Churg-Strauss syndrome is an autoimmune disease characterized by asthma, eosinophilia and systemic necrotizing vasculitis. The authors report the case of a 53-year-old man who developed Churg-Strauss syndrome associated with extremely severe pain and neuralgia of unilateral leg. In the initial four days, he complained of persistent low back pain, and subsequently showed drop foot together with extremely severe pain. MRI examination and diagnostic nerve root block ruled out the involvement of spinal canal disorders including disc herniation. Laboratory and electromyographic examinations revealed hypereosinophilia and low contraction amplitude with normal nerve conduction velocity. Biopsy to skin and muscle tissues, however, failed to detect significant inflammatory reaction around vessels probably due to the relative long-term interval from the onset of the disease. Systemic administration of prednisone for three days dramatically improved the pain. Although the dropped foot still remains, the patient is now receiving physical therapy outside his home. The etiology, diagnostic features, and treatment of Churg-Strauss syndrome have been briefly reviewed, and the pertinent literature discussed.
Sagittal spinal alignment and narrowing of the spinal canal were evaluated in 15 thoracolumbar burst fracture patients treated by Dick's method using Synthes Universal Spine System. The kyphosis angle averaged 17.0±10.0° before surgery and minus;2.2±5.4° immediately after surgery (P<0.001), wedging rate 54±11% and 90±6.1% (P<0.001), collapse rate of posterior wall 5.7±4.9% and 1.9±3.4%, and canal compromise 53.4±18.3% and 33.1±15.0%, respectively. Postoperative sagittal balance was acceptable even in the elderly (more than 50 years old) or neglected (operated more than eight days after injury) patients. Preoperative severe stenosis with more than 50% canal compromise tended to be less improved in the elderly and neglected patients.
We surveyed the score of Japanese version Craig Handicap Assessment and Reporting Technique (CHART) in addition to the original questionnaire in 90 patients with spinal cord injury who belonged to Spinal Injuries Japan prefectural branch office in Miyazaki. We received 64 answers for the questionnaire. To clarify the relation between CHART and welfare apparatus, we added our original questionnaire for locomotion, elimination and decubitus ulcers, and compared the score of each CHART area in this study. The results showed that the area of independence of body was highest, and the area of occupation was lowest in the score of CHART. In addition, the elimination-control-independent group was significantly higher than the non-elimination-independent group for the total CHART score. On the other side, most patients used hand-operated wheelchairs indoors and outdoors. The CHART score of the normal type wheelchair group was higher than that of modified wheelchair group. In the comparison of the presence and absence of decubitus ulcer in past medical history, the total CHART score in the present group was lower than the absence group, but not significantly.
In spite of improvements in diagnostic modalities, and antibiotic therapy, pyogenic spondylitis remains difficult to diagnose and treat in some cases. A series of 17 cases were reviewed based on patient records from 1999 to 2003 at our hospital. Seven patients (41.2%) had complications such as diabetic mellitus, abnormality of hepatic function, and administration of steroid hormone. During the clinical course, 10 patients (58.8%) had sub-acute or chronic onset, and 13 patients (76.5%) were already receiving antibiotic therapy before diagnosis. All patients except for one patient who developed paraplegia were successfully treated with conservative therapy.
Severe spasticity of spinal origin has been proven to be a good indication for intrathecal baclofen (ITB) infusion. ITB is nondestructive, reversible, and can be titrated precisely, allowing retention of extant function while diminishing spasticity. It is also associated with few complications. In our hospital, a patient with spinal cord injury underwent implantation using a programmable pump and intrathecal catheter designed to deliver baclofen directly to the spinal cord. Rigidity (tone) decreased from a mean prebolus Ashworth score of 3.75 to a mean postbolus Ashworth score of 2.13. But during the course, the pump was removed due to MRSA infection, which resulted in reoccurrence of severe spasticity although the infection healed. Reimplantation was carried out due to the patients continuous request. Ashworth scores reduced to an acceptable level after reimplantation. Intrathecal therapy showed a statistically significant improvement of tone and spasms, and seems to be an effective treatment for patients with severe spasticity.
