We reviewed 127 cases (128 clavicles) who underwent various surgicl procedures for treatment of clavicular fractures between 1988 and 1993. 105 cases were treated with plate fixation. Delayed union was seen in 4 cases and nonunion occurred in 6 cases. The rate of nonunion in cases with clavicular fracture treated surgically was 4.7%. All cases of nonunion improved with plate fixation and bone-grafting.
From July, 1992 we surgically treated 12 patients with fractures of the middle third of the clavicle. Ten of 12 patients were treated by internal fixation using a cancellous cannulated screw, and seven of these 10 patients were able to be operated on using a semi-closed technique. The patients' ages ranged from sixteen to seventy-six years. This technique is excellent because postoperative external fixation is not necessary and early elevation of the shoulder joint is possible.
Intramedullary fixation for surgical treatment of clavicular fractures is the most popular method for treating fractures of the outer-middle third curvature of the clavide. We reviewed fifty-four cases out of eighty-nine treated surgically at our hospital during the past rive years. Of these, three were fixed using a plate and screws, seven received transcutaneous pinning using K-Wires, twenty-two with K-U screws and seventeen with a Steinmann pin including our modified type. Bone union occurred in all except one case of delayed union. This delay was considered to be due to K-U screw rupture and the patient's poor compliance. We began using our modified steinmann type of pin rather than the other methods of fixation in 1992, and concluded that the advantages of using the Steinmann pin were a shorter operation time, less operative trauma and less fluoroscopy.
Twelve cases with acromioclavicular dislocations were treated using the Neviaser's method combined with Bosworth's method. In all except two cases, excellent results according to Kawabe's evaluation were obtained. Our modified method uses a screw to hold the clavicle in position instead of a Kirschner wire. This method is more convenient than the original Neviaser's method and other modified methods and produces satisfactory results.
A female infant was delivered following an incomplete breech presentation. Four days after birth, it was noted that the child did not move her left arm. A radiograph of the left shoulder girdle was carried out, but no fractures were seen. The left arm was bandaged to the chest. Two weeks after birth, callus formation was visible and she was able to more her shoulder. One year later, she could elevate the arm fully although her left humerus was slightly deformed in valgus position.
During the last 10-year period, we treated 23 acute Monteggia fractures, 8 of which were open. The mean age of patients was 23 years, ranging from 3 to 52 years. According to Bado's classification, 13 fractures were Type I, 7 Type III and 3 Type IV. Six children sustained fractures, three of which were treated by closed reduction, and the other 3 by open reduction. The fractures in the adults were operated on as follows; 8 ulnar osteosyntheses, 5 ulnar osteosyntheses combined with fixation of the radial head using a K-wire pin, 3 open reductions of the displaced radial head, and for the remaining patients resection of the radial head was carried out. Of these the final outcome was poor, with 3 patients' complaining of severe rotational limitation and 2 patients complaining of an ADL disorder and motion pain. According to Bruce's criteria, excellent results were obtained in 11 patients, good in 1, fair in 7, and poor in 4. The results in children were all judged to be excellent, however, the results in the adults were excellent in 5, good in 1, fair in 7 and poor in 4. The difference in outcome between adults and children was considered to be mainly caused by the seveirity of fractures of the radial head occuring in adults.
Six patients with complications caused by malunion of the distal radius such as pain, ROM disturbance, entrapment neuropathy, etc were operated on by corrective osteotomy. Patients comprised five males and one female, ranging in age from 17 to 64 years (average age: 45.8 years). Their deformities were graded according to Frynkman's classification. Corrective osteotomy of the radius with bone grafting was performed in five and in one patient ulnar shortening was carried out. Excellent results were obtained in 5 cases and good in one. Four patients with neurological symptoms of the hand were cured by the operation. Average improvement of palmar tilt, radial inclination and ulnar variation were 23.6°, 6.2° and 1.8mm respectively. In conclusion, corrective osteotomy for malunion of the distal radius is thought to be very effective.
