We experienced a case of contralateral pedicle stress fracture associated with unilateral spondylolysis in a young baseball player. A 18-year-man presented with low-back pain. In the physical examination, there was some tenderness on the spinous process of the fifth lumber vertebra, but no abnormal neurological findings. Plain radiographs show only unilateral spondylolysis of the fifth lumber vertebra. CT scans revealed a right-sided fifth lumber vertebra spondylolysis and contralateral pedicle stress fracture. Bone scintigraphy with single photon emission computed tomography showed bilateral symmetric increased activity in the region of the pedicle and pars interarticularis. Conservative treatment affected bone healing of the pedicle and pars interarticularis did not heal.
Sacral cyst is considered a comparatively rare disease. We experienced six cases of sacral cyst reguiring surgical treatment. Although MRI is useful for diagnosis, myelography is indispeasable for exaning the symptons. All six cases showed good postoperative progress, and surgical treatment proved effective for patients who did not respond to conservative treatment for pain.
We studied the relation between operative findings and magnetic resonance imaging of lumbar intervertebral disc herniation in 124 subjects. The accuracy rate was 63% for rupture of the posterior longitudinal ligament. Operative findings indicated extrusion in most cases of hernia shifted to the cranial side in MRI. Central type herniated mass revealed by transverse MRI was found to be located in the subligamentous space in operative finginds.
We conducted a retrospective study on the surgical results of 49 patients with lumbar spinal disorders manifesting drop foot, and assessed the factors influencing surgical outcome. All patients (26 men and 23 women, mean age 56 years) underwent operation between 1997 and 2001, and were followed for more than six months. Surgical results were evaluated according to the manual muscle test of tibialis anterior. The relationship between surgical results and some clinical factors were analyzed. In conclusion, age at surgery is not a significant factor influencing surgical results. Significant factors that determine surgical results are the duration of symptoms before surgery, grade of muscle weakness at surgery and presence of cauda equina syndrome. These results suggest that patients presenting with drop foot and progressive cauda equina syndrome require early surgical treatment.
We experienced patients with spinal disorders presenting abdominal symptoms, many of whom had underwent repeated abdominal examinations at other hospitals. To prevent such concurrent disease, we should always bear in mind that spinal disorder is accompanied by abdominal symptoms in some cases.
The morbidity of bone grafting is generally considered relatively low, however it poses as a post operative complication. We investigated the clinical results of 52 patients with lumbar degenerative disease who underwent postero-lateral fusion (PLF) using the local bone compared with 21 patients who underwent PLF using iliac bone. The fusion rate with local bone was 81%, and that with iliac bone was 89%. The fusion rate with the local bone for elderly patients was 46.7% and that with the local bone for multilevel fixation was 53%. Rigid union is apparently difficult to obtain for elderly patients and multilevel fixation using the local bone in PLF.
Anterior spinal fusion is an excellent procedure for lumbar discopathy, but it has also been reported that unsuccessful bony union occurs occasionally. The purpose of the study was to investigate a device used for this procedure. The patients included four males and one female with age between 39 and 53 (median, 44). In this procedure, a bioabsorbable poly-L-lactic acid (PLLA) screw for spongy bone is inserted centrally from the anterior margins of the vertebral bodies into the bodies following iliac bone grafting into the intervertebral space. The polyethylene wire is then tightened in a cross shape between the two screws to compress axially and to stabilize the grafted bone. Solid bony union was achieved in all cases, and the average recovery rate of the JOA score was 73%. These results indicate that this method is useful for providing bony union to a certain extent and for avoiding artifact in MRI.
Purpose : We evaluated the results of re-notchplasty following anterior cruciate ligament reconstruction using hamstrings, and compared them with magnetic resonance imaging (MRI). Methods : Between 1997and 2002, 63 patients (32.8%) who underwent re-notchplasty in 192 second-look arthroscopy were examined. We classified them into three groups based on the intensity of MRI : Low, Low+High, and High. Results : 17 patients underwent re-notchplasty because of contact between the ACL and notch, 33 patients because of poor coverage of the synovium, 13 patients because of partial tear of the ACL. Five patients continued to show high intensity (Low+High) that did not decrease after re-notchplasty. In contrast, seven impinged ACL grafts showed decreased signal intensity (Low) of the graft after re-notchplasty. Conclusions : Seven cases showed decreased intensity and were considered to have impingement at the notch, influencing the maturity process by decreasing compression on the reconstructed ACL.