Somatosensory-evoked-potential technique is widely used for perioperative monitoring. We present a case of a 68-year-old woman who had sinus arret during electrical stimulation in her lower extremity for somatosensory evoked potentials. She underwent laminoplasty for cervical spondylotic myelopathy, anesthetized by propofol, fentanyl, sevoflurane, and nitrous oxide. After intubation and prone position setting, her bilateral tibial nerves were stimulated (50mA for 0.3 msec, 4Hz) . Sinus arrest occured right after stimulation started, and disappeared immediately after stimulation ceased. This phenomenon was seen even after atropine injection. Since no cardiovascular factors that can contribute to sinus arrest were present, the combination of anesthetic agents, prone position, and somatosympathetic reflex induced by tibial nerve stimulation are likely to have been responsible.
Cervical dumbbell tumors are relatively rare, and management is very challenging because of difficulty of surgical approach due to their location, proximity of vertebral artery, and need for spinal reconstruction to prevent post-operative instability and kyphosis. We experienced two cases of cervical dumbbell tumor. In both cases posterior approach was used. Tumor was removed after hemilaminectomy and complete unilateral facetectomy. Reconstruction was performed by pedicle screw fixation, and chips of local bone was grafted. After surgery, their neurological status improved and lordosis in the cervical spine was preserved.
We performed cervical pedicle screw fixations on seven patients. Lateral views could not be obstained on the image intensifier for two. One of these patients showed malposition of the pedicle screw to the disc.
It is obviously important to determine safe screwing in transarticular atlanto-axial fixation by the Magerl technique by evaluating the morphological features of the screw passing route. In the present study, we investigated the availability of reconstructed 3D-CT to prevent vertebral artery injury in this technique. Thirty patients underwent reconstructed 3D-CT prior to the operation to determine whether safe screw fixation by the Magerl technique, imaging coronal, and sagittal reconstruction CT were possible. As a result, safe screwing was found to be impossible in four cases, of which two therefore underwent Brookss method and the other two cases O-C2 fusion. Twenty-six cases who were compatible with Magerl's method had no neuro-vascular complications. We concluded that reconstructed 3D-CT is useful for determining safe screw fixation by the Magerl technique.
We reviewed 44 patients (29 males and 15 females) who had undergone laminoplasty for cervical myelopathy. A risk factor for surgical results was patient age at operation (over 70 in cervical spondylotic myelopathy and over 60 in ossification of spinal ligaments) . Complications of lumbar spinal canal stenosis reduce the improvement of symptoms at lower extremities and uro-rectal dysfunction. Risk factors for axial symptom were insufficient repairment of ligaments attached to C2 spinous process, extension of operation time, and delay of postoperative therapy.
We investigated the effects of early kinesitherapy for patients undergoing cervical laminoplasty. The subjects consisted of twenty-one males and eight females. The average age was 66.4 years. Twelve early stage patients used cervical collar for four weeks from operation. Seventeen late stage patients underwent early muscle training and ROM exercise of neck, and were able to remove their cervical collar after about ten days from operation. We investigated the loss of the lordotic angle of the cervical spine and verbal rating scale (VRS) as a nuchal pain scale in the post operative period for all patients. No significant differences were seen in the loss of the lordotic angle between the early and late stages. The mean VRS was 2.4 points in the early stage, and 3.9 points in the late stage. Nuchal pain was significantly relieved in the late stage compared to early stage. Early kinesitherapy after cervical laminoplasty is considered effective for the relief of nuchal pain.
We treated two patients with a giant cell tumor of the lumbar vertebra. Case 1: A 45-year-old male experienced low back and bilateral thigh pain. Metastatic bone tumor involving the L3 vertebral body was suspected, but the tumor origin was not identified. For progressive paralysis, emergency opertion was performed. The intraoperative histologic report confirmed a giant cell tumor. We performed posterior instrumentation and curettage of the tumor followed by anterior iliac bone grafting. Case 2: A 47-year-old female experienced low back pain, however, no abnormality was seen on plain X-p films. Two years later, low back pain exacerbated, and a pathological fracture of the L1 vertebra was seen on plain X-p films. CT guided biopsy revealed a giant cell tumor. The tumor involved the L1 vertebral body, lamina, and superior edge of the L2 vertebral body. Resection of the tumor and reconstructive surgery with instrumentation were performed. Giant cell tumors of the spine are rare. Radiation treatment may not be indicated because of the risk of malignant transformation. In general, operations are performed. Operations should aim at complete resection of the tumor, but complete resection is considered difficult for tumors of the spine due to location and extent. In these two cases, operations were performed by combined anterior and posterior approach. Both patients have not shown any evidence of recurrence for seven years and two and a half years respectively.
