Atlanto-axial subluxation is often associated with rheumatoid arthritis, Down syndrome, cerebral palsy, and the congenital fusion of the cervical spine. However, there are few reports on the instability of the ossification of the posterior longitudinal ligament (OPLL). Forty-one patients with OPLL were examined radiographically. Atlanto-axial subluxation, occipito-atlanto instability (O/C1 instability) and atlanto-axial instability (C1/C2 instability) were examined using the parameters ADI and Bull's angle, and Fujiwara's C1/C2 angle. Only one patient had atlanto-axial subluxation (ADI 6mm) among the 41 patients. Thirty-three percent of the subjects showed O/C1 instability or C1/C2 instability. No less than 50% of the cases of the continuous or mixed type showed upper cervical instability. The authors believe that these data are important in the assessment of the instability of the upper cervical spine in OPLL.
We investigated the relationships between cervical spondylotic alignment and motion in 30 patients with cervical spondylotic myelopathy or ossification posterior longitudinal ligament who underwent expansive laminoplasty. These 30 patients included 19 males and 11 females, with an average age of 59.7 years at operation. The postoperative results were evaluated by cervical lateral radiographs with a mean follow-up period of 38.3 months. We found that postoperative cervical lorodosis had a strong relationship to postoperative cervical range of motion.
A prospective study was carried out to determine the clinical and radiological characteristics of thoracic outlet syndrome (TOS), whose patients presented neurological or vascular symptoms in the upper extremity from the compression of the brachial plexus or subclavian vessels. Twenty-six patients with cervical disc disease (C-group), 36 patients with TOS (T-group), and 18 patients with cervical disc disease combined with TOS (CT-group) were compared on sex, age, weight, symptoms and radiological findings. The T-group had younger females with lean posture. In the radiographs of the T-group, cervical lateral X-Ps in the neutral position showed the inferior margin of the T1 vertebrae as the lowest level and kyphotic malalignment. The range of motion in the flexion and extension views was maintained and anterior-posterior views revealed the lower position of the clavicle. The total spinal lateral X-P in TOS patients demonstrated faulty posture and anterior deviation of the gravity line at the C5 level. The common evidence between the CT-group and the C-group suggested that the pathogenesis of the secondary TOS is caused by cervical disc diseases.
We have been trying non-collar fixation and early ambulation after cervical laminoplasty since July 1998. The aim of this report is to evaluate this postoperative physical treatment. In the radiological evaluation, the range of motion of the neck after operation was more or less the same as before operation. This group did not complain of post operative neck pain and showed no complications. The course of postoperative rehabilitation without collar fixation was shorter than traditional rehabilitation.
We analysed the results of the conservative treatment for cervical spondylotic myelopathy in 51 cases, but not for the other 24 cases operated on soon; Spinal cord with compression was assessed with magnetic resonance imaging, during the period from 1995 to 1997 when they were first seen. A number of aetiological variables were investigated to determine the factors for the change in the condition. Overall 11 cases improved, 7 cases remained the same, and 33 cases deteriorated. In each grade of cervical myelopathy, there were more cases of deterioration than no change or improvement. No significant factor was found. In conclusion, it was confirmed that the operative treatment was the first choice for cervical spondylotic myelopathy. The data suggested that the operative time should be at the early stage of cervical myelopathy.
The incidence of atypical mycobacterium (AM) infection is 2.71 out of a population of 100.000. Most were pulmonary infection and extra pulmonary infection counted 3%. Arthritis and osteomyelitis caused by AM is rare. We successfuly treated two patients with arthritis and osteomyelitis coused by AM. Case 1. A 62-year-old man with wrist pain and swelling for 6 years, was suspected as having RA. However, treatment for RA did not improve his symptom. He received synovectomy 3 times but synovitis recurred. Mycobacterium scrofulaceum was cultured from joint fluid. We started administration of RFP, INH, and SPFX with synovectomy. Eight months after surgery, no recurrence was seen and he returned to his original job. Case 2. A 45-year-old man suffered from a wound by a metal wire penetrating his right foot while mowing the lawn. He was treated with antibiotics, but he developed osteomyelitis of the right talus. Osteomyelitis was treated by curettage 3 times but recurred. A culture of the pus revealed mycobacterium fortuitum. He was successfuly treated with CAM, IPM, and CPFX administration combined with curretage and AMK cement beads insertion. This cement beads were replaced by the cancellous bone, and AMK and DKB impregnated hydroxyapatite 5 weeks later. Eight months after surgery, there was no signs of infection and he returned to his original job as a policeman.