We experienced a case of pulmonary embolism after surgical repair patellar ligament avulsed fracture. The patient was a 34-year-old man who fell two meters into a gutter. Two days after the accident, he underwent surgical repair. Operative findings showed that avulsed fragments were comminuted and patellar ligament was detached. The fracture was fixed with two cancellous screws and ligament was repaired by angmentation of soft wire. 16 days after operation, he suffered shock by pulmonary embolism. Diagnosis was performed by venography and emhanced CT, and treatment using a vena cava filter and thrombectomy system. Thrombosis completely disappered and the filter could be removed.
We evaluated the clinical results of tibial condyle valgus osteotomy for severe medial osteoarthritis of the knee. The subjects were 18 patients consisting of male and 17 females. Their average age was 72.5 years, and the mean follow-up period was 3.9 years. We evaluated the clinical results according to the JOA score, and measured FTA and %MA on X-ray. The JOA score, FTA, and %MA all showed significant changes after the operation. Most of the results were satisfactory but there was one case which had severe valgus deformity of the knee one year after the operation. This case presented a strong varus deformity of the distal femur. Careful planning before operation is recommended for achieving good clinical results.
Earlly treatment is reguired for pyogenic arthritis of the knee. We performed arthroscopic debridemnent on 19 knees of 18 patients. The mean age of the patients was 71.2 years (range: 11 to 100 years). These patients were operated on one to 11 days (mean: 2.5 days) after onset. Twelve achieved good results, and six fair results according to the Ballard's evaluation method. The infection was cured in all patients, with no recurrence.
To assess the results of treatment in partients receiving long-term hemodialysis, we performed knee arthroscopic surgery. Between January 2000 and January 2001, four patients underwent arthroscopic debridement because of severe gonalgia and knee hydrarthrosis. They consisted of three men and one woman with a mean age of 61 years (range : 45 to 78 years). The mean duration of hemodialysis was 15.5 years (range : 8.0 to 23.8 years), and mean follow-up was 1.6 years (range : 1.5 to 2.2 years). All five knees showed meniscus degeneration tear,moderate synovitis, and two articular cartilage (40%) in the subchondral bone. Pathological findihgs revealed amyloid deposits and ossification in the meniscus and synovium. After arthroscopic synovectomy and menisectomy of the knee, joint effusion decreased with a mean follow-up of 7.2 weeks (range: 1 to 12 weeks), and knee pain decreased with a mean follow-up of 6.4 weeks (range : 1 to 12 weeks). At the final follow-up, there were no gonalgia, joint effusion, and other complications. In the short-term, it can be concluded that arthroscopic debridement is useful for treating hemodialysis knee joints with a low risk of complication.
The purpose of this study was to evaluate the effectiveness of epidural anesthesia on the flexion angle after total knee arthroplasty (TKA). Thirty-seven TKAs with Advance system (Wright medical) performed on 32 patients were reviewed. There were 30 knees with osteoarthritis, six with rheumatoid arthritis, and one osteonecrosis. The average age at surgery was 74.9 years. Eighteen knees were categorized as group E, and introduced epidural anesthesia. Epidural one-shot injection was given prior to the range of motion (ROM) exercise for two weeks after surgery. NSAIDs were used for the other 19 knees, instead of epidural anesthesia, and categorized as group N. The flexion angle, flexion angle ratio (% : flexion after surgery × 100/flexion before surgery), and the Japanese Orthopaedic Association (JOA) score of each group was evaluated. Mann-Whitney analysis was used to assess the statistical significance (p<0.05 ). The flexion angle and the JOA score of each group were similar, and no significant difference was recognized before or after surgery. The flexion angle ratio of group E was 96.5 ± 21.6 % at two weeks and 104.1 ± 31.8 % at three months after surgery. Those of group N were 84.8 ± 17.0 % and 94.4 ± 13.3% retrospectively. Group E tended to show better ratio, however no significant difference was identified. Epidural anesthesia is considered to be a good method for managing pain during ROM exercise after TKA. However, the anesthetic effects were not clearly seen at the affected side in some cases. This should be one of the reasons why there was no significant difference.
We evaluated the effects of the drain-clamped method with tranexamic acid, a fibrinolytic inhibitor, for reducing blood loss during cementless total knee arthroplasty (TKA). TKA was performed on both knees of all subjects, utilizing the drain-clamped method with intra-articular infusion of tranexamic acid for one knee and intra-articular infusion of saline for the other. The knees were compared for the amount of postoperative blood loss, which was significantly less in knees with tranexamic acid infusion (353 ± 156ml) than those with saline (628 ± 221ml) (p<0.001). The drain-clamped method with intra-articular infusion of tranexamic acid is simple, inexpensive and effective for reducing the amount of blood loss in cementless total knee arthroplasty.
