Nine patients with thoracic and lumbar tuberculosis were treated by anterior debridement and fusion. Subjects included 4 males and 5 females, 58 to 75 years old (average age 67.2 years old). We added posterior fusion with instrumentation to 6 patients by pedicle screw or hook system. None showed persistent or recurrent spine tuberculosis despite posterior instrumentation. The 6 patients with posterior instrumentation were able to get out of bed about 37 days earIier than the 3 without posterior instrumentation. Loss of sagittal alignment was not greater than 10 degrees in 8 patients but reached 27 degrees in one patient who developed postoperative vertebral compression fracture above the posteriorly-stabilized vertebra. All patients achieved stable bone union with satisfactory results.
We report on the clinical results of 11 patients with tuberculous spondylitis treated by curettage, bone grafting, and instrumentation. There were 7 males and 4 females. The age range was 12 to 82 years old (average: 58 years). The follow-up period was 4 months to 5 years (average: 1 years and 11 months). We performed posterior fusion with instrumentation and anterior radical resection of the lesion and strut bone grafting. Seven patients in whom neurological deficits were obserbed improved after surgery. Complete bone union in 10 patients was achieved. Posterior instrumentation is thought to simplify outer fixation and enable patients to get out of bed earlier.
Twenty-three cases of cauda equina tumor were studied for clinical symptoms, image findings, and surgical results. Pathological diagnosis was Schwannoma in eighteen patients, ependymoma in two, and one case of oligodendroglioma, malignant lymphoma, and lung cancer metastasis, respectively. Resection of the tumor by laminectomy or laminoplasty was performed in all cases except patients with malignant lymphoma and lung cancer metastasis. Partial resection was done in lung cancer metastasis and radiation was applied after open biopsy in malignant lymphoma. Sixteen patients (70%) complained of low back pain and seventeen patients (74%) of leg pain. Neurological deficits such as motor weakness and difficulty in urination were seen in six cases. No specific clinical signs or symptoms which differentiated cauda equina tumor from other lumbar diseases were found. MRI clearly showed a tumor; although plane radiogram did not indicate cauda equina tumor. Tumor occupied ratio in the dural tube by axial MRI and level of tumors by the sagittal MRI had no correlation with paralysis incidence. Pain subsided in all cases after surgery but neurological deficits improved in only two of six paralysis patients. Two patients with malignant lymphoma and lung cancer metastasis died of primary malignant diseases within one year after surgery. Tumor recurrence has not been seen in all benign tumors.
Reports of endoscopic surgery for the spine have recently been increasing. Video assisted thoracic surgery (VATS) for the thoracic dumbbell tumor was attempted. The patient was a 21 years-old male with back and costal nerve pain. Lt. 4th thoracic nerve root dumbbell tumor (Eden type 4) was found on MRI. The tumor was totally resected with Bipolar scissors and Autosonics. Pathology was neurinoma. The operation time was 130 minutes, and blood loss was 210ml. No pain or recurrence of tumor was found at 6 months after surgery. VATS is a useful procedure for thoracic spine.
Nonsurgical clinical course for elderly patients with lumber canal stenosis was investigated and operative indication in those was examined. There were 27 patients (15 males and 12 females) averaging 76 years of age. The average period of observation was 2.4 years. We estimated clinical course by low back pain, lower extremity pain, numbness, intermittent claudication, JOA score, and ability to walk. We also inquired whether they were living alone or with others. JOA score slightly improved from 14.3 points to 17.0 points. Low back pain also improved in half of the patients. On the other hand, lower extremity pain, numbness, and intermittent claudication remained unchanged or worsened. However, since most of the patients lived with their families and could be taken care of, they did not seek operation. The clinical course and living conditions of patients are important in determining whether an operation is necessary.
Over a period of 14 years from 1986 to 2000, we surgically treated 42 cases of delayed paraparesis following osteoporotic vertebral fracture. Anterior decompression and spinal fusion using instrumentation were performed on 15 patients, posterior decompression and fixation using Luque rod on 26 patients, and postlateral lumbar fusion with pedicle screwing on one, Seven cases of other vertebral fractures were observed after operation. The interval between operation and fracture recognized radiographically ranged from 5 to 37 months (mean, 17 months). Although these cases were treated conservatively, more careful observation is necessary in osteoporotic spines.
