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Toshifumi Fujiwara, Seiya Jingushi, Toshihide Shuto, Yasuharu Nakashim ...
2007 Volume 56 Issue 1 Pages
1-4
Published: 2007
Released on J-STAGE: June 01, 2007
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Pelvic osteotomy for osteoarthritis hips secondary to acetabular dysplasia is usually indicated for young patients under 50 years of age. In our department, transposition osteotomy of the acetabulum (TOA), a kind of pelvic osteotomy, is carried out even for patients over 50 years. In this study, the clinical outcomes of patients over 60 years were retrospectively examined in order to discuss the indication of TOA according to age. Between 1994 and 2004, TOA was performed on six hips of patients over 60 years. All patients were female, whose mean age was 62 years. The mean duration of follow-up was 61 months. All hips showed excellent clinical outcome except for one in the advanced stage with relatively short rehabilitation schedule. Our results suggest that TOA could be indicated for patients over 60 years if the osteoarthritis stage was early or preosteoarthritis, and if rehabilitation would take time.
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Yasutaka Tashiro, Seiya Jingushi, Toshihide Shuto, Yasuharu Nakashima, ...
2007 Volume 56 Issue 1 Pages
5-8
Published: 2007
Released on J-STAGE: June 01, 2007
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Eleven patients, who underwent bilateral osteotomy for idiopathic osteonecrosis of the femoral head, were examined retrospectively. Due to previous osteotomy, the rehabilitation period of the next one may take longer, or the clinical outcome may be worse. The clinical outcome and treatment period were compared with those in the matched control cases that underwent osteotomy for unilateral symptomatic osteonecrosis. The JOA score at the last follow-up was similar, and the ratio of postoperative complications including collapse progression and osteoarthritis was similarly at low levels in both groups. These indicate that similar clinical outcome and treatment period can be expected in cases undergoing bilateral osteotomy compared to those undergoing unilateral osteotomy.
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Masahiro Nakamura, Shinji Yoshino, Arisa Tsuru, Masaru Higo, Masao Yam ...
2007 Volume 56 Issue 1 Pages
9-11
Published: 2007
Released on J-STAGE: June 01, 2007
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We recently encountered a rare case of osteochondritis dissecans (OCD) secondary to Perthes' disease. The patient was a 19-year-old male whose chief complaint was pain of the right hip joint accompanied by locking. He had a history of Perthes' disease (Catterall type 3, Herring class C). He underwent regular checkups after completion of treatment for Perthes' disease at school age. At age 12, abnormal shadow suggesting OCD was revealed by X-ray. At age about 15, he started to experience hip joint pain. Arthroscopy, carried out at age 16, disclosed degenerated cartilage everted like a flap behind the load-bearing area of the femoral head. When arthroscopy was performed again one year later because of relapse of hip joint pain, extensive cartilaginous degeneration and detachment were noted in the load-bearing area of the femoral head. The course of X-ray findings in this case suggests that healing of Perthes' disease was interrupted and the resultant nonunion of the newly formed bone led to the onset of OCD. It is also suggested that articular movements caused shear stress in the OCD-affected area, causing gradual separation and detachment from the base, eventually leading to manifestation of clinical symptoms.
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To Predict Prognosis by MRI Imaging
Hisato Tanaka, Mitsunori Komine, Hiroaki Kurokawa
2007 Volume 56 Issue 1 Pages
12-21
Published: 2007
Released on J-STAGE: June 01, 2007
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Subchondral insufficiency fracture (SIF) of the femoral head seems to be an important preliminary event in the development of rapidly destructive arthrosis (RDA) of the hip. However, in some cases, it can be cured conservatively only by rest. Although not all SIFs do not destroy the hip progressively, it is important to predict prognosis by early diagnosis. We proposed magnetic resonance imaging (MRI) of SIF or RDA for prognostic judgment. The subject was on 80-year-old woman suffering fall injury of AO31-A1. NTX114.3. X-ray indicated flattened femoral head at injury time. MRI examination showed a small low signal band at the subchondral area, and STIR image showed a diffused marrow edema in the femoral head and acetabulum. No remarkable abnormal changes were found in the T2 emphasis image. Partial load started after osteosynthesis (CHS) in four weeks, resulting in complete load in ten weeks. No collapse of the femoral head was found later. The T1 emphasis image and STIR image in MRI were effective for diagnosis reflecting bone edema but the only showed slight emphasis. These results suggest that T2 emphasis images are suitable prediction of later bone collapse.
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Akiomi Shimogai, Takako Nishihata, Toru Okano, Hiroshi Hagino, Ryota T ...
2007 Volume 56 Issue 1 Pages
22-25
Published: 2007
Released on J-STAGE: June 01, 2007
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We reported a case of psoriatic arthritis with septic arthritis of the hip. A 55-year-old female was treated for psoriatic arthritis for a long period of time. She was admitted to our hospital complaining of pain on her left hip. X-ray showed fracture of the acetabulum, and abscess of the left iliac fossa was seen in CT and MR-imaging. Although the abscess was treated by CT-guided percutaneous drainage, symptoms continued. Arthrogram of the left hip showed connection between hip joint and the abscess. Then we performed curettage and drainage of the abscess; however, methicillin-resistant Staphylococcus aureus was culture-proved from a sample of the abscess, and the infection was not controlled. Finally, we performed a resection arthroplasty of the femoral head using antibiotic-loaded cement, and the symptom and infection improved thereafter.
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Riki Ueki, Masamori Shigematsu, Tsutomu Motooka, Shuya Ide, Masaaki Ma ...
