We report 20 patients treated with Ace intramedulally rod (AIM rod) for femoral shaft fracture. The cases were 19 males and one female with a mean age at the time of surgery of 29.4 years (range, 17 to 55 years). The mean follow-up period was 2.4 years (range 1, to 5 years). All cases were evaluated as “Good” when using Connolly's criteria. We compared the cases operated on using the AIM rod and Ender nail. The mean operation time was 2 hours 33 minutes for the AIM rod group, and 1 hour 10 minutes for the Ender nail group. The cases treated with the AIM rod, could start the range of motion exercises on the 2nd 15th day (mean 5.6th day), and partial weight bearing on the 7th to 28th day (mean 15th day) after operatin. Patients could start rehabilitation when using the AIM rod earlier than using the Ender nail. In conclusion, the AIM rod seems to be a good treatment for the following cases. 1. Patients with unstable femoral shaft fractures (Type 3 to 6, according to Aoyagi's classification). 2. Patients requiring early rehabilitation (Social indication).
This study evaluated the results of surgery for femoral shaft fractures. We performed closed Ender nailing in 19 cases. Clinical evaluations showed excellent results in 65% and good in 30%. Ender nailing is a form of unreamed intramedullary fixation, and is therefore less invasive, easily performed and associated with few complications.
Compression Cerclage Gundolf (CCG band) is a device for fixation of fractures and bone grafts. We report three cases of femoral fractures treated with the CCG band. The final results were satisfactory, therefore it is suggested that the CCG band is useful for fixation of fractures after short term follow-up.
We have been treating femoral and tibial fractures using the interlocking titanium nail since 1992. We investigated the results of 14 fractures in 14 patients. The 14 patients were 9 males and 5 females with an average age at the time of surgery of 48 years (range: 15 to 75 years). There were 2 fractures with delayed union. One was a crush fracture of the femoral shaft and another involved a large fragment. All other others fractures achieved good bone union. There were no infections. Partial weight bearing began 1-8 weeks after operation (average time 2.9 weeks), and full weight bearing began 2 to 12 weeks after surgery (average 4.8 weeks). Patients were able to return to their normal social life at an early stage.
Internal fixation of femoral supracondylar fractures is sometimes difficult, especially when it is performed in elderly patients with osteoporosis. In those cases it is often difficult to begin ROM exercise and weight-bearing immediately after surgery. Ten cases of supracondylar fracture of the femur which were operated on at our hospital during 1991-1995 were reviewed. Nine patients were female, one was male with an average age of 78.5 years. The mean follow-up period was 22.8 months. Clinical results were evaluated using Neer's criteria: Excellent=4; Satisfactory=3; Failure=3. Factors which were associated with unsatisfactory results were severe osteoporotic conditions, general complications and osteoarthritis of the knee joint. It is necessary to establish a safer material and method to begin ROM exercise and weight-bearing in the early post-operative period.
We treated 6 fractures of the distal femur with the Intramedullary Supracondylar Nail using the closed technique. The mean age of patients was 70 years (range: 58 to 87 years) and the mean period of follow-up was 5.6 months. Patients were classified according to Müller's classification into type A3 (2 fractures), type C2 (4 fractures). The mean operative time was 97 minutes (range: 40 to 180 minutes) and the mean blood loss was 97g (range: 40 to 220g). The clinical results were classified according to Neer's criteria as excellent in one, and satisfactory in five. IMSC was useful for treating distal femur fractures with the closed technique except for articular comminuted fractures.
During the ten years from 1986 to 1996, 19 traumatic dislocations and fracture-dislocations of the hip were treated at the Tamana Central Hospital. There were 17 cases of posterior dislocation and 2 cases of anterior dislocation, in patients aged from 16 to 72 years (average age 40.6 years). The posterior fracture-dislocations were classified according to Thompson and Epstein's classification. In these cases there were seven Type I lesions, one Type II lesion, two Type III lesions, three Type IV lesions and four Type V lesions. Patients were clinically evaluated according to the Japanese Orthopaedic Association's (JOA) hip score. Six (Type I) cases were treated by closed reduction; thirteen, by closed reduction followed by open reduction. Traumatic arthritis was present in five: all of Type III, one of three Type IV, two of four Type V hips. Avascular necrosis was evident in three: one of two Type III, two of four Type V hips. The average JOA score for all hips was 92.2 points (range: 70-100 points) at the time of follow-up examination.
