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Yasutaka Tashiro, Hiromasa Miura, Shuichi Matsuda, Ken Okazaki, Taro M ...
2006 Volume 55 Issue 4 Pages
403-407
Published: 2006
Released on J-STAGE: December 01, 2006
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Rheumatoid nodules commonly occur on the extensor surface of the forearm and elbow where subcutaneous tissue is subject to recurrent pressure against bone. We found intra-articular rheumatoid nodules in four knees of two patients with rheumatoid arthritis. The masses appeared to slip in and out over the lateral femoral condyle. Snapping was noticed as the joint flexed 30 degrees.
There are no reports of the MRI characteristics and enhancement patterns of intra-articular rheumatoid nodules of the knee. Our findings on MRI were that the nodules were of low-to-intermediate singnal on T1-weighted (T1W) images and isointense to muscle and of heterogeneously hyperintense on T2W images. T1W image following gadolinium administration showed diffuse enhancement of the nodules. The symptoms were relieved by arthroscopic excision of the nodules. Mechanical stress, as well as immunological factors are supposesd to cause nodule formation.
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Tomonori Nagamine, Hideyuki Kawabata, Setsuro Komiya, Minoru Kijima, M ...
2006 Volume 55 Issue 4 Pages
408-409
Published: 2006
Released on J-STAGE: December 01, 2006
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The authors report a case of coronal fracture of the medial femoral condyle that subsequently developed into malunion. The patient presented with symptoms of knee pain and contracture eight weeks after a motor bicycle accident. The malunion fragment involved most of the medial femoral condyle articular surface. Afer treatment by osteotomy, stable internal fixation and early mobilization were achieved and the malunion healed.
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Ken Narita, Joji Noguchi, Gishichiro Shimoyama, Tatsuya Imai, Toshimor ...
2006 Volume 55 Issue 4 Pages
410-415
Published: 2006
Released on J-STAGE: December 01, 2006
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Nineteen patients with femoral neck fractures treated by Hansson pin fixation were reviewed clinically and radiologically with an average follow-up time of 48 weeks.
There were six undisplaced and 13 displaced fractures. The bony union rate was 84 percent. Two patients with each type of fracture developed avascular necrosis and pseudoarthrosis.
We found that the early relocation of patients after sugery in each type of fracture increases the risk of pseudoarthrosis.
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Yasutaka Kugimoto, Akihiko Asami, Tadatsugu Morimoto
2006 Volume 55 Issue 4 Pages
416-418
Published: 2006
Released on J-STAGE: December 01, 2006
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Purpose: We evaluated the clinical results of femoral neck fractures in patients aged ninety years and over.
Methods: Between 1995 and 2005, we treated nine patients with subcapital fractures graded as Garden 1 or 2 by internal fixation (group A). We treated six patients with subcapital fractures graded as Garden 3 or 4 by arthroplasty (group B). We compared the two groups with regard to mortality and functional outcome.
Results: The mean patient age was 93.9 years (range 90 to 106 years). One patient died in both groups within three months of surgery. Within one year, two patients died in group A and three in group B. In both groups, two patients showed decreased basic activities of daily living (ADL). There was no significant difference in mortality and functional outcome in our study.
Conclusions: Generally arthroplasty is more invasive than internal fixation, but there was no significant difference in mortality and functional outcome.
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Shinichiroh Seto, Kenji Kido, Noriyuki Kuwata, Toshikatsu Tominaga, Sh ...
2006 Volume 55 Issue 4 Pages
419-421
Published: 2006
Released on J-STAGE: December 01, 2006
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Forty-one cases of femoral neck fracture were fixed using the Hansson Pin system from April 2000 to March 2005. There were eight male cases and 33 female cases. Their average age was 74.5 years. There were eighteen cases of Garden type I, thirteen cases of type II, four cases of type III and six cases of type IV.
Six cases (14.6%) needed artificial femoral head replacement for re-operation.
Re-fracture of the neck after operation, poor reposition of fracture, inadequate position of the pins and femoral neck fracture with rheumatoid arthritis were considerable causes of failuse.