From 1997 to 2002, 16 patients with bone and soft tissue tumor were treated by means of vascularised composite tissue transfer. Their average age was 40 years (range : 9 to 75 years). Of these patients, seven cases were treated by vascularised pedicle tissue transfer, and nine cases by free vascularised tissue transfer. Twelve patients had good rescults, and four had complications. Three out of these four patients were cured. Vascularised tissue transfer was found to be a useful method for reconstruction of bone and soft tissue tumor.
Vascularized fibular graft and callotasis using Ilizarov external fixator were used in the reconstruction of the diseased area after a wide resection for osteosarcoma in three cases. All cases were children with osteosarcoma of the leg. Preoperative and postoperative chemotherapy were effective in all cases, and no local recurrence or matastasis was seen. Wide resection was carried out. A vascularized fibula was grafted into the diseased area, and the Ilizarov external fixator was applied. Callotasis was then performed using the fixator. The results were not satisfactory due to poor callus formation. SAFHS was effective for two cases with poor callus formation. The remaining case however did not respond to SAFHS and additional intramedullary nailing with bone graft was therefore performed. These results suggest that SAFHS provides good bone formation for poor callus formation which sometimes occurs during chemotherapy. Callotasis after chemotherapy can be used for reconstruction after wide resection for osteosarcoma.
We present a rare case of epithelioid sarcoma of trunk. A 76-year-old man with a huge recurrent tumor of the right anterior chest wall underwent simple excision of the primary small tumor at a local hospital. He developed local recurrence immediately after excision, and five months later he visited our hospital. He already had multiple metastasis, but wide resection was performed to prevent ulceration and bleeding. Histologic features were consistent with those of classic epithelioid sarcoma, but the behavior was quite aggressive. If a more aggressive behavior can be associated with the proximal tumor location, it seems to be meaningful to distinguish proximal-type from distal-type.
A 55-year-old woman first noticed palpable nodules in the left lower extremity. Two months later, she noticed another nodule on the other side and visited our hospital. On physical examination, she had scatterd intramuscular nodules without pain or muscle atrophy. MR imaging showed multiple nodules in the involved muscles. These structures were typical "stripe sign" with high signal on T1 and T2 weighted images at the peripheral portion, and low signal on all the sequence at the central structure. High uptake nodules were detected on Galium scintigraphy. Chest X ray did not show features of bilateral lymphadenopathy (BHL). Biopsy spicement of the palpable intramuscular nodule showed glanulomas composed of epitheliod cells without caseous necrosis. This was diagnosed as nodular muscular sarcoidosis. This case proved that MR imaging is very helpful for diagnosing muscular sarcoidosis from the pathological features of the nodules.
Schwannoma is one of the most common neurogenic tumor, and is usually found solitary on a single peripheral nerve. We report three rare cases of multiple schwannoma experienced. [Case 1] 51-year-oldfemale, found with multiple soft tissue tumors, histologically diagnosed as schwannoma. Lumbar MRI showed multiple nodular tumor on the cauda equina, suspected to be neurogenic. [Case 2] 24-year-old female. soft tissue tumors of the right lower leg and foot were extracted, and diagnosed as schwannoma. During follow-up, the patient was found with another soft tissue tumor on the right thigh. MRI was taken, and the tumor was suspected to be neurogenic. [Summary] it is not uncommon to find multiple schwannoma on a single peripheral nerve. In this paper, we report three cases of multiple schwannoma found on two or more peripheral nerves and on the cauda equina.
We report two cases of Cyber Knife Therapy for cervical spine and spinal cord tumor. One of the patients was a 38-year-old man, suffering from bilateral upper and lower extremity numbness, spastic gait and finemove disturbance. MRI showed intramedullary spinal cord tumor at the C2 vertebral level for which Cyber Knife Therapy was performed. After the therapy, the tumor did not become small, but myelopathy improved. The other patient was a 54-year-old man complaining of neck pain and dysphagia. MRI revealed a large mass which originated from the C2 vertebral body. He was diagnosed with Chordoma from biopsy, and placed on Cyber Knife Therapy, but the mass size did not change and his symptoms deteriorated.