Twelve cases of non-union of long bone were treated with our new method utilizing massive auto-iliac bone graft. Three cases were female and nine male with a mean age at the time of surgery of 48.2 years (34 to 72). The mean length of follow up was two years (7 months to 5 years 2 months). The site of non-union was the clavicle in 3, humerus in 4, fore arm in 2, femur in 2 and tibia in 1. Eleven of 12 cases united solidly with the majority uniting within 5 months after surgery. In one fracture of the surgical neck of the humerus, the grafted bone was absorbed and the internal fixation device (spiral pin) broken. In one clavicular fracture, refracture occurred after removal of internal fixation but went on to achieve union after the second internal fixation.
Nineteen cases with femoral subtrochanteric fractures were treated surgically using the Intramedullary Hip Screw or the Gamma Nail. In one cases a femoral shaft fracture occurred, requiring interlocking intramedullary nailing. All cases except one achieved bone union. This method is useful for treatment of femoral subtrochanteric fractures allowing early weight bearing.
We report 14 cases of psychiatric patients with orthopaedic injuries. The mean age at the time of injury was 48.9 years (range 24-75). The mean follow-up period was four years and seven months (range, two months to 12 years and eight months). Patients were evaluted both clinically and radiologically. Five patients were treated surgically, one of whom resulted in nonunion. Nine patients were treated conservatively. Three patients were judged to achieve poor results. It is necessary for orthopedic treatment of patients with psychiatric disorders to involve co-operation between the psychiatrist and orthopaedic surgeon during the pre-and post-operative period.
For the treatment of calcaneal fractures, evaluation of the posterior articular facet is very important. Intra-articular fracture of the calcaneus can be divided into three groups based on Crosby's classification using CAT. We treated type II and III fractures by open reduction through the lateral approach, and we evaluated clinical results and post-operative congruity of the posterior articular facet of the calcaneus using CAT. There were 11 type II fractures operated on, and no type III fractures. Five patients achieved an excellent result and 6 patients a very good result with minor complaints. The posterior articular facet was reduced anatomically in 9 patients. Two fractures retained their pre-operative congruity. Crosby reported that patients with type II or type III fractures were not satisfied with the results by conservative treatment. We recommend that displacement of the posterior articular facet of the calcaneus be evaluated using CAT and type II fractures be treated surgically, rather than conservatively.
Eight patients with spontaneous Achilles tendon ruptures were treated by percutaneous repair in my clinic. One rerupture occurred. This case was a 19 year old Kendo player. Open repair is recommended for young athletes who cannot afford any chance of rerupture. However I recommend percutaneous repair in recreational athletes and others who cannot afford any complication of open repair.
The distribution of motoneurons innervating human muscles has not been clarified, therefore many types of myotome and dermatome are used at present. We sent out a questionnaire about current myotome and dermatomes in man to 80 orthopaedic departments of universities in Japan and investigated the distribution of motoneurons innervating the muscles of the rat. From 53 replies, we found 11 types of myotome and 9 types of dermatome. Seventeen universities had no myotome facilities. The myotomes of Daniels, Jinnaka, Mayo Clinic, and Hoppenfeld were used in 9, 9, 7, 6 universities, respectively. The other myotomes are used in less than 2 universities. Two universities had no dermatome facilities. The dermatomes of Keegan-Garrett, Nozaki-Maeda, Edinger, Foerster, Chusid-McDonald, Brain, Bolk are used in 15, 10, 6, 4, 4, 4, 3 universities, respectively. The other dermatomes are used in less than 2 universities. The motoneurons innervating muscles of the rat were distributed as follows: 81% of C5 and C6 in deltoid muscle; 92% of C5 and C6 in biceps brachii muscle; 93% of C7 and C8 in triceps brachii; 85% of C7 and C8 in extensor carpi radialis; 97% of C8 and Th1 in flexor digitorum, and 91% of C8 and Th1 in flexor carpi ulnaris. The distribution of motoneurons innervating muscles of the rat was found to be similar to the current myotomes except for extensor carpi radialis.