Fixation of the femoral neck fracture using the Hansson pin is a good method. For better results, adequate adaptation and correct surgery are required.
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Tetsuo Hayashi, Satoshi Shidahara, Hideyuki Senba, Takahiro Kitamura, ...
2006 Volume 55 Issue 4 Pages
422-424
Published: 2006
Released on J-STAGE: December 01, 2006
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We report a case of injury to a deep femoral artery associated with osteosynthesis of femoral trochanteric fracture. A 79-year-old woman was admitted to our hospital for a trochanteric fracture of the right femur following tumble. Seven days after the injury osteosynthesis with compression hip screw was performed. On the fourth postoperative day, remarkable swelling was observed in her right thigh and hemoglobin was 4.5 g/dl. Enhanced CT showed enhancement in the medial aspect of the femur. A right femoral arteriogram showed extravasation of the deep femoral artery, therefore transcatheter arterial embolization (TAE) was performed to arrest arterial bleeding. The clinical course was uneventful after TAE. There are few reports concerning the combination of osteosynthesis with compression hip screw and injury of the deep femoral artery. The mechanism of injury was considered drilling beyond the medial border of the femur. TAE subsequent to arteriography was an effective treatment because of low invasion and selective hemostasis. Detection of injury to deep femoral artery is important and operations must be performed carefully.
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Naohide Takeuchi, Satoshi Shidahara, Hideyuki Senba, Takahiro Kitamura ...
2006 Volume 55 Issue 4 Pages
425-431
Published: 2006
Released on J-STAGE: December 01, 2006
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The purpose of this study was to examine the cause of poor progress after operation with compression hip screw (CHS), and the permissible length of telescoping of a lag screw. We evaluated 139 femoral trochanteric fractures which were treated with CHS from February 2002 to May 2005. Seven patients had displacement of fracture fragments, and four had cutting out of lag screws. The causes of poor progress were incorrect reduction in one, fracture of the lag screw hole in five, and unknown in five. The mean length of the telescoping one week after the operation in these 11 poor patients was significantly larger (14.7mm vs 3.2mm: p<0.0001), and 78% of patients who had telescoping over 10mm in a week had displacement and poor progress. In conclusion, over 10mm telescoping in a week is considered to be excessive telescoping and careful observation is needed.
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Katsuhiko Murakami, Tetsurou Aitani, Masayoshi Nasu
2006 Volume 55 Issue 4 Pages
432-435
Published: 2006
Released on J-STAGE: December 01, 2006
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A cyst-subarachnoid shunt was recently developed by Morio et al. (Spine 26. 2001) and by Aoki et al. (Surgical Technique for Spine and Spinal Nerves 6. 2004) as a treatment of symptomatic sacral cysts. The hydrostatic and pulsatile forces of cerebrospinal fluid are attributed to the growth of the cyst and their becoming symptomatic. The Morios technique consisted of insertion of a shunt tube via the check-valve aperture. We performed Aokis method on a sacral cyst in a 40-year-old woman who had left-sided sciatica and low back pain. A cyst-subarachnoid shunt was set to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and the cyst. The shunt tube (1.4mm in outer diameter; Create Medic, Yokohama, Japan) was placed outside the aperture and fixed to the dura and the cyst wall with a 6-0 nylon suture. Immediately after surgery, the patient had no pain and experienced substantial resolution of her symptoms in the 8 months after surgery. The advantages of Aokis technique are the prevention of nerve root injury during insertion of the tube into the check-valve aperture and enabling the surgeon to use a thicker tube than that used in a Morios technique.
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Tomohiro Hirai, Junji Ide, Satoshi Maeda, Hiroshi Mizuta, Motohiro Tak ...
2006 Volume 55 Issue 4 Pages
436-439
Published: 2006
Released on J-STAGE: December 01, 2006
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We report a 48-year-old man with synovial osteochondromatosis of the right shoulder joint. Preoperative X-ray and MRI were useful for the diagnosis. Arthroscopic debridement of the synovium and removal of the loose bodies were performed. He could enjoy volleyball two months after the surgery. The functional and radiographic results were excellent at six months follow-up.
