We treated 10 patients who had femoral trochanteric fractures with AO small proximal femoral nail (PFN). PFN is a new intramedullary device with lag screw and hip pin. One patient showed varus deformity by more than 10 degrees, but there were nocut outs. All patients achieved bony union within 11 weeks. Eighty percent of the patients regained almost the same gait ability after operation. We conclude that this new implant PFN is suitable for the treatment of femoral trochanteric fractures.
Trochanteric and neck fractures of the femur are generally treated with operations. As the average life span of our population increases, some hip fractures are now treated non-operatively because of the possibility of severe or fatal complications due to surgery. Often, refusal of surgery by the patient or the patients’ family obligates the need for non-operative treatment. A total of 31 patients with either trochanteric or neck fractures of the femur were studied in this report. All of the patients had been ambulating without assisting devices before injury and were treated conservatively due to unavoidable circumstances. Nineteen (61%) of the cases were ambulating without the use of a wheelchair when discharged.
MR imaging is useful in the diagnosis of occult fractures and bone bruises. MR imaging at an early stage after injury was performed in 17 elderly patients with a clinical suspicion of hip fracture who had normal radiograms. Ten patients had positive findings on the MR imaging. In these ten patients, follow-up radiograms were taken three months later, and we compared early-stage MR images and radiographic findings at three months. Three patients showed geographic areas of low intensity on T1 and high intensity on T2-weighted images, also referred to as bone bruise, but one of them had osteosclerotic findings in radiograms. Seven patients showed linear areas on T1 or T2-weighted images. One of them received compression hip screw because of the displacement of the fracture. Three showed osteosclerotic findings and the other three showed normal findings in radiograms. Our results suggested that MR imaging at an early stage of the injury was useful to detect occult fractures and bone bruises; however, differentiation between the two was difficult.
We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation.
This paper evaluated the utility of HATCP coated femoral head prosthetic replacement. This prosthesis has been used on 15 cases of femoral neck fractures and 3 cases with necrosis of the femoral head since 1995 in our department. All patients started partial weight bearing from 1 week postoperatively. A follow-up over 5 years (mean: 5 years, 4 months) was carried out. The subjects consisted of 11 males and 10 females ranging from 18 to 89 years of age (mean: 59.8). Spot welds in radiological results suggested bone ingrowth around the HATCP coated stem in many cases. Elderly patients who were able to control partial weight bearing gait obtained good fixation. In spite of the medullary canal filling ratio of the stem, good fixation was achieved with the HATCP coated stem. This radiological study exceeding 5 years showed good osteoconduction around the HATCP coated stem.
We report 13 cases of femoral neck fracture with hemiplegia that were surgically treated. Gait ability was investigated before injury, at hospital discharge, and at follow-up. There were 13 cases (9 females and 4 males) whose age ranged from 70 to 91 years (mean: 79 years). We treated all 13 patients with gamma nail. Nine patients (69.2%) regained their pretrauma walking ability. Four patients with dementia or major complications had poor results regarding the regaining of their pretrauma walking ability. Hemiplegia did not influence the results of the patients. Prompt firm fixation at the fracture site by gammma nailing allowed the patient to get out of bed and start weight bearing in the shortest postoperative span. The results suggest that operative treatment is essentially effective in femoral neck fractures even if they are hemiplegic.
We investigated 32 femoral neck fracture patients on hemodialysis treatment during a 10 year period from 1991 to 2000. The average age was 67.5 years (range: 38 to 88). The mean period of hemodialysis was 5.9 years (range: one month to 17 years). 17 patients had intercapsular fractures and 15 patients had trochanteric fractures. Blood loss during the operation was 327.7 ml in hip prosthesis and 118.2 ml in osteosynthesis. Operation time was 82.9 minutes for hip prosthesis and 66.6 minutes for osteosynthesis. Two patients developed hematoma after operation, and 3 patients required reoperation due to non-union.
We report a rare case of giant cell tumor (GCT) of the distal ulna. A 35-year-old male suffered from pain and swelling in the left wrist. Range of motion of the wrist was limited, and grasping power had decreased to about one-third of the right hand. There was a destructive, expansile osteolytic lesion of the distal ulna on X-ray. The cortex was thin and a part of the lesion was disrupted. On MR imaging, bone tumor of the distal ulna was identified as a low- and iso-intense lesion on both T1- and T2-weighted images, enhanced homogeneously by Gd-DTPA. Diagnosis of GCT was confirmed by open biopsy. We performed en bloc resection and arthroplasty of the wrist, and used an autogenous iliac bone graft for reconstruction. Wrist pain disappeared at 12 months after surgery, and mobility of the wrist improved enough that he was able to return to work. Both X-ray and MR imaging of his wrist showed no recurrence of the tumor.