For treatment of orthopaedic infections, antibiotics are usually administered parenterally. We report an effective technique for infective prophylactic countermeasures. Antibiotics (CZON 100-1000mg, CEZ 1000mg, ISP 40mg) were administered by intravenous regional injection after tourniquet to 36 patients and pharmacokinetic analysis was performed to assess concentration in bone tissue. The serum concentration in bone tissue of CZON, CEZ and ISP was 133-2430μg/ml, 2426.1μg/ml (mean) and 129.5μg/ml (mean). After tourniquet removal, the serum concentration in body blood of ISP was 2.7μg/ml (mean). The result suggested that a much higher concentration of antibiotics in bone tissue and a much lower concentration in blood after tourniquet removal were obtained, and side effects did not appear. This technique was demonstrated to be extremely useful for infective prophylactic countermeasures.
Quantitative ultrasound seems to be useful as a method of primary screening for osteoporosis. We compared stiffness (calculated from the combined data of SOS and BUA) with BMD. Thirty-eight females who recorded stiffness of less than 62 using quantitative ultrasound (Achilless, Lunar) were selected as subjects. The average age of the patients was fifty-eight years. BMD of their lumber spine, femoral neck and total body was analyzed with DXA (DPX-L, Lunar). The data were compared with stiffness. BMD of the lumber spine, femoral neck and total body were not significantly correlated with stiffness (r=0.150, 0.153 and 0.238). This fact indicates that further investigation is required regarding quantitative ultrasound as a screening method for osteoporosis.
We observed the surface structure of alumina ceramic prosthesis after clinical use to elucidate it's wear mechanism. The knee prosthesis (Kyocera co., Ltd.) had been used in 4 patients suffering from osteosarcoma of the distal femur, and those were retrieved at autopsy. The joints consisted of alumina ceramics in the femoral component and high density polyethylene (HDP) in the tibial component. All patients had been fully weight-bearing. The periods from limb sparing surgery to removal ranged from 13 months to 4 years. The surface of the weight bearing and non-weight bearing areas of the retrieved joints were observed under a scanning electron microscope. The surface of the alumina ceramics showed a polygonal crystal structure scattered with small holes. The density of the holes tended to increase in the weight bearing areas more than in the non-weight bearing areas. With regard to the HDP, a large number of linear scars were found to run in the direction of the joint movement. These results suggest that wear of the HDP in alumina ceramics joints in vivo occurs as a result of the tearing off of alumina ceramics crystals and the interposition of these crystals between the femoral and tibial components.
I-cell disease is a lysosomal storage disease and is characterized by severe psychomotor retardation and by many of the clinical features that are seen in Hurler syndrome. However, the onset is earlier, and the signs and symptoms are more severe and rapidly progressive than seen in Hurler syndrome. We describe a case of I-cell disease in a 6-year-old girl who has been effectively treated by bone marrow transplantation.
Neurilemmoma is a rare cause of tarsal tunnel syndrome. We report a case of tarsal tunnel syndrome caused by neurilemmoma of the posterior tibial nerve. A 39-year-old man visited our hospital complaining of tumor and pain in the medial side of the right ankle on August 5, 1995. He was diagnosed as tarsal tunnel syndrome caused by tumor and was operated on August 26, 1995. Tumor was excised and pathological findings confirmed a neurilemmoma. After the operation, the patient's sensory disturbance and pain disappeared.
Prostaglandin E1 (PGE1) has already been shown to improve vascular patency in experimental microvascular anastomosis. It is also widely used following clinical microvascular anastomosis. We designed a prospective study to compare the efficacy of Lipo PGE1 and PGE1-CD (PGE1-α-cyclodextrin) in 34 patients (14 free tissue transfers and 20 digital replantations). Dosage of Lipo PGE1 was 10μg daily for an average of 8 days and that of PGE1-CD was 120μg (60μg×2) for an average of 6 days. Success in microvascular anastomosis was evaluated by survival of the flap or replanted finger after 2 weeks. The success rate of free tissue transfers for the lipo PGE1 group was 100% and that of the PGE1-CD group was 75%. The success rate of digital replantations for the lipo PGE1 group was 88% and that of the PGE1-CD group was 75%. There was no significant difference between the two groups. Four of the 16 patients receiving PGE1-CD complained of vascular pain during injection, whereas, none complained of vascular pain in the group receiving lipo PGE1. Lipo PGE1 showed at least the same efficacy on patency after microvascular surgery as PGE1-CD with less vascular pain.
