We examined 5 cases of pubic osteolysis. All 5 cases were females ranging from 56 to 81 (average; 68.4) in years of age. A history of trauma was seen only in 1 case. Radiographs showed osteolytic region in the pubic bone of all the women, 3 of whom had pelvic bone fractures. 3 cases had osteopenia, 1 as a result of systemic lupus erythematosus, and the others rheumatoid arthritis. The degree of osteopenia was evaluated using Singh's index. Singh's index in all patients ranged from grade 2 to 3, and 4 patients had vertebral compression fractures. Laboratory studies revealed no remarkable changes. In all cases, the initial complaint of pain around the pelvis gradually subsided with conservative therapy. The results suggest that pubic osteolysis accompanies insufficiency fractures occurring in the pubic bone. A more conservative approach should be adopted for these patients.
We assessed the lumbar bone mineral density (BMD), body mass index (BMI), height, and weight of 800 people (400 men and 400 women aged between 31 and 50 years). All were teachers. The results obtained were as follows: The age, height, BMI, and weight were the same as the previous study. The BMD increased incrementally with the distal level through the lumbar spine (L2 to L4). The average BMD of the women was greater than the men's. The men's average BMD of the L2 was clearly higher than that of the women's (the women's BMD was 0.94, and men's BMD was 0.99 (p<0.05)). On the contrary, the men's average BMD of the L4 was clearly lower (the women's BMD was 1.056, and men's BMD was 1.027 (p<0.05)).
Twenty-three children with fracture or epiphyseal separation of the distal radius were treated with intrafocal pinning (IFP). Fifteen were boys and eight were girls. The age at surgery ranged from 8 to 15 years (mean age: 11.3 years). There were 14 extra-articular fractures and 9 epiphyseal separations (Salter-Harris type II in 8 and type III in 1). Follow-up ranged from 2 months to 42 months. The results were evaluated according to the radiographical measurements of the palmar tilt, radial inclination and ulnar variance, and were evaluated by Saito's demerit point system. The palmar tilt was reduced within the normal range in 22 of the 23 patients. The radial tilt was reduced within normal range in 21 of the 23 patients. Zero variance was achieved in 21 patients. These reductions were maintained through the end of the follow-up. All of the 11 patients who visited us for evaluation were classified as excellent. The IFP method is not only minimally invasive but also stable enough to enable early ROM exercise. We can conclude that IFP is useful for distal radius fracture and epiphyseal separation in children.
The functional and anatomical results of the distal end of radius fractures in 25 elderly patients are reviewed in this retrospective study. The average age of the patients was 70 years (range: 60 to 88 years) and the average follow-up time was 24 months (range: 6 to 88 months). Twenty-one fractures were treated by percutaneous pinning, two by plate, and two conservatively. According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were excellent in 52% of fractures and good in 48%. The anatomical results were evaluated by following three parameters in the final radiographs: radial tilt, ulnar variance, and palmar tilt. The average radial tilt was 20.5 degrees, ulnar variance was 3.7mm, and palmar tilt was -2.5 degrees respectively. The values of ulnar variance and palmar tilt were often found to be out of the normal range. Most of the patients had satisfactory outcome and the functional results did not correlate with the magnitude of residual deformities in the final follow-up radiographs. The grip power was the most significant factor related to subjective evaluation, and did not improve significantly in patients with fractured nondominant hands. All patients had excellent or good functional outcome irrespective of radiographic evidence indicating minor deformities.
The change in the range of motion and the factors influencing the postoperative flexion after NexGen posterior stabilized total knee arthroplasty were studied in 56 knees of 44 patients. Forty-six NexGen posterior stabilized knee prosthesis (PS type) and 10 NexGen legacy posterior stabilized knee prosthesis (LPS type) were used. The average follow-up period was 17 months (range: 12 to 48 months). The mean preoperative flexion was 128 degrees. At the final follow-up, the mean flexion was 127 degrees. Twenty-seven knees (49 percent) had a maximum flexion of more than 130 degrees at the final follow-up. There was a significant correlation between postoperative and preoperative flexion.
Gait analysis in six cases (osteoarthrosis: 5 cases, rheumatoid arththritis: 1 case) was perfomed before and after surgery to evaluate the effect, of Total Knee Arthroplasty. Each assessment was carried out using a large sized force plate and two motion camera systems. We compared the stability of gait before and after surgery in addition to common gait parameters. We used the original index comparing the stability, which normalized the Y-components tracing of the center of gravity by the maximum metakinesis of the center of foot pressure. Gait stability and velocity improved significantly, and lateral movement of the center of gravity was markedly smoother after surgery. The stability index of the center of gravity did not differ significantly diference between before and after surgery, but tended to be lower.
