It is difficult to treat transcondylar fractures of the distal humerus in adults. Stabilization of these fractures is difficult because the distal fragments are small and large portion of their surface is covered with articular cartilage. Furthermore, osteoporotic patients lose elbow motion due to immobilization by the splint after the ORIF. The “ONI Transcondylar Plate” is an instrument for the transcondylar distal humerus fractures. The plate is applied to the lateral aspect of the humeral shaft. The condylar screw is inserted in the central portion of the condyle. The insertion of the locking nut over the condylar screw’s head provides stable fixation of the fracture. This fixation with the plate allows early mobilization of the elbow. Although to date we have experienced only two cases, the transcondylar plate is considered to be a useful fixation material, because of its ability to prevent shortening of fracture site and reduce the period of postoperative immobilization.
We treated distal radius fracture with bone deficit using β-tricalcium phosphate (β-TCP). Two cases were added with internal fixation by Kirschner wire. Other cases were added with internal fixation by anatomical plate. We evaluated the clinical results. The mean age at the time of surgery was 74.5 years (range: 66 to 87 years). The mean duration of follow-up was 8.6 months (range: 3 to 13 months). All of the cases recovered well (results: two were excellent and two were good using Saito’s point cases recovered well (results: two were excellent and two were good using Saito’s point system). These results suggest that β-TCP is useful for the treatment of distal radius fracture with bone deficit.
This study was designed to evaluate the clinical results after surgery for fractrues of the distal end of the radius in the eldely patients. The average age at surgery was 73.6 years (range: 62 to 86 years) and the average follow-up period was 5.1 months. Thirteen fractures were treated by percutaneous pinning, 4 by plate, 5 by external fixation device, and 1 by corn head screws. Radial inclination, ulnar variance and palmar tilt were measured on X-ray films at the initial visit, after surgery, and at the final follow-up, in order to evaluaet the loss of reduction. The subjective gradings by Saito’s point system were excellent in 4 cases, good in 11, fair in 4, and poor in 4. There was a significatnt difference between the average value of the radius shortening after surgery (1.6mm) and at the final follow-up (4.0mm). Particularly, the shortening was significant in the cases treated by percutaneous pinning, probably because of bone defect and osteoporosis. We think that the indication of percutaneous pinning for elderly patients should be restricted, and the use of the plate or external fixation device, with bone graft or any other supplement, should be encouraged.
We treated four children with flexion supradondylar fractures of the humerus. One child was treated by traction for 14 days and an extension cast after closed reduction. One child was treated by closed reduction and fixation with percutaneous Kirschner wires. Reduction by the closed method was difficult in the other two children due to completely displaced fracture, and open reduction was required. Two of the four fracture were in cubitus rectus, but none had joint stiffness.
Operation was performed on three patients with age ranging from 7 to 15 years. According to Judet’s classification, type 2, type 3, and type 4 were found each in one case. Percutaneous reduction was performed within two days after injury. In case percutaneous reduction was difficult to perform, open reduction was carried out. Internal fixation was not used and plaster fixation was kept for 3 weeks. Sufficient results were obtained by open reduction. In the cases where there was no complicated injury, functional prognosis was also good.
It is sometimes difficult to choose the fixator of femoral shaft fractures in patients between the ages of 15 and 20, because of a remaining epiphyseal line or medullary space narrowing. We report a study on the surgical treatment of femoral shaft fractures with intramedullary nail in this age range. Forty-one femoral shaft fractures treated by intramedullary nail, which could be surveyed for over 3 months out of the 46 femoral shaft fractures we experienced for 10 years (from 1992 to 2002), were studied. Thirty-four patients were male and 7 female, with the mean age at surgery of 17.8 years. Thirteen patients were 1/3 proximal fracture, 24 were 1/3 middle fractures, and 4 were 1/3 distal fractures. Twenty-five fractures were type A, 11 were type B, and 5 were type C separated by AO’s classification. Thirty-four fractures were operated with Russell-Taylor nails (2 were reconstruction nails), and 5 were with Ender nails. Follow-up periods ranged from 3 months to 34.5 months (average: 17.5 months). We researched their range of motion, the period until bone union, and so on, separating AO’s classification, and their fixator. The average period of bone union was 23.9 weeks, and all patients were cured by bone union. Four patients underwent dynamization.