Numerous surgical approaches have been advocated for syringomyeria associated with Chiari malformation (type I ), but there is considerable controversy surrounding the method of surgical treatment. Foramen Magnum Decompression and Syringo-Subarachnoidal shunt are currently the accepted procedure of many neurosurgeons. The authors report the surgical results of two patients with syringomyeria associated with Chiari malformation (type I ) treated by Foramen Magnum Decompression only. In both patients, numbness, reduced pain and decreased temperature were observed in the upper extremities. MRI was performed pre-and post-operatively. Neurological symptoms and signs improved after operation in both cases. Post operative MRI showed a decrease in the size of the syrinx. The authors propose surgery by Foramen Magnum Decompression only as an effective treatment for syringomyeria associated with Chiari malformation (type I ) compared to Syringo-Subarachnoidal shunt.
We investigated the morphological characteristics of cervical nerve roots in 38 cadavers. The cadavers consisted of 20 males and 18 females with a mean age of 75 years (range : 44 to 93 years). The morphological correlation between the ventral nerve root and dorsal nerve root was classified into three types. Type I in which one anterior root joins one dorsal root. Type II in which two anterior roots join one dorsal root. Type III in which two anterior roots become one again and joins one dorsal root. The results of macroscopic investigation from C3 to C8 nerve roots in 38 cadavers were as follows : TypeI was mainly found in 261 roots (82.9%), typeII in 37 roots (11.7%), and type III in 17 roots (5.4%). In the lower cervical spine such as C6 and C7, type II and III were more frequently found than those of the upper cervical level.
We investigated the incidence of postoperative complications in open-door laminoplasty (ODL) and French-window laminoplasty (FWL). This retrospective study consisted of 320 patients who were treated by ODL and 122 patients by FWL between 1987 and 2001. Postoperative transient paralysis of the nerve root occurred in five patients (1.5%) in the ODL group and 7 (5.7%) in the FWL group. While postoperative paralysis due to hematoma occurred in five patients (1.5%) in the ODL group, there were none in the FWL group. ODL and FWL share certain features of neurological complications. Treatment should therefore be selected recognizing these features.
We successfully treated two patients with cervical disc hernia after anterior fusion. Case 1 was a 50-year-old woman. In 1991 she underwent anterior cervical fusion after being diagnosed with cervical disc hernia (CDH) at another hospital and postoperative course was good. Ten years later, due to numbness of both hands and finger elaborate movement disorder developed, and she visited our hospital for checkup. Cervical disc herinia was noted at the proximal adjacent level of the previous fusion level in magnetic resonance imaging (MRI), for which we performed anterior cervical fusion again. Postoperatively, numbness of the arms and elaborate movement disorder improved. Her Japan Orthopedic Association(JOA) score improved 16 points from 12 points. Case 2 was a 60-year-old man. In 1993 he underwent anterior cervical fusion after being diagnosed with CDH and ossification of the posterior longitudinal ligament. Eight years later, he visited our hospital again for checkup due to numbness of both arms and urine leak. We recognized CDH at the proximal adjacent level of the previous fusion level in MRI for which we performed front fusion again. Postoperatively, spastic paralysis improved. JOA score also improved 12 points from 10 points and he was able to return to work.
Anterior cervical fusion is established as an operative method for cervical myelopathy or radiculopathy. However, in the long term, secondary myelopathy occurs due to adjacent spondylotic lesions and there are cases which require additional operation. We reviewed 18 patients who required additional operation after anterior cervical fusion and examined their epidemiology and X-ray features. The patients consisted of 15 males and 3 females with an average age of 54.2 years old (range : 42 to 67) and the follow-up period ranged from 1 to 10 years (mean : 6 years). In the past 15 years, anterior cervical fusion was performed on 480 patients at our institution. Of these, additional laminoplasty was performed on 14 cases (2.9%). Another four patients underwent their first operation at other institutions. The period to the additional operation ranged from eight months to 20 years, averaging five years. As the risk factor of secondary myelopathy and additional operation, male, fusion at plural levels, existing canal stenosis, and instability at the adjacent levels were suggested.
Primary total hip arthroplasties were performed on 74 hips between 1998 and2001 at our hospital. We used the Hardinge approach on 36 hips of patients whose age ranged from 46 to 80 years (mean : 63.2 years) and Dall approach on 38 hips of patients whose age ranged from 43 to 76 years (mean : 60.2 years). Postoperative followup was carried out for over one year (mean : Hardinge 24.0 months,Dall 39.4 months). The results revealed trochanteric tenderness in 9 Hardinge hips and 4 Dall hips more than 12 months from operation. Radiological tests indicated abnormal assification in 13 Hardinge hips and seven Dall hips, and abnormal assification with trochanteric tenderness in seven Hardinge hips and one Dall hip during the same period.