Acute stable scaphoid fractures (Herbert typeA2) are generally managed conservatively with a plaster cast. But long-term immobilization in a plaster cast causes limitations in daily living and work. We treated acute stable scaphoid fractures surgically using a Herbert screw without requiring a cast and then compared the results obtained following surgical treatment to that following conservative management. 13 wrists were conservatively treated with a plaster cast Patients comprised 12 males and 1 female with an average age of 27.9 years. The average time of fixation with the plaster cast was 8.2 weeks. In comparison 19 wrists of 19 male patients were treated surgically. The average age of the patients was 26.6 years. We evaluated the results of both groups using symptons and roentogengrams. At follow-up no patients had wrist pain or limitation in daily living. The average time for bone union was 10 weeks in the conservatively treated group, and 7 weeks in those who were operated on. Herbert screw fixation through a small skin incision is useful for treating acute stable scaphoid fractures because it frees the patient from the inconvenience of wearing a plaster cast.
Cubitus varus deformity is the most common complication following supracondylar fracture of the humerus in children. It has been said that the deformity is related to rotation of the distal fracture fragment. However measuring rotation by X-ray is too difficult. To investigate the causes of cubitus varus we measured carrying angle (C. A.), tilting angle (T. A.) by X-ray, and humeral torsion (H. T.) using ultrasound in 33 cases treated in our hospital from 1977 to 1992 following supracondylar fracture of the humerus. To measure the H. T., which has been already described by Ito the patient is positioned in a supine position with the elbow in 90 degrees of flexion, and the probe placed on the bicipital groove. The shoulder is then rotated until the bicipital groove faces upward. The angle between the axis of the forearm and perpendicular line of the examination table is considered as the H. T.. C. A., T. A. and H. T. of the fractured side were compared with the healthy side. There was a positive correlation between C. A. and H. T.. However no such relationship was found between T. A. and H. T..
Supracondylar fracture of the humerus occasionally accompanies nerve palsy in children. This report discusses treatment of this fracture with reference to treatment of patients with combined nerve palsy. Nerve palsy was found in 5 of 34 patients (14.7%). The type of fracture, reduction maneuver and time course of palsy were examined in the 5 patients. According to Abe's classification, 1 was type I, 2 type II and 2, type III. The more severe the fracture, the more frequent was the nerve palsy. All 5 patients showed nerve palsy on their first visit to the hospital. In 4 patients, the palsy improved following anatomical reduction. One patient, with a type II fracture, did not improve after reduction, and 3 months later, the lacerated radial nerve was reconstructed surgically. This nerve may be injured by a fracture fragment at the time of the accident, furthermore during reduction this nerve may be impinged by proximal and distal fragments. Reduction in this case was mainly conducted by flexion force, since the fracture was a simple extension type. In comparison, in the 4 other patients the reduction force was produced not only by flexion but by traction as well, since their fractures were types III or IV. The nerve in the vicinity of the fracture site was separated from the site by traction, thus preventing impingement of the nerve. In conclusion, patients with nerve palsy may require reduciton to adequately tract the distal fragment first so as to prevent nerve impingement.
We report on orthopedic therapy required for fractures of extremities in patients with associated chest trauma. Subjects ranged in age from 6 to 88 years with a mean of 46 years. 61 were male and 97 were female. Fourteen cases required chest dyinage to be inserted indicating that care must be taken to check for hemorrhage even in cases with simple rib fractures. Hemorrhage from the arainagd site became maximum two days after insertion. Surgical treatment of the fractures must be avolded for even days following insertion of the chest drain.
Newquinolone is among the most frequentory used drugs in antibacterial medicines. However, this drug has been reported to cause episodes of convulsive seizures. In one particular case, it was reported that the patient treated with the combination of antibacterial drug enoxacin and the nonsteroid anti-inflammatory drug fenbufen had convulsive seizures. The convulsion caused fracture dislocation of the shoulder joint. The patient was a 33-year-old male who was diagnosed with inflammation of upper respiratory tract. He was given orally a daily dose of 600mg of fenbufen and a daily dose of 600mg of enoxasin. Convulsive seizure occured in the second day of this combination therapy and caused him to collapse at work. He was taken by ambulance to the hospital where he displayed signs of acute renalfailure. His general condition improved after 4 weeks, 8 sessions, of hemodialysis therapy, after which he was surgically treated for osteosynthesis of fracture dislocation of the shoulder. In this paper, we reported precautions for this combination therapy.