This study was performed to assess the influence of the femoral component size in total knee arthroplasty (TKA) on the clinical results, including the angles of the component position, the Japanese Orthopaedic Association (JOA) score, and the range of motion (ROM). We studied 51 knees in 45 cases (4 males and 41 females) who were treated by Nexgen CR TKA between February 1998 and December 1999 and could be followed-up. The mean age was 74 years (58 to 87). The average follow-up period was 13.5 months (5 to 27). Preoperative and postoperative anteroposterior widths were measured and compared with preoperative anteroposterior widths, and 51 arthroplasties were divided into three groups (smaller, same, larger). The angles of the component positions, JOA score, and postoperative ROM in the three groups were similar. The femoral conponent sizing method practiced today is considerd appropriate with regard to the clinical results.
To avoid severe kyphotic deformity due to multi-level osteoporotic vertebral fractures, an inter-spinous processes fixation technique using several instruments at the thoraco-lumbar region was employed in 9 cases. The extension of the motor segment is believed to decrease the compression force on the anterior column and the approach of faced each spinous processes. In the first 2 early cases, 2 segments were fused by wiring, and were followed up for 14 years and 12 years, the fixation levels remained on unchanged in spite of many vertbral fractures occured apart from the fixation lelvels. In another 7 cases, more than 2 levels were fixed using the Apophix Hook system in 2 cases, the Isola system was combined with wiring in 4, and only the Isola system was used in 1. Complaints resulting from the thoraco-lumbar fracture decreased in all cases after surgery. The average kyphotic deformity level of 33.5 degrees at the local levels could be corrected to 18.4 degrees after surgery, but within 6 months after surgery, an average loss of correction of 6 degrees was seen, after which conditions stabilized. This technique is considered the effective for preventing severe deformity by the simple and mild fixation of the selected levels. In the future, a combination of vertbroplasty and this technique may be recommended for preventing the loss of correction.
This study reviewed the relationship between the prognosis of 15 patients with compression spine fractures by osteoporosis and gadolinium-enhanced magnetic resonance imaging characteristics. All patients had undergone conventional and gadolinium-enhanced magnetic resonance imaging within 4 weeks of onset of the fractures except for 3 patients. Gadolinium-enhanced magnetic resonance imaging findings were classified into two types: fully vertebral body-enhanced type and partially vertebral body-enhanced type with the former, the degree of compression in the vertebral fracture did not become aggravated and back pain was easily relieved. With the latter the conditions of most of the patients become worse and back pain continued. These results suggested that patients who are partially vertebral body-enhanced continue to suffer back pain, and conditions become worse. The findings of the gad linium-enhanced magnetic resonance imaging were also found to be useful as a factor of prognosis for patients with compression spine fractures.
We experienced 42 patients with upper lumbar disc hernia over the past 12 years. 34 patients were male and 8 patients were female. Anterior spinal fusions were performed on 11 patients, and posterior nucleotomies on 31. The patients' average age was 40.8 years. Their pre-surgical symptoms were mainly lumbago, femoral pain, and some caudal syndromes. Most hernias prolapse centrally, and in some patients they prolapse posterior ligaments. Degenerative spinal disorders were seen in 75% of patients. Adolescent patients were found to be engaged in physical work and sports mainly, while middle and older patients in physical work. Obesity was seen in every age. Symptoms of upper lumber disc hernia were considered caused by upper lumbar canal's anatomical shape. And kyphosis was considerd as a important factor of onset of upper lumbar disc hernia.
The study investigates lower lumbar segments (L4-5, L5-S1) with disc herniation with respect to posterior vertebral shifts, the orientation of facet joints, age, sex, and body mass index. Decubitus lumbar radiographs as well as magnetic resonance imagings of 173 patients (226 segments) were analyzed. The results support biomechanical considerations, that the posterior vertebral shifts lead to the migration of herniated disc at L4-5.