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Ryuji Tabe, Wataru Komaki, Ichimaro Komaki
2006 Volume 55 Issue 4 Pages
440-443
Published: 2006
Released on J-STAGE: December 01, 2006
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Forty cases of vertebral compression fractures were classified by degree of dementia and evaluated in two groups. The non-dementia group obtained higher scores of functional independence measure (FIM) than the dementia group. The non-dementia group therefore showed improved ADL at discharge than the dementia group. FIM at admission, the changes of FIM, and duration of hospitalization were not significantly different in both groups.
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Kazuki Kanazawa, Ichiro Yoshimura, Akinori Takeyama, Masatoshi Naito, ...
2006 Volume 55 Issue 4 Pages
444-447
Published: 2006
Released on J-STAGE: December 01, 2006
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We reviewed the clinical results of treatment of lower extremity amputation in patients with ischemic necrosis of foot from December 1996 to April 2004. Results were evaluated using preoperative complications, amputation level, functional prognosis, and vital prognosis. The mean age at the operation was 69.5 years (range: 48-82). Preoperative complications were hypertension of 11 limbs, diabetes mellitus of 10 limbs, chronic renal failure of 9 limbs, cerebrovascular disorder of 5 limbs, and heart failure of 5 limbs. Amputation levels were thigh of 7 limbs, lower extremity of 7 limbs, foot of 5 limbs, and digit of 1 limb. The rate of ambulation was digit (100%), foot (80%), lower extremity (33%), and thigh (0%) in the last follow up. The mortality was digit (0%), foot (20%), lower extremity (58%), and thigh (58%) in the last follow up. We conclude that most elderly patients undergoing leg cutting for the ischemic necrosis of foot have serious complications preoperative, and therefore attention is needed for the periphery method.
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Hideomi Kondo, Nario Ihara, Masahiro Suzuki, Kinya Hiroshige, Akinori ...
2006 Volume 55 Issue 4 Pages
448-450
Published: 2006
Released on J-STAGE: December 01, 2006
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Thirty-three cases of amputation in 24 hemodialysis patients were treated at our hospital between June 1992 and May 2005. They had undergone lower extremity amputation. We divided the patients into two groups: those who were healed and those who were not by the primary amputation. We compared them in terms of patients complications and clinical data, such as diabetes, ischemic heart disease, ejection fraction (EF), CRP, and albumin levels. In the unhealed group, the value of EF (49.2) was significantly lower than that in the healed group (63.9). EF signifies a cardiac function, but we consider that lower EF could be a prognostic factor for unsuccessful amputation. In the case of lower EF, the proximal safety level of amputation should be recommended in the patients with hemodialysis.
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Takuya Ikuta, Futoshi Kuga, Yo Mintaku, Yasunori Tome
2006 Volume 55 Issue 4 Pages
451-454
Published: 2006
Released on J-STAGE: December 01, 2006
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Three cases of femoral fracture and one case of femoral lengthening were treated surgically by mimimally invasive plate osteosynthesis. All cases except one achieved good bone union. One case of distal femoral fracture needed re-operation because of re-fracture. Mimimally invasive plate osteosynthesis is useful for femoral fractures for which intramedullary nailing is not suitable.
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Kiyofumi Mitsutake, Shinichi Harada, Hiroshi Baba, Takeshi Miyaji, Hid ...
2006 Volume 55 Issue 4 Pages
455-458
Published: 2006
Released on J-STAGE: December 01, 2006
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Epiphyseal separation of proximal tibial is rare. We report the experience of two cases treated for epiphyseal separation it the proximal tibial. Case 1 was a 15-year-old boy who suffered traumatism in a basketball match. Salter-Harris III type epiphyseal separation was recognized in his left proximal tibia. Closed reduction was difficult in this case, so we performed internal fixation by CCS in open reduction. He resumeds athletic activities four months after the operation. Case 2 was a 10-year-old boy who suffered from epiphyseal separation of the proximal tibia in a traffic accident. Salter-Harris II type epiphyseal separation was recognized in his left proximal tibia. We performed closed reduction, but added internal fixation in k-wire percutaneously because bone chip was unsteady. He resumed athletic activities three months after the operation without any problems.
