Increasingly higher functional results are reguired in the treatment of distal radius fractures with osteoporosis and surgical procedures must be selected carefully in case of inadequate reduction of the fracture. Of these surgical procedures, pinning using K-wire is widely used for ease and minimum invasion, however, complications are occasionally seen. To solve these problems, we have been using modified Desmanets intrameddullary pinning in recent years. In some cases, we experience over collection, and add the volar pin for better results. From 2003 to 2004, 10 patients with osteoporotic distal radius fractures were treated at our hospital. The clinical results were satisfactory according to the demerit point system of Saito; six were assessed as excellent and four as good. Dorsal 2 pins aid reduction of the fracture and maintain reduction by 3 point support. Moreover, the added volar pin acts as to prevent over-reduction. This technique minimizes morbidity by successfully handling the osteoporotic bone allowing early return to function and provides good final results.
This study was conducted to evaluate the performance of the simple clinical tool "FOSTA" in patients at our clinic using dual-energy X-ray absorptiometry (DEXA) to define osteoporosis. There are several reports on the relation between FOSTA and weight bearing bone BMD (i.e. vertebra, femoral neck, etc.) , but no report has discussed the forearm bone BMD, which is non-weight bearing bone BMD. The subjects of this study were 141 women whose forearm bone BMD was measured at our clinic. Their ages ranged from 28 to 92 (mean 68). In this study, the FOSTA index achieved 99% sensitivity and 54% specificity for osteoporosis. These results indicated that the FOSTA index is efficient for identifying Japanease women with osteoporosis, and relates well with both weight and non-weight bearing bone BMD.
Twenty patients with a mean age of 36 years (16-60 years) and a dorsaly displaced intra-articular fracture of the distal radius were treated by dorsal plating. Seventeen Forte plates and three symmetry plates were used. Eighteen required iliac bone graft. Mobilisation of the wrist was started at one to two weeks. At the latest follow-up, there were a mean radial inclination of 23°, palmar tilt of 9.3°, and ulnar variance of + 1.8 mm. The functional results, according to the point system of Saito were 16 excellent and four good. There was no cases extensor tendon rupture nor reflex sympathetic dystrophy (RSD). In the younger age group, dorsal plate fixation with iliac bone graft for comminuted colles' fractures provides favorable advantages such as more accurate reduction of the articular surface and early rehabilitation.
We report a rare case of the locking of the extensor pollicis longus (EPL) tendon after fracture of the distal end of the radius. A 16-year-old boy was injured with comminuted-Smith type fracture in a traffic accident. After osteosynthesis, we found extension lag of the thumb. Seven days later, extension was impossible. Subcutaneous rupture of EPL tendon was suspected, but the tendon was caught in the fracture, and covered with callus and scar tissue. It was treated with tenolysis, and the extension lag disappeared in five weeks. It is important to find such cases in their early stage.
Femoral neck fracture after a healed trochanteric fracture is rare. We experienced one case of femoral neck fracture after removal of the compression hip screw. A 90-year-old woman sustained a two part stable trochanteric hip fracture that was reduced and stabilized with a compression hip screw. Postoperative radiographs showed that the lag screw was positioned very properly. The fracture healed. Six months later, radiographs showed lag screw penetration. The patient reported occasional gait hip pain. We decided to remove the implants, to prevent the acetabular cartilages from destruction. The device was removed, and the patient was discharged two weeks later. She returned 21 days after removal because of increasing groin pain without evidence of trauma. Radiographs did not showed the fracture line. But magnetic resonance intensifier images revealed a subcapital femoral neck fracture. A bipolar end prosthesis was performed the following day. The combination of bone defects present after implant removal and osteoporosis may contribute to the weakness of the subcapital region of the femoral neck. We hope to draw attention to the possibility of femoral neck fracture as a serious and frequent complication after implant removal.
Between April 1999 and September 2004, 58 cases of femoral trochanteric fractures were treated with a CHS (compression hip screw), and 25 cases with a Gamma nail. We evaluated the multivariate studies and the post-operative walking ability between two groups. There were significant differences in the duration of admission, fracture types, post-operative walking ability in unstable fracture type, and complications. Because of the operative-technique, complications in the Gamma group were more than the CHS group. In the unstable fractures type, 88 percent of the patients in the Gamma group regained pre-injury walking ability, but only 40 percent in the CHS group regained the ability. In the decreased factors of walking ability, there were significant differences in unstable fractures type and dementia of the CHS group. We conclude that the Gamma nail is a more useful device than CHS in unstable fractures type and dementia.