Talar tilting angle (TT) of 10 degrees is usually defined as the borderline value for diagnosing lateral ankle ligament rupture in many clinical reports. Until now we have conservatively treated patients with more than a 10 degree TT from acute injuries under our protocol of “functional treatment”. The purpose of this report is to discuss the results of such treatment in 16 competitive sports players. All cases were given full information of the study, with informed consent obtained in all cases and all cases choose non-operative treatment. As a result, all patients completely returned to competitive game level. TT was improved to 7.7 deg. from 14.9. Slight pain after particularly hard training was the only symptom that remained in seven cases. Mean duration to time of excercise return was 3.4 weeks, game return 6.6 weeks.
We treated 43 cases of lateral ligamentous rupture operatively during a 7 year period. We investigated the relationship between the position of the ruptured ligament, stress roentgenogram and arthrogram. Rupture of both the anterior talofibular and calcaneo-fibular ligaments was frequently seen in cases with large talar tilt angles and peroneal tenogram. We evaluated 24 cases, by comparing pre-with post-operative stress rentgenograms and by using Furuya's scale for clinical assessment. The mean period of follow up was 2 years and 2 months. The mean talar tilt angle seen in pre-perative stress roentgenograms was 10.3 degrees and postoperatively this changed to 7.0 degrees. The anterior displacement distance changed from 8.1mm to 6.2mm. Both stress roentgenograms improved. Clinical results were satisfactory in all cases, with a mean total score using Furuya's scale of 93.4 points. With satisfactory results achieved surgically, we prefer operative to conservative treatment, due to the long-term possibility of instability remaining in conservatively managed cases.
We followed up 44 cases of old rupture of the lateral ligament of the ankle joint treated by either the Gould or Glas procedure. Thirty-four patients were treated with the Gould procedure and ten were treated by the Glas procedure. The results were evaluated using Hujita's scale. Results: At follow-up, there were no differences in pain, swelling, arthritis and ROM between both groups. The Glas procedure was better than the Gould procedure in a subject with instability.
Twenty-four patients with hip and low back disorders, were objectively with sagittal and coronal lines of gravity determined by the moment theory in the standing position. Results were studied in relation to clinical symptoms. The sagittal line of gravity was found to have an influence on scoliosis. The coronal line of gravity was related to kyphosis and/or lordosis. The 1 ne of gravity when standing may possibly serve as the basis for treatment of hip-spine syndrome.
We designed a new method to assess the three-dimensional “combined” range of motion (ROM) of the hip joint, which the conventional method of measuring ROM (that is, flexion, extension, abduction, adduction, external rotation and internal rotation) could not reveal. The new method expresses ROM by the movement of the distal end of the femur on the sphere, whose center is the femoral head, with a radius of the length of the femur. In the lateral decubitus position with the peldius of the patient fixed in a special device, the hip joint was passively circumducted and the trail of the end of the femur was recorded by the three-dimensional gait analysis system, Locus III D (Anima, Tokyo). This method reveals changes in the pattern of ROMs in abnormal hip joints, and is thought to be helpful for studying pathogenesis, determining surgical treatment and assessing the result of treatment.
We performed bipolar hip arthroplasty combined with bone grafting acetabuloplasty on 26 hips since 1986 and reviewed them clinically and roentgenographically in this study. The average follow-up period was 4.5 years (range 3-6.3 years). Clinical results using JOA score were excellent in all cases with marked relief of pain; preoperative total average score of 52.7 points was improved to 85.8 points postoperatively. Outer head migration was frequently detected in cases which had insufficient post-operative coverage of the original acetabulum and a significant relationship was found between the post-operative CE angle by the original acetabulum and outer head migration (p<0.01), however, no relationship was found between post-operative CE angle involved with grafted bone and outer head migration. These results appeared to show that acetabular bone grafting did not prevent migration and outer head migration was stopped with the appearance of a sclerotic line in the acetabulum. These results suggest that special care should be paid to the operative indications of bipolar arthroplasty for osteoarthritis with acetabular dysplasia.
