We performed Unicompartmental Knee Arthroplasty (UKA) for two patients who were diagnosed as having idiopathic osteonecrosis of the knee according to its characteristic clinical course, roentgenographic findings and magnetic resonance imaging. Patients were both women and their ages were 75 and 72 years. The lesion was located in the medial femoral condyle, producing instability of their medial joints. Femoral condyle cartilage was detached and dystrophied widely as shown by arthroscopic surgery which was performed simultaneously. After the surgery, their knee pain was relieved and their function improved markedly. Usually we perform high tibial osteotomy (HTO) for cases who have pain and disability in their daily life in spite of conservative treatment and achieve success using this treatment. In the past if the osteonecrotic lesion is wide and the knee is unstable, total knee arthroplasty (TKA) has been performed, but now we encourage using UKA for such patients.
We reviwed 24 cases treated by High Tibial Osteotomy (HTO) and Unicomparmental Knee Arthroplasty (UKA) for spontaneous osteonecrosis of the femoral medial condyle. The average age of patients at surgery was 62.4 years in the HTO group, and 75.5 years in the UKA group. Clinical evaluation was carried out for a mean follow-up period of 72 months in the HTO group, and 64 months in the UKA group. Pain on walking and in climbing stairs was remarkbly improved in both groups, but range of motion was slightly lost in the UKA group. Not only does UKA have a great effect on relieving pain with easier rehabilitation, it also is easily performed in eldery or poor risk patients because it is less invasive. We believe that UKA is a useful procedure in treating spontaneous osteonecrosis of the femoral medial condyle when it is performed with adequate patient selection and operative technique.
High tibial osteotomy was performed in 45 patients (49 knees) with simultaneous arthroscopic debridement of knee joint. Preoperative and postoperative intraarticular evaluations were compared in 49 joints with osteoarthritic changes in medial compartment type and possibility of repair was discussed using this method. Among 49 joints, the subchondral bone was exposed in medial condyle of 47 joints, second look arthroscopy revealed that the exposed bone in 34 condyles were completely covered by fibrous cartilage, in 6 joints partial cartilage ulcers were remained, in 3 joints cartilage fibrillation was observed and in remaining 4 joints no change was seen. Among partially excised menisci, only 5 had retear. This treatment method is found to be satisfactory in intra-articular repair.
We studied the clinical effects of sodium hyaluronate (HA) on patients treated with high tibial osteotomy (HTO). Nine knees from 9 patients with osteoarthritis (OA) were selected randomly as a case group, and were injected with HA into the affected knee inter-articularly once a week for five weeks after HTO (HA group). Nine knees from 9 patients with OA of the knee without HA injection were selected as a control group (non-HA group). Controls were matched to cases for age, body weight, range of motion (ROM) and JOA score before HTO. ROM at five weeks and one year after HTO, and JOA score at one year after HTO were compared between the two groups. ROM at five weeks for HA group and non-HA group (118° and 93°, respectively) reached statistical significance (P<0.03). ROM at one year for HA group and non-HA group were 134° and 132°, respectively without statistical significance. JOA score at one year for HA group and non-HA group were 82 and 86, respectively without statistical significance. Intra-articular injection of HA after HTO is effective on the early achievement of full ROM.
The results of 4 supracondylar femoral varus osteotomy that were done for lateral osteoarthrosis were evaluated. The mean age of patients was 66.5 years old. The length of follow up averaged 7 years and 5 months (range 6 to 9 years). The preoperative tibiofemoral angles of each cases were 167°, 162°, 150° and 164° which were corrected to 180°, 184°, 183° and 172°. At the last follow-up study, they changed to 183°, 180°, 198° and 167°. It seemed difficult to predict the post operative change of tibiofemoral angle. According to the Japanese Orthopaedic Association knee score, it improved from an average of 72.5 points preoperatively to 83.8 points post operatively. All patients expressed satisfaction with the outcome.
Thirteen knees with patellar malalignment syndrome were operated on during the past five years. All cases were female with a mean age of 24 years (range, 12 to 29 years). Mean follow up period was two years and three months (range, four months to four years and ten months). Only one case had proximal realignment (Insall method) performed, three cases received scopic lateral release and nine cases were treated with proximal plus distal realignment. Distal realignment was tibial tuberosity medial transplantation with 5mm ventralization. Results were as follows: 1. All cases were excellent in the patient's subjective. 2. All cases were excellent by MacNab classification. 3. Proximal plus distal realignment was necessary for reccurent dislocation and major instability of patella.