We reported the surgical results of two patients with tethered cord syndrome. Case 1 was a 12-year-old girl complaining of low back pain, urinary incontinence, motor weakness, sensory disturbance of the lower extremities, and bilateral pes cavus. Radiological findings and MRI revealed the spina bifida of the sacrum, conus medullaris located at the L1 level, and the filum terminale running dorsally. The tight filum terminale was confirmed during surgery, and resection of the filum terminale allowed the caudal displacement of the conus by as much as 1cm. Five years after surgery, all the symptoms except the pes cavus improved. Case 2 was a 13-year-old boy complaining of gait disturbance and urinary incontinence. He showed cutaneous dimple on the sacral area. Although he showed hyperreflexia of the lower extremities, neither motor weakness nor sensory disturbance was seen. Images showed the spina bifida of L5 and sacrum, and low and dorsally placed conus medullaris at S1. During surgery, we confirmed a fibrous band connecting the sacral dimple with the dura, and thickened filum terminale. Resection of the filum terminale and release of the fibrous tissue allowed cranial displacement of the conus by 1cm. Five months after surgery, all the symptoms except the pes cavus improved.
We report a case of a 50-year-old man with adult-onset tethered cord syndrome of the lumbosacral lipoma. Clinical symptoms were progressive bladder and sexual dysfunction, and back pain for 4 years. For the purpose of loosening the spinal cord, spinal shortening between the Th12 and L1 vertebrae was performed. There were no surgical complications. 6 months after surgery, his sexual functions improved. Spinal shortening is an effective method for adult patients with tethering cord due to lipoma.
A 72-year-old woman experienced severe left lower extremity pain associated with muscle weakness and sensory disturbance. Rentgenograms of the thoracolumber spine showed old compression fracture of L1. MRI studies showed spinal canal stenosis at L1 upper vertebral level. The patient's symptoms was thought most likely caused by the spinal canal stenosis, we performed anterior spinal instrumentation surgery on the thoracolumbar spine Th12-L2. No problems were encountered during the operation, but her left lower extremity showed cyanosis one day after the operation. Emergency angiography showed chronic occulusion of the terminal abdominal aorta, and she was diagnosed with Leriche's syndrome. The deterioration was thought to have been segmental arteries approaching to the vertebral body. Since consevative therapy was not effective so axiller-femoral bypass grafting operation was done.
Between July 1996 and April 1999, we treated 5 thoracolumbar burst fracture patients with anterior decompression and reconstruction using the Kaneda SR system. We studied the neurological changes, complications, changes of kyphotic angle, and unions of bone graft in these cases. Neurological findings improved in all cases by at least one rank of Frankel's classification. There were no serious complications. Good sagittal alignments and bone unions were obtained in all cases on X-ray photographs. Anterior decompression and reconstructive surgery is a useful treatment for thoracolumbar burst fractures.
We report a case of degenerative lumbosacral kyphosis for which posterolateral intervertebral fusion was first performed, but failed to relieve, severe back pain which the patient complained of. We performed posterior wedged osteotomy of L4 and fusion from L2 to S1 using the intrasacral fixation technique. We believe the previous operation failed because maneuvering only the disk region was not enough for improving kyphotic lumbosacral alignment. Intrasacral fixation with vertebral osteotomy is an effective method for the correction of degenerative lumbosacral kyphosis in that it can improve the kyphosis of the lumbar spine, as well as reduce the posterior tiliting of the sacrum which we regard as the 6th lumbar vertebrae. It is for this reason that we chose ISF. One year after the operation, the patient is free from the severe back pain which had prevented him from walking.
We studied 39 cases which were operated for lumber canal stenosis. Retrospectively, it was very important to know the degree of canal stenosis of the lumber spine in extension to determine whether to include the moderate stenosis site in the operated area. The dynamic study of myelography was useful, but it was harmful in some aspects such as drug toxity and irradiation. We found that it was possible to obtain the same information as the dynamic study from the lateral view of the MR myelography of the lumber spine in extension.
There are few reports on the rupture of the ischial origin of the hamstring muscles among the rupture of all muscles. We report a case of rupture of the ischial origin of the hamstring muscles. A 48-year-old male complaining chiefly of pain in the posterior part of his right thigh after slipping on rollers while carrying something. He fell with his right knee extended and his right hip flexed in exessive flexion. He felt pain around the posterior part of his right thigh, and could not stand up and walk. We recognized recess at the distal part of the ischial tuberosity and a bulge at the posterior center part of the thigh. MRI (T2_??_) imaging showed a low signal area that was assumed to be the avulsive part. 3 days after injury, we performed surgery with reattachment of the avulsive muscles to the ischium. 9 months after surgery, he returned to his job.