We investigated the clinical results and prognosis following use of endoprosthesis for treatment of necrosis of the femoral head over five years. 25 hips of 17 patients were examined. Twelve patients were male and five patients were female. The mean follow-up period was 7.4 years (range: 5-11 years). The mean age at operation was 42.9 years (21-79 years). Operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, and subjects were divided into two groups according to their JOA score. (The first group≥80, and the second group<80). The two groups were compared and statistically analyzed according to the following six criteria: sex, age at surgery, stage of avascular necrosis, type of endoprosthesis, bilateral involvement, and radiographical results. Radiographical examination included evaluation of outer head migration, sinking and clear zone of the stem, sclerosis of the stem tip and calcar absorption. The average postoperative JOA score for all hips was 83.5 points (range: 47-100 points). The first group consisted of 15 hips and there were 10 hips in the second group. Sclerosis of the stem tip which was prevalent in the second group showed unsatisfactory results.
We carried out and observed the results of RAO in 44 hips (41 cases). Overall results were generally satisfactory. For advanced stage and end stage cases, we performed excessive rotation of acetabulum and also varus osteotomy on a wider range of indications. In cases of patients over 50 years old there can be some problems with rehabilitation, however RAO could be carried out in some of our cases (unilateral, involvement advanced cases without marked deformity). In addition, coxa plana-vara trochanterica were treated by RAO with additional procedure. A pre-operative arthrogram using the positions of abduction and pelvic anterior tilt was useful for estimating postoperative joint congruity.
We studied the preoperative ACTH-test in 27 patients with corticosteoroid-induced necrosis of the femoral head. 11 patients had SLE, 3 had ITP and the rest comprised other diseases. We compared the ACTH-test data with the results of patients with rheumatoid arthritis (RA). Suppression of adrenocortical function of patients with RA was stronger than corticosteroid-induced necrosis of the femoral head. We concluded that care needed to be taken with patients who had taken long-term corticosteroid hormones, such as RA and SLE patients, to check for suppression of adrenocortical function.
Total hip replacement (THR) has been shown to be of great benefit in decreasing pain from osteoarthritis of the hip, and the side on which the THR is camed out will become the main weight bearing limb. We radiogrophically studied eleven patients with bilateral osteoarthritis of the hip treated by unilateral THR. Loosening of the cup became worse five years post-operatively, and progression was seen on the stem side after seven years. The loosening stage tended to increase after five years more in study subjects than in controls. Joint spaces on the contralateral side were reformed in five cases. We concluded that the THR side becomes the main weight bearing limb and bilateral treatment will be required.
We performed radiographic evaluation of the Nishio type surface total hip arthroplasty. This type of replacement has been performed in 138 hips in 127 patients. Almost all cases showed aseptic loosening. Typical findings were sinking of the femoral component and migration of the acetabular component. Eighty-seven hips in 83 patients were followed-up, and, at an average of 9 years after initial surgery, 57% of these patients had already had revision surgery. However, the average follow-up period for the remaining patients is 15.7 years, therefore this procedure achieved our initial aim of time-saving.
Fifty hips in 40 patients with Charnley THR of more than 15 years follow-up were examined in terms of walking ability and survival against revision at the average follow-up period of 18.1 years. Patients consisted of 8 males and 32 females with underlying disease comprising 43 cases of osteoarthritis and 7 avascular necrosis. Twenty six with original THR were further evaluated both clinically by JOA hip score and radiologically on findings such as clear zone, socket migration, stem sinking and cortical thickening at the stem-tip. Fifteen of the 40 patients could walk without any help, however, another 15 used a cane and the other 10 were unable to walk either using a wheel chair or remaining in bed. Revision surgery had been done in 12 hips (24%), seven of which were needed because of prosthesis loosening. Survival until revision at 5, 10 and 15 years after the primary operation was 96%, 94% and 86% respectively in our series. The result of JOA hip score of the 26 with original THR ranged from 16 to 96 points with an average of 66 points. A radiological clear zone of more than 1mm was observed in 23 hips (88.5%), socket migration in 6 hips (23.1%), stem sinking of more than 2mm in 2 hips (7.7%) and cortical thickening at the stem-tip in 10 hips (38.7%). There was no significant radiological findings correlating to the clinical result of JOA hip scores.