We analyzed the mechanism of patellofemoral joint instability, using new parameters by Computed Tomography. Knees with PFJI consisted of four knees with recurrent patellar dislocation and eight knees with patellar subluxation. Twenty seven normal knees were also evaluated. A CT scan was taken at the level of the femoral epicondyle, the tibial tuberosity and the ankle joint both in full extension and at 30° of flexion. The tibial tuberosity in knees with PFJI was significantly positioned laterally compared with that in normal knees in full extension. At 30° of flexion, it was positioned in the normal range. When recurrent patellar dislocation and patellar subluxation were compared, tibial tuberosity in knees with recurrent patellar dislocation was significantly positioned laterally compared with patellar subluxation. A CT scanning at two different angles should be performed to evaluate patellofemoral joint instability.
A fifteen year old boy is reported with bilateral hypoplastic patellae. This patient had syndactly and right patella partita, but no other skeletal anomalies. Also, the mother of this patient had the same patella condition. The pattern of inheritance in this family is consistent with the transmission of a predisposing factor as a autosomal dominant gene. The clinical and radiological appearance of the patella is consistent with the ‘small patella’ syndrome a rare patella disorder.
We have operated on two patients 3 knees with dislocation of the patella, although their growth plate remained. Two were permanent dislocations and one was a habitual dislocation. We report the result of their surgery. Case 1. A ten year old girl has habitual dislocation of the patella with right knee and permanent dislocation of the patella with left knee. Her right knee was operated on 18 months previorsly and left knee was treated 9 months ago. Case 2. A thirteen year old girl has permanent dislocation of the left patella. Surgery was performed on her left knee 6 months ago. Results of operation were excellent or good according to Macnab's criterion, but lateral shift was not improved. This was due to deformity of their joint surfaces and their Q-angle was large, and our operating method performs proximal realignment only. Petients were satisfied with the results of our operation. We think that this technique is suitable for treating juvenile patients' patella dislocation.
MRimaging of the knee is a useful method for diagnosing meniscal tears. Although the spin echo method is usually used for diagnosing meniscal tears, we examined the utility of thin slice scan with the three-dimensional method. We reviewed 70 menisci in which arthroscopic findings were confirmed. In this series, sensitivity was 90.9% for medial meniscal injuries and 68.8% for lateral meniscal injuries. There were 3 meniscal tears in which we could not detect tears on preoperative MRimages. We could find tears in two of these cases when re-evaluated using the same MRimaging. In conclusion, we can get the same diagnostic rate with the three-dimensional method compared with the spin echo method. Scan time of the three-dimensional method is 3 minutes, on the other hand that of spin echo method in 17 minutes. This slice scan with three-dimensional method is useful for screening meniscal injuries before arthroscopy.
A 73-year-old woman presented with rapidly destructive changes of the knee joint due to calcium pyrophoshate dihydrate crystal deposition disease. The patient was complaining of pain and swelling of the left knee joint. She became progressively limited in movement and got around using crutches with difficulty. Radiographs showed osteoarthritic changes and chondrocalcinosis in the knees, shoulders, and hips. On X-ray, the left knee showed destructive changes affecting the medial femoral condyle and tibial plateau on June sixth, 1996. On July forth the destructive change was more marked and on August eighth gross destruction had occurred. Investigations showed a normal erythrocyte sedimentation rate (ESR), serum calcium, and alkaline phosphate. The serological test for syphilis was negative and no increase in rheumatoid factor was found. Deep pain sensation was normal and there were no abnormal neurological signs. We performed total joint replacement with bone graft of the left knee joint. At the operation, calcium pyrophosphate dihydrate crystals were found in the meniscus. After the operation, the left knee joint was stable and painless.
Ganglion cysts arising from the cruciate ligament are rare, with very few reports available in the literature. We report two cases of ganglion cysts in the cruciate ligament, treated successfully with an arthroscopic extraction. Case 1: 42-year-old man had right knee pain. The pain occurred in the knee when in a sitting position. He denied any locking sensations or instability symptoms. Magnetic resonance imaging (MRI) of the knee showed a 5×9mm fusiform smoothly marginated mass in the ACL. At arthroscopy, a ganglion cyst was seen arising from the ACL. Case 2: 15-year-old man had right knee pain and clicking. The pain symptoms were exacerbated by prolonged running. He had no locking, instabiliy, or swelling of the knee. MRI of the knee showed a 10×12mm fusiform smoothly marginated mass in the PCL. Arthroscopy of the knee demonstrated bulging of the PCL. Both cysts were treated successfully with arthroscopic extraction. After cyst removal, patients remained symptom free.