We treated 283 patients (49 men and 234 women) for femoral neck fracture in our hospital between 2001 and 2003. These cases were classified into two groups: patients with experience of contralateral femoral neck fracture in the past (33 patients) and those without such experiences (250 patients). We compared the two on fracture type, bone mineral density, location of injury, activities of daily living (ADL), and complications. Significant difference was found for bone mineral density. We concluded that it is desirable to treat osteoporosis and care for other complications and ADL of patients in order to prevent bilateral femoral neck fracture.
We developed a "hybrid exercise" technique that uses the force generated by an electrically stimulated antagonist muscle to provide resistance to a volitionally contracting agonist. In other words, the agonist performs volitional concentric contraction against an electrically stimulated eccentric contraction of the antagonist. Hybrid exercise has several advantages. These include; 1) activation of type I muscle fiber as a result of the volitional contraction of agonist muscles, 2) simultaneous exercise both agonist and antagonist musculatures, 3) longitudinal bone force loads, 4) requiring minimal external stabilization of the subjects, and 5) proven safety of the electrical stimulation as a physical therapy modality.
We treated 546 cases of intertrochanteric fractures with the Gamma nail between April 1996 and March 2004. Intraoperative complications were seen in two patients and postoperative complications in twenty. The former were femoral shaft fracture in two patients and the latter were femoral shaft fracture in six patients, cut out of the lag screw in six, infection in six, pseudoaneurysm in one, and nonunion in one. To prevent shaft fracture and cut out of the lag screw, appropriate techniques are necessary.
In this report, gait analysis was performed on 176 patients (mean age 61.1 years) who underwent total hip arthroplasty from March 2003 to June 2004. All patients were tested during "free" walking along an 5-m walkway in which a ground reaction force plate (gait scan 8000; Nitta, Inc.) was installed. Clinical evaluation was carried out on age, sex, Japanese Orthopaedic Association (JOA) score, OA stage, and limb length discrepancy. Multivariate analysis showed that clinical data associated with single support duration were JOA pain score (p<0.001), JOA gait score (p<0.001), and JOA ROM score (p<0.05). Clinical data associated with double support duration were JOA pain score (p<0.001) and JOA gait score (p<0.001). The results of gait analysis can be used as objective index of hip pain and gait ability.
The gait of 27 patients with unilateral coxarthrosis using T cane was analyzed in terms of temporal factors and distance factors. Temporal factors were single stance phase rate (single stance phase/gait cycle) and double stance phase rate (double stance phase/gait cycle); distance factors were step length, stride width, and gait speed. Comparisons of gait in patients using and not using the T cane indicated that single stance phase rate, double stance phase rate, and step length were significantly improved when T cane was used. These factors nearly matched in both sides. This outcome supports Pauwels theory on the dynamics of the hip joint.
We report a case of abnormality of the bilateral lateral meniscus and medial meniscus. A ten-year-old boy complained of pain and locking of the right knee. On magnetic resonance imaging of the right knee, there was a longitudinal tear on the posterior portion of the lateral meniscus. In arthroscopic findings, the medial meniscus had abnormality of attachment on the anterior portion, and the lateral meniscus comprised of two parts which were completly separeted and duplicated at the midportion. The anterior part was connected to the capsule and the posterior part to the cartilage surface of the tibia plateau at the midportion. We peformed meniscorrhaphy for longitudinal tear on the posterior portion. We checked his left knee for bilateral congental abnormalities. In the arthroscopic findings of the left knee, the shape of the lateral meniscus was almost the same as the right knee, and the medial meniscus had two layers on the anterior portion (double-layers medial meniscus). We found a horizontal tear on the posterior portion, and peformed partial menisectomy on it. We could not find literature on this abnormality of the lateral meniscus and double-layers medial meniscus.
Arthroscopic surgery for 525 knee disorders (519 patients) was performed from July 2003 to June 2004. Shelf was found in 284 of 525 knees. According to Sakakibaras classification, there were 106 Type As, 78 Type Bs, 53 Type Cs, and 47 Type Ds. In 47 knees, ruptured shelves were detected. All of them were resected under arthroscope. Fifteen out of 47 knees showed no complications. Good results were achieved in 15 knees by resection of the ruptured shelves. Excellent results (complete pain free) were obtained in 10 cases and good results (improved, but pain remained in strenuous activities) in five cases. Thirteen athletes returned to sports one month after the operation.
