issue 2 Pages
825-830
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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It is difficult to treat serious complicated fractures. The prognosis of open fractures is especially influenced by early treatment. We report the examination of extremity fractures in the critical care center of Kurume University Hospital from 1988 to 1991.
228 patients have had 416 fractures in the past 5 years and 54 patients of these had 88 open fractures. Patients ranged in age from 5 to 91 years with an average of 42.4 years. We examined the cause of fratures in these patients, their complications, the time of initiation of orthopaedic treatment and the relation ship of these factors to the prognosis.
Recently the number of patients with fractures has increased with traffic accidents accounting for 70.4%. Among the complications a great deal of heads and circulatory system trauma was found. Patients with serious complications had to wait a much longer time to receive orthopaedic treatment, and many of them subsequently became infected thus worsening their prognosis.
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Over Five Years Follow Up
Yoshiaki Kunimune, Kenji Nagano, Shinji Nishihara, Toshiharu Kawanishi ...
1993 Volume 42 Issue 2 Pages
831-835
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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Suppurative knee joint infection probably due to intraarticular steroid injection, has been increasing recently. In this study, we report the results of a follow-up survey conducted in eleven patients (chiefly those with over five-year course after onset) who were referred to our hospital from other medical institutions during the past ten years.
For clinical assessment knee joint function was evaluated on the basis of the “SANDAIGAKU” tentative plan. On X-ray medial and lateral joint spaces were determined bilaterally on the frontal image of lower limbs in the standing position, and PF joint spaces were measured on the lateral image. Evaluation was made for each item before disease onset, one year after surgery, and at the time of final follow-up.
All eight patients who could be followed up for over five years have experienced no recurrence of the suppurative arthritis after surgery, and their gait ability was relatively satisfactory. Total scores of the “SANDAIGAKU” tentative plan improved in four patients, declined by 15 points or less in three patients, and significantly declined in one patient. Medial joint space was 3.9mm on average before surgery, 2.6mm one year after surgery and 0.9mm at the time of the final survery. Lateral joint space was also reduced in size in chronological order from 4.6mm to 3.9mm and 2.0mm, respectively. PF joint space also chronologically decreased from 2.5mm to 1.3mm and 0.6mm, respectively.
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Kazuya Takeuchi, Masateru Ijichi, Tsuyoshi Sugamori, Atsushi Funahashi ...
1993 Volume 42 Issue 2 Pages
836-838
Published: March 25, 1993
Released on J-STAGE: February 25, 2010
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An 82 years old man with four large tumors on his left forearm visited our hospital in July 1991. At first these tumors were suspected to be malignant. Xray, bone-scintigram and angiogram of the forearm suggested malignant tumors. There was no evidence of tuberculosis on the chest Xray when first taken. Six months later the tumor developed, producing a fistula and the patient decided to be admitted for surgery. A diagnosis of tuberculosis was made and administration of INH RFP EB was effective. It is important to be aware that tuberculosis sometimes closely resembles malignant tumors. Therefore, if a malignant tumor is suspected biopsy is necessary to make a diagnosis, keeping tuberculosis in mind.
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