Seven (0.5%) out of 1399 patients with postoperative spinal epidural hematoma underwent spinal surgery over 9 years from 1992 to 2000. For all cases, operative decompression was performed, and neurological recovery was obtained. To prevent hematoma, suction drainage system is inserted into the wound at a desirable position. It is important to watch for neurological symptoms after spinal surgery.
We analyzed postoperative hematoma in cervical expansive laminoplasty, and examined 15 cases by ultrasound. Eight cases showed hematoma in the sutured area of cervical posterior muscles. All cases showed absorption of hematoma in 3 to 4 weeks. Ultrasound confirmed the presence, size, and depth of the hematoma. These results indicated that the start time of exercise to cervical posterior muscles was 3 to 4 weeks postoperatively.
Lumbar disk hernia (LDH) is a typical desease which causes low back pain (LBP). We analysed LBP in 45 operated cases with L4/5 LDH except for cases of relapse, spondylolysis, and pondylolisthesis between March 1999 and March 2001. 29 patients were treated by microscopic Love operation, 12 patients by laminoplasty and microscopic herniotomy, 4 patients by posterior lumbar interbody fusion (PLIF). 31 patients (68.9%) had LBP as a primary symptom of LDH, and only 3 patients (6.7%) continued to complain of LBP until preoperation. LBP with LDH changed to lower extremity pain. Patients who continue to complain of LBP should undergo fusion if LBP is caused by discography.
We experienced 134 cases of surgically treated lumbar disc herniation within the past seven years. Six of these cases, all males, showed lateral lumbar disc herniation. We studied these cases with regard to involved levels in the sagittal plane and localization in the horizontal plane, surgical procedure and postoperative improvement. The average age at the time of surgery was 44.2 years old, with a range between 27 and 62 years. The average follow-up period was 2 years with a range from 8 months to 3 years and 8 months. The level was L3/4 in one case, L4/5 in two cases, L5/S in three cases. Localization of herniation in the horizontal plane was extraforaminal in five cases, and intraforaminal herniation associated with L5 spondylolysis was seen in one case. In the former five cases, we performed resection of herniated discs following lateral fenestration, and in the other case herniated disc was removed after Gill's method, followed by posterolateral fixation Clinical symptoms improved in all cases after surgery. The mean Japanese Orthopaedic Association (JOA) scores of lumbar spine before surgery were 13 out of 29 points and after surgery were 26 points. The mean improvement rate was 60 percent.
We attempted Tekmilon tape fusion on 30 patients for lower lumbar instability in 300 lumbar posterior surgery cases between June 2000 and June 2001 in our hospital. We followed up on 20 patients, who consisted of 5 men and 15 women. Their average age was 68 years old, and their average follow-up period was 7.3 months. All suffered lumbar cannal stenosis or degenerative spondylolisthesis with lumbago. Five patients underwent fusion by the Spinous process, and 13 patients by the McGraw changed method. Two patients underwent fusion by the Spinous process and McGraw changed method. Twelve patients underwent fusion in one facet joint and 2 patients in 2 facet joints. We compared and studied surgical invasion, lumbago, mobility in X-P, and change of slip angle in fusion and nonfusion cases.
Microendosopic discectomy (MED) is a minimally-invasive operative therapy for lumbar disc herniation. The purpose of this study is to review our clinical results and the problems of MED. We have obtained good cosmetic results by this method and reduced pain in early postoperative days. Patients are usually very satisfied with the results of MED because it dose not cause severe complications in short and mid-clinical term. However there is still room for improving our skills and the MED system to expand indications and obtain a good field of vision. Despite certain limits of indications, it way be possible to switch the operative method safely for lumbar disc herniation from conventional LOVE method to MED in certain cases.
We report a retrospective study comparing the use of Gamma nail and CHS regarding the long-term results in 36 elderly patients with intertrochanteric fracture treated in our haspital. The use of Gamma nail showed no difference in the degree of telescoping in hip roentgenogram taken consecutively after surgery. There was no significant difference in time consumption and amount of bleeding at surgery. But the use of Gamma nail showed no decreasing of neck shaft angle due to the long term loading force. Moreover it had shorter convalescence and earlier weight bearing than CHS.