We experienced 11 revision total hip replacements using cupshell and bone grafting. The peried of follow-up ranged from 6 months to 4.3 years, mean 2.7 years. We had one stage 4 case (according to the Nagaya criteria of Cup Clear Zone), but the remaining cases achieved good results. Leg length was elongated an average of 11.2mm compared with pre-secondary operation. Cases in which the diameter of destruction of the inner wall was over 30mm and the ratio of the area of destruction of the inner wall and edge of acetabulum is over 30%, demand better bone grafting technique and a longer period of partial weight bearing post-operatively.
We studied 195 hips of 171 patients treated with a Pavlik harness for congenital dislocation of the hip joint between 1970 and 1992 at Kyushu University. Patients were classified into two groups: 148 hips in the reduction group, and 47 hips in the non-reduction group. We compared these two groups in regard to sex, affected side, family history, fetal presentation, birth weight, and fetal age. The results were then classified by Severin's criteria for patients aged over six years in the reduced group. The rate of reduction was 81% in those patients in whom treatment was begun between birth and the age of six months, and 51% between 7 and 12 months. Yamamuro's “a” distance was 8.2mm on average in the reduction group, and 4.6mm in the non-reduction group. The difference of “OT” distance was 2.4mm in the former, and 5.6mm in the latter. There were significant differences between the two groups in regard to both of these distances.
We reviewed 19 hips (16 patients) which had been treated by derotation and varus femoral osteotomy (DVO) for residual dysplasia after initial treatment of congenital dislocation of the hip (CDH) and followed up until at least six years of age. Eight of the 19 hips were treated by DVO only, ten by DVO and acetabuloplasty, and one by DVO, acetabuloplasty and open reduction. The mean age at surgery was 24 months (14 to 55) and the mean age at follow-up was 13 years. Sixteen of the 19 hips (84%) were rated as Severin group I or II, and three (16%) as group III. All hips whose ages at surgery were lower than 24 months were rated as group I or II. Some of the young patients may have been overtreated, because recent studies show that many with residual dysplasia after initial CDH treatment recover spontaneously without treatment. But we consider DVO to be an effective method for some cases in which valgus and anteversion of the femur is one of the causes of progressive dysplsia.
Cross-sectional area of the bilateral gluteus maximus and medius was measured in 10 cases with hemilateral Perthes' disease, using CT scans at the level of the anterior superior iliac spine. The period ofmeasurement from the onset of the disease was 2 months to 3 years and 8 months, and the total number of measurements was 32. The area ratio of the affected/unaffected side was calculated to evaluate the degree of muscle atrophy. We use wheel chairs and abduction braces for non-weight bearing and good containment. We compared the averages between the two groups; group 1) non-weight bearing period using wheel chairs, group 2) more than 12 months after the start of walking. A 6.5% increase was seen in gluteus maximus and 5.5% increase was seen in gluteus medius. Recovery of muscle atrophy was very slow and it tended to need a very long time. 5 cases showed Trendelenburg's sign during the measurement and in 4 of the 5 cases, the sign disappeared within 4 months. In the 5 cases that showed Trendelenburg's sign, the affected/unaffected area ratio in both gluteus medius and maximus was less than 91%.
We report three cases of suprascapular nerve paralysis caused by a ganglion and discuss the methods of diagnosis and treatment of such a suprascapular nervelesion based on our observations. All patients were males ranging in age from 33 to 42 years (average age 37.7 years). On clinical examination marked wasting of the infraspinatus muscle and weakness of external rotation of the shoulder were observed and also electromyographic studies revealed denervation of the infraspinatus muscle in all cases. No cases had a palpable mass, however on MRI examination a cystic lesion was found in two cases. Two patients on whom ganglionectomy was performed made uneventful recoveries with immediate relief of pain after the operation. The remaining patient whose clinical symptoms decreased over time was no operated upon even though MRI showed a cystic lesion. MRI is a useful method for diagnosising ganglion which can compress the suprascapular nerve. Moreover there are some cases who can recover without any treatment.