We report a case with an unusual pattern of posterolateral instability of the knee in an 18-year-old male who sustained an injury of the popliteus tendon and LCL after a motorcycle accident. This was associated with a patellar subluxation, but not combined rupture of the cruciate ligaments. Fujikawa et al. showed that the injury was produced by external rotation and posterior forces on a flexed knee. Open reduction and internal fixation are used in order to achieve anatomic reduction. Fourteen months after operation the fracture was healed with good functional results.
Radiographic enlargement of tibial and femoral tunnels has been observed after ACL reconstruction. We examined bone tunnel enlargement 10 months or more postoperatively. Thirty-seven patients were reconstructed using the Modified over the top method (MOT) and 26 patients received the Bone tunnel method (BT). In the MOT group, between the enlargement group (n=10) and no-enlargement group (n=27), there was no significant difference in clinical results (KT2000, ADT, JOA score), direction of bone tunnel, position of bone plug and isometricity. In the BT group, between the enlargement group (n=18) and no-enlargement group (n=8), there was significant difference in only the femoral position of bone plug. To prevent enlargement of the femoral tunnel, the bone tendon junction of BTB should be placed in the articular position of the femoral tunnel.
In order to monitor changes in the major matrix components following Chondroitinase ABC injection, immunohistochemistry was performed to demonstrate the localization of chondroitin sulfate, type I and type II collagen. Immunopositive staining for chondroitin sulfate was decreased in the inner annulus fibrosus at 2 weeks but recovered at 6 months. However, the amount of positive cells for chondroitin sulfate in the nucleus pulposus was not restored to the control level. In addition, morphology of the regenerated cells in the nucleus pulposus was not analogous to that of the control discs.
We investigated the thermogram of rat tails using an acute inflammatory model applied percutaneously to rats with adjuvant induced arthritis. After 2-4 weeks injection, the mean temperatures, as well as calories of the tails, were significantly higher in adjuvant treated groups than in the control group. This increase of both parameters was correlated with the degree of edema. These results suggest that monitoring the temperature and calories of the tails in adjuvant arthritis rats could be a useful method for pre-clinically evaluating the efficacy of anti-inflammatory drugs.
In order to investigate prosthetic wear, we observed the fine structures of the joint surface consisting of metals or ceramics in several kinds of hip and knee prostheses using a surface profile measuring system and a SEM. The hip prostheses examined were made of Al-ceramics (Kyocera), Zr-ceramics (Kyocera) and Co-Cr alloy (Zimmer). The materials of the knee prostheses were Al-ceramics (Kyocera), Co-Cr alloy (Zimmer) and Ti alloy (Zimmer). None of the prostheses were used clinically. Surface profile measuring disclosed that surface roughness values of 0.025-0.029μmRa on all the hip prosthesis were less than those of 0.114-0.150μmRa on all the knee prosthesis. In a SEM examination, many streaks running in various directions, probably due to polishing, were observed on the surface of all prostheses. However, the streaks were coarser in all knee prostheses. We conclude that the polishing process should be improved, particularly in knee prostheses.
Anterior cruciate ligament (ACL) reconstruction with bone patellar tendon bone can usually be secured with interference screws on the femur and tibia. Its strength depends on bone quality, size of the tunnel and screw, and direction of forces. Infrequently, patella alta, which results in a longer tendinous component of the graft construct, can result in a construct mismatch, leading to a large portion of the tibial bone plug extruding from the tibial tunnel, requiring graft fixation with a suture/screw and post technique. For treatment we prefer to use tying sutures over a post technique. However in the first few weeks after reconstruction, the weakest link in the reconstructed ligament system is the site of fixation. This study investigated initial graft fixation strengths of various methods of bone fixation. Fixation was performed using three suture methods with no. 5 Ethibond. An Instron material testing system was used and loading rates at 50mm/minutes until failure was performed. Statistically significant differences were noted for load to failure and elongation. Group 1 specimens' mean maximum load to failure was 439 N, whereas the load to failure for group 2 specimens' was 555 N. In our model, figure-of-eight sutures (group 2) was stronger than simple double suture technique (group 1). Our study has several important limitations. However, these results confirm the hypothesis that this technique avoids the potential pitfalls of interference screw fixation. We used tying sutures over a post with satisfactory clinical results.