Component design and operative technique for total knee arthroplasty have been established based on anatomic configuration of normal knees in the United States and Europe, but these are not suitable for osteoarthritic knees in Japanese patients. We therefore have developed a modified dependent cut method called “Joint gap control method”. In this method, the distal femur and proximal tibia are cut. Ligament balance is established in full extension using a ligament balancer. The knee is flexed at 90°, and the degree of external rotation of the femoral component is determined according to the angle between the posterior condylar line and cut surface of the tibia keeping the ligament balance. The distance of the joint gap can be set equally between full extension and 90° knee flexion. The size of the femoral component is also decided according to the distance of the joint gap at 90° knee flexion. With this method, ligament balance can be obtained from full extension to 90° knee flexion in any knee.
We reviewed 11 knees with osteoarthritis that had undergone tibial condyle valgus osteotomy. These cases were evaluated in regard to mechanical axis, femorotibial angle, lateral condylar plateau angle and arthroscopic finding. We graded the arthroscopic cartilage according to Fujisawa’s classification. We found that degeneration of the lateral compartment had grown more serious in 2 cases. In the lateral compartment, the lateral condylar plateau angle was significantly different between the unchangeable group and serious group in arthroscopic finding.
Radial tear of posterior horn occurs as a type of medial meniscus injury that is frequently observed in middle age and elderly patients; however, it is rare in young patleuts. There are only a few detailed reports on the clinical features and treatment of this injury, indicating the need for thorough investigation. The purpose of this paper is to evaluate the incidence, etiology, symptoms and treatment. Arthroscopic knee surgery was performed on 88 knees in 86 patients over 40 years of age, from July 1999 to August 2001. Radial tears in the posterior horn of medial meniscus were found in 14 knees of 13 patients (male; 3 knees; female, 11 knees). The mean age was 63.6 years (range: 44 to 80). The JOA knee score was used for the evaluation of operative treatment. Medial meniscus tears were observed in 67 of 88 knees and the incidence of radial tear in the posterior horn among medial meniscus tears was 20.9% (14/67knees). Thirteen of these 14 knees had a history of minor trauma. Hemarthrosis was observed in all 5 knees that were examined within 3 days after injury. Partial meniscectomy was performed on all 14 knees. The mean JOA scere improved from 38.9 to 88.2 points after operation. The incidence of this type of tear is considerably high in middle age and elderly patients. Careful probing of the posterior horn is an essential procedure in knee arthroscopy.
It is not easy to detect radial tears of the posterior horn of the medial meniscus (torn posterior horn) under arthroscopy if the surgeon does not notice the tear before arthroscopy. Occasionally the tear goes undetected or is missed during arthroscopy. The sagittal view of MR imaging is very useful for diagnosing torn posterior horns. The normal posterior horn of the medial meniscus appears as an image of low intensity triangle of the sagittal MRI medial slice next to the PCL. On the contrary, the image of the torn posterior horn shows a high intensity triangle, so we refer to the feature as a white meniscus sign. We prospectively examined the accuracy of white meniscus sign of MRI. Forty-two knees in 41 patients were studied. They were over 40 years of age, diagnosed with medial meniscus tear and had undergone MRI before arthroscopy. Before arthroscopy, we predicted the existence of torn posterior horn by the white meniscus sign and examined the accuracy of the MRI after arthroscopy. Total accuracy rate was 90.5%, sensitivity was 94.1%, and specificity was 88.0%. We concluded that the white meniscus sign on MRI is very useful for defecting torn posterior horn of the medial meniscus.
We performed a prospective study to evaluate arthroscopic findings for the treatment of articular defects at 6 months after mosaicplasty. Five knees in 5 patients were enrolled in this study. The mean age of the patients was 22.0 (range 15 to 38). The diagnosis of the original disease was osteochondritis dissecans in 3 and osteochondral fractures in 2. Three cases were on lateral femoral condyle, 1 involved medial femoral condyle, and 1 involved patella. The size of the defects ranged from 156 to 195 mm2 (mean: 176.4 mm2). All implanted osteochondral grafts united with the original defects. The gaps between the grafts and the surrounding articular cartilage were completely filled with reparative tissues except in the patella case. On close observation, surface incongruity was seen in 2 cases, and focal disruptions of the gaps between the grafts and the surrounding articular cartilage were seen in 2 cases. There was no softening on the surfaces of the grafts, but a soft indentation was felt upon probing all surfaces of the reparative tissues in the gaps. It is currently unknown whether surface incongruity, focal disruptions of the gaps, and softening on the surface of reparative tissues will lead to degenerative changes.