We report a case of leg lengthening for an atrophic limb using the Ilizarov method. The patient was involved in an accident in which a falling rock hit and injured his right knee when he was four years old, and for which he received treatment at another hospital. As he grew up, his leg length discrepancy became obvious. When he first visited our hospital at age eleven, the patient was limping due to his leg being 4cm shorten than his left. In angiography, popliteal artery was found to be completely obstructed. We planned to perform leg lengthening by the Ilizarov bone transport technique, and devised a preoperative plan of taking two rotational angiography in order to avoid injuries to the co-lateral arteries by surgical procedures such as osteotomy and the insertion of pins. We achieved 4.3cm lengthening and the patient's limp improved. There were no major complications in the operative and post operative periods. We believe the Ilizarov method is necessary to perform the operation according to the preoperative plan, since it allows the flexible insertion of pins.
We studied 25 patients who underwent surgical treatment for tibial condylar fractures with a mean follow-up of 3 years 1 month. We evaluated the clinical results according to Hohl & Luck's criteria. 24 patients achieved excellent or good results of functional grading and 22 patients achieved excellent or good results in anatomical grading. Our study results suggest that anatomical reduction is an important factor for treating this fracture.
The juvenile Tillaux fracture is a Salter-Harris Type III intraarticular fracture of the ankle in adolescent children whose distal tibial epiphysis is partially closed. This fracture is caused by the avulsion of the lateral portion of tibial epiphysis by inferior tibiofibular ligaments during the lateral rotation of the foot at the ankle. We treated two cases. Both cases were examined with CT scan, underwent open reduction and internal fixation with bioabsorbable osteosynthetic implants. The range of motion and functional results were excellent. When displacement is more than 2mm, open reduction and internal fixation should be performed to reduce the articular surface.
Seven cases with medial malleolar fracture were treated using tension band wiring that involved the use of a screw to anchor with a figure eight wire. In all cases, satisfactory results were obtained. This method reduces soft tissue stripping and retraction associated with the creation of a hole for the wire, reduces the possibility of wire cut out through the osteoporotic bone, and provides stable fixation.
We report 7 cases of the triplane fracture of the distal tibia (5 males and 2 females). The age at injury ranged from 12.1 to 16.4. The average age of the male cases was 15.0, and that of female cases was 12.4. One case which did not show displacement was treated with casting without reduction, five cases underwent surgical treatments after open reduction, and the last case underwent performed percutaneous internal fixation after manual reduction with K-wire. All cases showed good results without pain, restriction of the range of motion, or deformity. Anatomical alignment is important, and reduction is necessary if displacement is evident.
The Westhues' method or closed reduction (Omotos' method) appears to be an effective treatment for calcaneal fracture. Some patients, however, complain of persistent pain. We report 4 cases (5 feet) showing surgical complications of calcaneal fractures. These complaints are related to the occupation of the patient, especially patients who were carpenters and streetplejack often complained of persistent pain at the talo-calcano joint or the external malleolar region. Such cases require not only accurate reduction of the talo-calcano joint, but also correction of the prominent buldging of the lateral calcaneal cortex. CT, Peroneal synovigram, and block were effective for diagnosis.
We evaluated the clinical results of talar fractures in twelve patients and thirteen feet. Eight patients were men, and four were women. The mean age of the patients was thirty-three years (range; 14 to 64). The type of fracture was classified by the Marti-Weber system. There were five type II fractures, five type III, and three type IV. Type I fractures are minor injuries, and were therefore excluded from this study. We used the Hawkins' scoring system for the evaluation of the clinical results. The latest follow-up revealed five excellent results, seven good, and one fair. Hawkins' sign was seen on seven feet at an average of 7.5 weeks after the injury, but not on the remaining of six feet. Three progressed to the avascular necrosis of the talar body.
We reported two cases of compression neuropathy of the common peroneal nerve misdiagnosed and treated as lateral meniscus lesions. Case 1. A 24-year-old man complaining both knee pain had visited a hospital and had been diagnosed as both lateral menicus lesions. He had accepted four times arthroscopic surgery on each knee in the hospital during 10 years. Because his pain remained unchanged, he visited our clinic in August 1997. Case 2. A 24-year-old female had accepted arthroscopic meniscectomy for left lateral knee pain. Postoperative course was uneventful. Two years after the operation, she noticed left lateral knee pain and spastic feeling on the lateral aspect of her left leg. She visited the same hospital. She was diagnosed as having recurrence of lateral meniscus tear and was suggested operative treatment. She visited our clinic in April 1999. We diagnosed these patients having a compression neuropathy of the common peroneal nerve and tried nerve blocks at compression site. Since the effect of the blocks was temporary, neurolysis was performed. The complaints of the patients disappeared in the evening of the operative day and they satisfied the results. On differential diagnosis of lateral knee pain, it should be differentiate compression neuropathy of the common Peroneal nerve.