We report a case of bone marrow signal change in the medial tibial condyle (MTC) on MRI shortly after arthroscopic medial meniscectomy. A 52-year-old man visited our hospital complaining of pain on the medial side of the left knee for a one-month duration without specific trauma. Anteroposterior radiograph showed no bony lesion. MRI, however, suggested a medial meniscal tear. There was no abnormal change in the bone marrow of the MTC. The diagnosis was medial meniscus injury and we performed arthroscopic medial meiscectomy. At the time of surgery, there was no apparent chondral damage at the MTC. He was temporally relieved of his pain, however three weeks later he experienced postoperative pain at a more acute level than initially. MRI suggested bone marrow edema in the medial tibial condyle. After retuning to the hospital, the patient was issued a cast for three weeks and seven weeks later he was relieved of his pain and symptoms. We can conclude this case to be subchondral microfracture caused by weight bearing after meniscectomy based on the results of MRI and findings during clinical course.
Postoperative sports activities at a minimum of two years after surgery were examined in patients (N=100) who received anterior cruciate ligament (ACL) reconstruction using the hamstring tendon. All patients were classified in two groups: recreation groug (R group, N=32, male 17 knees, female 15 knees) and competition groug (C group, N=68, male 20 knees, female 48 knees) according to their previous sports activities. The average follow-up period was 3.1 years (2.0 to 6.9) in the R group and 3.4 years (2.0 to 6.3) in the C group. The average time to the peak level of sports activities postoperatively was 2.4±1.2 years in the R group and 2.0±1.1 years in the C group. Eighty-two percent (47% participated in the same level of sports activities and 35% lower level) of patients who had participated in some sports at regular intervals returned to their previous sports, (78% in the C group and 91% in the R group). Patients who did not return to preoperative sports activities completely complained of pain, muscle weakness, instability and/or apprehension and no other complaints. Apprehension was the worst complaint. No significant correlation was found between apprehension and articular cartilage damage, muscle strength (measured by Cybex), instability (over grade 3 in N-test, measured by KT1000). However, apprehension was significantly nigher in female athletes; they were worried that their performance was not able to reach the preoperative level. This suggests that surgical treatment is very important for provinding the opportanity to return to their previous sports.
Localized pigmented villonodular synovitis (PVS) of the knee is a relatively uncommon entity. We report a case of 29-year-old male who presented with acute knee pain and limited range of motion. Magnetic resonance imaging revealed a soft tissue mass adjacent to the posterior cruciate ligament. The lesion could be resected arthroscopically and histologic examination confirmed the diagnosis of PVS. The patient maintained an asymptomatic status during the six-month follow-up period.
We report a case of chronic osteomyelitis of the left tibia treated by β-tricalcium phosphate (β-TCP) and hydroxyapatite (HA) block impregnated with antibiotics. An 80-year-old male was admitted to our hospital due to cervical spine injury. He had a fistula with pus discharge for 40 years without treatment. His clinical findings were only slight discharge on the left lower leg. Laboratory findings indicated chronic infection. After admission, he had high fever and left shin pain. We curetted and inserted β-TCP block impregnated with imipenem (IPM/CS) and HA block including gentamicin (GM). There were no symptoms or side effects during the nine-month follow-up after operation.
Synovitis and arthritis due to atypical mycobacterium (AM) infection is rare. It is often misdiagnosed and treated unsatisfactorily. We report two patient with synovitis caused by AM. Case 1. A 71-year-old man with right wrist pain and swelling was suspected as having an AM infection and therefore given synovectomy. Mycobacterium abium was cultured from his joint fluid. We started administration of RFP, CAM, and LVFX. Case 2. A 51-year-old-man was treated with PSL for SLE. He had prolonged left wrist swelling and was suspected as RA. After receiving synovectomy twice, mycobacterium intracellular was cultured from his joint fluid. He was treated with INH, EB, and RFP, but synovitis recurred many times.
The patient was a 55-year-old female with a 10-year history of diabetes. On July 1, 2004, swelling at the tip of the third digit (left hand) developed, although definite cause is unknown. From July 3, redness and swelling increased and she visited a nearby doctor for examination. Exacerbated symptoms were found and the patient was admitted to our hospital on July 7. Upon hospitalization, with the exception of the finger tip, a dark red color, swelling and pressure point pain were seen. Inflammation and laboratory findings (CRP:15.1 WBC:11500) were detected, but bacteria was not found in culture. (After hospitalization) On July 9, the diagnosis of necrotizing fasciitis was uncertain. The patient was immediately treated by hyperbaric oxygen (HBO) therapy and intravenous antibiotics. No symptomic improvement was seen. Debridement and amputation of the third digit were performed. On July 13, an expansion of necrotizing tissue on the dorsal side of the hand was found and additional wide area debridement was peformed. On July 18, pig skin coating (brand name:Aroask) was used and no furter growth of necrosis had been seen. Wound granulation was slow. As a result, it can be said that wide debridement of necrotizing fasciitis including areas of reduess and edema shoud be peformed. Also, surgical treatment by adequate debridement, drug therapy by antibiotics, and HBO therapy should be combined to treat necrotizing fasciitis.