We experienced 2 cases of ipsilateral fractures of femoral supracondyle and shaft. Case 1. A 92-year-old woman complained of left thigh pain. Plain X-lay films showed supracondylar fracture. The next day, operative treatment was done by a 20-centimeter-long retrograde nail. Post operative radiographs revealed femoral shaft fracture. We performed re-operation with a 32-centimeter-long nail provided good stability. Case 2. A 81-year-old woman fell 6 months after total knee arthroplasty. She sustained ipsilateral fractures of femoral supracondyle and shaft. For four days, the extremity was treated with skeletal traction through a pin in the proximal end of the tibia. On the 5th day in the hospital, a 34-centimeter-long nail was inserted and locked statically with two screws proximal and three screws distal to the fracture. Alignment was seen to be nearly anatomical on the fluoroscopic image. At the most recent follow-up examination, four months after the operation, the patient was able to walk with the use of a cane. She reported no pain at the fracture site or in the right knee. The range of motion of the right knee was 0 to 120 degrees, and there was no pain. The patient was satisfied with the result. The nail provides stable internal fixation with good control of rotation and allows early range of motion.
It is known that severe osteoarthritis of the hip joint develops onto secondary osteoarthritis of the knee joint. Twenty patients (leg length discrepancy more than 50 mm) were studied for etiology, morphology, and alignment of the lower extremity. The mean age was 61.3 years (from 44 to 77 years). The mean leg length discrepancy was 60.7 mm (from 50 to 92 mm). The ipsilateral knee joint (lower extremity of short side) was in the valgus position in 12 patients and opposite knee joint (lower extremity of long side) in the varus position in 10 patients. The type of malalignment was windswept deformity in 12 patients. Windswept deformity is a bilateral condition in which one knee exists in valgus demormity, while the other shows varus deformity. There is a tendency for development of lateral OA of the knee joint in the short side and medial OA of the knee joint in the long side with severe leg length descrepancy. The rate was 60%.
It is assumed that female athletes are prone to non-contact injury, the frequency of which is especially high in the left knee in ACL injuries. (1) ACL injuries were analyzed retrospectively in 467 patients to see whether they were non-contact or not, and which side of the knee was involved. (2) A questionnaire survey was conducted on 106 students belonging to a university athletic club on the laterality of the lower extremity. (1) The result were as follows; contact injury to female left knee was found in 39 cases, contact injury to female right knee in 38 cases, contact injury to male left knee in 48 cases, contact injury to male right knee in 66 cases, non-contact injury female to left knee in 124 cases, non-contact injury to female right knee in 84 cases, non-contact injury to male left knee in 42 cases, and non-contact injury to male right knee in 26 cases. Chi-square test demonstrated that non-contact injury to female left knee was significantly frequent in ACL injuries. (2) The questionnaire survey also revealed the following; left side was significantly involved in non-contact injury to the lower limb from the chi-square test results. We conclude that female left knee is at an increased risk for ACL injuries. Further studies are needed to determine the factors associated with functional characteristics of the female knee.
The purpose of this study was to evaluate knee muscle strength following anterior cruciate ligament (ACL) reconstruction in female. We treated 12 female patients with a bone-patellar tendon-bone autograft (BTB) and 29 female patients with a semitendinosus-gracilis autograft (STG) in ACL reconstruction. Knee extensor and flexor strength were measured by KIN-COM before operation, and 3 months, 6 months and 9-12 months after operation. The angular velocity was set at 60 and 180 degrees/second. The results showed that the STG group was better than BTB group on extensor and flexor muscle strength after 3 and 6 months, but there were no significant differences after 9 to 12 months. BTB group patients over 30 years of age showed the worst recovery of extensor muscle strength after 9 to 12 months. The results suggest a delay or deficit in the recovery of knee muscle strength in middle-aged female with BTB in ACL reconstruction.
Recently, it was reported that cyclic venous administration of bisphosphonate decreased the fracture rate, increased bone mineral density, and improved height gain in osteogenesis imperfecta (OI). We treated an 11-year-old girl with OI type I and vertebral deformities for 2 years with intermittent oral administration of alendronate (15mg/ week). The treatment resulted in markedly increased bone mineral density, decreased back pain, and an amelioration of the vertebral shape. No side effects were encountered. It was suggested that oral administration of alendronate might be a useful treatment for patients with OI and vertebral fractures.