The present study demonstrated the usefulness of the Multi Fixation Hip Screw Nail System (Multi-Fix) for the treatment of trochanteric or subtrochanteric fracture patients. 25 patients (3 males and 22 females) aged 42 to 96 years were managed with this system, and the intraoperative handling of this system and post-operative results were compared with those of patients treated by Gamma nails. It is to be emphasized that we can easily insert lag screws in the optimal position in the femoral head using a targeting device modified to custom specifications. This study shows excellent clinical results of cases treated by the Multi-Fix system. No significant differences were found between the two groups.
We reviewed the early clinical results of 117 peritrochanteric fractures treated with the Gamma nail. The average age of the patients was 77 years. The mean follow-up period was 264 days. The fractures were grouped into 5 types according to Jensen's classification. There was a significant difference in the sliding of lag screws between stable and unstable fractures. The main post-operative complication was cut out of the lag screw. It is essential to decide their operative indications carefully, because peritrochanteric fractures with fractures at the base of the femoral neck showed poor results.
Endovis nail is an instrument for the trochanteric fracture of the femur. It has a slit end and two lag screws for insertion into the femoral head, a large one for distal and small for proximal. Twenty-five cases were treated with this instrument between August 1996 and January 2001 and were followed-up for more than four months. The patients were three males and twenty-two females with ages ranging from 56 to 96 years. The mean age was 79.3 years. Postoperative complications were seen in four patients, late segmental collapse of femoral neck in one patient, slightly vurum deformity of the femoral neck in one and slight shortening of the lag screw in two. Endovis nail is a “Gamma nail type” instrument, which has several improvements. In this series there were no serious intra-and postoperative complications in the Gamma nail, such as femoral shaft fracture or cutting out of the femoral head.
There are few reports on rotational deformity of the femoral head neck fragment after treatment with Proximal Femoral Nail (PFN). This report describes a rare case which showed rotational deformity of the head-neck fragment after treatment with PFN. An 84-year-old woman sustained displaced left trochanteric fracture during a fall, which was classified as 32-A1-2 according to AO classification. The grade of osteoporosis of contralateral femur was grade 3 in Singh's classification. She was treated with PFN 8 days after injury. A hip pin was inserted to the level of great trochanter, which was not fixed rigidly enough. One day after the operation, she started standing training with full weight bearing. One week later, it was observed that she had a rotational deformity of the head-neck fragment, and weight-bearing standing training was stopped for 4 weeks to prevent progression of rotational deformity. No progression was observed even after full weight bearing walking after 10 weeks postoperatively. This case suggested rotational deformity in patients treated with PFN with severe osteoporosis may be prevented by deeper placement of the hip pin to the subchondral bone, which may prevent persistent rotational instability of the head-neck fragment.
we treated intertrochanteric fractures of the femur by using adjustable sliding hip screw, and evaluated the clinical results. The mean age at the time of surgery was 79.4 years (range, 56 to 96 years). The mean duration of follow-up was 6.3 months (range, 1.5 to 14 months). X-ray showed that the mean angle of lag screw/plate was 130.3 degrees. The benefit of using adjustable sliding hip screw was variability (inserting point of guide pin, angle of lag screw fixation). All of the cases recovered well without varus deformity of the femoral neck and cutting out of the lag screw. One of them felt out of place in an area in which we inserted a plate at the time of final examination. The adjustable sliding hip screw system is useful for the treatment of intertrochanteric fracture of the femur.
We investigated 42 patients with femoral trochanteric fractures treated surgically. 22 patients had stable fractures and 20 unstable fractures. The preoperative general condition of the latter group was slightly poorer than the former group. We concluded that tracking and improving the preoperative general condition is more important in patients with unstable trochanteric fractures.
We reviewed 128 femoral neck fractures in patients over 65 treated between 1997 and 2000. The mean age was 78.4 years. We paid attention to place of residence at injury as social background. Place of residence at injury was classified into two groups, own home and hospital facilities. Activities of daily life (ADL) was evaluated by gait ability. We report the connection between place of residence at injury and transition of ADL. ADL in the patients with dementia declined. In patients whose ADL was comparatively good and who did not have dementia, the transition of ADL in the group that stayed in their own home improved more than in that of those who remained at hospital facilities. We found that place of residence at injury is an important factor that affects the transition of ADL.