It is known that severe osteoarthritis of the hip joint develops into secondary osteoarthritis of the knee joint. In the present study, we observed and examined the influence of leg length discrepancy on knee joint alignment of patients. Between November 2002 and August 2004, 120 patients who had one side hip joint disease were studied. The mean age was 62.6 years (from 34 to 95). Patients with leg length discrepancy of 24 mm or less were categorized as group I, 25-49 mm as group II, and 50 mm or more as group III. We evaluated both sides femorotibial angle (FTA), leg length discrepancy on a preoperative rediograph, and %MA in these groups and investigated the relation with knee joint alignment. There is a tendency for the development of valgus position of the knee joint on the short side and varus position of the knee joint on the long side in patients with severe leg length discrepancy of more than 50 mm.
We experienced a case of cauda equina syndrome as a postoperative complication of lumbar disc herniation. The patient was a 57-year-old man and suffered from left leg pain and lumbago. We diagnosed lumbar disc herniation at L4-5 and L5-6 and performed L4-5 and L5-L6 discectomy and posterolateral fusion. Three days after operation, he did not complain of leg pain and lumbago, but he experienced numbness in the perineum and urinary retention. We carried out emergency MR imaging study, but no compressive findings were demonstrated. The patient was expected to recover spontaneously, and numbness in the perineum and urinary retention were resolved three months postoperatively. Vascular insufficiency of the cauda equina was suspected.
No clear analysis has yet been made to determine whether the postsurgical course of tight hamstrings is attributable to the surgery or to the natural course. This study examined whether or not tight hamstrings had improved in pediatric patients with lumbar disc herniation following surgical treatment. This study involved 21 patients who developed lumbar disc herniation under the age of 16 years and who manifested tight hamstrings on initial examination. The mean postoperative follow up period was 11 years and five months, ranging from one year to 19 years. In patients who underwent surgery, lower back pain and leg pain disappeared shortly after surgery. Tight hamstrings persisted postoperatively even after lower back pain and leg pain had disappeared. However, the symptoms gradually improved with regular stretching exercises and disappeared completely in all the patients between 3 months and 1 year after surgery. None of the patients who were followed up until adulthood suffered problems in daily life due to recurrence of tight hamstrings. In our study, although the long-term results of surgical treatment of pediatric lumbar disc herniation were favorable, tight hamstrings did not improve promptly with surgery alone.
We performed surgical treatments for lateral lumbar disc herniation on 12 patients. The methods included lateral fenestration, osteoplastic hemilaminectomy and hemi-facetectomy +PLF. We compared their clinical results.
Vertebral compression fracture in patients of advanced age is disadvantage as it forces long term rest. Recently some surgical treatments have been reported. We have been treating vertebral compression fracture by body cast and good results have been achieved. In this study, the subjects comprised of 44 females and 8 males with a mean age of 77.7 years (range: 58 to 92 years) treated by body cast within two weeks from injury. We evaluated patient pain according to VAS (Visual Analogue Scale) and recorded days when patients could sit on a wheel chair, walker gait, and T-cane gait. Results were as follows: (1) the average VAS when patients were admitted to our hospital was 7.5, three days later was 5.4, one week later was 4.6, two weeks later was 3.0 and when discharged was 1.2; (2) the average days the patients could sit on a wheel chair was 4.3 days, walker gait was 6.8 days, and T-cane gait was 12.2 days; (3) the average VAS of posterior wall damaged cases was higher than non-damaged cases; (4) the average days of admission of posterior wall damaged cases was longer than non-damaged cases.
We reviewed 36 patients with osteoporotic vertebral fractures treated conservatively (33 females and 3 males, average age 76.3 years), and examined for predisposing factors to poor results. Continuous back pain and increased collapse on X-ray images were judged as poor results. The correlation between the results of conservative therapy and the factors (age, sex, cause of fracture, degree of collapse on first examination, existence of old vertebral fracture, BND, and MRI findings) were examined. Old age, existence of old vertebral fracture, and damage of posterior wall on MRI were correlated with continuous back pain. None of the factors was correlated with increased collapse on X-ray. More prompt therapy is considered necessary for patients with these factors.