Severe osteoarthritis of the hip joint is known to lead to secondary osteoarthritis of the knee joint. Three cases of coxitis knee were studied etiologically and morphologically. Case 1 was a 77-year-old man with terminal stage coxarthrosis. The opposite knee joint of the coxarthrosis showed medial OA and ipsilateral knee showed lateral OA. Case 2 was a 73-year-old woman with terminal stage coxarthrosis. The bilateral knee joint showed lateral OA. Case 3 was 62-year-old woman with bilateral dislocated coxarthrosis. The bilateral knee joint showed lateral OA. There is a tendency for coxarthrosis to develop into lateral OA of the ipsilateral knee joint with dislocated or contracture hip.
In this study, we report the diagnostic utility of diffusion-weighted MR images in primary bone tumors. Diffusion-weighted echo-planar imaging was performed on thirty two patients with primary bone tumors. The apparent diffusion coefficient (ADC) was determined from each image. The average ADC of six bone cyst cases was 2.51±0.36; it was 1.74±0.54 for fourteen cases with solid benign bone tumors. In addition, with the exception of four chondrosarcoma cases, ADC of the malignant bone tumors (eight cases) was 0.89±0.11. The value of malignant bone tumor ADC was significantly lower than that of the bone cyst group or the benign solid bone tumor group (p<0.0001). This indicates that diffusion-weighted imaging is useful in the differential diagnosis of primary malignant bone tumors and benign bone tumors.
We report a giant cell tumor of the femur recurring 16 years after the cement packing method. A 59-year-old man was treated surgically with curettage, bone grafting and cement packing method for a giant cell tumor on one of his femurs in 1985. Part of plain radiograph indicated radiolucent area on the subchondral bone at an early stage, but the size of this radiolucent area did not change until 1994. In 2001 (16 years later), he experienced knee pain, and we observed enlargement of the radiolucent area on his radiograph. We suspected recurrence of the giant cell tumor on the bone, osteoarthritis or bone cyst as a result of examination. We performed surgical treatment of this lesion with curettage, bone grafting and hydroxyapatite packing. Pathological diagnosis indicated recurrence of giant cell tumor.
Aneurysmal bone cyst (ABC) is spongy or multilocular cystic, and is filled with blood. Large long bones, flat bones, and vertebrae are prone to ABC, while it rarely occurs in the small bones of hand. We experienced a case of ABC of the capitate. The lesion was treated by curettage and autologous bone-grafting. The present case was our second experience of capitate ABC. We will also review other reported cases of ABC of the hand in the paper.
We report a case of desmoplastic fibroma of the left femur. The patient was a 26-year-old male, presenting dull pain mass in his left thigh. Serological examination was within normal range. An osteolytic lesion existed in the medial condyle of the left femur, but no periosteal reaction was found radiographically. Computed tomography revealed a lesion in the posterior cortex of the medial femoral condyle, extending into the soft tissue. The tumor revealed low intensity in T1-weighted imaging and high intensity in T2-weighted imaging in MRI. Biopsy samples indicated a desmoplastic fibroma as its pathological diagnosis. Curettage and bone grafting were thus performed. The sections microscopically showed fascicles of spindle cells separated by abundant collagen fibers. Cellularity was not high. Destructed bone and osteoid were seen at the periphery of the tumor, which was considered to be reactive change. Immunohistochemically, the tumor cells were positive for vimentin, and some were positive for α-SMA, S-100 and CD34 were negative. Based on these findings, the histological diagnosis of desmoplastic fibroma was established. Three months after surgery, the patient showed no local recurrence or metastasis. Since desmoplastic fibroma is reported to show local recurrence at the rate of 30% to 60%, careful follow-up is needed.
Localized solitary plasmacytoma of the bone is a rare disease, and is characterized by only one isolated bone lesion with no evidence of disease dissemination. Two cases of solitary plasmacytoma that originated in the 12th thorachicae and the right 5th rib are reported in this paper. Radiotherapy was mainly performed on these cases. Both cases are alive without recurrence or dissemination, 12 and 2 years after the treatment respectively.