We report two cases of pyogenic coxitis following pyogenic spondylitis. One case was a sixty-five-year old male treated for diabetes mellitus over a long period time, and the other case was a sixty-six-year-old male suffering from a subarachnoid hemorrhage and gastric cancer. They were confirmed to be immnocompromised hosts from their previous history of pyogenic spondylitis and iliopsoas abscess was seen in MR-imaging and CT. After treatment, pyogenic coxitis also occurred. The hip destruction of the first case continued since then, and the shape of the destruction was similar to a protrusio acetabuli seen in rheumatoid hips at the end. We therefore performed an operation using Bipolar hip arthroplasty with bone grafting. That of the second case was not progressive, so we chose a conservative treatment using only antibiotics. We believe that the direct route through the iliopsoas from the spine to the hip joint is the route of infection.
Progress in radiological diagnosis such as magnetic resonance imaging (MRI) improves the diagnosis of bone tumors. We however experienced false diagnosis by believing only these tools. We experienced 2 cases of osteomyelitis suspected with bone tumor. The first case was a 13-year-old boy who complained of left coxalgia. Conventional X-P and MRI suggested chondroblastoma or other bone tumors. The final diagnosis was Brodie's abscess by core biopsy. The second case was a 10-year-old boy who had high fever and right coxalgia inspite of using 4 kinds of antibiotics. The symptoms of the illness, CT, MRI, and Radionuclide bone scan suggested Ewing sarcoma. We made a definite diagnosis of acute osteomyelitis after open biopsy. Radiological diagnosis is very useful for supporting diagnosis. We however need to carefully evaluate the symptoms of the illness and abnormal findings in physical examinations.
We report a rare case of obuturator internus pyomyositis due to salmonella. A 13-year-old girl complained of left hip pain and slight fever. MRI revealed a high intensity lesion in the left obuturator internus muscle. Yellow pus was obtained by ultrasonograpically aspiration drainage. Laboratory finding and clinical symptons were improved by drainage, antibiotics, and hyperbaric oxygen therapy.
Gas gangrene mostly occurs after trauma, but we report a case of nontraumatic gas gangrene. A 75-year-old man with fever and right hip pain was referred to our hospital with a large gas area in the right gluteus muscle detected by Xp-ray and CT. Because we suspected gas gangrene, we performed debridement and open dressing. Clostridium septicum was proved by blood culture. He recovered by various treatments once, but died after four months.
We present a case of renal abscess with septic bilateral mobile buttock abscesses associated with diabetes mellitus. A 56-year-old man was admitted to our hospital for mild fever and pleural effusion. Staphylococcus aureus was detected by blood cultures. Two days after the admission, left buttock swelling appeared and was treated by antibiotics. Because it did not improve with antibiotics, surgical draining was performed. Three days after left buttock draining, his right buttock began to swell and the course was the same as the left side; antibiotics were not effective and surgical draining was performed. However although the bilateral buttock lesions were cured by surgical draining, intermittent fever continued. Ring enhanced cystic lesions of the right kidney was recognized by follow-up computed tomography and diagnosed as renal abscess. After percutaneous draining of the right renal lesion, intermittent fever improved immediately. The cause of the intermittent fever must be the renal abscess. Renal abscesses must therefore be taken into account when intermittent fever cannot be controlled by strong antibiotics therapy and local surgical draining.
Supracondylar fracture of the femur following total knee arthroplasty is a serious complication and the management of this complication is controversial. We treated supracondylar fracture of the femur using the Intramedullary Supracondylar Nail (IMSC nail). The advantages of using the IMSC nail are both biomechanical and biological, such as decreased lever arm, and biological advantages of having less periosteal stripping, and preserved alignment. The two largest advantages are the ease of placement of this device and the decreased operative time. The IMSC nail allows early range of motion exercises at the knee without the need for prolonged bed rest. Our case healed while preserving nearly all of the prefracturure range of motion and showed no complications. We concluded that the IMSC nail is an effective method for treating supracondylar fracture of the femur following total knee arthroplalsty.
We examined a surgical treatment and surgical results for pilon fractures. The subjects consisted of 27 men and 7 women with an average age of 47 years who were followed-up for 6 months to 8 years and 7 months (mean, 2 years and 1 month). We classified these fractures according to the Rüedi classification. Postoperative results were evaluated using R. Gay & J. Evrard's criteria for function and Burwell's radiographic criteria. The treatment for the Rüedi type I and II fractures was more or less open reduction and internal fixation (ORIF). The treatment for the Rüedi type III fractures was selected according to the type of comminuted fractures and soft-tissue injuries, and consisted of ORIF, external fixation, and external fixation with limited internal fixation. The results indicated that most patients were satisfactory except for some cases of Rüedi type III fractures. The selection of treatment is important, and should be made according to the type of fractures and soft-tissue injury.