Postmenopausal osteoporosis is a serious health problem, and additional treatments are needed. We studied the effects of oral alendronate on bone mineral density (BMD) in the distal end of radius and L2-L4 spine, on a marker of bone resorption and on the incidence of fractures of the spine in 224 women with postmenopausal osteoporosis. The subjects were treated with alendronate or non alendoronate, calcium, vitamin D and vitamin K. Eighty-nine cases received alendronate and 153 cases non alendronate. Relative to non alendronate-treated patients, the distal end of radius BMD increased by 3.3 percent. Increases at the lumber spine were 3.7 percent. Alendronate groups showed significant progressive decreases at 20.9 percent relative to non alendronate in a marker of bone resorption. Alendronate reduces bone turnover and has highly positive effects on bone mass of radius and lumber spine. Alendronate is a promising treatment for osteoporosis in postmenopausal women, but improvement of bone quality remains a problem to be solved.
The usefulness of magnetic resonance imaging (MRI) for the diagnosis of rotator cuff tears is widely known. Many studies classify rotator cuff tears on the basis of size of depth of the tear. Recently, the importance of locating the tear site on facets of the greater tuberosity has been reported. However there have been few reports that classify tear lesions based on the measured site and size of tears. In this study, we classified the tear site on facets using preoperative MRI, and compared with intraoperative findings. The study comprised of 17 shoulders in 17 patients who underwent MRI before treatment with arthroscopic rotator cuff repair between May 2003 and February 2004. In general, preoperative MRI findings were consistent with intraoperative findings. We conclude that MRI is useful for evaluating the site and size of tears on facets.
The purpose of this study was to examine whether local injection of sodium hyaluronate as a treatment for calcific tendinitis of the shoulder joint contributes to the elimination of calcification on roentgenogram, relief of pain and improvement of the range of motion of the joint. Calcification completely disappeared in two acute cases and one subacute case. In most cases, pain was relieved. Even in chronic cases, favorable results in the range of joint motion were observed. In the treatment of calcific tendinitis of the shoulder joint, injection of sodium hyaluronate into the synovial bursa is found to be a simple and safe method compared with puncture, aspiration, and incision. Although the mechanism of the elimination of calcification by means of sodium hyaluronate injection is still not clear, this method is expected to serve as an effective treatment for the calcific tendinitis of the shoulder joint.
We examined 24 shoulders undergoing arthroscopic resection using needle puncture detection technique for shoulder calcific tendinitis against conservative treatments. Without x-rays or fluoroscopy during operation, we were able to remove calcium completely in 22 out of 24 shoulders arthroscopically. Survival calcium deposits of two shoulders disappeared three months after operation. Arthrocopic needle puncture detection technique for shoulder calcific tendinitis is superior to conservative methods and can detect even small size calcifications.
We report a 19-year-old man who presented pain and inability to move his left shoulder after collision with a van. Physical examination of his left shoulder revealed an obvious deformity consisting of a protruding upper border of the scapula. Radiographs of the shoulder revealed a dislocated scapula. There were no associated fractures and dislocation of the scapula or humerus. An attempt to reduce the scapula by overhead traction was unsuccessful. In preparation for a closed reduction under general anesthesia, the patient was given vecuronium bromide intravenously. Spontaneous reduction of the scapula occurred from vecuronium bromide blockade. In this case, the scapula was locked by muscle fasciculation or impaction. This report discusses a case of locked scapula experienced and related studies.
Ten proximal humeral fractures patients (two males and eight females) with an average age of 65.8 years (range; 47 to 78 years) treated operatively using an intramedullary locked nail (Polarus nail) were studied. The average period of follow-up was 9.9 months (range; 4 to 21 months). The subjects consisted of eight cases of 2-part and two cases of 3-part fractures classified according to the Neer system and the results were assesed by post operative X-ray and the JOA score system. The mean postoperative JOA acore was 81.5 points (range; 40 to 98). All cases achieved complete bone union, but one case of total avascular necrosis of the humeral head fragment and one case of back-out of the proximal screw were found in this series.
Seven cases of displaced fractures of the distal clavicle were treated using the clavicle hook-plate. They were classified into type II (six cases) and type II+III (one case) according to the Neer classification. All cases had bone union. In addition, all cases achieved more or less full range of motion at the shoulder joint. The clavicle hook-plate provides stable fixation for fractures of the distal clavicle even in the presence of communited small fragments.