We evaluated the clinical results and perioperative medical complications of 167 intertrochanteric fractures of the femur. The mean age at the time of operation was 83 years (range: 65 to 96). Preoperative medical conditions mainly consisited of hypertension (29%), cardiac disease (16%), disease of central nervous system (28%), and dementia (31%). Various diseases of the digestive tract were observed as postoperative medical complications. Six patients (3%) died during their hospital stay, because of acute myocardial infarction, cerebral infarction and 3 cases of pneumonia. Fifty-five of the 69 patients (80%) were discharged ambulatory with a walker, cane, or without external support.
The purpose of this study is to evaluate the results and problems of surgical treatment for subtrochanteric fractures of the femur. We treated 8 patients with this fracture between April 1997 and March 2001. They consisted of 2 males and 6 females with a mean age of 76 years. Bone union was obtained in all cases. However, there were 18° varus deformity in one case and 2 grade decrease of walking ability in two cases after operation. This fracture tends to be of the comminuted type accompanied by therapeutic problems.
We report a case of recurrent intraspinal cyst. The patient was a 29-year-old male. His initial complaint was lumbago. Four weeks after onset, lumbago and left sciatica appeared. An epidural mass was detected at L4/5 by MR imaging, myelogram and CTM. In MR imaging, the mass showed low intensity in T1, high intensity in T2 and ringed enhancement effect with gadolinium. The mass was thought to be a synovial cyst or ganglion, but surgical and histological diagnosis was a discal cyst. His pain subsided after surgery, but left sciatica appeared again seventh seven days after the operation. A cyst larger than the first one was found with MR imaging.
Idiopathic epidural lipomatosis is a very rare condition. It usually appears as a secondary chronic steroid or endocrinopatic disease. We report three cases experienced intermitted claudication and radicular pain in their legs. They were evaluated by myelography, computed tomography, and magnetic resonance imaging. Surgical treatment was performed by laminectomies and fat debulking. After surgery, there was gradual improvement in symptoms, and the patients resuned daily activities and neurological conditions returned.
We studied 33 cases of lateral lumbar disc herniation (LLDH) retrospectively. In radiological examinations, coronary view by magnetic resonance imaging (MRI) proved most useful. Selective radiculography and root block were effective for the diagnosis of the LLDH level. Discography and CT-discography were useul for diagnosis of the occupied region. On the other hand, lateral fenestration was considered the best surgical method for LLDH because it was comparatively easy and reguired no fusion. The details of this study are as follows. We performed lateral fenestration on 19 patients. The locations of disc hernia were intraforaminal type (IF) in 4 cases, extraforaminal type (EF) in 11 cases, intara and extraforaminal type (IEF) in 5 cases. The average recovery rate of the JOA score (Japan Orthopedic Association score, Assessment of Treatment for Low Back Pain) was 97.1% for IF, 80.8% for EF, and 84.8% for IEF. The results were not significantly different, and were satisfactory. We believe that lateral fenestration is effective for not only the EF type, but for the IF and IEF types, as well.
X-P evaluation of the upper disc of segments fixed using pedicle screws (PS) was performed on 45 cases available for an over 4-year follow-up, and was compared with the data of cases fixed using anterior fusion (ASF). The overall results of the development of disc degeneration were identical with those of the ASF group, but several cases developed instability or spondylolisthesis, and their results were poor. Four cases underwent operation again, and the number of re-operations is expected to increase in the future. Careful evaluation of pre-operative conditions and considerations of the operation are necessary, and the indication of the PS operation must be selected.
We reviewed patients with unilateral leg shortening treated by surgical leg lengthening in order to determine the incidence of preoperative scoliosis and changes in scoliosis produced by surgical equalization of leg length. This study involved a total of 25 patients (14 boys and 11 girls). Their preoperative leg length discrepancy averaged 33.2 mm at the femoral head level and 22.1 mm at the iliac level. They underwent surgical leg lengthening at a mean age of 13.2 years, and this review was performed at a mean age of 17 years. When a Cobb angle of 10° or more was considered a sign of scoliosis, the incidence of scoliosis was 72% (18/25 patients) pre-operatively, and all of the 18 patients with scoliosis were found to have leg shortening characterized by lateral convexity. Surgical leg equalization was associated with reduction of the Cobb angle from the preoperative mean of 18.1° to a postoperative mean of 5.2°. When classified by degree of vertebral rotation, patients with no vertebral rotation and those with degree I rotation were found to have significant improvement of the Cobb angle after surgery, whereas those with degree II rotation had only poor improvement.