The protein product of the c-Cb1 proto-oncogene is involved in several signaling pathways and exerts a negative regulatory function on receptor and non-receptor tyrosine kinase. We used the overexpression experiment, and demonstrated that the c-Cb1 inhibits phosphorylation of intracellular protein in osteosarcoma cell line, SaOS2. Luciferase reporter assays revealed overexpression of c-Cb1 suppressed PDGF-induced c-Fos promoter activity as well as v-Src-induced STAT3 promoter activity. Thus, our results demonstrate that c-Cb1 negatively regulates several signaling pathways in the osteosarcoma cell line, suggesting that c-Cb1 is a good candidate for gene therapy against osteosarcoma.
Pigmented villonodular synovitis (PVS) is common in the knee joint. However, it is rare in the ankle joint. We report a case of PVS arising in the ankle joint and review releated literature. A 53-year-old woman was referred to our hospital complaining of chronic ankle joint pain after running for one year. She did not have a history of trauma to the ankle joint. We did not find destructive lesion in the ankle joint on roentgenograms, nor abnormal lesion on magnetic resonance imaging in the early phase. We treated this case by marginal excision using lateral and medial approach. Histological diagnosis indicated PVS. Nine months after surgery, the patient showed no local recurrence or distal metastasis.
Ganglion cyst of the hip is rare. This case report describes a large ganglion cyst in a 44-year-old woman with hip dysplasia. She experienced mild right groin pain after prolonged activity. Physical examination revealed a large soft mass in her right inguinal region. No obvious evidence of infection was noted. Radiographic evaluation of her right hip revealed evidence of severe hip dysplasia. Magnetic resonance imaging revealed the mass to have signal characteristics similar to water. It was diagnosed as ganglion cyst. Periacetabular osteotomy was performed for hip dyaplasia. The mass was covered by pseudocapsule and filled with clear mucinous fluid. Further dissection revealed a typical stalk arising from the hip capsule. Histologic examination showed a fibrous connective tissue wall with no distinct cellular lining. Diagnosis of ganglion cyst should be considered when patients present inguinal mass and hip dysplasia.
Extraskeletal Ewing’s sarcoma is a rare soft tissue tumor composed of small round cells. We report three cases of extraskeletal Ewing’s sarcoma. All cases were male (average age: 24 years). Tumors were located in the juxtaposition of the right upper arm (case 1), lateralis of the left hip joint (case 2) and vicinity of the left ilium (case 3). We performed chemotherapy and radiation therapy according to the protocol of the National Cancer Institute. (Cancer. 1996; 78: 901-11) Patients received seven cycles of vincristine, doxorubicin, and cyclophosphamide, and eight cycles of ifosfamide and etoposide. Radiation therapy was the primary approach to local control. In case 1, the tumor disappeared for 4 months and no local recurrence was found. In case 2, the tumor size did not reduce but metastasis of the lung disappeared. We resected the tumor and resumed the protocol. In case 3, the tumor size reduced markedly. Despite substantial toxicity, this protocol seems to be feasible and improve the outcome for patients with extraskeletal Ewing’s sarcoma. Longer follow-up is needed to evaluate the late effects of the protocol of the National Cancer Institute.
42 cases with fractures of the proximal end of the humerus were treated by osteosynthesis using the hook plate. All cases achieved bone union. In the 26 cases that we could evaluate, the average JOA score was 84. 1 points, and the average flexion angle was 152.3°. This method is useful for the treatment of fractures of the proximal end of the humerus, even in cases with dislocation, displaced fragments, or osteoporosis.
Isolated avulsion fracture of the lesser tubercle of the humerus has rarely been reported. We report a child who suffered from this fracture. When a 12-year-old boy was playing basketball, he tried to make an overhead throw with his right hand, and his arm was blocked in late cocking phase. He visited our hospital the next day after the injury, complaining of motion pain, swelling and limitation of right shoulder motion. Roentgenograms, especially scapula-Y view, revealed an avulsion fracture of the lesser tubercle of the humerus, which is usually combined with other injuries. MRI and MR arthrography did not reveal any remarkable damage to the muscle, capsule, and bone except for the fracture. We confirmed isolated avulsion fracture of the lesser tuberosity by shoulder arthroscope. The fracture was reduced with a suture wire by open reduction. At five months after the surgery, shoulder pain disappeared and the range of motion of the right shoulder recovered completely, but weakness of internal shoulder rotation still remained.