From 1990 to 1998, 26 displaced intra-articular calcaneal fractures were treated operatively using lateral approach fundamentally. Results were evaluated using the Sanders classification with computed tomography and Maxifield clinical evaluation. Good postoperative evaluation results with CT scan, and anatomical reduction were achieved in 85% of these patients. Irrespective of the grades of the Sanders classification, the postoperative evaluation results of the CT scan were more or less satisfactory. The Maxifield clinical evaluation results were excellent in 42%, very good in 58%, fair and poor in 0%. Our clinical evaluation results more or less agreed with postoperative evaluation results by CT scan. We conclude that open reduction and internal fixation are effective in the treatment of displaced intra-articular calcaneal fractures.
We report a case of painful os peroneum syndrome. That was one of the largest os peroneums reported. The patient was a 49-year-old woman who complained of lateral base aspect of her right foot. It was not possible to reduce her complaints by conservative methods using equipment. We then performed excision of the os peroneum. After surgery, her pain disappeared and ankle motion was not limited. We recommend an operative method for prolonging pain caused by os peroneum syndrome.
A case of the failure of the ACE Retrograde Trauma (ART) Femoral Nail System (9mm, Titanium alloy) is presented. A 55-year-old female was injured in a traffic accident, and X-ray films showed right femoral supracondylar and shaft fracture. She was treated using an ACE Retrograde Trauma (ART) Femoral Nail System (9mm, Titanium alloy) at our hospital. Partial weight-bearing gait was started 4 weeks after operation, and full weight-bearing 6 weeks. The patient complained of right femoral pain 11 weeks after operation. The nail was broken at the proximal screw hole and femoral shaft fracture was displaced again. The patient was reoperated on using the Osteo IC-Nail System (11mm). The surface of the broken nail was analyzed by Scanning Electron Microscopy (SEM). It was shown that the cause of nail breakage was fatigue destruction. In conclusion, we should use larger nails in this case.
We report 4 cases of coronal fractures of the femoral condyle. They consisted of 2 men and 2 women whose mean age at the time of injury was 32 years. The cause of injury was motorcycle accident (2 cases), dashboard trauma (1 case), and struck by fallen snow (1 case). Three cases were treated with open reduction and one was performed by cemented TKA. The manipulation for the knee joint was performed on 3 cases, because of the contracture of the joint. We evaluated the clinical results 18.3 months after operation by the Neer's score. The results were excellent in 3 cases and satisfactory in 1 case. In our experiences, the surgical treatment for the coronal fracture of the femur provided satisfactory clinical and radiographical results. But to avoid joint contracture, the range-of-motion exercise should be begun as soon as possible after operation.
We report a case of large bone defect after open tibial fracture treated with bone transport. The patient was a 38-year-old male who had left open tibial fracture (Gustilo Type III B) caused by a traffic accident. Débridement and fixation of the tibia with K-wires were performed, however, osteomyelitis developed. We then inserted GM-beads and applied an external fixator. The osteomyelitis of the tibia, however, did not subside. Nine months after injury, segmental resection of the tibia including infectious nonunion was performed and an external fixator for bone transport was applied. We started bone transport 8 days after the operation and continued for 160 days. After the docking of the transported segment to the distal tibia, we lengthened the tibia by 1cm. After 9 months, we carried out cancellous bone graft from the ilium to the docking site. About 1 year later, union was obtained and the external fixator was removed. The healing index was 61 days/cm. During the follow-up of 3 years and 7 months, the patient had neither fracture nor recurrence of osteomyelitis.
Internal fixation by use of cannulated cancellous screws is a common orthopaedic procedure. However, screw holes through the lateral cortex of the femur cause reduction of the strength of the bone. We studied 2 patients who sustained subtrochanteric fracture at the level of the distal screw after the osteosynthesis of femoral neck fractures with cannulated cancellous screws. Their aetiology, prevention, and management are discussed. It is recommended that CCS should be inserted as far as possible from another screw. If subtrochanteric fracture occurs, removal of CCS and osteosynthesis with ENDER nails is advised.