Endoscopic or mini-open ventral fusion was performed for thoracolumbar trauma. Two patients were treated with retroperitoneoscopy (Retro), four with thoracoscopy (VATS), and four with mini-open retroperitoneal approach (MINIALIF). Average operation time was 10 hours 12 minutes in Retro, 7 hours 12 minutes in VATS, and 2 hours 50 minutes in MINIALIF. Average blood loss was 2048 g, 1718 g, and 1065 g. A patient in Retro had neurological deterioration postoperatively, while a patient in VATS was converted to open surgery.
Clinical results of surgical treatment for thoraco-lumbar burst fractures were studied. Fourteen patients (eight males and six females, average age 36.8 years) who were operated for posterior decompression and fusion were evaluated. The fusion of the instrumentation (pedicle screw system) applies to two areas above and two below the injured vertebral body. There was screw breakage and the average correction loss for Cobb's angle between the first examination after operation and the final follow-up examination was 1.1 degrees in this series. As a result, clinical results of the surgical treatment were thought to be evaluated as good. But our surgical method may be too invasive to be safe, and the fusion area may be too extensive to prevent complications. In conclusion, in cases of severe communicated vertebral body, the hybrid construction method and our method are thought to be recommended. In cases of moderate grade transpedicular fixation with transpedicular bone graft in addition to the above is thought to be recommended. In mild cases, the so-called short fusion is thought to be recommended.
We investigated the long-term outcome of bilateral Perthes disease in 12 patients affected bilaterally and 134 patients affected unilaterally. The bilaterally onset rate was 8.2%. The average onset age was significantly lower in bilateral patients (4.8 years) than in unilateral patients (6.8 years). The average interval period between earlier and later onsets in the bilateral patients was 16.5 months. We used X-ray photography to examine the severity of involvement in unilateral patients and bilateral patients. There were no significant differences between them at onset time according to Catterall classification. By estimating Stulberg classification, the results were worse in bilateral patients than in unilateral patients significantly at final examination. We also studied the rate of patients needing additional surgical treatment. There were no significant differences, but there was a tendency for bilateral patients to need additional surgery frequently.
We describe retroodontoid pseudotumor associated with slight atlantoaxial instability in three elderly patients. The average age at the time of surgery was 82.7 years (range: 79-85 years). All cases underwent laminectomy of the atlas for progressive cervical myelopathy. The average follow-up was 2.1 years (range: 1-3.7 years). We assessed the results by the Japanese Orthopaedic Association (JOA) score for cervical myelopathy. The average JOA score markedly improved from 5.7 to 12.5. According to previously published reports, even if there is no atlantoaxial instability on X-ray film, the main surgical treatment is procedure with occipitocervical posterior fusion because of reduction of pseudotumor. However, these results suggest that if there is no overt atlantoaxial instability in the elderly, even laminectomy of the atlas for decompression alone, which is less invasive comparing to other procedures, is a useful surgical treatment.
Spinal epidural abscess is an uncommon disease, especially cervical infection is rare. Recently, epidural abscess by methicillin-resistant Staphyrococcus aureus (MRSA) is slightly increasing. Rapid evaluation and immediate surgical drainage and antibiotic therapy are very important for possible functional recovery. We report two rare cases of a 73-year-old woman and 75-year-old man with cervical spinal epidural abscess caused by MRSA after surgery for malignant tumor. They also complained of diabetes mellitus. The infection spread to the epidural space hematogenously from the central venous catheter. MRI revealed that abscess was low- or iso-intensity signal on T1-weighted image, high-intensity signal on T2-weighted image and ring-enhanced signal on Gadolinium-enhanced image. We treated case 1 with surgical drainage and antibiotic therapy and case 2 with only antibiotic, and used vancomycin as the antibiotic. Use of vancomycin requires therapeutic drug monitoring.
Fourteen cases of femoral or tibial fracture were treated surgically using the LCP (locking compression plate). All cases except one achieved good bone union. No implant-related complications were observed. LCP can provide stable fixation for proximal or distal part of long bone fractures.
We treat tibial condylar fractures using beta-tricalcium phosphate (β-TCP) implantation instead of auto-bone-graft. In this study, we report and investigate the process of replacement of missing auto-bone with beta-tricalcium phosphate. To evaluate this study, we use the Scion image analyzing system, and reviewed the changes of the area filled with the β-TCP. In all cases the β-TCP was absorbed and replaced the auto-bone, but it had considerable variations. Our results indicate that the replacement process is influenced by various factors such as bone defect.