Since 1994, we have performed the Sauvé-kapandji procedure in 11 the patients for distal ulnocarpal joint disorders. The age at operation ranged from 18 to 54 years (average 41.3 years). Follow up averaged 8.8 months. All cases had ulnocarpal abutment syndrome. The average ulnar variance was +4.9mm and all were corrected with ulnar null variance. Clinical results were evaluated by Fernandez and Inoue's Criteria. Seven cases were evaluated as excellent and four were good. We consider that the best indication of this procedure is for osteoarthritis of the distal radioulnar joint or instability of the distal ulnar head.
The long-term result of 18 cases of Kienbock disease treated with a closed wedge osteotomy of the radius by dorsal approach for 10 cases (Lichtman classification; II-2, III a-7, III b-1), replacement of the lunate with a tendon ball prosthesis for 7 cases (Lichtman classification; III a-2, III b-3, IV-2), wrist arthrodesis for 1 case (Lichtman classification; IV-1), between 1978 and 1995 are presented. Mean duration of follow-up was 6.13 years (range: 6 months-13 years). Regarding the wedge osteotomy, the result of Lichtman's scoring system were satisfactory in 9 of 10, unsatisfactory in 1. Regarding replacement of the tendon ball prosthesis, the results were satisfactory in 5 of 7, unsatisfactory in 2. Regarding the wrist arthrodesis, the results were unsatisfactory in 1 of 1. Regarding stage at operation, no cases of stage II and III a were found to be unsatisfactory. All unsatisfactory cases were stage III b and IV. In radiological assessment, carpal height ratio and Stahl's index were not improved with our method. In several cases, slight osteoarthritic changes were found in the radio-carpal joints. However these changes did not affect clinical results. There were no findings of pseudoarthrosis.
We report a case of shortening and deformity of the ulna with dislocation of the radial head caused by enchondroma in the ulna. The patient was a 4-year-old girl with shortening of 3cm and varus deformity of the left forearm. Extension and internal rotation were limited in her left elbow joint. Radiographic findings showed an enchondroma at the distal of the ulna, shortening and varus deformity of the ulna, and a dislocation of the radial head. Because the displacement of the radial head increased with growth, we treated the dislocation by ulnar lengthening using callotasis. As length increased the displaced radial head gradually moved in the distal direction by traction of the interosseous menbrane. When there was 30% lengthening of the ulna, its dislocation were completely repositioned. Due to concern about the recurrence of the radial head-dislocation in the future, the ulna was lengthened by 42% of its original length. The limited motion in the elbow joint was improved and the length in the forearm was almost equalized. No neurological disturbance was seen. In such cases with ulnar shortening and dislocation of the radial head, ulnar lengthening with callotasis may be a more safe and accessible treatment compared with previous therapeutic methods.
We experienced a rare case of palmar dislocation of the proximal interphalangeal (PIP) joint. The case was a 21 year-old female who sustained a twisting injury to the left index finger. In this case, the condyle of the proximal phalanx was trapped by the central slip. The acute lesion should be treated by open reduction. If this is not recognized promptly and treated effectively, it may result in permanent disability.
We have experienced five cases of subcutaneous flexor tendon rupture in patients without RA from 1990 to 1995. Subjects were three males and two females and their ages ranged from 53 to 64 years (average 60 years). In two cases the involved tendon was the FPL, the FDP tendon of the little finger was ruptured in two and the FDP and FDS of the index in one. Considering the mechanism of injury, all cases received flexion against force injury and the site of ruptures were in the carpal tunnel. Free tendon graft was performed in all patients using the palmaris longus tendon. The results were evaluated according to Buck-Gramcko's criteria. Three cases were graded as excellent, one good and one was satisfactory. From this study it can be suggested that free tendon graft for subcutaneous flexor tendon rupture is an effective treatment.