We report the short-term results of revision of cemented acetabular component to cementless acetabular component in 15 patients (15 hips) between 1997 and 2000. The mean follow-up period was 3.2 years (range : 2 to 5.6). There were two males and thirty-three females. Their mean age was 67 years (range : 60 to 77). The mean period between primary THR and revision THR was 9.9 years (1.8 to 19.5). The cause of revision was aseptic loosening in all cases. Acetabular deficiency was graded according to classification of AAOS : 12 hips were type II and three hips were type III. Only the acetabular component was revised in nine hips and both acetabular and femoral components in six hips. Eight hips underwent bone graft. Clinical and radiographical evaluation were performed. All but one hip were good results. One acetabular component was revised for aseptic loosening.
Between 1998 and 2001, we performed five primary total hip replacements in four rheumatoid arthritis patients (RA) using a Ganz acetabular reinforcement ring with hook and acetabular impaction grafting. The mean age of the four females and one male was 47.2 years (range : 28 to 62 years). The mean follow-up period was 3 years 8 months (range : 2 to 5 years). Partial weight-bearing was started one week after surgery. In spite of early weight-bearing, all grafts appeared to have united radiologically with no radiolucent lines between graft and acetabulum and no signs of collapse. None of these 5 rings showed any signs of material loosening radiologically. Clinical evaluation was performed according to the Japanese Orthopaedic Association (JOA) hip score system (JOA hip score, except ADL score). The mean JOA hip score improved, from 19.0 before the operation to 62.4 at the latest follow-up. The acetabular reinforcement ring may prevent graft resorption and cup migration, which are major causes of socket failure in protrusion acetabuli for RA.
The purpose of the current study was to describe methods for revising the Gamma nail. From March 1997 to March 2003, inter-or sub-trochanteric femoral fractures (n=315) were treated routinely using the Gamma nail. Twelve cases (3.8%) were treated surgically because of post-operative complications including cutting out of the femoral head, loosening of the lag screw, femoral shaft fracture and wound infection. Of the six cases whose femoral heads were cut out, two were treated by hemi hip arthroplasty and three by total hip arthroplasty. In these cases, we managed massive bleeding, added trochanter osteotomy for exposure of the hip joint in three cases, and used femoral components for replacement because of large bone defects.
Femoral head necrosis after extracapsular fracture is a rare complication.Until now, we have experienced only one case of femoral head necrosis after CHS operation. Three months later, the patient complained of hip pain when walking, and radiograph 10 months after operation showed a penetrated rag screw. The cause of fracture was simple fall that was not high energy accident. The vascural anastomotic ring at the base of the femoral neck plays an important role in the circulation of the femoral head. In this case, a possible etiology was the iatrogenic damage of blood supply to the femoral head (due to rotational force applied to the femoral head during reaming). It is therefore important to use a dase pin during operations.
The prognosis of patients with femoral neck fractures who were over 65 years old was evaluated between three to four years after their operation. Thirty-three patients (4 men and 29 women, mean age, 83) who underwent surgery between November 1998 and November 1999 were included. A telephone survey was conducted on these patients or their families concerning the prognosis and their present state of ambulation. Fourteen of 33 (43%) were deceased at the time of the follow-up. Among the remaining 19 patients, only 11 (33%) were capable of ambulation and able to engage in social activities and 8 could not walk. Their present ambulatory state is influenced by their condition before the fracture. For example, 54% of the patients who could walk without the aid of devices were able to walk at the final follow-up. On the other hand, all patients, who were not capable of walking for social purposes, could not walk. Also influencing the prognosis was the patient's age when the fracture occurred. Among 13 patients over 85 years old, 69% were deceased by the final follow-up and only 16% were capable of ambulating for social purposes. Senile dementia is a crucial complication affecting one's ambulatory status after surgery. On the whole, only 14% were socially ambulatory, and all patients 85 or older with senile dementia could not walk at the time of the final follow-up.
In this study the problems of surgical treatment for femoral trochanteric and subtrochanteric fractures were analyzed in 1993 and 2002. We treated 46 patients with CHS from January to December 1993, and 53 patients with CHS and CHS with wire and screw from January to December 2002. The average age of the patients and the number of complications before surgery have been increasing over the last 10 years. Complications after surgery were frequent in grade 4 (Evans) in 2002. It was found that patients with numerous complications after surgery had to pay high medical expenses and stay in the hospital many days. Patients with complex type fracture had to pay high medical expenses even after returning home.