Although the arterial rupture of lower extremity is usually associated with fractures, the subcutaneous complete rupture of the artery is quite rare. This article discusses a 58-year-old man who was injured by collision against a concrete wall. On initial evaluation, he was noted to have blunt trauma of the left thigh with no fracture. Three hours after the injury, paresthesia and motor weakness were recognized in his lower leg. Angiography was therefore performed and it showed complete rupture of the femoral artery. At operation, an extensive hematoma was evacuated and femoropopliteal bypass graft was performed. Postoperative angiography showed sufficient blood flow in the grafted vein. Postoperative follow-up of the patient after 8 months showed no paresthesia or motor weakness in his left leg.
Treatment of femoral shaft fractures following hip prostheses is difficult. We present five patients with periprosthetic femoral fractures. Four of these were after gamma nailing, one after total hip arthroplasty. They were all successfully treated by open reduction and fixation with Dall-Miles cables and compression plates. The Dall-Miles cable and plate system provides a reliable rigid internal fixation, without disturbing the bone cement or prosthesis. Fixation can also be augmented by unicortical or bicortical screws through the plate. Excellent clinical outcome was seen in all five patients and we suggest that this augmented fixation method be given further consideration when planning the treatment of difficult periprosthetic fractures.
Solitary bone cyst is common in tubular bones. However, it is extremely rare in the spinal column. Only nine cases have been reported with histologically proved solitary bone cyst associated with the spine. A 23-year-old man was referred to our hospital complaining of lower back pain for 3 years. Roentgenograms disclosed a well-defined radiolucent lesion in the fourth lumbar vertebra. Computed tomography scan disclosed cystic lesion in the fourth lumber vertebral body spreading to the left pedicle and articular process. MRI of the lumbar vertebra demonstrated the lesion, that is iso-intensity with respect to the spinal cord on T1-weighted image, and hyperintensity on T2-weighted image. At operation, we curetted the lesion of the cystic cavity filled with bloody fluid by the transpedicular approach. Alkaliphosphatase (ALP) of the fluid was twice the serous ALP Level. Histological examination showed a thin layer of loose connective tissue with no rimming of the epithelial cells consisting of solitary bone cyst.
Intraspinal osteochondroma is rare. Only 29 intraspinal osteochondromas were reported in the Bone Tumor Registry in Japan from 1972 to 1992 and this accounts for 0.4% of all osteochondromas. We report a case of intraspinal vertebral osteochondroma causing thoracic myelopathy. An 8-year-old boy was noticed to fall down easily on gait by his mother. He showed spastic gait, and one week later he had difficultly in walking progressively. Neurological examination revealed hyperreflexia of both lower extremities, right ankle clonus, positive Babinski signs, and sensory change under the level of Th4. A myelogram demonstrated a right lateral extradural mass with complete spinal block at Th1. Computed tomogram (CT) demonstrated an osseous mass arising from the right facet of Th1/2. A right hemilaminectomy of Th1 was carried out, and the osseous mass including the right superior articular facet of Th2 was excised. No spinal fusion was performed. Histopathologically, it was determined to be a benign osteochondroma. Eight months after surgery, neither recurrence of the tumor nor instability of the spine was seen.
Solitary myeloma is a rare disease and has better prognosis as compared with multiple myeloma. The present report describes a 64-year-old female. Her chief complain was lumbago and leg pain. Skeletal roentgenograms showed sclerotic lesion only in the sacrum. Serological examinations indicated the monoclonal component of Ig-Gλ in serum electrophoresis. Urine did not contain the Bence-Jones protein. Myeloma cell was not seen on examination of the bone marrow. We performed open-biopsy. Histological diagnosis of myeloma was performed, after which solitary myeloma was diagnosed. We performed radiotherapy with 45 Gy. 6 years after radiotherapy, lumbago and leg pain abated and the monoclonal component of Ig-Gλ disappeared. The patient did not show local recurrence and multiple myeloma.
Malignant lymphoma with osteosis is a rare disease. We report a case of malignant lymphoma seen in the third cervical vertebra body. A 63-year-old man experienced mild neck pain. Deep tendon reflexes were normal and symmetric. Sensory was intact. MMT was all 5. In the radiography, we found a lytic change in the third cervical vertebral body. We suspected metastatic tumor, but we could not find the primary tumor. We operated with instruments for spinal support. Diagnosis of the malignant lymphoma (B cell type) was by the post operative pathological examination. We performed chemotherapy. 4 months after surgery, there was no recurrence.
Chondrosarcoma arising from the thoracic vertebra is rare. Total excision in such cases is quite difficult because of its proximity to the vital structures such as the spinal cord, aorta, etc. Here we report two cases arising from the thoracic spine-One involved the T7 to T10 vertebral bodies and ribs and the other the T4 to T7. Both cases were histopathologically diagnosed as chondrosarcoma (Gradel) by open biopsy. The lesions were surgically removed through thoracotomy. The chest wall defects were reconstructed with Marlex meshes and posterior spinal instrumentations were employed in both cases. Preoperative detailed evaluation by MRI and CT is necessary for the surgical procedure for such tumors.