We used a silicon rod for treatment of flexor tendon rupture in six cases. If destruction of the pulley and the sliding floor is diagnosed prior to surgery, we reconstructed the pulley and sliding floor over a silastic Hunter rod as the first step. The rod was then replaced with a palmar tendon graft after 3 months. Using this technique we achieved fair results in 2 cases and poor in 4 cases according to the Japanese Society for surgery of the hand functional evaluation of the digital flexor tendon.
The margins of intramuscular hemangiomas are usually obscure making extensive resection, including normal muscle necessary. Such resections can at times result in impairment of function. To reduce the post-operative functional impairment, we performed preoperative embolization to intramuscular hemangioma by percutaneous tumor puncture with n-butyl cyanoacrylate (Histoacryl®) for clarifing the tumor margins. Consolidated tumor margins were easily identified at the time of surgery. After five months follow-up, there was no signs of recurrence and the patient has no impairment of function. Preoperative percutaneous embolization with n-butyl cyanoacrylate was useful to clearly delineate the range of tumor resection needed.
We report a case of angiosarcoma in a 46-year-old man with cerebral palsy. He had difficulty walking caused by the rapid growth of a tumor mass in his left posterior thigh. The tumor was 24×13cm in size, and was an elastic soft mass giving off local heat. Magnetic resonance imaging and computed tomography showed multivacuoles in the semitendinous muscle and semimembranous muscle with signs of compression of muscle and blood vessels. After biopsy granulation was seen, with bleeding from the wound continuling leading to enucleation of the tumor mass. The pathological diagnosis after surgery was angiosarcoma. Local recurrence occurred post-operatively Note to Anther one-half what (days, months). After wide resection of local tumor, the patient was treated with chemotherapy, radiotherapy and immunotherapy. Multiple metastases to bone occurred eight months later and the patient died thirteen months from onset.
Whereas most osteosarcomas occur in patients younger than 25 years, five patients over 50 years with osteosarcoma have been diagnosed and treated at our hospital. Osteosarcomas occuring in older patients are reported to be more frequently secondary to other bony conditions such as Paget's disease, or following irradiation. Two of five were radiation-induced osteosarcomas arising in the pelvis. Three patients were treated by chemotherapy, but this was not effective in two of them. Only one of the five patients is still alive without the disease, while four have died from the disease. Three of these four died within one year after admission.
Intraosseous epidermoid cysts are rare. A 47 year-old male was seen on October 26th, 1995, complaining of pain and swelling of his left thumb. Thirty years previously, he had sustained an injury on the ulno-palmar side of the distal phalanx of the thumb. He had been shown to have a radiolucent area in the distal phalanx at another clinic, two years prior to visiting our hospital. He had suffered from pain and noticed swelling of the tip of the thumb for two months before presentation. Physical examination revealed a clubbed finger with local tenderness and a small scar. Roentgenogram showed a round radiolucent lesion with expansion and destruction of the cortex. The tumor was encapsulated and filled with atheroma-like material. Microscopically, the cyst wall consisted of stratified squamous epithelium. The cyst was filled with horny material arranged in laminated layers. We surmise that the past trauma is implicated as the cause of this condition, and highly proliferative tissues of the finger tip were implanted into the distal phalanx. On roentgenogram it is very difficult to distinguish an epidermoid cyst from other intraosseous tumors or tumorous conditions.
We report a rare case of malignant hemangiopericytoma (MHP) arising from the ulna of an eight year-old boy. X-ray findings revealed expansive lytic lesions with bubble appearance in the distal metaphysis of the right ulna. Computed tomography showed no cortical destruction. By magnetic resonance imaging, the lesion was highly enhanced with gadolinium. Histologically, the oval tumor cells tended to cluster around numerous capillaries. Reticulin stain revealed that proliferating neoplastic cell were hemangiopericytes. Vimentin and HLA-DR were positive, while SMA, myoglobin, desmin, EMA, cytokeratin and S-100 were negative. Ultrastructure of MHP revealed pinocytotic vesicles and distinct basal laminae. After preoperative chemotherapy, the tumor was removed en-bloc, and one forearm bone was adopted for the reconstruction MHP of bone is reported to be only 0.1% of all malignant primary bone tumors. Also, the presented case was the youngest and the only ulna case ever reported.