Bone mineral density (BMD) and stiffness index were measured using SXA of the calcaneus, DXA (dual X-ray absorptiometry) of the lumbar spine, DXA of the radius and ultrasoud bone densitometry of the calcaneus from 200 women, consisting of forty women in each decade, from twenties to sixties. Correlation of calcaneal BMD measured by SXA and others were made. Calcaneal BMD measured by SXA was highly correlated with BMD and stiffness measured by densitometry in 200 women (vs lumbar DXA: r=0.78, vs radius DXA: r=0.71, vs calcaneous ultrasound: r=0.81). However, SXA of the calcaneus from forty women in their thirties and fourties were not correlated significantly with DXA of the distal Radius (r=0.29, 0.38). These facts indicate that analysis in each age group must be required for diagnosis and observation of osteoporosis.
Bone density of the calcaneus, lumbar vertebrae, femur neck was measured. Correlation between BMD and age, body height, body weight, body mass index (BMI) was assessed. Evaluation of calcaneal bone density was examined. Subjects included 95 women, ranging in age from 19 to 85 years (mean 53.5 years). For all cases, bone density was neasured using DEXA (Lunar company. USA) Furthermore cases were divided into three groups, the climacteric first period (for less than 10 years), the climacteric latter period (for more than 10 years) and before climacteric, and comparison of weight and BMI among three groups was performed. I recognized a strong correlation between weight and BMI of the before-climacteric group. BMD of the calcaneusand Lumbar vertebrae decreased in the climacteric first period. Femoral neck BMD almost de-creased uniformly. Bone density of the lumbar vertebrae and calcaneus with many trabecular bones decreased during the high turn-over period.
Maffucci's syndrome is a congenital, non-hereditary mesodermal dysplasia manifested by multiple enchondromas and hemangiomas. It is associated with diverse secondary musculoskeletal deformities. A high proportion of the enchondromas undergo malignant degeneration. We report one case of Maffucci's syndrome in a 17-year-old girl.
We examined 68 newborns (136 hips) by ultrasonography using Graf's method from November 1996 to May 1997. Eighty one hips were type I a, 41 hips were type I b, 13 hips were type II a+, and one hip was type II c. Dysplastic hips were reexamined after one month. Dysplastic hips had improved to type I a or type I b.
We performed ultrasonographic examination on twenty-eight congenital dislocation of the hips ranging from 0 to 6 months old by the anterior approach. The pubic bone, the anterior acetabulum and the femoral metaphysis yielded strong echoes on the ultrasonograms. In the normal hip, the femoral metaphysis positioned symmetrically and the ring hyperechoic line was visible clearly at the inner end of the metaphysis. Anatomically this line coincided with the outline of the femoral head. In the dislocated hip, the femoral metaphysis was seen posteriorly compared with the normal side and the hyperechoic ring was not produced. When the dislocated hip was reduced, the femoral metaphysis moved anteriorly and the ring appeared. The fact that in the normal hip and the reduced hip the ring was clearly visible indicated that this finding demonstrated good articular congruence between the femoral head and the acetabulum and was useful for ultrasonic diagnosis of the d: slocated h: ps.
Radiological results of twenty four congenitally dislocated hip joints of twenty three patients, which had been reduced by the Pavlik harness (eleven joints), manual reduction (ten joints), or open reduction (three joints) were assessed using Severin's classification. Severin's classification at the latest follow-up (more than six years old) was as follows; ten of group I a, twelve of group III, and two of group IV. Regarding joints which were reduced by the Pavlik harness, the average age of patients with good results (group I a) was less than that of patients with poor results (group III). One joint with severe deformity due to avascular necrosis showed a poor radiological result.
Soft tissue release of the hip joint, open reduction of the femoral head and derotational, varus and shortening osteotomy of the femur have been performed for dislocation of the hip in cerebral palsy. This retrospective study evaluated 11 hips in 7 patients. Results were analyzed a mean of two years and four months after treatment with assessment of their range of hip motion, locomotion, radiological findings and postoperative complications. In all cases, postoperatively, the femoral head had been reduced in a concentric position, and when reviewed, flexion and adduction contractures had recovered. Locomotion improved in all cases. Worsening of acetabular dysplasia was not found in any cases. Ectopic bone formation was found in 5 hips in 3 patients, and 2 hips of 1 patient needed surgical resection.