Treating physical disability with mental disorder is often difficult in hospitals where the cooperation of psychiatrists is not available, and reports on such cases are few. We studied the postoperative course of patients with femoral neck fracture injured while in a mental hospital and treated at our hospital. Of the 35 patients injured while in a mental hospital, treated at our hospital and returned to the mental hospital from January 1998 to November 200, 25.7% underwent rehabilitation after having returned to the mental hospital. In general patients, the percentage of walking without aid/walking with a cane decreased from 70.6% before injury to 39.9% at the time of investigation. In patients with mental disorder, on the other hand, the rate was 42.8% before injury and 45.7% at the time of investigation, indicating that their walking capability is maintained relotively well. It appears that the prognosis of femoral neck fracture complicated with mental diseases is by no means poorer than that of general patients.
From August 1997 to February 2000 we treated 16 clavicle fractures using the J plate and followed up on them for more than 4 months. The patients consisted of 10 males and 4 females with ages ranging from 15 to 80. According to the Robinson's classification method, all fractures were classified as Type 2 (1 case was Type 2A1, 3 cases were Type 2B1 and 10 cases were Type 2B2). We allowed 90 degrees abduction of the shoulder joint 4 weeks after the operation. All fractures achieved union, but union was delayed in 1 case. Plate failure occurred in 1 case, the bending of the J plate was seen 2 weeks after the operation and this deformation continued for 6 weeks. After the fracture achieved union, bending of the J plate stopped. We concluded that J plate is useful for midclavicle fractures.
We report a case of post-traumatic osteolysis of the distal end of the clavicle. The case was a 48-year-old man who sustained an injury to his shoulder in a bicycle accident six months before. He had felt inveterate pain and swelling in his left acromio-clavicular joint after the accident, though the shoulder radiograph taken soon after the accident showed no abnormality. After five months, osteolysis of the distal end of the left clavicle was found on radiograph. According to laboratory data, there were no findings of infection. Comparison of radiograph taken just after injury with that taken two and five months later revealed that the patient sustained fracture of the distal end of his left clavicle (Neer's classification type III) first, and later developed osteolysis of his left claviclar distal end occurred because he did not rest his shoulder. By conservative trearment, pain is decreasing and no progress of osteolysis has been seen in follow-up radiograph.
Proximal humeral fracture is a typical fracture in elderly people with osteoporosis and problems are often faced in these operations. We treated 21 cases by intramedullary fixation using spiral pins. All achieved bone union and their pain decreased gradually. All also showed comparatively good results with no contracture due to the early start of rehabilitation. The spiral pin is conisdered a useful operative method for the elderly because it provides sufficient fixation and less invasion.
We performed osteosynthesis for proximal humeral fractures using Sprout pins. The cases consisted of eight females, with an average age of 79.2 years. Under general anesthesia, the fractures were reduced, and alignment of the fracture was checked using an image intensifier. Sprout pin was inserted from the deltoid tubercle to the humeral head, along a medial portion of the humeral neck under image intensifier control. This operative procedure provided less surgical stress and sufficient stability for fractures. Pendulum exercise was started two days after operation. Active assisted exercise was started three days later. These patients were assessed using the Japanese Orthopaedic Association Shoulder Scoring System (JOA score). Eight patients had sound union of fractures and satisfactory results. The average JOA score was 89.6 points at discharge from the hospital, except for one case of inferior subluxation. We confirmed that osteosynthesis for proximal humeral fractures using Sprout pin is very useful.
We report a case of fixation of a radial head fracture with PLLA screw and pin (FIXSORB®). A49-year-old male fell and sustained a fracture of the right radial head by direct injury. The radiological finding was classified as Mason type 3. We removed the radial head, fixated two fragments of the head of radial head with two PLLA pins, and fixated it to the shaft of the radius with one PLLA screw. In addition, one PLLA pin was used for the prevention of rotation. The elbow was immobilized in a splint for two weeks. Active movement was begun after two weeks. One year after the injury, his only symptom was a slight limitation of pronation. Extension-flexsion was full range of motion (zero to 140 degrees), as was supination (90 degrees). Pronation was 35 degrees. The JOA score was 98.
External fixator is essential for unstable fracture of the distal radius. From January 1997 to December 2000, we treated 12 distal radius fractures with the Poanfix external fixtor. They included 1 male and 11 females aged 64 years on average. We classified them by Frykman's classification. To assess maintenance of reduction, ulnar variance (UV), palmar tilt, radial tilt, and carpal height ratio were measured before reduction and after removal of the external fixator. Clinical results by Saito's point system were excellent in 7 cases, good in 4, poor or fair in none, indicating results were satisfactory. X-p showed that palmar tilt and radial tilt did not differ significantly between before and after removal of the fixator. But 5 cases had UV greater than 2 mm. Two groups with more or less 2mm UV had different mean age and duration of external fixtor. The reason is suspected to be bone defect of distal radius due to osteoporosis. Consequently, we recommend a supplyment ary operation with external fixator for patients with radial fracture developing osteoporosis.