We radiologically evaluated 46 knees undergoing interlocking wedge osteotomy for osteoarthritis between 1998 and 2000 at Kyushu Kosei-Nenkin Hospital. They started ROM exercise by CPM one week after the operation and partial weight bearing at three weeks. Their JOA Score significantly improved from 62.1 to 83.3, %MA improved from 12.0% to 66.3% ant FTA improved from 181.3° to 168.5° seven cases who had loss of correction of osteotomy, of which three had loss of correction within two months after operation, and four cases after two months. The etiology of loss of correction is considered to be bone weakness of the medial malleolous and insufficient lateral staple fixation for maintaining correction during bone union.
Though radiograph under load is useful for foot evaluation, patients stand as they like without giving particular attention to load. In order to determine whether it is necessary to consciously place load on the forefoot for forefoot diseases such as hallux valgus, we investigated ten cases of normal feet on whether HVA, M1M2 and M1M5 changed by changing the load direction. When load was placed on the forefoot measurements were significantly higher than when placed naturally, suggesting that the value between standing naturally and placing load on the forefoot may differ.
Lumbar canal stenosis often causes chronic and progressive symptoms. Patients with lumbar canal stenosis sometimes show bladder and rectal dysfunction. We report two cases of lumbar canal stenosis showing acute bladder and rectal dysfunction. They were successfully treated with decompression.
The purpose of this study was to investigate the effects of utilizing the OneShot Guide (OSG) during gamma nail surgery. From 1998, we performed 104 gamma nail surgeries (84 trochanteric fractures, eight subtrochanteric fractures and 12 basal neck fractures) utilizing the OSG (OSG group). The average ageat surgery was 82.0 years, and the average follow-up was 5.5 months. To evaluate the position of the lag screw, 121 proximal femoral fractures for which the OSG was not used were assigned to the control group. The position of the lag screw and rate of complications (postoperative varus deformity, cut out, protrusion of nail head, ectopic ossification, and pseudarthrotis) were compared between these two groups. In the OSG group, 96 of 104 cases (92.3%) had ideal setting of the lag screw. In the control group, only 57 of 121 cases (47.0%) had ideal insertion of the lag screw, indicating statistical difference between the two groups. There were seven post-operative varus deformities in the control group, and only one in the OSG group. Regarding other complications, there was a case of cut out, seven cases of protrusion of the nail head, four cases of ectopic ossification and no case of pseudoarthrosis in the control. On the other hand, there were no cases of cut out, three cases of protrusion of the nail head, five cases of ectopic ossification, and no cases of pseudoarthrosis in the OSG. The OSG is an effective tool for facilitating insertion of the lag screw at the ideal position, reducing the complication rate when using the OSG during gamma nail surgery.
The purpose of this case report was to evaluate gait patterns in two adults with cerebral palsy before and after orthopaedic selective spasticity-control surgery (OSSCS) for the hip. Case 1 was a 20-year-old woman with hypotonic diplegia and crouched gait level. Her complaint was low back pain. Anterior tilt of the pelvis and lordosis of the lumbar spine were excessive. She had to use a corset all the time. Roentgenograms revealed L5 spondylolytic spondylolysthesis. After OSSCS, crouched posture and low back pain decreased. Gait analysis demonstrated that flexion contracture of the hip decreased, excessive pelvic tilt decreased, and rotationl instability of the pelvis decreased. Case 2 was a 32-year-old man with spastic diplegia and crouched gait level. His chief complaint was low back pain. Although he had been plying soccer until three years ago, he could not play sports before the surgery because of low back pain. Roentgenograms revealed L5 spondylolytic spondylolysthesis. After OSSCS, he could walk more easily and his low back pain decreased. Gait analysis demonstrated that the flexion angle of the hip increased, extension angle of the knee increased, and step length increased. However, the pelvic tilt increased after surgery. Intramuscular lengthening of proximal biceps femoris tendon seems to cause increase in pelvic tilt.