A 69 years old male presented with a large Baker's cyst in his left knee. He previously underwent the arthroscopic meniscectomy with a diagnosis of the medial meniscus injury of the left knee. Some authors have reported about the Baker's cyst occurred after the arthroscopic meniscorrhaphy, but, to our best knowledge, there is no report about the Baker's cyst occurred after the arthroscopic meniscectomy. This report describes the rare case about the Baker's cyst occurred after the arthroscopic meniscectomy and its process to the open surgery.
Between June 1998 and January 2000, 83 patients underwent preoperative MRI and subsequent arthroscopy. Twenty-two patients were available for this study. They had undergone arthroscopical meniscectomy, and follow-up MRI was obtained three months after arthroscopy. Intensity change of the bone marrow was recognized in five patients (23%), which suggested osteonecrosis or edema of the subchondral bone. Lateral subluxation of the retained lateral menisci occurred in three patients. Since the frequency of abnormal findings is low and the cost of MRI is expensive, we recommend follow-up MRI after arthroscopic meniscectomy only when the patients have sustained symptoms.
We examined the degeneration of the lateral meniscus (LM) by MRI in 47 knees with OA. The average age of the patients was 65.5 years (range from 47 to 90). They were divided into two groups radiographically by Kellgren classification: One group was classified as early stage, consisting of grades I and II, and the other as advanced stage, consisting of grades III and IV. There were 22 knees in the early stage, and 25 in the advanced stage. The MRI findings were evaluated according to Mink's classification. Grades 3A and 3B were regarded as significant degeneration. In the early stage, a significant degenerative area was observed in the anterior, middle, and posterior regions in LM at the rate of 18.2%, 9.1%, 13.6%, respectively in MRI. On the other hand, in the late stage, the degenerative area was observed in the anterior region at the highest rate of 48%; In the middle and posterior regions, the rate was 28% and 24%, respectively. The tendency for the anterior region in LM to degenerate more frequently in the late stage may be correlated with the loose attachment to the capsular ligament in the subpopliteal recess in the posterior region.
We examined 16 knees in 16 patients aged over 40 (range: 43 to 77, mean: 56), with a follow-up time of more than 10 years after arthroscopic meniscectomy. We classified these patients into two groups: mild type and severe type. The mild group consisted of patients with a low grade of preoperative osteoarthritis (Fairbanks grade 0, 1), while the severe group consisted of patients with a high grade (Fairbanks grade 2 to 4). We evaluated the two groups regarding JOA score, radiographical changes and activities in daily life. The mild group showed good results on the whole, similar to the general results of arthroscopic meniscectomy in adolescents. There were two knees that had to re-operated in the severe group. We concluded that factors of pour results are poor alignment (FTA) after operation, and continuing activities before and after operation.
We reviewed the early clinical results of 19 pertrochanteric fractures treated with the Proximal Femoral Nail (PFN). The average age of the patients was 78.4 years. The mean follow-up period was 70 days. The fractures were grouped into 5 types according to the Jensen classification. There were no significant differences between the sliding of lag screws in stable and unstable fractures. Intra-operative and extra-operative complications were one fracture of the lateral cortex and two cases of excessive telescoping. It appears that the hip pin of the PFN method might at least prevent rotational instability of the femoral head.
We treated 35 trochanteric fractures of the femur using Proximal Femoral Nails (PFNs) in 5 men and 30 women with a mean age of 84.1 years (range from 65 to 97 years). According to AO classification, they were classified into 31-A1 (20 cases), 31-A2 (10 cases) and 31-A3 (5 cases). The mean PFN operation time was 52.4 minutes (range from 26 minutes to 90 minutes) and the mean amount of hemorrhage was 86.9 grams (range from 20 to 200 grams). We reamed the femoral shaft only in one case due to the thin diameter of the femoral shaft, which caused femoral shaft fracture during operation. After a follow-up period of at least 4 weeks, 17 cases could walk with or without crutches. We did not observe the cut out of the lag screw or hip pin. However, 12 cases showed over-telescoping (more than 11mm) of fracture, which caused various deformities of femoral proximal regions in 5 of them. Telescoping tends to be seen in the 31-A2 type cases and/or cases with severe osteoporosis without using the distal screw of the PFN method. These results suggested that the distal screw of the PFN should be used in 31-A2 type cases and/or cases with severe osteoporosis.