Ultrasound examination was performed with 7.5MHz transducer on 9 patients (10 wrists) with lateral epicondylitis of the elbow. There were 5 men and 4 women. Their age ranged from 40 to 57 years with a mean age of 47.9 years. The period of suffering ranged from 1 month to 3 years, with a mean duration of 11.4 months. Normal cases were also studied for comparison. Ultrasound examination included longitudinal scan of the ECRB and EDC, and transverse scan of the lateral epicondyle of the elbow. The longitudinal and transverse scan of the ECRB and EDC showed enthesopathy with hypoechoic thickened extensor tendon. Ultrasonography seems to be useful for the evaluation of the degree of degeneration at the extensor tendon insertion.
In general the prognosis of rotator cuff repair is good or excellent. We report a case of rotator cuff tear which underwent multiple operations. A 62-year-old male with rotator cuff tear was admitted to our hospital because of severe pain and limitation of range of motion of the right shoulder. After one month of conservative therapy failed, we parformed cuff repair operation with anterior acromioplasty. After surgery, he suffered severe pain. Postoperative examination showed no re-tear of the rotator cuff. For a period of six months beginning one year after the first surgery, he suffered RSD (reflex sympathetic dystrophy), for which we performed three surgeries. The second surgery was partial resection of the superior labrum, the third was arthroscopic decompression of acromion, and the forth was arthroscopic resection of the biceps long tendon. Despite these operations, his pain still remains.
We investigated the clinical results of total shoulder replacement and performed a radiological evaluation. Total shoulder replacement was performed on 6 shoulders with osteoarthritis and on 4 shoulders with rheumatoid arthritis. JOA score was determined pre- and post-operatively. The patients consisted of 3 males and 5 females, and the age at operation averaged 69 years for osteoarthritis and 64 for rheumatoid arthritis. The average follow-up period was 36 months (minimum follow-up: 12 months). The post-operative JOA score of the osteoarthritic shoulder was significantly higher than pre-operative, especially for pain score and range of motion score. In the rheumatoid arthritic shoulder, post-operative pain score was significantly higher than pre-operative, although there was no statistically significant difference between the pre- and post-operative JOA scores. Radiological evaluation was performed according to Brenner's classification. Radiolucent zones of one millimeter or less were seen in 6 cases around the glenoid component and the proximal half of the humeral component, and were not seen in the distal half of the humeral component. However, loosening was not noted in both components. Two rheumatoid patients demonstrated subluxation of the glenoid component and 1 case showed a broken glenoid component. Only 1 case was found with radiolucent line around the proximal humeral component. Our results revealed that total shoulder replacement provides effective pain relief and recovery of the range of motion in osteoarthritis, and pain relief in rheumatoid arthritis.
The results of fifty-five cementless total hip arthroplasties using the Omniflex system were reviewed. All patients were followed clinically and radiographically for more than four years. The AD stem (non-HA stem) was used from January 1993 to October 1995, and the Securflex (HA stem) was used from November 1995 to December 1996. On the stem side, five unstable fixation stems were observed in the non-HA group. In the HA group, we found early osseointegration in all cases. On the socket side, there were no loose shells. We need to observe osteolysis carefully since the onset of osteolysis seems to increase gradually with polyethylene wear.
We performed cementless total hip arthroplasty (THA) with cancellous bone chip grafting for acetabular deficiency in seven hips and reviewsd radiographic findings of grafted bone. The mean age at operation was 55.6 years (range: 46 to 72) and the follow up period was 23 months (range: 8 to 53 months). The grafts covered 22% to 40% (mean 32%) of the socket. In all cases, union of the grafts was achieved within one year and remodeling of the grafts occurred within 6 months. Extensive absorption of the grafts was not observed. Minor radiolucent line was seen in four hips and heterotropic ossification in two. There were no problems concerning socket stability. These results suggest that cancellous bone chip grafting is available for acetabular deficiency in THA.