We reviewed the clinical results of 34 children (21 males, 13 females) with supracondylar humeral fractures, treated by percutaneous pinning from 1983 to 2001. Their age ranged from 1 to 13 years (average age: 6.2 years) and follow-up ranged from 3 to 64 months (average: 16.9 months). They were classified as type 1 to type 4 (described by Abe). There were zero type 1, two type 2, 19 type 3, and 13 type 4. Pinning methods consisted of bilateral cross pinning (28 cases) and parallel pinning from the lateral side (6 cases). Perioperative complications were seen in 11 cases (5 nerve injury, 4 cubitus varus, 2 ROM limitation). Prevention of soft tissue swelling, pin insertion, method of reduction and Baumann’s angle should be taken into cousideration to prevent these complications.
We retrospectively studied MRI on the frequency of bone-bruises in ankle sprains, especially those of the lateral collateral ligaments of the ankle joint. Bone-bruises occurred in 3.8% (4/106) of ruptures of anterior talofibular ligament (ATFL), and 6.3% (5/79) of ruptures of ATFL and calcaneofibular ligament (CFL). Bone-bruises were more likely to be seen in ATFL and CFL ruptures than in ATFL rupture alone.
Subtalar dislocation is rare injury. The incidence has been estimated to be about 1% of all traumatic dislocations. We have experienced a case of the lateral subtalar dislocation. The patient was a 30-year-old male, a Self-Defense Force member. He caught another member who fell a few meters and was resulted from forceful eversion of the foot. X-ray showed a lateral subtalar dislocation with a fracture of the lateral malleolus of ankle. He was treated by closed reduction under intravenous anesthesia immediately and it was successful. After one week, osteosynthesis was performed for the fracture and three weeks after the operation a cast was applied. The period of nonweight bearing was six weeks and full weight bearing started eight weeks after the reduction. At four months after the injury, there were no severe complications in his daily activity and avasucular necrosis of the talus in X-ray and magnetic resonance imaging.
We experienced a rare case of a plantar fracture-dislocation of the tarsal navicular. A 69-year-old man was treated with cast fixation for three weeks at another hospital without dislocation of the navicular being noticed. He visited our hospital two months after the injury. X-rays and MRI showed a plantar-dislocation and osteo-necrosis of the navicular. We performed an open reduction and fixation with Kirschner wires. Nine months after treatment, X-rays showed increased sclerotic change at the navicular, and arthropathy at the talo-navicular and cuneo-navicular joints. However, X-rays did not show collapse of the navicular after the operation, and he is making satisfactory progress.
315 cases with a closed ruptured Achilles tendon were repaired by percutaneous suturing. In 8 cases, re-rupture occurred, and in 4 cases, hypesthesia at the lateral side of the foot occured due to injury of the sural nerve. Although this method was more promising than surgical repair or conservative therapy alone, it also presented problems when compared with either method.
To determine the relationship between pain at maximum flexion-rotation and the status of labral tear, a physical examination we refer to as “limbus sign” and hip arthroscopy were carried out. Between February 1998 and 1999, 30 patients with dysplastic osteoarthritis (2 males and 28 females) with a mean age of 42 years (range, 18 to 64 years), underwent 30 hip arthroscopies following physical examination. All hip joints arthroscoped demonstrated incomplete or complete detaching tears of the acetabular labrum in the weight-bearing area. Ten patients experienced pain during the maximum flexion-internal rotation test, and 10 patients were positive in the maximum flexion-external rotation test. Positive maximum flexion-external rotation test results correlated with early stage osteoarthritis. Positive maximum flexion-internal rotation test results were associated with incomplete detaching tears; however, there was no statistically significant relationship between maximum flexion-rotation test and arthroscopic findings of labral tears. This test may therefore be influenced by the degeneration of joint cartilage. We conclude that the maximum flexion-rotation test may be used to assess the labral tear of the acetabulum in early stage dysplastic hips, but not in advanced stage osteoarthritis.