From May 1995 to July 1999, we operated on 57 cases with trochanteric and subtrochanteric fractures of the femur, using the gamma nail on 54 cases, IMHS on 2 cases, and ¥ nail on 1 case. In this study, we evaluated the post-operative results of the ambulation status and alteration of X-rays. Twenty nine patients (85.2%) regained the ability to walk. Five of the 7 patients who did not regain the ability to walk had senile dementia. To evaluate alteration in X-rays, we defined two types of reduction pattern, focused on the aligment of the calcar femorale; one is “sinking type”, and the other is the “gearing type”. During the process, the degree of telescoping and decrease of collodiaphyseal angle were larger for the sinking type. For alteration in X-rays, we could not detect significant differences between the trochanteric fracture and subtrochanteric fracture, not for the position of the lag screw. Result of this study indicated that the reduction of the calcar femoral is important thing in the treatment of trochanteric and subtrochanteric fractures with gamma nails.
Gamma nailing is in principle performed for fractures proximal to the femur at our hospital. We conducted intraoperative and postoperative investigations in 97 cases who had undergone gamma nailing, and studied 86 cases for which follow-up data were available. This paper is a report of our findings. Complications were found in 2.3% intraoperatively and in 5.8% postoperatively. Studies of indications for surgery with consideration given to the medullary space diameter, complete reduction of the fractured region, skill in surgical techniques and regular postoperative follow-up are considered important as measures to deal with complications.
We compared the result of the ¥-nail to the compression hip screw (CHS) in the management of the intertrochanteric fracture (¥-nail 42 patients, CHS 50 patients) by comparing perioperative details and analysing the radiographical and clinical result. The details compared were operation time, the decrease of Hb, and ability to walk, the location of the lag screw in the femoral head, sliding distance of lag screw, decrease in the neck shaft angle, and inter-post operative complications. Clinical results showed that the ¥-nail is a lower invasive implant. Radiographical findings showed that internal fixation using ¥-nail showed better results especially for the unstable fracture.
103 cases of trochanteric fracture were treated by an operative method with captured hip screw. Telescoping of the lag screw occurred within 2 weeks after operation in 80%, and almost all cases ended within 6 weeks. In spite of centrally positioning of the lag screw, considerable telescoping and complications after operation may occur in unstable fractures. We must pay attention to the indication of the captured hip screw for trochanteric fractures.
The comparison of the compression hip screw with a brim supporter (brim-CHS) and that without a brim supporter (non-brim-CHS) was studied in 46 femoral intertrochanteric fractures. Since 1998, 15 consecutive patients have been treated with brim-CHS. There was no significant difference between the two methods in the mean operating time and surgical blood loss. However, the non weight bearing period and hospital stay of brim-CHS were significantly less than that of non-brim-CHS. The sliding length of the lag screw of brim-CHS was shorter than non-brim-CHS, however, the difference was not significant. Although the cost of brim-CHS is 100, 000 yen more expensive than non brim-CHS, we recommend brim-CHS for all types of the femoral Intertrochanteric fractures to achieve rigid fixation and reliable outcome.
Ideal posture and marking methods are proposed for reducing operation and fluoroscopy time. We operated on 109 patients with femoral neck fractures using CHS. The posture in operation was the semi-lateral position and the leg was tractioned with the Broun table. The incert portion was marked before operation. The operation time was 10 to 63 minutes (average: 35.1 minutes). The fluoroscopy time was 66 to 195 seconds (average: 107.2 seconds).
Ultrasound examinations were performed with 3.5 or 5MHz transducers on 13 patients with femoral neck fractures. There were 6 trochanteric fractures and 7 intracapsular fractures. The examination was performed on bilateral hips. The hip were in neutral position and the transducer was in the saggital plane alnog the axis of the femoral neck. We could examine 4 patients when they visitted to our hospital. The hematoma was seen in 2 hips with trochanteric fractures, and the expansion of the articular capsule was seen in one hip with intracapsular fracture. The fracture was found in all patients. The other 9 patients were examined just before the operation. Three of the 5 patients with intracapsular fractures, and one of the 4 patients with trochanteric fractures revealed the swelling around the hip joint. The fracture line was permitted in all cases. Ultrasonographic examination seems be useful for the confirmation of the presence of hematoma or soft tissue injury.