We evaluated the functional results obtained in 33 patients after they had had limb sparing procedures performed. The histological diagnosis was as follows: osteosarcoma; 11 cases, chondrosarcoma; 9, malignant fibrous histiocytoma of bone; 3, giant cell tumor of bone; 3, parosteal osteosarcoma; 2, metastatic bone tumor; 5. Twenty-four patients had had endoprosthesis replacement; 3, rotation plasty; 6, wide resection alone. The duration of follow-up ranged from 1-11 years (mean 4.3 years). Function was assessed according to the revised classification system of the Musculoskeletal Tumor Society. Functional scores of the endoprosthesis, rotation plasty, and resection alone groups were 64%, 69%, and 100%, respectively. In cases with endoprosthesis, patients who had had a tumor of the distal femur achieved the highest functional scores. However, their incidence of complications including local recurrence was 12%.
We reviewed 28 cases with serious blood dyscrasias who underwent orthopaedic surgery, and studied their perioperative management. 10 of the 28 cases were suffering from fractures. 5, 4, 3, and, 3 cases were suffering form tumors, lumber degenerative disorders, infection, and osteonecrosis of the femoral head, respectively. Acute leukemia was the major combined blood disease, which occurred in 9 cases. Idiopathic thrombocytopenic purpura (ITP) was found in 5 cases. We preoperatively gave platelet transfusions to the patients, if laboratory data showed their platelet counts were under 5×104/mm3. High-dose gammaglobulin therapy was an effective treatment for ITP. We managed to achieve platelet counts of over 5×104/mm3 in all patients. Leukocyte poor red cells were used for blood transfusion, if necessary, to avoid graft versus host disease. In all cases, the perioperative course was uneventful.
Local recurrence of tumor cells are a risk associated with marginal or intralesional tumor resection. To prevent additional local growth, a bone cement containing an anticancer drug was developed. Two cases of pathological fractures associated with metastatic bone tumors of lower extremities were treated by local resection, using bone cement with pirarubicin (THP) to reinforce internal stabilization and to fill defects. THP 30mg to 40mg, was sealed into the bone cement (40mg). Case 1, was a 69-year-old man who had femoral and tibial metastases from a renal cell carcinoma. Case 2, was a 77-year-old man who had tibial metastases from lung cancer, which was unknown before operation. Postoperatively, THP concentration in suction drainage and plasma were measured in series. The local concentration was much higher than that in the plasma, whereas the systemic concentration remained at a minimum level. In both cases, the patients could walk with or without a cane even temporarily. These results indicate that THP loaded bone cement can be used in the treatment of skeletal metastases.
We performed anterior transfer of the toe flexors in 5 patients (5 feet) with pes equinovarus. Two cases were due to cerebral palsy and two were due to peroneal palsy and one was caused by drop foot resulting from a venomous snake bite (Habu). The follow-up period ranged from 1 year and 6 months to 2 years and 6 months, with an average of 2 years and 2 months. Four feet were judged to achieve good correction, one foot had a slight pes equinos deformity. On walking, all 5 patients were satisfied with their results physically and mentally. This method was found to be effective for drop foot resulting from a venomous snake bite (Habu).
Gangrene of the foot is one of the major complications associated with diabetes mellitus (DM), Arterio sclerosis obliterans (ASO). The treatment for foot gangrene is commonly surgery, especially amputation of the foot or below the knee. The selection of Chopart joint for amputation level is very rare, and there are few papers to describe this method in Japan. We have experienced 6 cases (5 males, 1 females) of foot gangrene caused by DM and ASO who underwent surgical treatment using Chopart joint's amputation from 1990 to 1996. 5 cases had a history of DM ranging from 0-20 years, while 2 cases were only diagnosed as having DM after coming to our hospital complaining of a foot abnormality. All cases had diabetic complications of neuropathy, retinopathy, nephropathy etc. Chopart joint's amputation was performed in 4 cases as a first method, in 2 cases as a second or third method. Considering the Japanese life style of “no-shoes indoors”, from the view of postoperative function in which there is no difference in leg length, to be able to walk without leg equipment, Chopart joint's amputation is a useful method for treating foot gangrene.