A 48-year-old male had been suffering bilateral knee pain while going up and down stairs and after hard work for about 12 months. Plain radiograph of the bilateral knee joint showed valgus deformity with hypoplastic lateral femoral condyles and patella alta. Also, plain radiograph of the elbow joint showed posteromedial dislocation with bone defect of the medial epicondyle and trochlea with bended deformity of the radial head and radial neck. Nails of the fhumb, index, middle and little finger were short compared with the ring finger and distal dorsal finger crease of the index, ring and little finger were absent. Other abnormal findings consisted of scoliosis, spondylosis, and kyphotic deformity of the cervical spine. Arthroscopy of the knee joint was performed due to persistence of complaints, although he was conservatively treated for eight months. Arthroscopic findings showed hypoplasia of the lateral cartilage of both femur and tibia rather than degeneration. Patello femoral joint showed normal alignment and no arthrosis. The degererated lateral meniscus was partialy resected. Three months after the operation, the patient was able to return to work with improvement in both knees. This case was diagnosed as atypical nail-patella syndrome with hypoplasia of the knee joint, elbow joint and neil.
Leg lengthening by callotasis with Orthofix external fixator was performed for seven femoral and three tibial bone segments in ten patients with hemihypertrophy to equalize leg length discrepancies. The mean age at operation was 11 years (range : 6 to 14 years). The mean follow-up after the operation was five years (range : 2 months to 9 years). Of the ten patients, six patients had hemihypertrophy of the non-syndromic overgrowth in one side of the lower limbs, three patients had Klippel-Trnaunay-Weber syndrome, one patient had Beckwith-Wiedmann syndrome. The mean leg length discrepancy before operation was 35mm (range : 23 to 50mm). At follow-up, none of the patients had limp, pain, deformities of bones and limitation of joint motion in the lower limbs. Leg length discrepancies in nine patients were equalized, but one patient had residual leg length discrepancy due to insufficient distraction lengthening by complications. Leg lengthening by callotasis appears to be effective for obtaining equal leg length in patients with hemihypertrophy.
We treated two cases of tibia vara deformity with metaphyseal dysplasia using hemicallotasis technique. One was a 16-year-old boy with 12 degrees of bilateral tibia vara. Another was a 17-year-old boy with 17 degrees of tibia vara in the right side, and 18 degrees of tibia vara in the left side. After osteotomy, hemicortical elongation was gradually performed until the aimed angular correction was gained. Height was increased by 1.5cm. There were no problems in both cases and we concluded that the Orthofix technique is useful for the treatment of tibia vara deformity and shortening.
Trichorhinophalangeal dysplasia (TRPD) is a genetic disease, characterized by sparse hair, severe metacarpo-phalangeal shortness, beaked nose, long upper lip, and short height. In this report, we experienced bilateral total hip arthroplasty (THA) in a patient with TRPD. A 55-year-old female visited our hospital because of bilateral hip pain. On the initial visit, the following characteristic features were noted : sparse hair, severe metacarpo-phalangeal shortness, beaked nose, long upper lip, and short height (138.6cm). Remarkable findings were not found in family and past histories. Radiographs showed dislocated hip joint with deformed femoral head and severe osteoarthritic changes. She underwent bilateral THA (right side first and left second) by transtrochanteric approach in a two months interval. Postoperative rehabilitation was performed according to conventional course. Six months after final operation (left hip), she is ambulatory with no assistance and satisfied with the operative results.
Targeting outpatients of our hospital, we administered alendronate to 143 cases from January to December 2002, and risedronate to 64 cases from August 2002 to February 2003. As a result of these experiments, we noticed that the occurrence rate of hazardous findings in the digestive tract in each period was 18.1% and 7.8% respectively. The results of large scale experiments indicated no significant difference between them. As the occurrence rate ranged from 20% to 30%, the occurrence rate of hazardous findings in the digestive tract due to arendronate at our hospital was more or less reasonable, but that by risedronate seemed extraordinarily low. This is apparently due to our staff's awareness that risedronate was marketed lately, so the occurrence rate of hazardous findings in the digestive tract is low, resulting in the psychological effect of instructing patiens to take this drug.