We report five patients with metastatic spinal tumor treated with Instrumentation surgery. They consisted of four males and one female. Their average age was 68 years old, ranging from 52 to 82 years old. Three had been previously diagnosed as colon cancer, rectal cancer or endometrial cancer. Two were diagnosed as prostate cancer or lung cancer after surgery. We performed posterior spinal arthrodesis with Horizon CD for all the cases. The operation time was 3.5 hours, and intraoperative bleeding was 297 gram on average. All the cases showed improvement of the activities of daily living (ADL). We recommended Instrumentation surgery for the treatment of metastatic spinal tumor.
Osteosarcoma rarely occurs in the hand. We report a case of osteosarcoma arising in the fourth metacarpal and review of the literature. A 40-year-old man suffered from the pathological fracture of the fourth metacarpal while playing volleyball. Bone tumor of the fourth metacarpal was found in radiographs of the fracture of the left index finger 15 years ago. Serological examination results including alkaline phosphatase were within the normal range. Pathological diagnosis of the incisional biopsy indicated possible mesenchymal chondrosarcoma. Wide resection and reconstruction with fibula graft were performed. Final pathological diagnosis was osteosarcoma, fibroblastic grade 4. Following surgery, chemotherapy was done. One year after surgery, bone union was achieved and the patient showed no local recurrence nor distant metastasis.
We report a case of broken Kotz modular system due to metal fatigue. A 25 year-old woman suffered left knee dislocation 9 years after total knee arthroplasty with Kotz modular femur and tibia reconstruction (KMFTR) system for osteosarcoma of the left proximal tibia. Roentgenograms showed breakage of the housing part in the proximal tibial component. At revision surgery of the component, bearing bushes had worn off and the housing part had severed into several blocks. Electromicroscopic studies showed many irregular cracks in the severed anterior face. These findings demonstrated that breakage in the housing part of the prosthesis was due to metal fatigue.
We reported a case of primary hyperparathyloidism (PHPT). The patient, a 19-year-old male, was suspected of pelvic tumor at first. We diagnosed this case at PHPT on the grounds of typical radiogram and increase of serum-calcium on blood examination. Differential diagnosis was necessary for bone cyst, giant cell tumor of bone, and McCune-Albright syndrome, etc. The parathyloid tumor was resected, and osteoporosis and serum-calcium improved 5 months after the operation. It is useful to test for serum-calcium in the screening of PHPT.
We presented a case which was strongly suspected of an extrapleural malignant solitary fibrous tumor within the muscle. A 74-year-old man presented a painless mass in his left thigh in May 1999. The lesion was depicted as a mass in his vastus lateralis muscle on MRI. The histological features of the tumor at open biopsy were spindle cell proliferation with myxoid and fibrocollagenous background and positive immunoreactivity for CD34. It was compatible for solitary fibrous tumor. The tumor was resected as a wide resection, and the patient received radiation therapy in the operation region. A lesser part of the resection specimen showed a malignant pattern. It was therefore suspected as a very rare malignant solitary fibrous tumor, only one reported to our knowledge.
Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease. The loss of sterol 27-hydroxylase in bile acid synthesis results in accumulation of cholestanol in the tendon and nervous system. We present the case of a 42-year-old male with CTX suffering from enlargement of the bilateral Achilles tendon and gait disturbance. Clinical features consisted of bilateral Achilles tendon xanthomas, mental retardation, pyramidal signs, cerebellar signs, and cataracts. CTX was diagnosed by normal serum cholesterol levels and high serum cholestanol levels as well as characteristic clinical manifestations. We performed partial rsection of the Achilles tendon xanthomas because of gait difficulty. The patient postoperatively obtained improvement in the range of motion of the ankle joint and gait ability. We are also treating the patient with chenodeoxycholic acid (CDCA) for the purpose of correction of biochemical abnormalities and improvement in neurological symptoms.