We reviewed the results of 10 patients (10 hips) after revision total hip arthroplasty with use of cement for 6 aseptic loosenings, 2 septic loosenings, 1 femoral shaft fracture, and 1 component fracture. Three patients were men and 7 women. Their mean age was 73 years (range 56 to 86). The mean duration from primary operation to revision was 64 months (range 13 to 180). The mean duration of follow-up was 41 months (range 8 to 84). The mean J. O. A. score significantly improved from 41.9 points to 70.7 points at the time of the latest follow-up examination.
We report a case of habitual posterior dislocation of the shoulder. The patient is a 16-year-old boy in high school. He started karate exercises when he was 3-years old. He had been feeling pain and apprehension on movement since 1992. On examination, the left shoulder demonstrated posterior dislocation in the position of flexion 90° and internal rotation 45°. Radiographs and CT showed dysplasia of the glenoid fossa and relaxation of the posteroinferior capsular. At surgery, there were no signs of any distinct injured lesions. Glenoid osteotomy and inferior capsular shift were performed in this patient. One year after surgery, he restarted Karate exercises. 6 months after resuming this activity he remains free of problems.
Roentgenograms of 17 healthy adults' feet were taken in using Cobey's poterior view in a standing position. Medial and lateral wedge arch support were used. The medial side's degrees were 5, 10, 15, 20, and lateral side's degrees were 5, 10. In all roentgenograms we measured Ankle mortise-heel contact angle (A-H angle) and Tibiocalcaneal angle (TB-C angle). On the inversion side the mean A-H angle was 9.3, 7.7, 6.3, 5.6, 4.0 in 0, 5, 10, 15, 20, respechvely and mean TB-C angle was 1.7, 3.6, 6.4, 9.2, 11.5 in 0, 5, 10, 15, 20 respechvely. There was a significant relationship between degree of arch support and A-H angle or TB-C angle. On the eversion side, the mean A-H angle was 9.3, 8.6, 9.0 in 0, 5, 10, respechvely and that of TB-C angle was 1.7, 1.0, 1.2 in 0, 5, 10 respectively. There was no significant relationship between degree of arch support and A-H angle or TB-C angle. However the TB-C angle can distinguish the eversion side from that of the control or inversion side.
We experienced a case of serratus anterior paralysis due to long thoracic nerve palsy which was treated by pectoralis major muscle transfer. The aim of this paper is to report the analysis of pre- and post- operative scapulo-humeral rhythm of this case. The patient is an 18-year-old girl. Before surgery she could abduct her arm only 90 degrees with a prominent winged scapula and her scapulo-humeral rhythm was markedly disturbed. We performed pectoralis major muscle transfer. After surgery, abduction improved to 180 degrees and her scapulo-humeral rhythm was improved, however, the winged scapula persisted. The anatomical size of the scapula was determined by taking two anterio-posterior view roentgenograms from a distance of one and two meters respectively. The pre- and post- operative scapulo-humeral rhythm was recorded on a video recorder by use of a large image intensifier and then analyzed. Before surgery, with abduction, the inferior angle scapula moved medially and the vertebral border of the scapula moved upward even with optimum abduction. Moreover, the upward rotation angle was small during this process. After surgery, the abnormal motion of the inferior angle and the vertebral border was minimized and became close to the normal rhythmic pattern with an increase in the upward rotation angle.
Gait analysis was performed using a large-sized force plate in 15 patients with osteoarthrosis of the hip joint. All patients were in the advanced-end stage of coxarthrosis. Weighting-off effect, deceleration phase, acceleration phase, maximum deceleration force, maximum acceleration force, single stance phase, step length and walking speed were measured. Weighting-off effects on the un-affected side were larger than the affected side in nine patients (Group A). Weighting-off effects of the affected side were larger than the un-affected side in four patients (Group B). There were no weighting-off effects on both sides in two patients (Group C). In Group A, deceleration and acceleration force of affected side were larger than the un-affected side. On the other hand, in Group B, acceleration force of the affected side was larger than the un-affected side, but the deceleration force of the un-affected side was larger than the affected side. In Group B, step length of the affected side was longer than that of the un-affected side.