Polydactyly of the thumb is frequently seen among congenital anomalies. Twenty-four hands of 22 patients were operated at our department, and registered in this study. One hand was classified as Wassel's type 1, 5 hands as type 2, 1 hand as type 3, 8 hands as type 4, 3 hands as type 5, 0 hand as type 0, 6 hands as type 7. The age at initial operation ranged from 7 months to 42 months with a mean of 14.0 months. All patients were examined using modified Tada's criteria. The results were good in 19 hands, fair in 5 hands (4 hands of type 4 and 1 hand of type 1). 80% of fair cases were type 4. Eight hands of type 4 were analyzed in order to determine factors affecting the outcome. Fair hands all showed more than a 20 degree radial deviation of the interphalangeal joint (IPJ). Our results suggest that cases of more than 20 degree malalignment at the IPJ initially needs the correction osteotomy of the proximal phalanx.
We reviewed 133 cases of congenital spinal anomalies with regard to associated congenital anomalies. All cases were treated in our department from 1980-1997, excluding only Spina Bifida. The Male/Female ratio was 59 to 74. The rate of associated congenital anomalies in cases of congenital spinal anomalies was 72.2%. The association rates for cardiac anomalies was 26.3%, intestinal anomalies was 18.8%, and genito-urirevy anomalies was 12.0%. Cervical spine anomalies were highly associated with upper limb anomalies. Thoracic spine anomalies were highly associated with cardiac anomalies. Sacral anomalies were highly associated with imperfected anus. We should, therefore, always investigate for anomalies of other organs when we looked for spinal anomalies.
We report two cases of periosteal chondroma of the phalanx. A 6-year-old boy complained of swelling of the left index. Radiography showed a depressed lesion with some calcification. Resection and curettage of the tumor was performed. A 71-year-old man complained of swelling of the left ring finger. Radiography showed a depressed lesion with some calcification. Angiography showed hypervascularity. MRI showed low intensity area on T1 weighted image, high intensity area on T2 weighted image and enhancement on Gd-DTPA. Resection and curettage of the tumor was performed. Periosteal chondroma is a rare benign chondroid tumor that arises under or in the periosteum. It is ofter difficult to distinguish periosteal chondroma from chondrosarcoma. We diagnosed these cases as periosteal chondroma by radiographic and pathological findings.
Osteoid osteoma is a relatively common bone tumor of benign origin and can be easily diagnosed. However, when intraarticular lesions occur, they may pose a diagnostic challenge. Recently, we experienced a rare case of osteoid osteoma in the hip joint of a fifteen-year-old girl and describe the method of diagnosis and treatment. She complained of right hip pain and restriction of motion without any history of trauma or joint disease. The pain was aggravated by motion and she also had night pain. There was no findings on initial roentgenogram, however, two months later roentgenogram had showed a calcified mass in the acetabular fossa. MR imaging in early phase showed only localizad hypertrophic synovium with slight joint effusion. However, Gadolinium (Gd) enhanced MR imaging revealed a ringed area of low signal intensity around a calcified mass. A bony mass covered with synovium was observed in the acetabular fossa using an arthroscope and the mass was excised. Histopathologically itwas diagnosed as a osteoid osteoma with a nidus. From this study it can be suggested that Gd enhanced MR imaging is useful for the accurate diagnosis of intraarticular Osteoid osteoma.
School of Allied Medical Sciences, Kagoshima UniversityThe optimum treatment of solitary bone cyst (SBC) remains controversial. We have treated 24 patients with SBC using five kinds of treatment in the past 10 years; intralesional steroid injection, shunt therapy, percutaneous trepanation, drainage by cannulated screw, and curettage and bone grafting. The rates of healing or improvement by a single therapy, as evaluated by roentogenograms were 53%, 71%, 80%, 100%, and 67%, respectively. The final results of 24 cases were as follows; healed in g cases, improved in 13 cases, and unchanged in 2 cases. Regarding the 17 cases of long tubular bone; healed in 5 cases, improved in 11 cases, and unchanged in 1 case. In this series, most of the cases improved, however, the rate of complete healing was not high. We will therefore have to treat SBC with more successful methods.