This report describes a case of bilateral osteonecrosis of the humeral capitellum in an adult patient. A 23-year-old male complaining of right elbow pain visited to our hospital in August 1999 several weeks after a slight elbow injury. Roentgenograms of his right elbow demonstrated a radiolucent area in the right humeral capitellum and irregular subcortical bone. The same findings were present in his left elbow. He was treated conservatively for about three months but the condition of his right elbow deteriorated. Upon admission, he underwent continuous epidural anesthesia, physical therapy, arthroscopy of the elbow joint and bone peg grafting. At four months after the operation, the patient had good elbow mobility and was free from elbow pain. Careful follow-up is required to prevent the reccurence of the pain.
The purpose of this study was to evaluate the clinical results of the surgical treatment of acromio-clavicular joint dislocations and distal clavicular fractures with wolter clavicular plates. Four patients with acromio-clavicular joint dislocations classified as Tossy's grade III and 6 patients with distal clavicular fractures classified as Neer's type II were treated between November 1998 and January 2000. All the patients were men and their mean age at surgery was 46.8 years. The mean follow-up period was 1 year and 2 months. The average JOA shoulder score was 95.3 points at the time of evaluation. Wolter clavicular plates firmly fix the acromio-clavicular joint at the anatomical position with no damage to the joint. Post operative rehabilitation can be started earlier than other surgical techniques, contributing to excellent results. However, in the case of one case of 82-year-old, the hook of the plate was cut out from the acromion 2 months after the operation. For elderly patients with osteoporosis, the post operative management shoud be performed carefully, and the hook hole of the plate must not be enlarged when inserting the plate for a long time, regardless of the score that is assigned after the operation.
The purpose of this study was to evaluate the results of interlocking intramedullary nailing for surgical neck fractures of the humerus. We used the ACE humeral nail system which others the advantage of transfixing locking screws for reliable fixation. From 1997 to 1999, 7 consecutive displaced 2-part surgical neck fractures of the humerus were antegrade nailed with the ACE humeral nail system. The average age of the patients was 61.9 years (range 43 to 80). There were 2 males and 5 females and the average follow-up period was 12.9 months (range 5 to 29). All shoulders were assessed retrospectively and scored using the JOA shoulder scoring system. All fractures achieved union and there was no delayed union, but one shoulder showed severe varus deformity radiographically. The average JOA score at final follow-up was 85.5 (range 75.5 to 95). The shoulders had an average active flexion of 130 degrees active abduction of, 131 degrees active external rotation of 55 degrees and internal rotation to the 9th thoracic vertebra. Due to technical errors, one patient had subacromial impingement caused by the protrusion of the proximal nail tin. The operative method reported here otters the advantages of enabling sufficient fixation for osteoporotic cases. It is a useful alternative for the treatment of displaced surgical neck fractures of the humerus.
We studied elderly patients with malunion, pseudoarthrosis or delayed union, as well as those requiring further operation after percutaneous pinning for surgical neck fracture of the humerus. Twenty-four cases of surgical neck fracture of the humerus were treated by percutaneous pinning at our hospital from 1995 to 1999. The average age was 76.9 years, and consisted of 21 females and 3 males. The pinning methods were conventional antegrade percutaneous pinning (19 cases) and retrograde intramedullary pinning with curved Kirschner wires (5 cases). With the antegrade procedure, four cases resulted in malunion, causing varus deformity of the Numeral neck, and two cases showed pseudoarthrosis or delayed union. With the retrograde procedure, one case showed varus deformity and another case delayed union. The common cause of malunion and pseudoarthrosis in the antegrade procedure is incorrect reduction in percutaneous pinning, which causes varus deformity and separates the fracture site. On the other hand, retrograde procedure enables good reduction, but the Kirschner wires used tend to slip out distally, which causes malunion or delayed union. We conclude that retrograde intramedullary pinning should be performed using more multiple-curved Kirschner wires or any other device to prevent slipping-out.
Surgery outcomes for rheumatoid cervical spine were clinically evaluated in twenty patients. Eighteen patients complained of pain in the nape and occipital region, and neural deficit was noted in seventeen patients. We performed posterior fusion for nineteen patients and anterior fusion for one patient. Surgical outcomes were evaluated with Ranawat's classification. Nape and occipital pain improved in sixteen patients, and neural deficit improved in six patients, one improved from class III A to II. Five patients improved from class III B to III A. Three III B patients improved to III A by the operative treatment for rheumatoid cervical spine and total knee or hip arthroplasty. Two III B patients, who could not anbulate within four months, improved to III A by the operative treatment for rheumatoid cervical spine. Other III B patients, who had not been able to walk for several years, did not show improvement in their neural deficits. Neural deficit can be improved by the operative treatment for rheumatoid cervical spine at an early stage.