We compared the gait pattern before and after surgery in children with cerebral palsy (CP). Twelve children (6 male, 6 female) with CP were assessed; eight patients had spastic diplegia and four patients had spastic hemiplegia. Stride length, step width, cadence and walking velocity were measured using large-sized force plate, and weighting-off effect, acceleration force ratio and deceleration force ratio were assessed. Stride length and walking velocity were significantly improved, cadence and step width tended to decrease. Weighting-off effect, at three months after surgery, was decreased. However one year after surgery, it increased signicantly. The difference of the affected side to un-affected side in deceleration and acceleration force was decreased after surgery.
We studied 168 patients with a fracture of the femoral neck to investigate the influence of their preoperative medical condition on postoperative complications. Patients ages ranged from 31 to 91 years, nean 76.9 years. The majority of the patients, apart from twelve, had some problems preoperatively. Severe postoperative complications, such as pneumonia, brain infarction, deep infection, pulmonary infarction and angina, occurred in twenty-two patients. There were no postoperative complications in patients who had no problems preoperativerly, and who. were aged under 70 years old.
We investigated the problems encountered in 12 femoral neck fracture patients who had been on long-term hemodialysis and were treated during the 6 year period from 1989 through 1995. The average age was 61.3 years with a range of 46-76. 6 cases were intracapsular fractures and 6 were trochanteric. The mean period of hemodialysis was 11.8 years with a range of 4-23 years. Six cases had been treated by osteosynthesis, 3 of whom did not achieve bone union. 6 cases were treated with prosthetic replacement. In the 3 cases treated with cemented prosthetic replacement, 2 showed loosening rediologically and required a surgical revision. We reported problems with revision of cemented prostheses, therefore we prefer to use non-cemented to cemented for prosthetic replacement of the femoral neck fractures in hemodialysis patients.
Our study population consisted of 116 patients aged over 70 years who had been operated on for hip fractures at this hospital and were followed up for 7-70 months. We investigated complications at discharge and postoperative walking ability. Patients who were unable to walk at discharge were older, and had complicated dementia (45.5%) with a poor prognosis. We speculate that early prevention and treatment for dementia produce smooth postoperative rehabilitation and an improved prognosis.
Nine cases of avascular necrosis of the femoral heads caused by fractures of the femoral neck and dislocations of the hip joint were treated by vascular bundle transplantation. The results of these 9 cases are described in this paper. The follow-up period ranged from 5 to 20 years and the results of the operations were examined roentgenographyically and clinically.
We report two cases with combined rapid. destruction of the femoral head and intracapsular femoral neck fracture. These cases were similar in regard to clinical, radiological, MRI and histological findings. The possible causes included avascular necrosis, osteoporosis and ischemic changes from the femoral head to intertrochanter. The patients underwent Bipor hip prosthesis without cement, and were well postoperatively.
We treated 47 cases of peritrochanteric fracture of the femur using the Gamma Nail without distal locking from January 1995 to September 1995. Ten patients were male and 37 were female, with a mean age of 81 years. Fractures were classified radiographically according to Jensen's classification. There were 25 cases of stable fractures and 22 unstable cases. The mean operation time was 53 minutes and mean blood loss was 42g. Radiological evaluation demonstrated that in 35 cases the tip of the lag screw was inserted into the femoral head in a good position. Twenty-eight cases were restored to the mobility status before injury. Postoperative complications were found in 2 cases. One was non-union, the other a fracture of the femoral shaft. The prognosis was affected not by type of fracture, but by complications that disturbed their rehabilitation. The reaming and inserting of distal screws was not to be done as a routine.
Nine cases with intra-articular fractures were treated surgically using a bioabsorbable screw and pin. All cases achieved good bone union with no problems associated with bioabsorbable implants. Bioabsorbable osteosynthetic implants are safe and useful for achieving osteosynthesis of intra-articular fractures.