Intraosseous lipoma accounts for only 0.1% of all bone tumors. We treated a 33-year-old male with this bone tumor of the humerus. He had complaind of right shoulder pain. Radiographs of the shoulder showed a well-defined lytic lesion in right proximal humeral metaphysis. Its border was sclerotic and the lesion had a central calcific dencity. Computed tomography (CT) showed lipo-density in the aera. Magnetic resonance image (MRI), on the T1 and T2 weighted images was also compatible with adipose tissue. This tumor showed no enhancement after administration of gadolinium. Histological analysis revealed mature lipocytes. We emphasize that MRI examination is useful for preoperative diagnosis.
Two cases of hemangioma which occurred in the rib were reported in this study. Tumor located in the neck of the left gth rib, and in the right 4th rib. Both cases had no symptoms, and incidentally taken X-ray film demonstrated osteosclerotic changes in the ribs. CT showed an expansile, well demarcated lesion, with thin cortices and fine trabeculae. In the first case, marginal resection was performed after needle-biopsy. In the second case, wide resection was performed. Both cases were diagnosed as cavernous hemangioma of bone.
We experienced three cases of giant cell tumor of the sacrum. The average age of the patients was 37 years old (ranging from 31 to 47 years old.). In all cases, patients had severe sciatic nerve pain, with all requiring continuous epidural anesthesia. One also needed phenol block, and another needed continuous spinal anesthesia. The initial treatment for all was radiation therapy. Two were by Co60 (total 60Gy) and one was by Liniac (total 50Gy). In the latter case, as tumor and pain were not decreased by radiation therapy, cryosurgery with liquid nitrogen and lumboiliac fixation was performed. Two patients irradiated by Co60 had no recurrences 18 and 12 years after irradiation respectively. But in one of them, subcutaneous MFH occured 5 years after irradiation. One irradiated by Liniac had no recurrence 1 year after irradiation, but had minor infection and fistula at the sacral lesion. One can not walk alone because of paraplegia, but two can walk alone with light sciatic nerve paralysis. We report on giant cell tumors of the sacrum with a review of the literature.
In this study, we report the clinical differences between osteosarcomas arising in elderly patients and those in children and adolescents. Since 1978, we have treated 9 patients with osteosarcoma occurring in patients older than 40 years. Four men and 5 women were affected, with a mean age of 56.6 years, ranging from 48 to 76 years of age. In contrast to osteosarcoma in children and adolescents, where 75% of the tumors arise around the knee, this region was involved in only 33% of the elderly patients. The percentage of patients with elevation of serum alkaline phosphatase levels was significantly higher in older patients compared with younger patients (78% versus 39%: p<0.05). Seven of g patients were treated with radical surgery. Although preoperative chemotherapy was used for only 44% of patients, 5-year survival estimates of the elderly patients were 66.7%. No significant differences in the survival rates were observed between elderly patients and children.
From 1983 to 1990, we performed limb salvage procedure using alumina ceramic knee prosthesis in 7 patients with malignant bone tumor arising in the distal femur. We observed radiological skeletal changes around the alumina ceramic knee prosthesis in 2 patients who survived more than 6 years. Their ages at surgery were 15 and 25 years old, and their histological diagnosis was osteosarcoma and MFH. As characteristic findings, the linear sclerotic bone surrounding the prosthesis and clear zone between the linear sclerotic bone and prosthesis appeared within 2 years after the operation. However, the progress of their findings subsided after that. From these results, we conclude that reconstruction using alumina ceramic prosthesis was of use in limb salvage procedure for malignant bone tumors.
To improve the quality of life for cancer patients, we have performed surgical treatment of metastatic bone tumors of the limbs. Here we report on the postoperative functional status and the length of stay at home. Surgery was performed in 23 patients, who had 26 operations, comprising 5 on the humerus, 16 on the femur, and 5 on the tibia. The average age at surgery was 64 years. Curettage of lesions and rigid fixation were generally performed in the lower extremities, and fixation alone was done in most upper extremities. Intramedullary nailing was most commonly used (16 cases). The average length of follow-up was 20 months and 8 months for surviving and dead subjects, respectively. Functional status was good or better according to the criteria of Beppu and Suzuki in 24 cases, and the duration that function was maintained for 11 months on the average (68% of the survival period). In 13 cases stayed at home, its duration was 18 months (75%). These findings indicate that surgical treatment can contribute to the improvement of quality of life.