We report eleven patients with old lateral collateral ligament injury of the ankle joint due to sports that were treated using the Glas procedure. Subjects consisted of six males and five females. Injuries were basketball-related (five cases), soccer-related (three cases), and there was one case of tennis-, dance-, and rugby-related injury, respectively. The average age was 18.4 years, ranging from 14 to 25 years. We determined cases requiring operation by recognizing ankle instability on radiographs: subjects experienced continued ankle pain and could not play sports satisfactorily. Radiologically, the mean of the talar-tilt-angle improved from 17° to 5.3°, and that of anterior drawer distance improved from 9.4 mm to 5.6 mm in the post-operative period. Range of motion was almost full, and all patients were able return to the sport they played prior to injury. The Glas procedure for lateral collateral ligamentous injury of the ankle joint is considered a good surgical method for young patients.
We studied sports injuries in high school baseball players in Miyazaki prefecture via a questionnaire survey (711 players, 37 high schools). 672 players had started to play baseball before they entered high school. 515 players experienced pain when they were in elementary school or junior high school. 542 players suffered from injuries at the time of the questionnaire survey. Injuries were predoninantly elbow joint, low back, and shoulder joint. Except for pitchers, approximately 70 to 80% of the players with injuries continued training without changing their schedule. These results suggest that close contact between physicians, players, and their coaches is important in providing medical support.
We treated two patients with osteochondral fracture of the talar dome with the Herbert screw. The screw can be inserted through the articular cartilage and leaves no protruding head within the joint. There was no incidence of avascular necrosis in either case during follow up. Herbert screw is useful for internal fixation of talar dome osteochondral fracture.
We report the rupture of the bilateral quadriceps tendons in a hemodialysis case. The case was a 37-year-old man who fell on his knees. Though it was a low energy injury, his bilateral quadriceps tendons were ruptured. The patient was treated by surgical repair with artifical ligaments which were pierced through the patella bones and quadriceps tendons. Histologic examination showed degeneration and fibrosis but no amyloid deposit in the tendons. We considered chronic acidosis as a cause of weakness of the quadriceps tendons. Surgical treatment with artifical ligaments enabled the patient to start early rehabilitation and results were satisfactory.
We studied the incidence of deep vein thrombosis (DVT) before operation in leg fractures. DVT was evaluated in 36 cases using venography between May 2001 and December 2001. There were 30 femoral neck fractures, three cases of osteoarthritis of the knee, one osteonecrosis of the femoral head, one rapidly destructive coxarthropathy, and one multiple fracture. DVT was seen in three of the 30 femoral neck fracture cases (10%). According to other literature on DVT, the incidence of DVT is mainly higher after operation than before. Also D-dimer was high in DVT cases. Consequently, D-dimer was useful for the diagnosis of DVT.
A 74-year-old woman was admitted with an asthma attack. She had a 40-year history of sinusitis, nasal polyp and aspirin-induced asthma; however, asthma had never occurred when she used a 0.3% ketoprofen adhesive patch for stiff shoulder or lumbago. In the hospital, a life-threatening asthma attack suddenly occurred two and a half hours after application of a 2.0% ketoprofen adhesive tape to her shoulder. She was treated with bronchodilator and glucocorticoid and extubated after 20 hours. A drug lymphocyte stimulating test (DLST) was strongly positive for ketoprofen. We suspected that drug-induced hypersensitivity coexisted in this case, but it was not clear whether the hypersensitivity was related to the pathogenesis of analgesic-induced asthma.
Pyomyositis is a pyogenic infection of the skeletal muscle with or without obvious local or adjacent source of infection. The diagnosis of pyomyositis is often delayed because other primary diagnoses are first considered. This article discusses a case of pyomyositis of the medial head of the gastrocnemius muscle in a 73-year-old man who was not immunocompromised. A review of medical literature in also presented.