There are increasing opportunities in operative treatment for advanced aged patients with degenerative spinal disease aiming for better quality of life. We studied such patients concerning operative results, complication and problem in pre- and peri-operative management, and achievement of better quality of life. Twenty-six patients were analyzed, 16 males and 10 females (average age: 82.3). All patients underwent laminotomy, and 3 patients had PL fusion. Clinical results were evaluated by JOA scoring criteria, except for ADL points. The JOA score was 7.1 preoperatively and 10.9 postoperatively on average. In objective symptoms, there was little improvement in all subjects, but in subjective symptoms, pain and numbness of lower extremity, and ambulant ability showed remarkable improvement. Operative results showed good improvement in advanced aged patients as well as younger patients.
We investigated a vertebral fracture resulting from surgical treatment for osteoporotic vertebral fracture. Twenty-seven patients who sustained osteoporotic thoracolumbar vertebral fracture were treated surgically. We used the spinal instrumentation system in all cases. Of these cases, a new vertebral fracture occurred adjacently in 10 vertebrae of 6 patients. Six fractures occured outside of the fused area and 4 occured within the fused area. All cases were treated conservatively. We concluded that it is essential to take saggital alignment before injury into consideration when determining the fusion area.
From 1987 to 1995, consecutive fifty-two patients with degenerative lumbar disease were surgicalty treated with spinal instrumentation. Forty-two patients (81%) were followed up on; minimum follow-up was 5 years. Their fusion area was extended over two segments. They were classified into four groups according to pathology: spinal deformity, spondylolisthesis, lumbar disc hernia, and after wide laminectomy. Clinical results were assessed by Prolos criteria. Several radiographic measurements were also performed. The mean score before operation in spinal deformity patients was 1.1 (20 cases); it was changed to 2.8. For spondylolisthesis patients (7 cases), the mean score was 1; it was changed to 3.1. In lumbar disc hernia and after wide laminectomy patients (4 and 11 cases) mean score was 1.3 and 1.4 pre-operatively, and was changed to 4.3 and 3.8, respectively. The mean pelvic angle in the last follow-up was 38.5 degrees in spinal deformity, 30.8 degrees in spondylolisthesis, and 24.3 degrees in after wide laminectomy. Alignment of the lumbosacral to the pelvic hip region was an important factor in the clinical results.
We treated femoral neck fractures with the proximal femoral nail (PFN), based on good results achieved in the past for internal fixation of femoral neck fracture on a cose with double fracture of the femoral neck and peritrochanteric. There were 12 cases; 3 males and 9 females, Seven cases had femoral neck basement fracture and 5 had femoral neck fracture (femoral neck and peritrochanteric fracture in 1 case). The average age of the patients was 82.6 years (range from 75 to 92 years). All cases showed good results for osseous union. PFN might at least prevent rotational instability of the femoral head in femoral neck basement fracture and femoral neck fracture.
Patients with spina bifida often have hip dislocation. We report a case of unilateral hip subluxation with spina bifida. A 16-year-old girl suffered left hip pain when walking. We performed operative treatment in two phases; first, we performed arthrodiatasis on the left hip. After about five weeks, the femoral head moved about 3cm, and was positioned on the same level as the other femoral head. In the second phase we performed Chiari osteotomy, varus derotational osteotomy, and transfer of the external oblique muscle. After two weeks postoperativle, she was able to move around using a wheel chair. She is now able to walk without crutches or hip pain. It is often difficult to perform acetabuloplasty for dislocation or subluxation of the hip with spina bifida. However, if arthrodiatasis is first performed, acetabuloplasty may also be considered for hip dislocation or subluxation.
We report two cases of one-stage correction of rotational deformities of the lower extremity. Case 1 was a 75-year-old woman with extra-articular rotational deformity of the femur and osteoarthritis of the hip joint. The femoral deformity occurred due to malunion of the femoral fracture at age 20. Corrective osteotomy of the femur and total hip arthroplasty were performed simultaneously. External rotational deformity of 50°, which was determined by preoperative computed tomography, was corrected with angulatory deformity of 22° at the apex of the angulatory deformity. The osteotomy site was fixed with Cannulok® interlocking hip prosthesis. Case 2 was a 16-year-old girl with Kniest syndrome. She had an external rotational deformity of the hip secondary to severe osteoarthritis. Derotational osteotomy of the femur at the mid-shaft was performed. The distal segment was internally rotated by 60° so that the foot progression angle was brought into normal range. The osteotomy was fixed with interlocking nailing. This patient developed delayed union at the osteotomy site, which was successfully treated with ultrasonic therapy. Both cases have had a satisfactory outcome without major complications.