In recent years, surgical treatments have been applied to cases with intense pain due to bone metastases of a malignant tumor and to those with pathological bone fractures. In the present study, we examined the postoperative result of cases in which osteosyn thesis combined with bone cement was performed in our department for metastatic bone tumors, aiming at improvement in QOL. Subjects were three men and one woman with the mean age of 66 years, with metasttic bone tumors in long cavity bones for which osteosynthesis combined with bone cement was performed. The observation period varied from 2 months to 13 months with a mean of 5 months. The regions were the femur in two cases, tibia in one and humerus in one, and the primary foci were renal carcinoma in two, bladder cancer in one and malignant neurinoma in one. During surgery, the metastatic focus was curetted and the bone fixed with a plate or an intermedullary rod and reinforced bone cement. In regard to QOL, pain was relieved in all cases and the patients recovered to the ADL level before appearance of symptoms. In the aspect of surgical indication, this technique had little surgical invasion with satisfactory short-term postoperative results leading to a marked improvement in QOL.
We report a rare case of benign mesenchymoma with carpal tunnel syndrome.The patient was a 37 year old female who presented complaining of numbness of the right index. When she came to our hospital in November 1996, an ambulatory tumor was palpable at the carpal tunnel. She had sensory disturbance and numbness in the median nerve area. The distal motor latency was 5.1 msec. Roentgenogram did not show tumor. In magnetic resonance imaging (MRI), tumor showed high intensity in T2 image. In December 1996 surgery was performed. The histology of this tumor was benign mesenchymoma.
This is a case report of nodular fasciitis of the left popliteal space. The patient was a 56-year old man. MR imaging revealed this tumor to be iso or low intensity on Ti-weighted image and high intensity on T2-weighted image and enhancement with Gd-DTPA. Angiography demonstrated the tumor stain and the feeding artery. We diagnosed this tumor as nodular fasciitis because pathological findings didn't appear abnormal with no atypical mitotic figures. It is very important that we distinguish nodular fasciitis from malignant tumors, especially MFH.
Angioleiomyoma mainly occurs in the lower leg, and it is a painful tumor. We report two cases of angioleiomyoma of the foot. Case-1: A seventy three year old woman suffered from swelling of her left lateral malleolus. X-ray showed calcification in the tumor. Resection of the tumor was performed. Pathological diagnosis was angioleiomyoma. Case-2: A sixty two year old woman suffered from swelling and pain of her right planta pedis. X-ray showed no phlebolith or calcification in the tumor. Resection of the tumor was performed. Pathological diagnosis was angioleiomyoma. We consider that if we examine a patient with a painful tumor, we should consider the diagnosis of angioleiomyoma.
We review the clinical results of 19 cases with intramuscular hemangioma. Subjects included 6 males and 13 females ranging in age from 5 to 58 years (median, 23 years). The tumor was located in the upper extremities in 3 patients, the trunk in 3, and the lower extremities in 13. Pain on motion was found in 17 patients (89.5%) and limitation in motion range was reported in 60%. Surgical planning was done using MRI and a wide surgical margin was used in regard to the affected muscle and a marginal margin for surrounding tissues. The excision was performed in all patients and no recurrence was found in the duration of follow-up ranging from 7 to 101 months (median, 57 months). Furthermore, the limitation of motion was completely improved and the postoperative disability such as gait disturbance was not noted. Thus, the wide surgical excision of intramuscular hemangioma achieved satisfactory results.
Three cases of Multiple Angiolipoma are presented. Case 1: A 51-year-old man, complaining of tumors on both arms and back, visited our clinic on October 2, 1989. In 1970, he had noticed a subcutaneous tumor on the flexor side of his right forearm. After that, many tumors appeared symmetrically on both arms and some of them were painful. In 1980, he noticed many tumors on his back. There were a total of sixty five tumors with a size of 0.5cm to 1.0cm, a smooth surface and elastic hard consistency, on both arms and the back. Almost half were tender. On October 5, 1992 biopsy was performed, but the patient did not wish for any additional treatment. Case 2: A 31-year-old man, complaining of tumors on both legs and low back, visited our clinic on August 11, 1992. In the beginning of August 1992 he had noticed some painless subcutaneous tumors on both legs and low back. There were a total of eleven tumors with a size of 0.5cm to 1.0cm, a smooth surface and elastic hard consistency, on the flexor side of his left upper arm, low back, upper abdomen and both legs. A tumor of the right back was tender. On October 6, 1992 surgical excision of all tumors was performed. They were in the subcutaneous tissue and similar to lipoma. There was no reccurence, when he was reexamined on October 14, 1992. Case 3: A 32-year-old man, complaining of multiple tumors on both arms and legs, visited our clinic in December, 1996. In 1992, he had noticed a painless subcutaneous tumor on the flexor side of his left forearm. After that, the size of the tumor gradually increased and two tumors appeared at the proximal side of the first tumor. In 1995, six tumors appeared on the right forearm and both legs. There were total number of 9 tumors with a size of 1.0cm to 3.0cm, a smooth surface and elastic soft consistency, on the extremities. All tumors had slight tenderness. On December 20, 1992 surgical excision of all tumors was performed. They were in the subcutaneous tissue capsulated with a thin membranous tissue and similar to lipoma. There was no reccurence, when he was reexamined on February 8, 1997. Pathological diagnosis of all cases was angiolipoma. Tumors were capsulated with a thin membranous tissue and composed of mature adipose tissue and varying amounts of capillaries, which contained variable amount of micro thrombosis.