A 54-year-old women injured her leg in a traffic accident, and her tibia categorized as Grade IIIA open fracture resulted in nonunion with bone loss. We treated it by segmental bone transport (SBT) technique with Ilizarov apparatus. The external fixator time (EFT) was seven months and the external fixator index (EFI) was 63 days/cm. There were some complications. EFT and EFI were higher than usual SBT by Ilizarov method, and a bone graft was needed at the docking site at the end of transport. But the patient finally achieved union and satisfactory functional result with this method. However the treatment is lengthy with considerable risk of complications. SBT is a useful method for treating large tibial bone defects in elderly patients.
Until recently, the inferior vena cava filter (IVCF) has been presupposed as a treatment for prevention of pulmonaly embolism (PE) after orthopaedic surgery. However, a number of recent reports have described both efficacy and high complication rates in permanent IVCF; and the temporary IVCF has come to be used rather than permanent one. New various complications such as a hematoma of the insertion part, bleeding, infection, and removal difficulty are clarified with using temporary IVCF. We experienced a case of postoperative thrombus at the proximal side of temporary IVCF. This phenomenon is very rare, and it is difficult to treat because of the possibility of PE. Finally, it could be treated by the intravenous dose of both heparin and urokinase at the same time. This experience suggests that the selection of patients for indication of temporary IVCF should be made with extreme caution. And, it is very important to cooperate with other departments such as cardioangiology. The necessity and complications of postoperative IVCF need to be explained exactly to patients and their family.
Bipolar hemiarthroplasty systems are currently widely employed for the treatment of femoral neck fractures. Disassembly of bipolar femoral prosthesis, however, occurred in three patients during the closed reduction of the dislocated hips. Of 168 patients who underwent bipolar hemiarthroplasties between September 1999 and June 2002, eight hips (4.7%) were dislocated wna three hips (1.8%) were disassembled. All of the three patients were hospitalized in the psychiatric floor because of dementia, schizophrenia or depression. In all cases, open reductions were required, and hip brace was used after the reoperations. No breakage was found in femoral components. The mechanism of disassembly was considered impingement between the outer head and acetabulum during the closed reduction. Although prevention is important for dislocation, gentle and careful reduction should be required in the management of the dislocated bipolar heads.
We report a case study of Weber-Christian disease. On May 23, 2003, a 33-year-old woman developed right foot arthralgia. Pain increased in the next morning and complications such as local heat, local swelling and local redness were seen. CFDN was administered due to diagnosis of cellulites, but there was no symptomatic improvement. A similar symptom appeared on the left wrist joint without improvement of symptoms on May 26. She was hospitalized and was administered drip CTM from May 27, but inflammation did not improve. In addition to subcutaneous nodule with redness, heat occurred in the right calf region. Collagen disease was doubted and a general search was carried out using, skin biopsy. The results revealed panniculitis and those of pathology examination diagnosed it as Weber-Christian disease. The inflammation findings settled by oral steroid administration. Weber-Christian disease required discrimination from disorders of the subcutaneous nodule such as SLE, erythema nodosum, lymph increase disorder. A decisive factor for diagnosis is skin biopsy, and the collection of appropriate specimens including existing subcutaneous fat layer of inflammation is important.
We treated the basicervical neck fracture of the femur with Gamma nail, and evaluated the clinical results. The mean age at the time of surgery was 83.7 years (range: 72 to 94 years). The mean duration of follow-up was 9.5 months. Eleven cases were treated with this instrument between July 1993 and July 2003 and were followed-up for more than one month. We treated eight cases of the basicervical neck fractures of the femur with Gamma nail to Octover 2002, and from November 2002, we treated three cases with Gamma nail and a cannulated cancellous hip screw (CCHS). The average time of the operations was 48 minutes (Gamma nail) and 60 minutes (Gammma nail and CCHS). Nine out of 11 cases (82.0%) had the appropriate position of the lag screw. There were no cases of the rotational displacement of the proximal fragment, varus deformity, and cutting out of the lag screw. It is important to insert lag screw to the appropriate position, and Gammanail and CCHS may prevent the rotation of the proximal fragment for the basicervical neck fracture of the femur.