Although the overall treatment of osteosarcoma, Ewing’s sarcoma and rhabdomyosarcoma has improved, patients with metastases (M1) at diagnosis continue to have poor prognoses. The effects of high-dose chemotherapy and autologous peripheral blood stem cell transplantation (PBSCT) on sarcoma patients at M1 have been reported. Here we assess the results of treatment for 22 M1 patients including osteosarcoma (7), Ewing’s sarcoma (10) and rhabdomyosarcoma (5). Original locations were 12 bony lesions and 10 soft tissues. All patients were treated with systemic chemotherapy; five patients (Ewing’s sarcoma, 3; rhabdomyosarcoma, 2) were treated using high-dose chemotherapy with PBSCT. Most patients were also treated with radiation and/or surgery. The results were DOD 18, CDF 3 and AWD 1. The mean survival time for DOD patients was 14.8 months. All surviving patients were treated using high-dose chemotherapy with PBSCT. None of the patients who received conventional chemotherapy survived. The poor prognoses of M1 sarcoma patients might be improved by high-dose chemotherapy with PBSCT, however, true prognostic value of the treatment should be evaluated by prospective randomized studies.
Clinical symptoms, imaging diagnosis and operative treatment were evaluated in fourteen patients with osteoid osteoma. Most of the patients experienced a prolonged period of symptoms. Diagnosis of osteoid osteoma is challenging, because the nidus is small. When the lesion exists in the vicinity of joints, recognition of the nidus is much more difficult. It is important to consider the possibility of masked osteoid osteoma when young patients have a long history of pain such as arthritis. Complete removal of the nidus is required to cure the disease. Furthermore, minimum resection of surrounding scleotic bones is important for early recovery.
We evaluated the relationship between the intramedullary lesion on MRI and cartilage damage in patients associated with acute anterior cruciate ligament (ACL) rupture. Thirty-two cases documented by MRI and arthroscopy within one month from injury underwent ACL reconstruction using ST-G, and arthroscopy was performed again after surgery. The mean term between reconstruction and postoperative arthroscopy was twelve months. The cartilage damage on arthroscopy was compared with the intramedullary lesion on MRI. Cartilage damage was observed in 9 cases (28.1%) during the initial arthroscopy and in 16 cases (50.0%) during the second arthroscopy. Intramedullary lesion was detected in all 32 cases (total: 73 lesions) on MRI. Intramedullary lesion leading to cartilage damage was common in the geographic-type lateral femoral condyle. There was significant difference between the lateral meniscus tear and the cartilage damage of the lateral compartment.
A retrospective clinical and radiographical study of 8 traumatic spondylolysis/spondylolisthesis cases was performed. The patients were classified into two types: fracture-dislocation (F-D) type and flexion-tear-drop (F-T-D) type. Four patients were classified as F-D, and 4 as F-T-D type. Lack of correction occurred in 4 cases. Two F-D type cases were treated with posterior spinal fusion. One F-T-D type case was treated with posterior spinal fusion, and another F-T-D type case was treated with anterior spinal fusion, in which most of the caudal fused vertebrae had bilateral pedicle fractures. The F-D type was caused by compressive-extension injury (stage 4) and F-T-D type by high energy compressive-flexion injury. For these patients, anterior spinal fusion with corepolectomy of the pedicle fracture vertebrae is recommended.
We investigated changes in the biomechanical properties of the ligamentum flavum (L4/5) with age. The ligaments of young patients with herniations and elderly patients with lumbar canal stenosis (LCS) were studied. We used a very specific machine for tensile test: it can maintain the edges of the ligament; and the stress-strain curve is equal to that of the ligament itself that is separate from the bone. Comparison between the young and elderly showed no clear differential mechanical properties in the physiologic strain range and speed. This indicated that histological change does not influence ligament properties to a greet extent, and disc narrowing (major changes with age) causes ligament shortening and disfunctioning.
Osteochondritis dissecans is a common disease and is usually accompanied by solitary lesion, especially on the medial femoral condyle. But familial osteochondritis dissecans is rare. A total of 46 families in whom more than one member was affected by osteochondritis dissecans were reported up to 1988 in literature. These families were characterized by multiple articular lesions, autosomal dominant inheritance and short stature. This paper reports one family of familial osteochondritis dissecans. A mother and her three children had some articular symptoms, including in both knees, and short stature. Two of the children were affected by osteochondritis dissecans, whereas the mother showed early degenerative joint disease in both knees. Familial osteochondritis dissecans appears to be caused by disorder of epiphyseal ossification.