We evaluated the preserved limbs of 2 cases reconstructed with affected bone and Huckstep intramedullary rod for invasive malignant fibrous histiocytoma (MFH) of the femur. Case 1, a 65 year old female, had 5×5cm mass contacting with the lateral side of the right femur. At surgery, the partially resected femur was treated with 70% alcohol and was osteosynthesized with the Huckstep rod. Case 2, 67 year old male, had 15×11cm mass invading the left femur. The tumor invaded bone, and was treated with intraoperative radiotherapy. The femur was then reconstructed using the Huckstep rod. Both cases were able to achieve full weight bearing gait within four months after surgery. This limb salvage procedure was useful for elderly patients with soft tissue sarcoma invading the long bones.
We examined the treatments and prognosis in 28 cases of malignant soft tissue tumors in patients 65 years aged or older from 1977 to 1995. The mean age was 73 years. Histologic diagnoses were as follows, malignant fibrous histiocytoma (MFH) in 18 cases, liposarcoma in four cases, synovial sarcoma in three cases, malignant schwannoma in two cases and leiomyosarcoma in one case. Twenty six of 28 cases were treated surgically, and the others were treated conservatively. The over all fiveyear survival rate was 53%. In regard to MFH, the cases of upper extremity tumor seemed to have a better prognosis than those of the lower extremity and trunk.
On June 13, 1996 an airplane crashed just after takeoff at Fukuoka airport. The causes and levels of injuries suffered by passengers following the crash and resulting fire are reported. 21 of the injured passengers were sent to our facility. There were 10 males and 11 females with an average age of 44.9 years (range 16-64 years). 6 patients (1 male, 5 females) had suffered fractures, 15 had contusions and 9 had sprains. All of the fractures occurred as a result of the passenger jumping from a hole in the main hull of the aircraft generated during the crash, from the main wings, or from an emergency exit door. The height of the jump was about 3 meters in all cases. Fracture types were; one burst fracture of L1, one compression fracture of Th12, one compression fracture of L1, two compression fractures of L2 and one fracture of the left calcaneus.
The aim of this study is to confirm the safety and usefulness of postoperative autologous blood retrieval and transfusion using the Stryker CBC II ConstaVac Blood Conservation System (CBC II), and to avoid homologous blood transfusion when heavy bleeding is indicated during and after hip joint surgery. CBC II was used in 20 patients who were treated with Spherical Acetabular Osteotomy (SAO) for osteoarthritis of the hip joint. The average amount of postoperative bleeding was 648.3ml, and reinfused blood was 431.3ml. The mean rate of reinfusion (the amount of reinfused blood/the amount of postoperative bleeding) was 66.6%. The average value of hemoglobin in reinfused blood was 8.9g/dl. There were no cultures showing gram negative and gram positive bacteria in reinfused blood. In all cases, there were no complications of CBC II and homologous blood transfusions were avoided. It is concluded that CBC II is safe and useful for avoiding homologous blood transfusions when heavy bleeding is indicated during and after hip joint surgery.
We studied the method of anesthesia, perioperative management, pre-and post operative complications of 58 patients with femoral neck fractures in the aged people over eighty years to reveal safety aspects and problems of anesthesia. 12 patients had post operative complications, but there were no severe complications caused by anesthesia. We recommend spinal and/or epidural anesthesia for surgery when treating elderly patients with senile femoral neck fractures.