Beals syndrome (congenital contractural arachnodactyly) is an autosomal dominant disorder characterized by multiple joint contracture, long arms and legs, arachnodactyly, crumpled ears, and scoliosis. We surgically treated a Beals syndrome patient with severe flexion contracture of both knee joints. The patient was a 3-year-old boy who could not walk in an upright position because of severe flexion contracture of both knee joints. Conservative treatment including physical therapy and application of braces was not successful. We performed surgical correction of contracture including skin release, tendon elongation of knee flexors, the posterior thigh flap (6×4 cm for the left popliteal defect) and venoneuroadipofascial flap (6×4 cm for the right popliteal defect). After skin release and tendon elongation, both knees could not be straightened because of tightness of the neurovascular bundle. Pins and plaster fixation were applied in both knees to maintain the flexed position. The Ilizarov external fixator replaced pins and plaster fixation one month after the operation. Both knees were gradually extended with telescopic rods. The Ilizarov external fixators wree removed after 2 months. The quadriceps strength of both knees was weak (MMT1) but gradually improved by rehabilitation. After 1 year and 9 months, he could walk in an upright position without any support. Quadriceps strength improved to MMT4 and the range of motion improved to extention −25 degrees and flexion 115 degrees.
We report a rare case of entirely intra-osseous chordoma occurring in the fourth cervical vertebral body. Chordoma is a rare tumor of the axial skeleton most commonly found in the sacrococcygeal region and the base of the skull. The typical findings are large bone destruction and expansive growth into the soft tissue. A 67-year-old female complained of neck pain extending into the right shoulder. Radiographs and bone scintigraphy were normal. MRI demonstrated the lesion clearly, and showed low-intensity in T1 weighted images and high-intensity in T2 weighted images within the vertebral body. No expansion into the soft tissue was revealed. CT showed no bone destruction. We performed vertebrectomy and anterior spinal fusion. histopathological findings were compatible with chordoma. Her pain disappeared after surgery. One year after surgery, there is no local recurrence, but lung metastasis was suggested by CT. Careful follow up is necessary.
We consider osteoplastic laminectomy for entrapment radiculopathy at the foraminal and extraforaminal lesions of the lumbar spine. Nineteen operative cases with a mean age of 62.3 years were reviewed. The mean preoperative JOA score was 14.5, which was increased to 23.0 postoperatively. Fourteen (60%) of the cases were degenerative change. It is important to pay attention to the presence of compression due to degenerative change at the foraminal and extraforaminal lesions for proper diagnosis. Osteoplastic laminectomy allows appropriate decompression for involved nerve roots under a comprehensive view, preserving posterior structures.
There are two points in single-injection digital block techniques. One is at the palmar (A1 pulley level) and the other is at the palmophalangeal crease. There are only a few reports describing pain sensation on the interphalangeal crease and palmophalangeal crease. Conseguently, we investigated by pin-prick test in this study. The subjects were 100 index fingers of 100 normal volunteers. They were tested at 8 points from the finger tip to the palm (A1 pulley level). The palmophalangeal crease showed lower sensitivity than the palm (Wilcoxon signed-rank test).
We reviewed the early clinical results of 4 distal tibial fractures using the minimally invasion plate osteosynthesis (MIPO) technique. The average age of the patients was 67.7 years. The mean follow-up period was 3.9 months. All fractures were extraarticular fracture of the distal tibia, and mean operating time was 54 minutes. Time to full weight-bearing was 7 to 8 weeks. Though the minimally invasive technique for plate osteosynthesis in the treatment of diatal tibial fracture is considered useful, the indicaton for using this technique must be evaluated carefully. The MIPO technique is considered a better choice for patients with severe general conditions, and fractures with little displacement.
Six patients with hemodialysis-associated cervical myelopathy underwent cervical expansive laminoplasty. Duration of hemodialysis ranged from 0.5 to 26 years (average: 11.8 years). No patients had destructive spondyloarthropathy (DSA). Pre- and postoperative neurologic status was assessed using the cervical myelopathy scoring system of the Japanese Orthopedic Association. Neurologic recovery was obtained in all six patients. We compared this group with forty patients, whose cervical myelopathy was not associated with hemodialysis. There was no significant difference between the two groups.