We reported muscle transfers for the reconstruction of shoulder abduction and external rotation in birth palsy. Case 1: A 5-year-old boy with left birth palsy presented co-contraction of shoulder abduction and elbow flexion. His preoperative active range of motion (a-ROM) was 80 degrees in abduction and —20 degrees in external rotation. The clavicular part of the pectoralis major was transfered to the infraspinatus for external rotation. Seventeen months after surgery, abduction improved to 130 degrees and external rotation improved to 60 degrees. Case 2: A 10-year-old girl with left birth palsy presented co-contraction of abduction and adduction, external rotation, and internal rotation. Her preoperative a-ROM was 130 degrees in abduction and —30 degrees in external rotation. Transferring the teres major to the infraspinatus for the reconstruction of external ratation, and lengthening of the sternal part of the pectoralis major for release of internal rotation contracture were performed. Twenty-six months after surgery, a-ROM improved 170 degrees in abduction and 90 degrees in external rotation. Case 3: A 5-year-old girl with bilateral birth palsy presented incomplete flaccid paralysis of the shoulder and elbow joint. We performed reconstruction of the elbow flexion by the Steindler procedure when she was four years of age. Her preoperative a-ROM was 0 degrees in abduction and —20 degrees in external rotation. Reconstruction of abduction and external rotation was performed like Case 1. Ten months after surgery, a-ROM improved to 145 degrees in abduction and 60 degrees in external rotation. Muscle transfers for the reconstruction of shoulder abduction and external rotation mentioned above are efficient surgical treatments in birth palsy.
We experienced a case of left side C8 root palsy which occurred after laminectomy for the ossification of intraspinal canal ligaments in the thoracic spine. The patient was a 52-year-old man. He had laminectomy from C6 to T4 level. The next day he complained of numbness and hypotonia of the left side C8 region. The hypotonia aggrevated and MMT decreased to 2, so we performed foraminotomy of the left side C7 and C8 nerve root three days after the laminectomy. After the reoperation, the hypotonia improved gradually, and the MMT in the left side of the C8 region increased to 4 after four months. Palsy of the C5 region often occurs after cervical spine surgery, but palsy of the C8 region is rare. Palsy of the C8 region occurs because of the traction of the root nerve with the backward shift of the spinal cord and slipping disability due to narrowing of the root nerves. Foraminotomy should be considered in some cases of ossification intraspinal canal ligaments in the thoracic spine that may damage cervical root nerves after surgery.
There are few reports on the prognosis of emergency operations for spinal diseases. We investigated the prognosis of emergency operations. Twenty-nine out of 632 patients with spinal diseases, who were operated during the fifteen years between 1998 and 2003, were treated by emergency operations. These patients were followed up for an average of one and a half years. Operations were performed for the following diseases; nine lumbar disc herniations, four spinal epidural hematomas, three spinal tumors, three spinal fractures, two osteoporotic vertebral fractures, one cervical disc herniation, one lumbar canal stenosis, and five pyogenic spondylitis with sepsis. When operations were performed 24 hours from paralysis, the dysuria or sepsis occured. Nineteen patients showed paralysis, 13 of which improved. Lumbar disc degenerative diseases and spinal epidural hematomas tended to improved better than the spinal fractures. Fifteen patients showed dysuria, 9 of which improve. Four out of five pyogenic spondylitis improved, and the remaining one with secondary pyogenic spondylitis after posterior spinal fusion with instrumentation needed further closed suction irrigation. Emergency operation was effective for paralysis, dysuria, and severe inflammation. The indication should be considered depending on disease.
We retrospectively evaluated the efficacy of arthroscopic anterior capsular release for patients with refractory adhesive capsulitis. The purpose of this paper is to describe the results of this treatment. Between January 2000 and October 2003, 17 patients (seven males, ten females) with a mean age of 58.4 years (range; 44 to 72 years) were studied. The mean duration between the onset of symptoms and surgery was 8.2 months. All patients were evaluated before and after surgery with the JOA score (pain, function (muscle strength and activities of daily living), range of motion, instability and X-ray, maximum 100 points). The mean preoperative JOA score was 50 points, and the mean postoperative was 94 points. There was a significant decrease in pain and significant increases in muscle strength, the ability to perform activities of daily living and range of motion. There were no complications related to the operation. We concluded that arthroscopic anterior capsular release provides pain relief as well as satisfactory function and range of motion.
A case of dislocation fracture of the calcaneus is reported. A-32-year-old man fell from the carrier of his truck. Roentgenograms and CT scan were performed for diagnosis. The lateral calcaneal fragment was dislocated at both the talocalcaneal and calcaneocuboid joints. Closed reduction for dislocation could be performed easily. Instability was not recognized after reduction. Open reduction and internal fixation with kirschner wires (k-wires) were performed to reduce the talocalcaneal joint. Four weeks, later k-wires were removed, and partial-weight-bearing was started using foot sole brace. Weight-bearing increased gradually, and the brace was removed after ten weeks. Nine months later, he experienced pain while he was working. Pseudoarthrosis of sustentaculum tali was recognized on CT image.