Dewar-Harris's procedure is often performed for paralysis of the trapezius caused by accessory nerve injury in order to restore shoulder function. This is a method in which the scapula is fixed on the second and third thoracic vertebrae using the fascia lata to obtain stability of the scapula and forces necessary to rotate it. We used the Leeds-keio artificial ligament instead of the fascia lata in three patients with trapezius paralysis. Abduction functional brace was used for four weeks postoperatively. All patients achieved good functional recovery of the shoulder.
We have reported that thoracis outlet syndrome (TOS) results not only from neurovascular compression but also from stretching and defined any such patients as brachial plexus stretching type of TOS. In 1984, T. R. Swift described that droopy shoulder syndrome (DSS) also results from brachial plexus stretching, and that in all patients with DSS, because of their characteristic features, the second thoracic or lower vertebrae visible above their shoulders on lateral view of cervical spine X-rays are one of the diagnostic criteria for DSS. Therefore, we studied the relationship between brachial plexus stretching and the lateral view of cervical spine X-rays. We examined 40 cases with brachial plexus stretching type of TOS from 1990 to 1993, in whom a neurography of the brachial plexus had been carried out. In 18 cases, 45% of them, lateral view of cervical spine X-rays demonstrated that the secone thoracic or lower vertebrae was above the level of the shoulders. Patients with brachial plexus stretching type of TOS had a “long neck”. In 1990 Y. Kataoka reported that all patients whose second thoracic or lower vertebrae were visible above their shoulders on lateral view of cervical spine X-rays had no symptoms induced by brachial plexus stretch. We found that this finding on X-rays did not always represent brachial plexus stretching and its symptoms.
Thirty three patients with thoracic outlet syndrome were examined regarding autonomic symptoms and psychiatric symptoms using the Toho-Medical-Index. Seventy eight % of cases had autonomic symptoms, and 34% of cases had psychiatric symptoms. The longer the duration of morbidity, the more these symptoms increased. Therefore duration of morbidity is one of the risk factors. In addition autonomic symptoms and psychiatric symptoms worsen in association with each other.
The patient is a 6-years-5-month-old boy, who complained of difficulty in elevating his right arm after practicing with a 3.5kg weighted drum when aged 6-years-3-month-old. Muscle weakness was evident in the deltoid and supraspinatus muscles. However, we found no limitation in nect range of motion. No remarkable results were seen in the following tests; Jackson test (-), Spuring test (-), Wright test (-), Eden test (-), Moley test (+), Three minute stress test (-). On EMG examination, results started to improve 5 months after his initial complaint. We concluded that brachial plexus injury in this case was caused by compression and/or overtraction of the brachial plexus by the heavy weight of the drum and the band.
Eight patients who complained of neck pain and numbness of the hand were treated by low power laser irradiation around the Stellate ganglion and the change in hand palmar temperature was evaluated by thermography. Clinical results showed that low power laser irradiation was effective for five patients with neck-shoulder-arm syndrome and radiculopathy was more effective than for myelopathy patients. The skin temperature of the face and hand palmar region rose significantly and bilaterally after ten minutes of irradiation. Low power laser irradiation lowers the tension of the sympathetic nervous system and increases peripheral tissue blood flow, thereby relieving pain and numbness.
Our new post-operative regimer following flexor tendon repair was evaluated retrospectively. There were ten cases with 12 digits. repaired. (2 thumbs and, 3index, 1 long, 4 ring, and 2 little digits.) All flexor tendons were repaired primarily. Our postoperative method was smilar to the “W ashington regimen” with the difference being the spring of the toy car was used instead of the rubber hand. %TAM and Buck-Gramcko methods were used for evaluation of our regimen. Thumb; there were two excellent cases and one good case. index-little; there were five excellent cases, one good case, two satisfactry cases and one poor case, one good case, two satisfactory cases and one poor case using the Buck-Gramcko method. In cnclusion, our postoperative method achieves good results after flexor tendon repair.