Malignant fibrous histiocytoma is the most common soft tissue sarcoma. We reviewed the results of treatment for this disease in 24 patients who were managed since 1986. They comprised 14 men and 10 women with a mean age of 56 years and mean follow-up period was 5 years. The primary lesion was treated surgically in all cases. Radiotherapy was given for the primary tumor, local recurrence, and metastasis in 7, 3, and 3 patients, respectively. Chemotherapy was given for primary and metastatic lesions in 11 and 3 patients, respectively. The survival rate determined by the Kaplan-Meier method was 72% at 5 years and 63% at 10 years. The survival rate was low in stages III B and IV B, with the median survival time being 3 years for III B and 10 months for IV B. Among the prognostic factors investigated, the site of the tumor was related to the prognosis. The relative risk was 9 and the 95% confidence interval was 1.5 to 59 in the patients with tumors of the trunk. The response of chemotherapy was NC and PD in 3 patients each, while that of radiotherapy was NC and PD in 4 and 6 patients, respectively. Thus, this disease was resistant to adjuvant therapy. The survival rate of patients who were alive without symptoms at 5 years after treatment was relatively high subsequently. However, the response rate of advanced disease to adjuvant therapy was low, indicating the need to develop new treatments in the future.
We experienced a typical rare case of dedifferentiated liposarcoma. MRI showed that the mass was consisted of two different elements. The proximal element showed high intensity with T1WI and low intensity with T2WI. The other, a distal element, showed low intensity with T1WI and iso-intensity with T2WI. From these images, we diagnosed this mass as dedifferentiated liposarcoma. We resected the mass around the marginal margin, and found that it was dedifferentiated liposarcoma, histologically. The patient is alive without reccurence.
We report of 24 patients who underwent surgery to repair rotator cuff tears from 1997 to 1999. All cases were followed-up for 4 months to 2 years and 6 months (average; 12.3 months). They consisted of 13 males and 11 females whose ages ranged from 47 to 82 years with an average of 63.1 years. The tear size varied from small to massive (small; 2, medium; 6, large; 6 and massive; 5 cases). The small, medium, and large cases were repaired using McLaughlin's technique. The massive case was repaired using McLaughlin's technique with subscapularis transfer or teres minor transfer. One case underwent reparation of the deltoid and rotator cuff suture. The clinical results were evaluated by the Japanese Orthopedic Association (JOA) score. The JOA score of all the patients improved from 56.5±5.6 to 93.5±9.6 points. The cases which could be repaired by McLaughlin's technique had good results regardless of the tear size and age. The result of the massive tear was inferior to the other cases. Showed slow ROM improvement without contracture, suggesting those with muscle weakness or atrophy may take time to recorer.
We present 3 cases of recurrent anterior dislocation of the shoulder with rotator cuff tear in the aged. All cases were of females and their age range was from 56 to 76 years. One case had traumatic history but two cases did not. Two cases had repeated anterior dislocations of the shoulder, and one case had repeated dead arm. MRI did not show typical findings of the recurrent anterior dislocation of the shoulder as in Bankart lesions. All cases however had rotator cuff tear (supraspinatus). In arthroscopy, all cases had massive rotator cuff tear along the fiber direction. All rotator cuffs were sutured and no cases showed repeated dislocation of the shoulder after operation. Rotator cuff tear often causes unstable shoulder in the aged. Repair of the rotator cuff tear is therefere more effective than common treatments for recurrent anterior dislocation of the shoulder.
A fifty-four-year-old man complained of dysbasia with exacerbating numbness of the abdomen and lower extremities, but no subjective symptoms of the upper extremities. On physical examinations, gait was spastic, and sensory disturbance was found in the same lesion as numbness, but motor loss was not found, reflex of lower extremities were hyper-reflexia and Babinski's reflex was observed. The JOA score of the thoracic myelopathy was 7.0 per 11.0 full points. Mixed type ossification of the posterior longitudinal ligament (OPLL) from C5 to Th7 was found on plain roentgenograms and tomograms. About 60% severe spinal canal stenosis of C7/Th1 and Th2/3 was observed on CT and MRI, suggesting myelopathy accounts for the spinal canal stenosis due to C7/Th1 or Th2/3 OPLL. We performed Crutchfield skull traction to minimize the dynamic factor of myelopathy. An improvement of the subjective symptoms was observed after five days of traction, suggesting it may be effective for improving symptoms. Therefore, we performed an anterior interbody fusion of only C6/7 and C7/Th1 but not Th2/3. Numbness and spastic gait were cured after the operation. Three years after the operation, the patient was able to walk more than 5km. The JOA score improved from 7.0 to 9.5 points.
We studied the clinical course of 5 patients (2 males and 3 females) with rheumatoid arthritis (RA) whose first symptoms were foot or ankle pain. To assess the changes in swollen feet and ankles, we examined them by fat-suppressed, gadolinium-enhanced magnetic resonance imaging (MRI). In each patient, the synovium or Achilles tendon sheath showed high signal intensity. It is difficult to diagnose early stage RA in patients complaining of pain and swelling of the foot or ankle. Fat-suppressed, gadolinium-enhanced MRI however proved useful for detecting tenosynovitis in the foot or ankle and for early diagnosis of RA.