A case of spinal cord injury in a 16-year-old girl that was caused by stab wound is reported. She was admitted to the emergency department one day after being stabbed. When admitted she was conscious but was experiencing weakness in the lower limbs. The knife had penetrated through the left lamina to the right vertebral body at Th8. Treatment was conservative, and very good functional recovery was achieved.
Necrotizing fasciitis (NF) is an acute, potentially lethal soft-tissue infection accompanied by distinct clinical features such as exquisite pain, local heat, swelling, flare, and bubbles in the affected regions. The diagnosis is confirmed upon isolation of causative organisms and pathological findings of the necrosis of the fascias. In most cases, patients with NF suffer systemic symptoms caused by sepsis, such as shock, DIC and MOF when they are referred to tertiary medical facilities. Mortality is usually due to delayed diagnosis. Therefore, early diagnosis and prompt treatment are the key to reducing mortality and morbidity of patients with NF. We present six patients with NF who required intensive care at our center. Subjects consisted of four men and two women, age ranging from 56 to 70 years, with an average age of 62.5 years. The affected regions included one upper limb (one patient), one lower limb (two patients), one upper limb and torso (two patients), and one lower limb and torso (one patient). All of the patients had underlying diseases such as diabetes mellitus, and cirrhosis of the liver. Most of the patients deteriorated rapidly, two of them underwent surgical treatment, and five died in spite of aggressive treatment.
We investigated the clinical results of 39 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent expansive laminoplasty by sagittal splitting of the spinous process (Kurokawa’s method), from January 1995 to October 2000. The mean age was 62 (42 to 75) years. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 38 (12 to 77) months. The mean JOA score was 7.82 points before surgery and 12.73 points after surgery. The overall mean recovery rate by JOA score was 52.5%. The patients were divided into two groups; Group 1 consisting of 8 patients with spinal canal stenosis due to OPLL or ossification of the ligamentum flavum etc. at the thoracic and/or lumbar level, and Group 2 consisting of 31 patients without stenosis. The mean JOA score of Group 1 was 6.75 points before surgery and 10.94 points after surgery, while the score of Group 2 was 8.10 points before surgery and 13.20 points after surgery, with no significant difference in the score before surgery between the two groups. However, the JOA score after surgery was significantly lower in patients with spinal canal stenosis at the thoracic and/or lumbar level of Group 1, than the patients without stenosis in Group 2.
We reviewed ninety patients with degenerative disorders who underwent a L5/S1 posterior lumber interbody fusion (PLIF) procedure by titanium threaded cage (interfix) to examine operative indication, complications and postoperative treatment. Their mean age at surgery was 36.4. The mean follow-up period was 2.1 years. All of them started to stand up, sit down and walk with lumber belt two days after surgery. They wore the lumber belt for three months. There were no major complications except one superficial infection. Radiographically there was no loosening around cages and pedicle screws. Though the titanium threaded cage was hard to examine the fusion, we inserted a local bone in front of the cage to monitor for fusion between cages. In cases which underwent PLIF without pedicle screw systems, the disc height was restored to the titanium threaded cage. The titanium threaded cage was very useful for L5/S1 disorder because of excellent stabilization in an early stage.
The purpose of this study is to determine the validity and limitation of the percutaneous transpedicular biopsy of the vertebral body. Eighteen cases of transpedicular biopsies were performed between 1991 and 2001. All patients were placed in prone position and the biopsies were performed under local anesthesia. Trephine needle of 3 or 4 mm in outer diameter was inserted into the vertebral body under fluoroscopic guidance. Pathological diagnosis was succesful in 13 out of 18 cases. These diagnoses consisted of pyogenic spondylitis in 5 cases, metastatic vertebral tumor in 4 cases, compression fracture in 3 cases, and hemangioma in 1 case, whereas accurate diagnosis was not possible in 5 cases. The accuracy rate of this procedure was 72.2%. Although the percutaneous transpedicular biopsy is safe, rapid, and easy to bring the needle to the target site, considerable care should be taken to obtain adequate samples for accurate diagnosis.