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Takuya Ikuta, Futoshi Kuga, Yo Mintaku, Yasunori Tome
2006 Volume 55 Issue 4 Pages
459-462
Published: 2006
Released on J-STAGE: December 01, 2006
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Seventeen cases of lateral malleolar fracture were treated surgically using processed 1/3 tubular plate. Fifteen cases were classified into SER stage II (9 cases), SER stage IV (4 cases), SA stage II (one case), PA stage II (one case) according to Lauge-Hansen classification and two cases were accompanied with distal tibial fracture.
All cases achieved good bone union. No implant-related complications were observed.
Plate osteosynthesis using processed 1/3 tubular plate can provide stable fixation for small midway lateral malleolar fractures.
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Shinji Tanishima, Takahide Kikkawa, Masaaki Murata, Tetsuya Otsuka, Ry ...
2006 Volume 55 Issue 4 Pages
463-466
Published: 2006
Released on J-STAGE: December 01, 2006
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A 29-year-old male with dislocation of the IP joint of the great toe is reported. Closed reduction without anesthesia was not successful, due to interposition of a sesamoid and plantar plate. An open reduction was carried out by the dorsal approach under lumbar anesthesia. The sesamoid was found to be displaced over the proximal phalangeal head. The sesamoid was pushed plantarly while the distal phalanx was pulled distally and medial collateral ligament was excised for repositioning. After operation, we fixed IP joint with Kirshner wire. The post operative course was good, and there were no complications two month after the accident. Miki et al. classified irreducible dislocations of the IP joint of the great toe into two types. Our case is classified as type II. The proposed mechanism of our case is as follows: The great toe was forcefully hyperextended at the IP joint. And the plantar plate was displaced over the proximal phalangeal head with the displacement of the distal pharanx over the proximal pharanx. The sesamoid was trapped in the outlet composed of the distal pharanx, the proximal pharanx, and the collateral ligament.
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Masaki Yoh, Masayoshi Oga, Junichi Arima, Ko Ikuta, Soichiro Nakano, T ...
2006 Volume 55 Issue 4 Pages
467-470
Published: 2006
Released on J-STAGE: December 01, 2006
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We have performed the unilateral-approach bilateral decompression method, utilizing METRx-MD instrumentation, on 17 patients with lumbar spinal canal stenosis since 2002.
The mean JOA score of all patients improved from 16.4 points to 23.0 points. The mean operative time was 124.5 minutes and the mean blood loss was 38.5 ml per level.
Our method of bilateral decompression using METRx-MD instrumentation is minimally invasive and can be performed with reasonable operative times, minimal blood loss, and minimal pain in patients with acquired spinal stenosis.
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Koji Tozawa, Masami Tokunaga, Junichi Tokunaga, Takaaki Yoshimoto
2006 Volume 55 Issue 4 Pages
471-474
Published: 2006
Released on J-STAGE: December 01, 2006
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We investigated the usefulness of predrill procedure with Gamma nail using OneShot Guide. From April 2003, we performed the procedure on 22 proximal femoral fractures (two basicervical neck fractures, 17 trochanteric fractures, three subtrochanteric fractures) with Gamma nail according to OneShot Guide utilizing the predrill procedure (the predrill procedure group). To compare with this group, 104 cases (12 basicervical neck fractures, 84 trochanteric fractures, eight subtrochanteric fractures) for which we did not use the predrill procedure were assigned to the control group. The average time of the operation was 44.1 minutes (the predrill procedure group), and 52 minutes (the control group). The average time of irradiation was 360 seconds (the predrill procedure group), and 261 seconds (the control group). Twenty-one out of 22 cases (95.5%) achieved ideal insertion of the lag screw in the predrill procedure group, and 96 out of 104 cases (92.3%) in the control group. It is important to insert the lag screw at the appropriate position with Gamma nail, and this possible at a higher rate using both the predrill procedure and OneShot Guide than using only OneShot Guide.