We performed percutaneous suction aspiration and drainage on six patients suffering from pyogenic spondylitis. In one case, recurrence of the inflammation occurred, however, five cases showed satisfactory results after this treatment. This technique was successful for obtaining bacteriological diagnosis, relieving the patient's symptoms and assisting in the eradication of the infection.
Twenty cases underwent posterolateral fusion with the Diapason pedicle screw system for unstable spine. All patients were followed-up radiographically. One third of the patients showed loss of correction in %slip and slip angle. This reduced the lordosis in the lesion. We concluded that the reduction for unstable spine is difficult to be maintained with the Diapason system.
22 aged cases (over 65 years old) and 21 adult cases (under 65 years old) of lumbar canal stenosis treated by fenestration are compared. The average age at operation was 70.0 among the aged and 53.3 among the adults. The average follow-up period after the operation was 3.3 years among the aged and 3.1 years among the adult. The JOA score of pre and postoperation, recovery rate by Hirabayashi, preoperative complication, radiological instability were studied. In the aged patients, the average JOA score improved from 13.6 points to 20.4 points and the recovery rate was 44.3%. In the adult patients, the JOA score changed from 12.6 points to 21.6 points, and the recovery rate was 56.0%. The aged patients did not show remarkable changes in the ADL score. Preoperative complication was found in 12 cases (57.1%) among the aged, and in 4 cases (18.2%) among the adult patients. Preoperative complication interrupts ADL improvement in aged patients. Radiological instability was found in only 3 aged patients, whose recovery rate was under 50%.
We reviewed a case of myasthenia gravis leading to degenerative scoliosis. The patient was a 62-year-old woman, who has been receiving treatment for myasthenia gravis since 33 years old. Her spinal deformity progressed rapidly during the last 7 years. Magnetic Resonance Image revealed atrophy of the paravertebral muscle and severe compression of the spinal cord. Instrumentation from Th11 to the ilium and posterior decompression were performed. After the operation, low back pain and intermittent claudication disappeared.
In many unstable distal radius fractures based on osteoporosis, if reduction is once gained, maintaining the reduction is difficult. We performed open reduction with bonegrafting, internal fixation with Kirschner wires, and external fixation. The fixator was applied with no gross distraction. We evaluated the results for ten patients with osteoporosis estimated by dual energy x-ray absorptiometry. Adjacent joint motion was encuraged immediately. The external fixation was removed at 6 weeks and wrist active exercises began. The average duration of follow-up was 16 weeks. At the follow-up examination, the range of motion of the adjacent joints was full; Dorsal flexion of the wrist averaged 87.8 degrees, volar flexion of the wrist 81.1 degrees, ulnar deviation 60 degrees, and radial deviation 27.8 degrees. The result was assessed by Saito's scale. According to the scale, all the patients were excellent.
To study the features of the neural arch in the immature lumbo-sacral spine with special reference to spondylolysis, we measured the angle between the upper-line of the vertebral body and the upper-line of the spinous process under functional X-ray (V-S angle) This paper reports on the assesment of the V-S angle in 114 cases of consecutive children and adolescent who visited our clinic for low back pain. There were 79 boys and 35 girls, whose mean age was 15 years (7 to 17) old. Spondylolysis was found in 16 cases (14%), spondylolisthesis in 4 cases (3.5%), and 97 cases were active in sport. In the 97 cases (85%), positive movement of the V-S angle (more than 3°) was seen all cases of spondylolysis and spondlolisthesis, and in 77 cases (82%) in the other group. In the athletes group, 83 cases (86%) showed positive movement. On the other hand, 15 cases (84%) in the non athletes group showed the same resalts. The bone age was classified into 3 groups, as (-) group I to II degrees group and III degrees group (complete excursion) according to the development of iliac apophysis. Positive movement was seen in 87% of the (-) group, in 92% of the I-II group and in 76% of the IV degree groups. Thus the frequency of the non-movement of the posterior element seemed to increase in the older group. In conclusion, a high frequency of the positive movement of the V-S angles was proved in immature lumbo-sacral spines. There was no correlation between active athletes and non active athletes.