Between February and September of 2000, we carried out radial magneic resonance imaging (MRI) on 8 hips consisting of 5 pre-osteoarthritis and 3 early stage osteoarthritis. There were 7 female patients with a mean age of 28 years (age range: 16-50 years). The radial MRI results were compared with intraoperative arthroscopic findings. In the weight-bearing portion, from 45° ante rosuperior to 45° posterosuperior, all patients had various tears of the acetabular labrum. In the anterosuperior portion, 4 hips (50%) showed imcomplete tears, 3 hips (38%) showed complete tears, and only 1 hips (18%) showed intact labrum. In the superior portion, each of the 3 hips (38%) showed imcomplate and complete tears. In the posterosuperior portion, each of the 3 hips (38%) showed imcomplete tears and intact labrum. The arthroscopic normal labrum was clearly depicted as a homogenous triangular area of low signal intensity. The incomplete tears were depicted as a moderate signal intensity or central high signal intensity. The complete tears were depicted as a diffuse and obscure high signal intensity. We conclude that radial MRI may be a useful non-invasive diagnostic method for tears of the acetabular labrum in oseoarthritis.
Sciatic nerve palsy is a proble troublesome complication of total hip arthroplasty. It may be caused by direct injury or over-traction at the time of operation. We investigated the effects of the hip and knee positions on the blood flow of the sciatic nerve of dogs. Tweyty hip joints of 10 adult mongrel dogs were examined. The blood flow in the sciatic nerve was measured using a Laser Doppler Flowmetry, at varying angles of flexion (90°, 120°, 150°) and internal rotation (0°, 30°) of the hip joint and angles of flexion of the knee (0°, 30°, 60°, 90°). This study showed that the blood flow in the sciatic nerve decreases with increasing flexion angle and increasing internal rotation angle of the hip joint, and that decreases in the flexion angle of the knee joint result in especially pronounced decreases in blood flow. We consider that the position of the hip and knee positions are considered a significant risk factor in total hip arthroplasty parformed with over-lengthening. Our results suggest that surgeons should pay attention to knee extension and the flexion and internal rotation positions of the hip tp prevent sciatic nerve palsy as a complication of total hip arthroplasty.
The Purpose of this study is to clarify the effects and problems of prophylaxis for deep venous thrombosis (DVT) following total joint arthroplasty in lower extremities using low dose heparin. We administerd 1000 units of heparin twice every 12 hours for 2 weeks to 19 patients, consisting of 7 total hip arthroplasty, 10 total knee arthroplasty, 2 hip prosthesis. Definite deep venous thrombosus diagnosed by ultrasonography or venography was seeen in 2 out of 19 cases (10.5%) and probable DVT diagnosed by value of D-Dimer (>10ug/dL) in 6 out 19 cases (30.5%). Thrombocytopenia occurred as a result of the administration of heparin, but there was no major bleeding. The effectiveness of low dose heparin for prophylaxis of DVT is doubtful but this serves as a safe method.
The clinical outcome of fifteen patients with traumatic posterior hip dislocations was reviewed. The mean follow-up period was 4.3 years. There were 14 males and one female, with a mean age at dislocation of 48.9 years. All radiographs were reviewed and graded based on the system devised by Thompson and Epstein in 1951, and all patients were reviewed clinically and radiographically and classified as excellent, good, fair or poor, based on the system described by Stewart and Milford (1954) and expanded by Epstein (1974). There were seven patients (46.7%) with type I, two (13.3%) with type II, four (26.7%) with type III, one (6.7%) with type IV and none with type V. Four patients (26.7%) were rated as having excellent results at the latest follow-up, six (40%) had good; one (6.7%) had fair and four (26.7%) had poor. Twelve patients (80%) had multiple injuries. The incidence of Knee injuries was especially very high (40%). Two patients (13.3%) with type I or III developed avascular necrosis in the series.
We treated 13 both column fractures of the acetabulum using open reduction and internal fixation, in 10 males and 3 females with a mean age of 47.9 years from 1994 to 2000. The interval from injury to operation was 14.3 days. We performed the anterior approach on 2 cases, combined approach on 11, and simultaneous anterior and posteriol approach on 3. Bleeding during operation ranged 1300ml to 3520ml, operation time 4 hours to 7 hours 50 minutes. The average follow-up period was 27 months. There was one case with poor JOA score and two cases evaluated as unsatis-factory according to radiographical findings. We recommend that open reduction and internal fixation should be performed for both column fractures of the acetabulum.