We report a 69-year-old female with gout who showed polyarthritis in the upper and lower limbs. She developed pain in multiple joints of the upper and lower limbs in 1987 and was diagnosed as having rheumatoid arthritis (RA) and treated in a local hospital. In January, 1996, she visited our department because of increased pain in multiple joints. At the time of the initial consultation, symmetrical swelling and pain were observed mainly in the finger MP·PIP joints of the bilateral hands and the toe MP joint. The fingers showed swan-neck deformity, boutonnière deformity, and Z deformity of the thumbs while the toes showed hallux varus and mallet toe deformity. X-ray examination revealed bone atrophy and destruction of the bilateral carpi. Hyperuricemia was also observed. Arthroscopic synovectomy of the knee joint and metatarsal osteotomy arthroplasty were performed for the swelling and pain of the right knee and deformities of the right foot. Subsequently, synovectomy of the left wrist and arthrodesis of the right index finger PIP joint and the right thumb IP joints were performed. During operation, white crystal deposition was observed on the joint surface, and histological examination demonstrated gouty arthritis.
The purpose of this paper is to evaluate the radiographical differences and biomechanical responses of laminectomy and laminoplasty in animal models. Twenty-three Japanese white rabbits were divided into 2 groups, one undergoing C3-C7 laminectomy and the other Z-shaped laminoplasty (Hattori's Method). Lateral cervical spine radiographs were obtained pre-operatively and 2, 4, and 12 weeks post-operatively, and biomechanical testing was performed after the rabbits were put to sleep. Laminoplasty was considerably reduced the frequency the postoperative alignment abnormality compared with laminectomy. The biomechanical results showed that the flexion stiffness at 20 degree for the laminectomy group was lower than for the intact and laminoplasty groups after the procedure. Radiographical and biomechanical of the rabbit models suggest that laminoplasty is more effective than laminectomy in maintaining cervical alignment and preventing postoperative spinal deformities.
We investigated the concentrations of prostaglandin E2 (PGE2) and bradykinin (BK) in the cerebrospinal fluid of patients with lumbar disc herniation. The preoperative PGE2 and BK levels were 3.7±1.8pg/ml and 4.9±3.8pg/ml, respectively. The PGE2 and BK levels did not correlate with the severity of the leg pain. The postoperative PGE2 and BK levels were 4.5±2.9pg/ml and 5.6±2.9pg/ml, respectively. There were no differences between preoperative PGE2, BK levels and their postoperative levels. This result suggested that the PGE2 and BK concentrations in cerebrospinal fluid do not reflect the severity of the leg pain.
We evaluated the current perception threshold (CPT) in 83 normal adult volunteers. CPT levels were obtained for large diameter myelinated, small diameter myelinated, and unmyelinated sensory nerve fibers by stimulation with three different neuroselective sine waves stimuli at 2000Hz, 250Hz, and 5Hz, respectively. The rapid screening (R-CPT) level of age differences, differences between median and ulnar nerve, between site ratios, and within site ratios were evaluated in this study. As CPT is a convenient, painless, and quick test for the sensation, it is useful for the screening of entrapment neuropathy and polyneuropathy.
We experienced a case of Crohn's disease with psoas abscess. A 30-year-old man was admitted to our hospital for low back pain and an inability to extend the right hip. He had been diagnosed with Crohn's disease 14 years ago. A plain roentgenogram of the abdomen showed scoliosis of the lumbar spine convex to the right side. Psoas abscess was diagnosed by abdominal CT and MRI. The abscess had destroyed part of the psoas muscle which changed to granulation tissue. It was curettaged, drained and treated with antibiotics. Cultures grew Candida species. We thought the abscess was due to candidemia because no fistulous tract was found between the bowel wall and the muscle. The postoperative course was unremarkable.
We report a rare case of rapidly progressive necrotizing fascitis of a lower limb, whose life could be saved with an amputation at the thigh. A 38-year old man consulted a near-by hospital with swelling and pain of his right crus without traumatic history, and was followed up conservatively. But got worse rapidly, and fasciotomy was performed with the diagnosis of compartement syndrome of crus. The next day, necrosis of the fascia was found, and swelling and redness had advanced to his right thigh. Suspecting necrotizing fascitis, deburidement of the necrotic fascia was performed. Soon after the operation, his consciousness level and blood pressure became low, upon which the patient was transferred to our hospital. On the same day we performed an amptation at his right thigh. After this operation, despite kidney failure and redness which had advanced to the hypochondrial level, chemotherapy, following the operation proved effective and has general condition showed improvement. About one month after the amptation we performed stump plasty and closed the wound.