We reviewed four cases of revision total hip arthroplasty (T. H. A.) which utilized bone allograft. The bone for allograf t was reserved at 80 degrees and processed using Telos Lobator sd-2. All cases were female, whose age ranged from 68 to 78 years (average: 73.5 years). The follow-up period was from five months to 12 months (average: 7.8 months). There were no evidence of infection and osteolytic change in X-P. The bone allograft seems to be a suitable method for revision total hip arthroplasty.
A 72-year-old male complained of low back pain, dysesthesia in the right lower limb, and difficulty in walking. Examination showed muscle weakness in the lower limbs marked on the right side and sensory disturbance in the right lower limb. Myelogram showed a complete block at the level of the 9/10 thoracic disc. At the same level, myelo-CT scans and MR images demonstrated a right-sided mass that compressed the ventral wall of the dura matar. In operation, after incision of the dura matar posteriorly, a herniated disc material were found intradurally and extra-arachnoidally. After removal of the disc material, a hole was formed in the ventral wall of the dura matar through the Th9/10 disc space. Postoperatively, the patient recovered extremely well.
Snapping elbow is a comparatively rare disease. We report two cases of snapping elbow caused by the annular ligament. The first case was a 44-year-old man. Overworking his left elbow caused snapping elbow. The second case was a 22-year-old woman. She had bilateral elbow snapping from childhood without pain. She started to practice gymnastics when she was in the fifth grade of her elementary school. She finally felt pain in her snapping elbows when she was 22 years old, and therefore underwent operation of both side elbows. We resected the obstacle liaked to her annular ligament at the radio humeral joint, and obtained good results.
Rehabilitation programs for patients after anterior cruciate ligament (ACL) reconstruction have generally focused on redeveloping functional strength of the knee musculature through a combination of closed kinetic chain (CKCE) and open kinetic chain exercises, although closed kinetic chain exercise has been more popular. Previous studies have demonstrated increased anterior tibial translation with open chain compared to CKCE. Normal static squat is generally one of the most popular CKCE. Basically, this exercise is hamstring and gluteus muscle exercise. The most important rehabilitation program after ACL reconstruction is quadriceps exercise. However, no studies have been published documenting the differences in tibial translation with trunk flexion and examining the effects of quadriceps contraction. The purpose of this study is to compare the electromyographic variables and anterior tibial translation when squatting on both legs in two different weight bearing positions and to examine the influence in the change in the trunk flexion angle. Maximal sagittal plane knee translation during squatting was investigated in 10 healthy subjects without any previous history of knee joint trauma using an electrogoniometer system (CA-4000, OS Inc., Hayward CA, USA). The CA-4000 was also used to measure tibial translation with two methods squatting at the variable trunk flexion. For each condition, angle of maximum translation were recorded and compared between the two conditions. The two exercises, normal squatting and tip toe weight bearing squatting, were simulated by adjusting tibial anterior translation across the knee at each flexion angle. The subjects then performed five bilateral squatting movement with no external load. Anterior tibial displacement was measured at every five degrees of knee flexion from 0 to 90 degrees. The electromyograms (surface EMG, Universal Ltd.) were monitored via telemetry for the vastus medialis, biceps femoris of the right leg. Surface EMG data were normalized to the percentage of the maximum voluntary contraction, the third highest surface EMG activity. The trunk flexion angle increased, and anterior drawer displacement decreased with normal squatting. As the trunk flextion angle increased, anterior drawer displacement did not increase with tip toe weight bearing squatting. Upon full extension of the trunk, anterior drawer displacement showed no significant differences between the two squatting methods. The amplitude observed on the electromyograms of the hamstrings increased as the trunk flexion angle increased, and the amplitude on the quadriceps increased with tip toe weight bearing squatting.
We treated a case of bilateral epiphyseolysis of the radial neck in a child. She was injured when she landed with her arms outstreched while practicing handspring, resulting in a pronation and flexion of the elbows. At the time of impact, her elbows were forced into valgus slightly, compressing the surface of the radial head and fracturing the proximal end of the ulna. Angulation of the right radial head was 70 degrees, and that of the left was 85 degrees. The case was classified as the severe group described by O'Brien (O'Brien type III). Closed manipulation was not successful, so we treated her by the percutaneous leverage method under general anesthesia. Many complications by open reduction such as limitation of the elbow and forearm movement, avascular necrosis and pseudoarthrosis were reported. On the other hand this method was demonstrated to be extremely useful and easy. Depression of the epiphysis over 60 degrees, as seen in this case, move or less requires some dislocation, thereby resulting in early closure of the epiphysis in most cases. The degree of valgus also depends on the remaining growth of the radius. It is concluded that the treatment of this epiphyseolysis should be by the closed method whenever possible. Internal fixation is seldom necessary and has its complications.