Primary total hip arthroplasty (primary THA) was performed on 157 osteoarthritic hips. The mean age of the patients was 65 years; range 42 to 89 years. Transition of the fever type and laboratory test were obtained. Patients with complications were excluded. Patients were divided into over 70 years of age and under 69 years. There was no statistically significant difference between the two groups. However, our results should prove important infections occurring in an early phase.
We conducted a retrospective review of a conseecutive series of posterio stabilized total knee arthroplasties (TKAs) to evaluate patellofemoral complications, in particular, patellar clunk syndrome. Sixty-eight consecutive elderly patients had eighty-five PFC Sigma posterior-stabilized total knees. The mean follow-up time was 2.8 years (range: 1 to 8 years). Three patellar clunk syndromes were identified in 3 patients. The relative frequency of occurrence of partellar clunk syndrome among patients with the PFC Sigma PS prosthesis was 3.5%. Two arthroscopic debridements were perfomed on two patients. The disorder resolved after nodule excision. One case improved within six months when given conservative treatment. It seems that the patellofemoral groove design of the femoral component is the potential etiologic agent of this complication.
A consecutive series of 11 patients (11 hips) with femoral neck fracture were treated with bipolar end prosthesis by the transgluteal approach as described by Bauer et al. All cases were female. The mean age at the time of operation was 87.5 years (77 to 94 years). The mean follow-up period was 5.7 months (1 to 10 months). There were no major complications during the operation, except in one patient who sustained major trochanter avulsion fracture. No patient had dislocation of the hip, nurve pulsy, and limping gait. Three cases showed ectopic ossification after surgery, but these did not grow during the follow-up period. There were no massive ectopic ossification, which caused limitation of R.O.M. All patients were satisfied with this operation by the transgluteal approach.
We present a case of extrinsic flexion deformity of the toes following surgical treatment of the closed tibial shaft fracture with a interlocking tibial intramedullary nailing. A 17-year-old woman was involved in a traffic accident and injured her right tibial shaft fracture. She was treated by interlocking tibial intramedullary nailing. One month after surgical treatment of the tibial fracture, claw big toe and lesser toes were noticed at the follow-up examination. The deformity was a source of continuted disability. Six months after osteosynthesis, the condition could be corrected by lengthening the flexor hallucis longus and flexor digitorum longus. As a result, the patient became asymptomatic.
We experienced a case of transferring the peroneus longus tendon to the peroneus brevis with soft-tissue release in Charcot-Marie-Tooth (CMT) disease. The patient was an 8-year-old girl who had bilateral cavovarus foot deformity with predominantly anterior cavus. Hindfoot varus was flexible in the Coleman block test. So we performed surgery by soft-tissue procedures alone which not only may restore more normal biomechanics and posture of foot, but prevent or delay the need for extensive bony procedures. It was performed on the right foot, at first and after one month, it was combined with peroneus longus transfer to sufficiently restore ankle eversion strength in the left foot. Three months after the operation, the left foot showed further correction, and the patient was more satisfied. The transfer of the peroneus longus tendon is useful for correcting cavovarus deformity in CMT.
A 63-year-old woman complained of increasing pain and swelling of the left ankle without any special reasons. Physical findings showed tenderness, swelling and local heat of the ankle joint. Laboratory data was WBC=70.2×10 ²/μlCRP=1.0mg/dl. Radiographic findings showed bone atrophy around the ankle joint, slight joint space narrowing of the ankle joint, and irregular destruction of the subtalar joint. Diagnosed as osteoarthritis of the ankle and subtalar joint, arthrodesis was performed by intramedullary nailing. Immediately after the operation, fistel formation occurred around the ankle joint, and Staphyroccocus aureus was detected from culture. In the second operation, fistel granulation was diagnosed as tuberculosis by pathological examination. After anti-tuberculosis chemical therapy, vascularized iliac bone graft to the ankle and subtalar joint was perfomed successfully. Bone and joint tuberculosis is rare nowadays, but should be remembered as an important differential diagnosis for orthopaedic disorders.
Since the transthecal digital block was first introduced in 1990 by Cliu, many authors have reported techniques using a single injection digital block. The efficacy of the single injection digital block for thumb anesthesia has not been adequately addressed. However, Torok described a modified transthecal digital block with improved applicability to the thumb. The purpose of this study is to evaluate the extension of the agent effusion of Torok's procedure. In this study, we used subcutaneous and transthecal single injections at a point half way between the proximal digital crease and palmophalangeal crease of a thumb. There was no significant difference between onset and durations of anesthesia between the two techniques. The contrast agent was delivered extensively to the dorsal side of the thumb by transthecal single injection, compared with the subcutaneous injection. These results differ from our previous report for the middle finger. In the middle finger, the contrast agent did not escape from the flexor tendon sheath, suggesting that the contrast agent may have diffused through the poor parts of the oblique pulley.