This study was designed to investigate the changes of low back pain and saggital pelvic inclination over time after total hip arthroplasty (THA) in osteoarthrosis (OA) of the hip. Fifty OA cases were classified into three groups according to age: Adult; 40 to 64 years of age, 19 hips; Young-Old; 65 to 74 years of age, 16 hips; Old-Old; 75 years of age ∼16 hips. The incidence of low back pain before THA was about 60% in all groups, but the transition of low back pain after THA was that the low back pain tended to improve more in the younger group. No improvement was seen in the “Old-Old” group. The degree of saggital pelvic inclination was calculated from the transverse axis length (b/a) ratio of the radiological shape of the pelvic cavity in antero-posterior radiographs. As a result, we found that the pelvis tended to incline posteriorly with increasing age. Therefore, pelvic anterior inclination was found in all “Adult patients” and pelvic posterior inclination in most “Old-Old patients”. After THA, the pelvis in most patients tended to slightly incline posteriorly over time.
Intramedullary cavernous haemangioma is very rare, and often diagnosed before intramedullary bleeding. We experienced six cases (five female, two male) from 1980 to 2001 in our hospital. Their ages ranged from 24 to 60 years. Lesions were located from the lower cervical to middle thoracic medulla. Magnetic resonance imaging (MRI) showed T2: low indicating intramedullary bleeding in most cases. We used the Frankel scale for neurological assessments. Five at of the six cases underwent laminectomy and microscopic tumor extirpation. Two operated cases suffered complicated posterior cord disturbance. However, five cases except one preoperative Frankel A nainfained Frankel D at the end of follow-up (from one month to seven yers, eight months). The changes in hemoglobin lead to MRI findings: T1; isointensity/T2; hypointensity at acute bleeding, T1; hyperintensity/T2; hyperintensity at subacufe bleeding, and T1; hypointensity/T2; hypointensity at over one month after bleeding. The most important findings of cavernous haemangioma are not enhanced at Gd-DTPA, and there are no abnormal findings by angiography. We recommend patients with symptoms to undergo operation as early as possible when diagnosed as cavernous haemangioma.
We report a rare case of isolated dislocation fracture of the trapezoid. A 41-year-old man who is a harbor worker suffered from right hand injury by traffic accident when holding a steering wheel tightly at the time of impact. Roentgenograms and CT revealed dislocation fracture of the trapezoid. Six days after accident, open reduction with ligament repair and temporary fixation with two K-wires were performed. One year after operation, the patient had no tenderness over the trapezoid. His right wrist motion was the same as the left wrist and his grip strength recoverd to 38kg (left: 53kg). Roentgenograms taken one year after surgery showed no dislocation of the traezoid, and MRI showed no evidence of avascular necrosis. The patient was able to return to his previous job.
We investigate the short-term results of immediate weight bearing after cementless THA. One hundred and seven hips of 102 patients were included in this study. Three different types of prosthesis were used. Patients were allowed full weight bearing three days after THA. Clinical and radiographical findings were observed for six months after surgery. Subsidence of the femoral prosthesis was observed in three hips. Two did not sustain injury. No other complications were observed. These three types of prosthesis had good initial stability for postoperative immediate weight bearing, and bone ingrowth may lead to the prosthesis.
We report a case of fracture of the ceramic head in total hip arthroplasty. A 67-year-old man who had osteoarthrisis managed to undergo right total hip arthroplasty employing a 28-mm-diameter alumina ceramic head and alumina ceramic cup (ABS; Kyocera, Kyoto, Japan) inserted without cement in July 1999. In Jun 2001, he did a jumping exercise in a swimming pool. The next day, he felt disconfort in the right hip, tripped when walking, and was not able to walk after ward. Radiograph disclosed fracture of the femoral ball. The fractured ball was found to cousist of two large fragments and several small fragments. There was no significant damage on the taper surface of the stem. Piston exercise in thought to have occurred between the stem and ball because loosening between the stem and ball resulted for some reason, and repeated concentration of weight on this point is believed to have caused the damage.