A two-year-old girl visited the orthopedic clinic of Fukuoka University Hospital in July 1974, complaining of leg- and wrist deformities. She was diagnosed as rickets and prescribed vitamin D alone. 1αOH D3 was prescribed from 1963. It was used at the maximum dose of 30 μg/day at the end of 1979. The dosage of 1α (OH) D3 was reduced from 1980. Since 1993 she had been treated with phosphate and 1α (OH) D3. Leg deformities were corrected with the administration of 1αOHD3 alone. After correction of the leg deformities, she suffered malunion of her left tibia. This caused valgus deformity of the tibia and was followed by secondary femur deformity. Correction oseotomy of the tibia alone was performed because she refused femur osteotomy. This procedure failed to improve leg deformity and the deformity of the tibia recurred. From 1984 October to 2002 February, the therapy was interrupted numerous times, because. she skipped her visits. This time she visited us twice, complaining of leg pain due to Looser's transformation zone in both the femur and tibia after long-term interruption of the therapy. The Looser's zones healed by medication and use of a cane. Since 2002 February, she has been continuing her therapy with her daughter who has also been diagnosed as hypophosphatemic vitamin D resistant rickets.
In two patients suffering brachial plexus injury, we transferred the accessory nerve to the suprascapular nerve for restoration of the shoulder function. This paper discusses the treatment and reports the results. Case 1 was a 21 year-old male who was injured in a traffic accident, and underwent operation about six months later. In another operation about eight months later, abduction of the shoulder was achieved Case 2 was a 22 year-old male also injured in a traffic accident and underwent operation about three months later. In another operation about eight months later, abduction of the shoulder was also achieved as in case 1. Although differences in the recovery of muscular power and ROM were seen between the two patients, there was no instability of the shoulder. We conclude that this operation is useful for the restoration of shoulder function in brachial plexus injury.
We analyzed 58 cases of hand tumor for which histopathological diagnosis was established in the 10 years from 1993 to 2002. Ganglions developed in soft tissue were excluded. They consisted of 25 cases of bone tumor and 33 cases of soft tissue tumor. Age range was 6 to 78 years and mean age was 26. 1 years. Of the 30 cases of benign soft tissue tumor, nine cases had giant cell tumor of the tendon sheath, eight cases hemangeoma, three cases neurilemmoma, two cases of tenosynovial chondromatosis in order of frequency. There were three cases of malignant soft tissue tumors that were malignant fibrous histiocytima, liposarcoma, and epithlioid sarcoma, respectively. The 25 cases of bone tumors, consisted of 16 cases of enchondroma, three cases of osteochondroma, two cases of intraosseous ganglion, two cases of periosteal chondroma, one case of aneurismal bone cyst, and one case of giant cell reparative granuloma. There were no malignant bone tumors in this series. As the favorite region, soft tissue tumors were noted in the finger region (61%), palm region of the hand (27%), wrist region (9%) and back region of the hand (3%). Bone tumors were noted in the phalanges (64%), metacarpals (32%), and carpals (4%). Soft tissue tumors and bone tumors developed most often in the finger regions. Recurrence was seen in one case of giant cell reparative granuloma, and case of epithlioid sarcoma, none in other soft tissue tumors and bone tumors. Benign soft tissue tumors treated with marginal excision and benign bone tumors treated with curettage and autologous bone transplantation showed good results, however, it was difficult to treat malignant soft tissue tumors without recurrence.
A rare case, in which the metacarpophalangeal(MP) joint of the ring finger was locked, was treated by operation. Locking was caused by the osteophyte of the metacarpal head catching the accessory ligament in the ulnar side. In accordance with references, the mechanism of derangement and treatment are discussed.
We investigated the possibility of external fixation for 4-part displaced fracture of proximal humerus by adding and connecting the clavicle part for correction. We experienced a 61 year old female who sustained a 4-part displaced fracture of the proximal humerus. The first treatment consisted of manual reduction and hanging cast left angulation of the humeral head. The next percutaneous pinning and direct traction from the olecranon was broken by the patient. External fixation by drilling two half-pins into the humeral head horizontally and six pins into the shaft was attempte. To stabilize the humeral head, we connected three half-pins in the clavicle additionally. The clavicle pins were removed five weeks after operation and functional exercise was started. In the four year follow-up, no refracture was seen. The functional results and range of motion of the shoulder were satisfactory.
The valgus impacted fractures of the proximal humeral head is a frequently occurring lesion. Attempts were made to formulate a fracture classification to facilitate the understanding and management of this fracture. Between 1999 and 2003, eight cases of this fracture were treated. They consisted of seven women and one man. The average age was 62.9 years (range:40 to 78), and the average follow-up was 12.86 months (range:3 to 38). Six cases were treated operatively with open reduction and internal fixation. With this fixation required insertion of the bone graft in the bone defect. Two cases stabilized with minimal internal fixation, one indicated prosthetic replacement, and one was observed non-operatively. Bone union occurred in all six cases treated operatively. In five cases, there were neither malunions nor loss of reduction. One case was considered ursuccessful due to the development of avascular necrosis of the humeral head fragment, and malunion observed non-operatively. Despite this being a 4-part fracture, primary prosthetic replacement may be overtreatment and dysfunction remains only in non-operative management in many cases.