We report a hemodialysis case of rupture of the quadriceps tendon complicated by hyperparathyroidism. The case was a 60-year-old man who his left leg when he attempted to stand steadily to avoid falling. In spite of low energy injury, his quadriceps tendon was ruptured. The patient was treated by surgical repair with Telos® artifical ligament, and satisfactory results, were obtained. Histologic examination showed avulsion of the fiblo-cartilage junction and amyloid deposit. Hyperparathyroidism and amyloidosis are considered to cause weakness of the quadriceps tendon.
Most osteochondritis dissecans in the ankle is found in the talar dome. Osteochondritis dissecans of the tibial plafond is rarely reported. We experienced a case of osteochondritis dissecans of the tibial plafond of the ankle. A 28-year-old man visited our clinic complaining of right ankle pain. Radiography, CT, and MR imaging showed abnormality of the tibial plafond. It was diagnosed as osteochondritis dissecans of the tibial plafond of the ankle. We perfomed arthroscopy on the right ankle. There was a loose body which was too smal to fix, and there fore removed. The cause of osteochondritis dissecans of the tibial plafond of the ankle was inuestigated.
The position of the hallucal sesamoid needs to be included in an evaluation of hallux valgus. In order to quantify the rotational of position of the hallucal sesamoids from weightbearing tangential radiograph, a new tangential positioning device was established. A lead marker line was placed on the most depression aspect of this device, and fitt to the metatarsal head resion. This marker line showed the horizontal plane, and the sesamoid rotation angle (SRA) was measured. The SRA consisted of the angle between tangential line of the most inferior aspect of mediallateral sesamoids and marker line. Hallux valgus angle (HVA) was measured from anteroposterior radiograph. Measurements were made of 20 feet in 10 patients with hallux valgus and 20 feet in 10 normal subjects. A comparison between the two groups showed a significant difference with respect to the SRA. There was a high correlation between SRA and HVA (r=0.876). This device can result in reliable radiographs, and the rotational position of the sesamoids can be assessed quantitatively. We concluded that the SRA is reliable and useful for assessing the rotational position of sesamoids in hallux valgus.
About the medical treatment of patella fracture, knee joint movement from an early stage is needed. We pay our attention to the dynamic intensity of Cannulated Screws, and perform Percutaneous Cannulated Screw Fixation to patella fractures. We examined results to 11 cases. All the men can sit up straight in about five weeks of averages. There was no obstacle of the sharp pain and the skin damage by screws. We think that there is little surgical stress and it has sufficient fixed power. We consider this method to be the method of obtaining a movable region at an early stage.
We experienced residual deformities and reconstruction after distal tibial physeal fractures in six children. There were three boys and three girls. They were injured at 6.8 years on average. There were four open fractures and two closed fractures. All patients in this series had been treated at other medical centers. Corrective osteotomy was performed at 11.8 years on average and the mean follow-up period was 4.2 years. Angular deformity involved five varus and one valgus deformity. Limb-length discrepancy was 2.0cm on average. Reconstruction osteotomy combined leg lengthening and bridge resection or complete ipsilateral epiphysiodesis of the tibia and fibula. At final follow-up, there was limited range of motion in all open fractures, two of whom had slight pain in hard movement or longdistance walking. Angular deformity and limb-length discrepancy were more or less corrected except for one patient who was in the growing stage. In treating children with distal tibial physeal fracture, we should consider the age, the area of growth arrests, and range of angulation, and select adequate operative procedures.
The purpose of this study was to evaluate the clinical results of internal fixation of orthopaedical surgery using Acutrak screw. Ten patients (11 cases) were treated between September 2000 and May 2001. Nine men (10 cases) and 1 woman were treated, and their age at surgery was 15 to 60 (mean 26.2) years old. The mean follow-up period was 3.8 (1.5 to 8) months. Problems encountered during this study were as follows: one guide pin broke and remained in the bone, two screw drivers broke, and the one of bipartita patella had delayed union. The Acutrak screw is a headless tapered, self-tapping and fully-threaded device designed to provide interfragmentary compression. Its variable pitch creates gradual compression with each turn. The Acutrak screw may have some of the advantages of the Herbert screw in being headless.