We performed selective soft tissue release and Salter osteotomy on 7 children (8 hips) with spastic subluxation and dislocation in cerebral palsy. The mean age at operation was 8.1 years (range: 4 to 11 years). The mean follow-up time was 5.3 years (range: 2.9 to 7.8 years). Three cases had gradually redislocation after renoval of their abductor cast. All hips were in the external rotational position after operation as compared to the internal rotational position before the operation. This position was suspected to have caused the anterior dislocation, and femoral varus-derotation osteotomy was considered necessary for these cases.
We report a case of congenital diastasis of the inferior tibiofibular joint that was treated with ankle reduction using external fixator and postero-medial release. A six-month-old infant (male) was referred to us with the present complaint of left foot deformity. We found diastasis of the inferior tibiofibular joint and equinovarus foot on X-ray. We performed operation as follows. The left ankle and lower half of the tibia and fibula were exposed through an antero-lateral incision. We removed fibrous and cartilaginous tissue between the tibia and fibula, and tendon of tibialis posterior and anterior, and flexor digitorum longus were released through a postero-medial incision. The Achilles’ tendon was extended. We shortened the left tibia with an external fixator, and reduction of talo-crural joint. One week after operation, we started bone lengthening. Presently at age four, leg length discrepancy is two centimeters, but he has no equinovarus deformity of the left ankle and can walk with a shoe brace. Congenital diastasis of the tibiofibular joint is a lateral dysplasia of the tibia, diastasis of the tibiofibular joint, and medial torsion. Two groups are classified including medial distal ectromelia with vertical diastasis, and intermediate distal ectromelia with horizontal diastasis and medial torsion. This patient was classified as medial distal ectromelia.
The results of 7 patients (5 males and 2 females) with Grade 3 acromioclavicular dislocation who underwent modified Neviaser’s procedure using the Wolter clavicular plate were reviewed after a minimum 5 year follow up. In this study, the outcomes of all cases were evaluated using Kawabe’s scoring system and JOA shoulder rating system. All the patients were graded as “Excellent” according to Kawabe’s scoring, and were rated as 100 points with the JOA score. Osteoarthritic changes of the acromioclavicular joint did not progress in any cases. Thus, the satisfactory long-term clinical results were obtained. By using the Wolter clavicular plate as a temporary fixator of the acromioclavicular joint in the modified Neviaser’s procedure, secure reduction and rigid fixation of the joint can be obtained.
We surgically treated 23 cases of distal clavicle fracture by internal fixation using K-wires. Twenty-one cases achieved bone union, but two cases them had subluxation of the acromioclavicular joint after bone union. Two cases had nonunion. In one case, resection of the distal part of the clavicle was performed and the other case, osteosynthesis with iliac bone graft by using a modified Amako plate was performed. Internal fixation using K-wires appears to be a simple procedure, and valuable for the treatment of distal clavicle fractures. It is important to evaluate preoperative X-ray accurately and to determine the site of inserting K-wires in order to prevent subluxation of the acromioclavicular joint after bone union.
We treated a rare case of coxa vara with pseudoarthrosis of the femoral neck resulting from septic arthritis of the hip at birth. The patient had been treated at another medical center, and was referred to our hospital because pathological dislocation was suspected. We performed valgus femoral osteotomy when he was two years old. The hip remained stable and the development of the femoral head was good, but coxa vara and leg length discrepancy progressed.
We experienced a case of spondylitis associated with pustulosis palmaris et plantaris. We diagnosed the disease radiologically using X-ray, MRI, and bone scintigraphy. However differentiation from pyogenic spondylosis was difficult, a comprehensive account was necessary by both radiological finding and reaction after the treatment (inflammatory findings, change of symptoms). In this case, we were able to achieve remission by conservative treatment including antibiotic therapy.
A retrospective analysis was performed on 338 patients aged over 60 years who had been operated on for femoral neck fracture. The purpose of this study was to evaluate the results of surgical treatment of hip fractures in elderly patients with particular reference to vital prognosis. Twenty-six patients died within three months after operation. The others were alive at the last follow-up. Most patients had some complications and abnormality in the blood examination before surgery. The most serious complications resulting in poor prognosis were pneumonia and cardiovascular disease. The results show that preoperative understanding of the general conditions of patients and perioperative general control are needed to prevent postoperative complications from occurring and worsening.