Two hundred forty-two primary total knee arthroplasties were done at the authors hospital between 1998 and 2002. Of these knee arthroplasties three knees (1.2%) became infected. We treated two of these knees, and another two infected knees received treatment after TKA at another hospital. We reviewed organism, onset time of infection, surgery for affected knee, and timing of reimplantation. Onset time ranged six to 108 months. Cultures grew Staphylococcus aureus in two knees, Pseudomonas aeruginosa in one knee, and Escherichia coli in one knee. Reimplantations were performed on three knees. The timing of reimplantation ranged from two to 13 months. There was no recurrence of infection.
We report a case of synovial sarcoma, which was successfully treated by wide resection and limb salvage procedure after an effective chemotherapy. A 17-year-old boy visited our hospital complaining of pain and swelling at the dorsum of his right foot. Needle biopsy indicated possible synovial sarcoma. MRI revealed that a tumor totally surrounded the second and third metatarsal bones. After four months of adjuvant chemotherapy including duxorubicine, ifosfamide, etoposide, and cisplatin, 66% reduction of the tumor mass was achieved, and wide resection with free vascularized fibula osterocutaneous flap was performed. One year and three months after the surgery, the patient could walk without using any support.
Thoracic outlet syndrome (TOS) can be a painful, debilitating condition for patients with neck-shoulder-arm symptoms and for physicians because of unawareness of accurate diagnosis. The aim of this study was to confirm more accurate diagnostic criteria, leading some authors to neurogenic TOS. Neurogenic TOS patients were studied with use of previous diagnostic tests (Morley, Wright or Roos test), and the results were compared with normal values. Physical examination of TOS patients revealed sensory deficit of the fourth or fifth finger and they complained of aggravated pain or symptoms when sleeping on their back or upon waking in the morning. On their radiographs, the lowest level of cervical spine demonstrated inferior margin of the T1 vertebral body in the neutral-lateral position. The ratio of patients with cervical kyphotic malalignment was higher. In addition, the lateral end on the clavicle of TOS patients mostly revealed the posterior side of the T1 vertebral body, while normal cases showed the anterior side of vertebra. These findings will significantly contribute to providing appropriate diagnosis for neurogenic TOS.
We experienced one case of posterolateral rotatory instability (PLRI) in post-traumatic cubitus varus. The patient was a 15-year-old male, motocross player who injured his right elbow while riding his motorcycle. He had a history of supracondylar fracture of the right humerus at nine years of age. He was treated with open reduction. Unstableness of his right elbow has been noticed since 13 years. On his visit to our clinic, the range of motion of his right elbow was three to 140 degrees. He presented deformity of the right elbow which was 20 degrees of the cubitus varus. Radiogram showed ulnar deviation of the orecranon and hypertrophy of the radial head, enlarged curvature of the trochlea notch, free bone fragment at the lateral epicondyle of the right humerus. He showed both 14-degree varus instability and posterolateral rotatory instability. Correction domed osteotomy of the humerus and reconstruction of the lateral collateral ligament with use of a triceps tendon were performed. Eight months postoperatively, there has been no recurrence of deformity and posterolateral rotatory instability.
The purpose of this study was to examine the process of early postoperative recovery in patients with rotator cuff tears, comparing the contracted with the non-contracted. Eighty patients with cuff tears underwent surgical intervention (ASD, ARCR, mini-open, and open procedures) in our hospital, from August 2002 to January 2004. Of these, 31 patients (< middle-sized cuff tears) were included in this study: 18 with contracture and 13 without contracture. Prior to operation, manipulation was performed in all patients. The presence of contracture was defined if an apparent improvement in range of motion (ROM) was achieved after manipulation. No additional procedure (arthroscopic capsular release etc.) was needed. ROM, muscle strength (MICROFET®, HOGGAN, USA), visual analogue scale (VAS), and JOA score were measured preoperatively and at 1, 2, 3, and 6 months after operation. There was no significant difference between the two groups in patient profile, VAS, JOA score, muscle strength preoperatively and postoperatively. In postoperative course, significant differences were noted in external and internal rotation at 1 month, and elevation at 2 and 3 months. At postoperative 6 months, however, ROM in two groups improved almost equally with no significant difference. We believe that preoperative manipulation is an effective procedure for contracted patients with cuff tears less than middle-size.