Eighteen humerus distal end fractures in adults (above 16 years) were treated from 1992 to 2002 at our hospital. We evaluated their clinical results for this fracture. The subjects were seven male and 11 female. The average age of injury was 55.6 years. The cause of this fracture was nine falls, six traffic accidents, two downfalls, and one arm wrestling. Using the AO classification, nine were Type A, three Type B, and six Type C. There were two open fractures, One case (hemiplasia) was nonunion Ten out of the eighteen cases showed excellent results. Upon evaluating poor results cases, the following complications were seen : for example, multiple trauma, hemiplasia, dementia, floating elbow, deformity before injury, OA, RA, and additional fracture after operation.
The purpose of this study was to evaluate results of the surgical treatment of lateral clavicle fractures in our hospital. We treated 32 lateral clavicle fractures in 27 men and five women with a mean age of 39.7 years (range: 13 to 69 years). The mean follow-up period was 11.3 months. There were 24 Robinson type 3B1 fractures and eight Robinson type 3B2 fractures. Tension band wiring was used in 22 cases and a clavicular hook plate in eight. Complications commonly occurred with K-wires, which migrated in eight cases, resulting in loss of reduction in four cases and two cases of re-operation. In the clavicular hook plate group, there was no complication. Radiographically, changes of the acromioclavicular joint appeared in 15 cases (12 cases in the tension band wiring group, three cases in the hook plate group).
Isolated fractures during the coracoid process of the scapula are rare. We report a case of isolated separation of the epiphysis during the coracoid process of the scapula in a gymnast. The patient was a 18-year old boy. He had his shoulder injured while playing rings without direct force to his shoulder. He underwent open reduction and internal fixation using CCS three weeks after injury. Six months after operation, he had no complaints and was able to resume gymnastic practice.
The Acutrak screw is a headless tapered, self-tapping fully-threaded device designed to provide interfragmentary compression. Its variable pitch creates gradual compression with each turn. The purpose of this study was to evaluate the clinical results of internal fixation of orthopaedical surgery using Acutrak screw. Some poor union cases have been reported. Twenty-three patients(25 cases)were treated between September 2000 and January 2003. Eighteen men (19 cases)and 5 women (6 cases)were treated, and their age at surgery was 15 to 62 (mean : 27.3)years. The mean follow-up period was 8.0 (3 to 22)months. There was one nonunion of the olecranon, three OA of the thumb CM joint, and bone union failed in two bipartita patella. The use of the Acutrak screw must be considered carefully for these cases.
From November 2002 to April 2003, fifteen patients with distal end fractures of the radius were treated using the distal radius plate. The patients consisted of four males and 11 females ranging in age from 31 to 86 years. The postoperative observation period ranged from three to six months. Postoperative clinical findings were evaluated according to the Saito classification. Functional results were 13 excellent and two good. All cases acquired bone agglutination. Surgical treatment using the distal radius plate proved to be effective treatment for distal radius fractures despite a short-term study.
Both-bone forearm fractures in children are usually treated conservatively, but numerous incidences of redisplacement, residual angulation, and loss of range of motion have been reported. We reviewed the clinical results of 24 children (18 boys and 6 girls) with unstable diaphyseal forearm fractures treated by intramedurally Kirschner-wire fixation from 1995 to 2003. The average age of the patients was 8.3 years (range : 2 to 15 years) and average follow-up time was 11.6 months (range : 3 to 32 months). All fractures healed with less than 10 angulations. One case had sustained internal rotation loss.
We evaluated the clinical results of distal radius fractures in children accompanied by epiphyseal injury. We treated 36 patients between July 1999 and June 2002. The average age was 9.8 years (range : 3 to 15 years). Twenty-two patients underwent conservative treatment and 14 patients pinning. All 7 patients under 7 years of age were treated conservatively. Both conservative treatment and pinning provided good results. Because the natural corrective power in the children was very strong, under 30°bone deformity healed satisfactorily. However both methods required a long time to achieve correction. Conservative treatment is the treatment of first choice, but if reduction is difficult or after reduction position is unstable, pinning is a useful method.