Minimally invasive solution (MIS) is a unicompartmental knee arthroplasty technique via a small incision without patellar eversion. Eleven unicompartmental knee arthroplasties have been performed by MIS since February 2001 in our hospital. We reviewed the surgical results by comparing them with 10 joints performed by the conventional method with patella eversion. We evaluated length of hospital stay, blood loss, operative time, degree of post operative pain, range of motion, and radiographic measurement of each patient. There were no significant differences in all subjects. MIS technique can, however, archieve rapid recovery of range of knee motion after surgery when compared with conventional techniques.
We experienced a 73-year-old woman who had a dislocated patella for 5 years after left total knee arthroplasty (TKA). She experienced no pain but could not extend her left knee. She could walk on flat ground with a T-cane, but could not climb stairs. 5.5 years after the surgery, she visited our hospital. Her patella was dislocated on the lateral side, and could not be reduced. Revision surgery was performed. The cause of dislocation was malrotation of the tibial component. After revision surgery, she was able to fully extend her left knee, and climb stairs. Patellofemoral complications after TKA are the most common postoperative problem associated with current design of prosthesis and are the major reason for revision surgery. During operation, adequate soft tissue balance and preservation of blood supply to the patella are required.
There are few reports on the conservative treatment of acute combined injuries of the posterior cruciate ligament (PCL) and medial collateral ligament (MCL). This study investigated 8 cases at one year after conservative treatment. All cases were men with a mean age of 26.7 years (range: 15 to 39) and an average follow-up of 19 months (range: 12 to 28). All 8 patients had undergone magnetic resonance imaging (MRI). Arthroscopy following the injury was performed to rule out intra-articular pathology and to identify the degree of the PCL tear. They were treated by immobilization of the knee in a plaster cast for about five weeks and the use of Don-Joy brace for three to six months. Full return to sports activity was allowed six months after adequate quadriceps and hamstring muscle strength was demonstrated. The clinical results were evaluated by the IKDC score. Subjective evaluation based on the IKDC score rated 6 as normal, 1 as nearly normal, 1 as abnormal. However, in view of total evaluation, 2 were rated as nearly normal, 5 as abnormal, 1 as severely abnormal. These results indicate the necessity of surgical treatment for achieving static and functional stability of the PCL.
Eighty-nine patients who underwent anterior cruciate ligament (ACL) reconstruction using multi-strand hamstring tendons were evaluated at least 2 years after surgery to compare the results with those of the previous double-stay reconstruction using iliotibial tract. This follow-up study included the IKDC subjective assessment, and the evaluation of the anterior and rotatory instability, ROM, the isokinetic maximum torque of knee extensor and flexor strength, and the flexion lag. In the subjective assessment, 86 patients (97%) were A, normal; or B, nearly normal. Lachman test was negative in 83 patients (95%) and 1+ in 5 patients (5%), which was consistent with the results of the KT-1000 measurement. The averaged side-to-side difference of the KT-1000 measurement (manual max) was 1.4±1.5mm. On the other hand, N-test was negative in 74 patients (83%), glide in 10 patients (12%), and clunl in 5 patients (5%). As for ROM, 8 patients had the extension limit of less than 10 degrees, and 5 had flexion limit of less than 5 degrees. All patients had muscle strength of 90% or more compared to the uninvolved side. The averaged flexion lag was 9.8 degrees. In comparison with the results of double-stay reconstruction, this technique using multi-strand hamstring tendons had the significant improvement of the anterior stability, while it was almost equal in the rotatory stability evaluated by N-test.
In order to examine the pathogenesis and related problems of femoral neck fracture in hemodialytic patients, 16 patients with hemodialysis (HD) who were operated on for femoral neck fracture from November 1998 to December 2000 were reviewed. Average age at operation was 71 years and the average duration of HD was 17.4 years. Two out of the 16 cases had no obvious history of trauma. Thirteen cases had subcapital fracture and three cases had trochanteric fracture. All three cases with trochanteric fracture showed severe anemia and required blood transfusion before operation, whereas all cases of subcapital fracture did not. Subcapital fracture seemed more likely to occur in patients with HD presumably due to bone fragility and anatomical weakness of the femoral neck. In addition, appropriate volume control and early transufusion, when necessary, are considered very important for patients with HD, because they lack self-regulatory capacity.