We report on percutaneous tenotomy for chronic lateral or medial humeral epocondylitis. Thirty-four patents, (16 males, 18 females) received 36 tenotomies. (27 lateral and 9 medial epicondylitis cases.) Patent ranged in age from 35 to 61 years with an average of 46 years. All cases were followed for an average of 13 months, the longest being 20 months and the shortest 7 months. The operation is done as an outpatient procedure under local anesthesia. Using a Noll blade, a puncture incision is made in the skin at the epicondyle. The release is carried down to the distal portion of the epicondyle. Results were judged to be good or excellent in 32 cases (88.9%). In our experience, percutaneous tenotomy is a safe, simple operation that can be performed as an outpatient procedure. Considerably high success rates can be expected with low risk and convenience to the patient.
Limited wrist arthrodesis had been used to treat serious pathological condition. To evaluate the utility of limited wrist arthrodesis, nine wrists of nine patients, seven men and two women, who had received this procedure for Kienböck's disease (6 wrists), osteoarthritis (2 wrists), and pseudo-arthrosis of scaphoid (1 wrist) were followed-up. Age at operation ranged from 18 to 61 years (average; 41.6 years). Follow-up period ranged from 10 months to 24 years and 6 month (average; 8 years). The site of arthrodesis was the midcarpal joint in 4 wrists, scapho-trapezium-trapezoid (STT) fusion in 2, radio-lunate (RL) fusion in one, radio-scaphoid (RS) fusion in one, and radio-scapho-lunate (RSL) fusion in one. Roentgenographic and clinical results were evaluated by Bolano's method postoperatively. Over-all postoperative results were excellent in 2 wrists, very good in 6, good in one, fair and poor in no wrists. Postoperative range of flexion and extension with midcarpal arthrodesis was larger than that of radiocarpal arthrodesis. None of the 9 wrists had osteoarthritic changes in the surrounding joints. Limited arthrodesis is a useful procecdure for relieving pain and improving wrist function, even though the range of wrist is limited.
To determine the surgical indications for teatment of Dupuytren's contractures, forty hands of thirty-three patients with partial fasciectomy, ranging in age from 33 to 81 years (average; 60.7 years), were reviewed. Pre-operative status was evaluated as nine grade 0, five grade 1, eight grade 2 and eighteen grade 3, according to Meyerding's classification, the average follow-up period was 3.8 years. According to Tubiana's post-operative evaluating sustem, in grade 0, 1 and 2, nineteen of twenty-two cases were rated as very good, however three of eighteen cases were rated as very good, twelve good, two fair and one poor in grade 3. The flexion deformity of the MP joints was improved satisfactorily by surgical intervention, however correction of the flexion defomity of the PIP joint was very difficult due to the complexity of the ligamentous structure at the PIP joint. We concluded that surgical teratment should be carried out before the flexion deformity of the PIP joint is severe.
We have used the Wrap around flap procedure in 8 cases for index finger reconstruction. Compared to other methods, the flap procedure provided both a better esthetic and functional replica of the index finger. It is completely adecuate functionally for amputation distal to the middle phalanx of the index finger. The recovery of 2PD and ROM achieved was good.
Eight patients with unilateral distal radio-ulnar wrist disorders were treated using the Sauvé-Kapandji procedure. Disorders consisted of 5 malunited Colles' fractures, 1 distal radio-ulnar osteoarthritis, 1 Madelung's deformity and 1 chronic dislocation of the ulnar head. Follow-up periods ranged from 6 to 20 months with an average of 12 months. Relief of wrist pain was obtained and foream rotation improved to become almost equal to that of the opposite side in all patients postoperatively. However three patients complained mild pain at the proximal stump of the ulna. This operation reduces pain well and improves forearm rotation but a propensity for ulnar impingement is still present. There fore we only use this procedure when the distal radio-ulnar joint disorder is caused by destruction of the sigmoid notch in RA, osteoarthritis and malunited Colles' fractures.
Since February 1987 we have been performing Kapandji's intra-focal pinning as first choice for treating distal radial fractures. From July 1991, we started to use new “ARUM” pins which were proposed specifically to avoid injuries to the tendons and nerves in Kapandji's method. The “ARUM” pin is so named because of its resemblance to the shape of an arum flower and composed of a 20/10mm full threaded pin and a special nut. The conical form of the nut makes possible sliding between tendons without damaging them and widens the gap of the fracture which will act as a reduction effect. From July 1991 to May 1993, we treated 30 distal radial fractures by Kapandji's intra-focal pinning with the new “ARUM” pins. Patients comprised 19 females and 11 males with an average age of 52.2 years, ranging from 15 to 91 years. Follow-up averaged 11.4 months with a range of 3 months to 2 years. According to Kawashima's evaluating system, 23 were rated excellent and 7 good subjectively, 15 excellent and 15 good functionally and 20 excellent and 10 good anatomically. There were no complications due to the cut ends of the pins. Present findings indicate that the new “ARUM” pin is not only effective for protecting against damage to tendons and nerves from the cut end of the pin but also improves the clinical results achieved by Kapandji's method due to its excellent reduction and fixation effects.