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Seiji Kamei, Kazuhide Tomari, Ken Uchida
2006 Volume 55 Issue 4 Pages
475-481
Published: 2006
Released on J-STAGE: December 01, 2006
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An antibiotic-loaded articulating cement spacer was used in the 2-staged exchang of infected total knee arthroplasty. Handmade facsimile molds made of silicon were used to produce articulating femoral and tibial spacer components. A small cement stem should be designed and added to the spacer block to allow anchoring of the block to the tibia and prevent its migration. The antibiotic-loaded articulating cement spacer allows the patient certain functions such as motion and patient weight-bearing between stages, maintains the length of soft tissues, and reduces scarring within the periprosthetic tissues. The advantages of articulating spacers include continued mobility, ease of rehabilitation, and ease of reinplantation.
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Toshifumi Fujiwara, Shunsuke Hotokezaka, Sanshiro Inoue, Takao Mae, Sh ...
2006 Volume 55 Issue 4 Pages
482-484
Published: 2006
Released on J-STAGE: December 01, 2006
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We evaluated patients with trochanteric fracture of the femur who were treated surgically and rehabilitated along our critical pathway. A total of 21 patients (5 males and 16 females) who underwent operative treatment were included. All patients were programmed to start partial weight bearing one week after operation. At two weeks postoperatively, we studied the radiographs and walking ability, and determined the time of starting full weight bearing. Nineteen patients (90.5%) were treated along the critical pathway. Variance was minimal, and it was found that our critical pathway was useful for elderly patients with femoral trochanteric fracture.
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Kotaro Shiraishi, Kenji Miyahara, Yoshiaki Makino, Takafumi Torigoshi, ...
2006 Volume 55 Issue 4 Pages
485-491
Published: 2006
Released on J-STAGE: December 01, 2006
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We report three cases of chronic osteomyelitis of femor with Papineaus method, and excellent results were obtained. There were two males and one female. The age of the patients ranged from 60 to 70 years (average; 64.7 years). The wound period was 23 to 52 years (average; 38.0 years). The average duration between the first and second stages was 47.3 days, and that between the second and third was stages 28.0 days. The average admission period was 110.0 days. For one case of 20 cm osteomyelitis of the femor, the space could be filled with own bone graft from both sides of the anterior and posterior iliac bones. During the third stage, we could close the skin of all cases without skin graft. There are many methods for treating chronic osteomyelitis. We treated some cases with bone transport using Illizal of external fixator. Although we should consider the character, age, and wound location, Papineaus method is very useful for chronic osteomyelitis of the femor.
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Akira Maeyama, Kazuhiko Saeki, Zhang Zingfan, Takeshi Kanamiya, Masato ...
2006 Volume 55 Issue 4 Pages
492-495
Published: 2006
Released on J-STAGE: December 01, 2006
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Bilateral rupture of the patella tendon is a rare lesion, usually associated with systemic lupus erythematosus, rheumatoid arthritis, chronic renal failure, and others. It is extremely rare in healthy individuals. A case of a 60-year-old male with no known history of systemic disease or knee problem is presented. Physical examination, X-ray and MRI demonstrated bilateral rupture of the patella tendon. The tendon was repaired by McLaughlins method. The evolution was satisfactory with both knees recovering full range of motion in a six-month period. The purpose of this presentation is to delineate the details of this unusual case and to relate it to previously reported cases.
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Hirokazu Saiwai, Isao Saikawa, Tsutomu Irie, Tetsuya Tanaka, Ken-ichi ...