Over an eight-year period (1990-1997), we performed total hip arthroplasty (THA) on four hip joints in three patients who had been undergoing dialysis. The duration of dialysis before operation averaged 16 years and the average age of the patients was 38.5 years. The average follow-up period was 9.8 years. We performed one cemented THA and three cementless THAs. Two hip joints resulted in loosening. One of them developed loosening in an early stage (2.5 years). The patient suffered from secondary hyperparathyroidism and bone brittleness. Parathyroidectomy was performed because conservative therapy was not effective. Revision THA was performed after hyperparathyroidism improved. The patient did well two to three years after the revision. We know that there is a lower success rate for THA in patients of long-term dialysis than in the general population. In such cases, it is suggested that secondary hyperparathyroidism may cause THA loosening.
A study on early weight-bearing after rotational acetabular osteotomy (RAO) was performed in our hospital. In this study, gait analysis was performed on 27 patients (all females; mean age 37 years, range 12-58 years) who underwent unilateral RAO between 1999 to 2003. The gait was analyzed preoperatively and 3 weeks, 1, 3, 6, and 12 months postoperatively. All the patients underwent a "free" walking test on a 5-m walkway having a ground reaction force plate (gait scan 8000; Nitta Inc.). The test was carried out for 5 seconds. Single and double support duration (% cycle) was assessed. The normal average value in healthy humans reported by Murray et al. 3) was used during the assessment. The preoperative single support duration was unchanged while the double support duration was increased when compared with that for a normal person. Three weeks post operation, single support duration showed increasing reduction while double support duration showed decreasing reduction. However, single support duration gradually attained the normal average value within 1 year. Double support duration attained the normal average value postoperatively. Thus, it can be concluded that the gait improved post RAO. These results concurred with other studies that also reported pre- and postoperativ results in patients with late weight-bearing post RAO. Given these results, we believe gait characteristics remain unaffected post RAO if early weight-bearing is performed.
Spinous process splitting laminoplasty was performed on 52 patients with cervical myelopathy. We evaluated the surgical results of laminoplasty on operating time, blood lose, JOA score, alignment of the cervical spine, and postoperative complications. Clinical evaluation based on the JOA score indicated improvement from 8.5 points preoperatively to 12.1 points postoperatively. Postoperative complications were axial symptoms (4 cases), epidural hematoma (1 case), and liquorrhea (4 cases). Spinous process splitting laminoplasty is an effective procedure for cervical myelopathy.
The purpose of this study is to compare the frequency of postoperative axial neck symptoms between patients who had undergone C3-7 laminoplasty (C3-7 group) and patients who had undergone C3-6 laminoplasty and C7 dome fenestration (C3-6 group). In the latter group, the muscles which attach to the C7 spinous process were preserved. As a result, the frequency of postoperative neck pain was 22.2% in the C3-7 group and 8.3% in the C3-6 group respectively. Neck stiffness was observed in 33.4% of the C3-7 group and in 20.8% of the C3-6 group. Although these results were not statistically significant, C3-6 laminoplasty and C7 dome denestration are considered to be effective for decreasing postoperative axial neck symptoms.
Interlocking wedge osteotomy (Ogata) shows many advantages compared with the traditional high tibial osteotomy (Coventry). In high tibial osteotomy, early weight bearing after the surgery using traditional internal fixation devices leads to correction loss of angulation. This correction loss causes recurrence of knee pain and poor long term results. In this paper, the surgery techniques used were mainly investigated and some problems of those techniques were shown retrospectively. Cases using blade staple were compared with cases using a newly designed Surfix Lock Plate system on roentgenograms. In interlocking wedge osteotomy, medial cortex of the tibia shows a marked tendency to split compared with Coventry osteotomy. And this split is associated with the recurrence of varus deformity at early weight bearing after the surgery using blade staple. In contrast, Surfix Lock Plate system caused no loss of correction in early weight bearing after surgery.
Acetabular dysplasia may influence the incidence of collapse in the osteonecrosis of the femoral head. The degree of dysplasia was investigated by measuring the Sharp angle, acetabular oblique angle, acetabular head index, and center edge angle in hips which collapsed and underwent operations except for THA, and comparing with the normal range reported. There was a tendency for collapsed to have more acetabular dysplasia than normal hips. Acetabular dysplasia may be involved in the collapse mechanism.