Twenty cases of cubutal tunnel syndrome in patients aged under twenty years were examined. These patients were classified into three groups. Group 1 included nine cases that had a history of humeral lateral condyle fractures or humeral medial epicondyl fractures. Group 2 included four cases with sports injuries. Group 3 included seven cases that did not have any preceding injuries. The charateristic views of this report are that the eleven cases had a complaint of elbow joint pain which is rarely seen operated on in an early stage of the cubutal tunnel syndrome as these cases dis not respond to any conservative treatments.
The purpose of this study was to investigate the electrophysiological prognosis of carpal tunnel syndrome (CTS) with surgical treatment. Ten female patients were studied, one of whom had a bilateral operation. We studied the motor terminal latency (MTL), sensory terminal latency (STL), amplitude of the compound muscle action potential (CMAP) and the evoked mixed nerve action potential (EMNAP). Results revealed that MTL had improved within 6 months after surgery. STL could be detected in only one patient, and the others could not be detected before operation. But in most cases, they were detected between 6 and 12 months after operation. CMAP improved between 6 and 12 month. Regarding EMNAP, there was a difference in the degree of recovery between severe and less severe CTS cases.
We treated 53 carpal tunnel symdrome patients from August 1990 to April 1993 using our new skin incision procedure. This incision can resect the transverse carpal ligament permitting decompression of the median nerve without crossing the distal wrist crease. Post-oper atively no patient has any complications such as painful hypertrophic scarring.
Peripheral nerve trunks are not rigidly fixed to surrounding tissues along their course. They slide longitudinally in their beds over several millimeters with movements of the extremity. This concept of peripheral nerve excurisions helps to explain the pathophysiological events occurring in entrapment neuropathy, chronic nerve irritation and nerve compression. Although this is an important physiological phenomenon, this has not been examined precisely. We examined excursion of the normal sciatic nerves of 10 adult rabbits. The following were investigated: 1) Percentage elongation of the sciatic nerve under nomal lower limb motion. 2) Excursion between epineurium and gliding floor. 3) Excursion between the funiculus. 4) Morphological changes of the sciatic nerves under nomal lower limb motion. 5) Microanatomical features of the peripheral nerves adapting movements of the extremity. The results were as follows: 1) Total percentage elongation of the sciatic nerve was 5.8% in 0° flexion of the knee and 90° flexion of the hip joint. But near the knee joint, the maximum percentage was 9.2%. 2) Excursion was found between the epineurium and gliding floor, and between the funiculus. 3) It was proven that in the funiculus the nerve fibres have an undulating spiral pattern, which is, after its discoverer, called Fontana's bands. When the nerve was stretched in the course of movement, the undulation straightened out until it disappeared. Microanatomical view represents the wave-like alignment of the nerve fibres. By these features, peripheral nerves can accommodate limb motion.
We investigated the clinical and radiological results in 10 patients using the compression hip screw with brim supporter for unstable trochanteric fracture of the fermur. All fractures were united successfully and excessive lateral displacement of the proximal fragment was not found. We concluded that the compression hip screw with brim supporter is useful for treating unstable trochanteric fracture of the femur.
We report a case of subcapital fracture following internal fixation of an intertrochanteric fracture of the fip. An 89-year-old woman fell and sustained an intertrochanteric fracture of the hip. This was successfully treated using the compression hip screw system. Nine weeks postoperatively, bone union was obtained and the patient discharged painfree. However five months later, she developed pain in her left hip. X-rays showed a subcapital fracture on the same side. Prosthetic replacement was performed after removement of the compression hip screw system and she was discharged a month after surgery.