2006 Volume 55 Issue 4 Pages
496-499
Published: 2006
Released on J-STAGE: December 01, 2006
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Adjacent segment degeneration is known to occur after spinal fusion operation. The purpose of this study is to evaluate the effects on adjacent segment after lumbar or lumbosacral fusion. We reviewed 66 patients who underwent lumbar or lumbosacral spinal fusion in 1999. We classified these patients into two groups according to the number of fusion segments: 29 patients in the monosegmental fusion group and 37 patients in the multisegmental (≥2) fusion group. We compared the two groups by analyzing the clinical symptoms and measurements of radiographs a few years after operation. The results indicated that adjacent segment instability tends to occur more often in the multisegmental fusion group.
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Fumihiro Miyaguchi, Takuya Yamamoto, Kyoji Hayashi, Shunji Matsunaga, ...
2006 Volume 55 Issue 4 Pages
500-502
Published: 2006
Released on J-STAGE: December 01, 2006
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We investigated 13 patients (5 males and 8 females) who underwent cervical laminoplasty and thoracic laminectomy for OPLL of the cervicothoracic spine. The average age at the time surgery was 56 years. Clinical outcome was evaluated with JOA score, kyphotic angle of thoracic spine with Cobb angle, and rate of occupied area in the spinal cord by OPLL with CT. The average recovery rate was 42.1%. The kyphotic angle of the thoracic spine and rate of occupied area in the spinal cord by OPLL were not related with clinical outcome.
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Hiroyuki Kitahara, Yoshihiro Yabe, Koji Yamaguchi, Shinji Adachi, Keis ...
2006 Volume 55 Issue 4 Pages
503-507
Published: 2006
Released on J-STAGE: December 01, 2006
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Indication of TCVO is moderate and severe which knee osteoarthritis disable contact between the medial and lateral condyl of the femoral and tibia at the same time. Good operation results have been introduced to the past by various authors. We have been performing this operation at our institution and have operated on 38 cases in the past six years. The results have been very good in most cases. However we experienced the cases of very bad outcome, which is thought to have been due to incomplete osteotomy and inappropriate technique in opening the osteotomy line.
TCVO is an excellent method for osteoarthritis accompanied with unstable knee joint, but changing the joint surface compared with HTO. This method must therefore be performed with joint conformity for good results.
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Shuya Ide, Jun Ito, Takao Hotokebuchi
2006 Volume 55 Issue 4 Pages
508-511
Published: 2006
Released on J-STAGE: December 01, 2006
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There are several quadriceps approach methods in total knee arthroplasty (TKA). Perioperative results of 22 cases of vastus medialis oblique (VMO) snip approach (mini-mid vastus) and 23 cases of quad sparing approach were compared. The operation time of the quad sparing approach was significantly longer than the VMO snip approach. There were no significant differences in postoperative bleeding, onset time of straight leg rising, and range of motion. Although for quadriceps invasion, the quad sparing approach was less invasive than the VMO snip approach, the former technique was more difficult than the latter. If there is no significant difference in perioperative results, we should perform the easy-to-use quadriceps approach to avoid complications.
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Junko Tanaka, Kei Yamada, Kenji Yoshida, Hisashi Yamashita, Toshiharu ...
2006 Volume 55 Issue 4 Pages
512-515
Published: 2006
Released on J-STAGE: December 01, 2006
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It is said that early diagnosis and treatment are important in spinal epidural abscess because the delay of the treatment can lead to the neulogical deficit and sepsis.
These days, because of the increase in the number of the compromised host, we frequently recognize pyogenic spondylitis with epidural abscess. Operation under general anesthesia for the compromised host involves severe risks. We performed percutaneous suction aspiration and drainage (PSAD) on four patients (three males and one female) suffering from pyogenic lumbar spondylitis with epidural abscess. One patient had severe liver cirrhosis, one had diabetes and another had colon cancer. All patients showed epidural abscess associated lumbar pyogenic spondylitis in MRI of the lumbar spine and they did not sustain neurological deficits. Treatment of four cases by PSAP decreased the sizes of these epidural abscess in all patients. One patient who sustained pyogenic spondylitis caused by MRSA had recurred four months later. She was treated conservatively by antibiotics and inflammation improved. This technique was useful for relieving the epidural abscess just by drainage of the original disc lesion and assisting in the eradication of the infection.
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