A case of a 53-year old woman with lateral parapatella synovial involvement of the knee joint was reported. She first noticed pain with snapping sensation on the lateral side of the knee after an episode of repeatedly going up and down stairs. Arthroscopic findings revealed proliferative lesion of the lateral parapatellar adipososynovial fringe, which connected with the infrapatellar fat pad. The snapping occured by the sliding of the lesion on the lateral femoral condyle with knee motion. After resection of this lesion, the snapping disappeared. Histological findings of the resected lesion showed proliferation of capillaries and hyperplasia of fibrous tissues, accompanied by infiltration of inflammatory cells.
We present a case of locked knee caused by degenerative partially torn anterior cruciate ligament stump. A 67 year-old woman was admitted to our hospital for right gonalgia. Her range of motion was -8 degrees to 100 degrees. Preoperative diagnosis by magnetic resonance imaging was anterior cruciate ligament tear and lateral meniscus tear. Arthroscopic partial resection of the lateral meniscus tear was performed, but an audible and palpable popping sound with terminal extension remained. After arthroscopic resection of the ACL stump, the audible and palpable popping sound with terminal extension disappeared, and the patient became asymptomatic.
This study was designed to evaluate long-term clinical results after total knee arthroplasty (TKA) with Mark III prosthesis. Among 85 knees which underwent TKA between 1988 and 1995, 33 knees of 25 cases were evaluated by direct examination more than 5 hears after surgery. 21 knees had osteoarthritis (OA) and 12 had rheumatoid arthritis (RA). The mean follow-up period was 10 years (range: 5 years and 5 months to 13 years and 6 months). The range of motion, JOA score, and roentgen graphic findings immediafely after surgery and at final follow-up were evaluated. There was no significant difference between the range of motion soon after surgery and that at the final follow-up. JOA score at the final follow-up significantly improved in both OA and RA cases. Loosening of the femoral components and sinking of the tibial components were identified in 11 and 3 knees respectively, and both were more common in RA cases. Although clinical results were excellent at the mean follow-up period of 10 years, further follow-up is necessary as the incidence of loosening was high (11/33) with this simple and unique Mark III prosthesis.
We evaluated the clinical and radiographic results of total knee arthroplasty in 20 cases using the Bisurface type (KU-3) system in compasison with 21 cases using the MG-II system. In the cases using the KU-3 system, the mean JOA score improved from 57.0 to 89.1 points, and the mean flexion angle improved from 116.1° to 130.0°. On the other hand, in the cases using the MG-II system, the mean JOA score improved from 56.3 to 84.8 points, and the mean flexion angle deteriorated from 121.7° to 117.3° The cases using the KU-3 system were more satisfactory than the cases using the MG-II system because of improvement in daily living from improved range of motion in the knee joint.
We use Critical Path for postoperative treatment of cementless Total Knee Arthroplasty (TKA). Full weight bearing is begun on the second postoperative day, and patients who can walk with a cane are discharged during third week after surgery. Between January 1998 and June 2000, forty-eight total knee arthroplasties were performed on 41 patients who were follow up for more than one year. Forty-four knees were osteoarthrosis and 4 knees rheumatoid arthritis. The mean follow-up period was one year and 5 months. We used Nexgen CR for all arthroplasties. We studied radiolucent lines and loosening by fluoroscopy, and examined the JOA score and complications. Radiolucencies were present at the posterior surface of femoral component, surface of the peg and posterior surface of the tibia component in most cases. There was no loosening and sinking however. No patients had complications due to early weight bearing. In conclusion, no problems were seen in radiologival findings and short period clinical results of cementless TKA for which we permitted early weight bearing after surgery.
We experienced a rare case of anterior dislocation of the tibia after total knee arthroplasty (TKA). A 61-year-old female, suffering from RA, was treated with left TKA with Mark IV at another hospital in 1997. After operation, joint laxity of her left knee appeared, and for which wore a knee outfit for 2 months. She noticed left knee pain for no apparent reason in March in the 2000. She came to our hospital in September due to increased knee pain. We found anterior dislocation of the tibia and an old fracture of the fibula in roentgenogram, and manual reduction failed. We were alde to reduce the knee joint during surgery by flexing it, but dislocation easily occurred by extending the knee joint. Although the posterior part of UHMWPE of the tibial conponent was worn out, both collateral ligaments were not lax in the reduced position. We performed revision TKA with Nexgen-LPS. 10 weeks after surgery, she was able to walk without brace and the ROM of her left knee was 0° in extension and 125° in flexion.