2007 Volume 56 Issue 1 Pages
26-29
Published: 2007
Released on J-STAGE: June 01, 2007
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In 34 patients (mean age 61.1 years) with hip disease who had undergone total hip arthroplasty (THA) from March to December 2003, gait analysis was performed preoperatively and at two, six, and12 months postoperatively. Sixteen out of 34 patients had external rotational contracture, four patients had internal rotational contracture, and 14 patients had slight or no contracture on the hip. All patients were tested during "free" walking along a five-meter walkway installed with a ground reaction force plate (gait scan 8000; Nitta, Inc.). The assessed parameter was foot progression angle (FPA).
The preoperative mean FPA of the external rotational contracture groups was externally rotated 19.8°. It improved to mean 8° within two months postoperatively. The preoperative mean FPA of the internal rotational contracture groups was externally rotated 17.8°. It improved to mean 6.2° within two months postoperatively. The preoperative mean FPA of the slight or no contracture groups was externally rotated 8.9°. It was gradually reduced to mean 4.6° within one year.
Our results indicated that FPA in all groups improved significantly after THA.
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Eiji Azuma, Michio Shinohara
2007 Volume 56 Issue 1 Pages
30-36
Published: 2007
Released on J-STAGE: June 01, 2007
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A 53-year-old woman experienced acute severe pain of the neck and left upper extremity, weakness in the left upper extremity, and numbness below left shoulder on December 2005. She had not fallen to get injured. She was immediately brought to the emergency ward of a general hospital. Her symptoms had disappeared on arrival at the hospital, but relapsed after coming home. The next day, she consulted another clinic. Because magnetic resonance imaging showed mass lesion in the postero-lateral part of the cervical epidural space, she was introduced to this hospital. Hematoma disappeared in about two weeks and symptoms of the left upper extremity improved. But she started to experience sensory disorder of the right upper extremity. During progress, there were no lower extremity symptoms. With this case, specific progress was followed, and a possibility of the involvement of cold exposure was considered.
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Yasuhiro Ochi, Kenji Kido, Hirohumi Inoue, Yoshikazu Azuma, Kouzou Sun ...
2007 Volume 56 Issue 1 Pages
37-41
Published: 2007
Released on J-STAGE: June 01, 2007
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A case of cervical myelopathy caused by osteochondroma in the inner surface of the lamina of the first and second cervical spine was reported. A 45-year-old female visited us complaing of numbness of the bilateral hand. Radiograph, CT, and MRI demonstrated a mass in the cervical canal. We resected the bone tumor by posterior approach. Histological examination showed osteochondroma.
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Koichiro Toyoda, Hiroyoshi Ogasa, Eiichi Shiigi, Tsukasa Kanchiku, Tet ...
2007 Volume 56 Issue 1 Pages
42-44
Published: 2007
Released on J-STAGE: June 01, 2007
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We studied ten cases of non-union of osteoporotic vertebral fracture.
The vertebral body vacuum phenomenon in osteoporotic fractures was seen in the transitional area between the thoracic and lumbar spine, appearing at a mean of three months after the onset of vertebral body fracture. Intravertbral cleft of the antero-posterior and lateral X-ray with supine position was useful for early diagnosis of non-union. Compression rate was 52% at first visit, 32% at diagnosis of non-union, 26% at final follow up. Although union was achieved in 55% of all cases, compelete union ratio was 18% Average VAS was 8.6 at first visit, and 2.6 at final. Conservative therapy, including restriction of the extension of the spinal column and prohibition of the supine position while in bed was useful. We should change the treatment of non-union cases at six months after conservative therapy.
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Ichiro Kawamura, Eiji Taketomi, Nobuhiko Sunahara, Mitsuaki Katahira, ...
2007 Volume 56 Issue 1 Pages
45-48
Published: 2007
Released on J-STAGE: June 01, 2007
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We report three cases of ankylosing spinal hyperostosis (ASH) surgically treated for thoracic vertebral fracture. All were injured by minor trauma and had been treated conservatively in other institutes but treatment failed. Finally, they visited our hospital and were treated surgically. The results of surgical treatment for ASH were successful by posterior fusion with instrumentation. We recommend primary surgical treatment for vertebral fracture with ASH to avoid complications of nonunion, deformity, and neurologic injury.
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Shoichi Kuba, Tsuyosi Uchida, Eiichiro Aso, Tadashi Tomonaga
2007 Volume 56 Issue 1 Pages
49-52
Published: 2007
Released on J-STAGE: June 01, 2007
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Reports of intradural lumbar disc herniation (ILDH) are unusual. We experienced a case at the level of L2/3. A 66-year-old male complained of low back pain and left lower limb pain. MR images and myelo-CT scans showed a left sided mass at the L2/3 level. In operation, the mass was found intradurally, and removed by piecemeal. It was reviewed pathologically, and found to be disc tissue.
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Yuichi Maeda, Haruhiko Chuma, Ichiro Seike, Ken Matsumura
2007 Volume 56 Issue 1 Pages
53-55
Published: 2007
Released on J-STAGE: June 01, 2007
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Patients with sciatica caused by lumbar disc herniation were placed on codeine phosphate therapy for nonsurgical management. As a result, numbness of the lower limb persisted in five out of the six patients and pain of the lower limb in the remaining. But they all came back to do their usual work.
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Value of Early MRI in Diagnosis of Postoperative Spondylitis
Nokitaka Setsu, Taichi Saito, Isao Saikawa, Tsutomu Irie, Tetsuya Tana ...
2007 Volume 56 Issue 1 Pages
56-59
Published: 2007
Released on J-STAGE: June 01, 2007
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We evaluated the role of magnetic resonance imaging (MRI) in the diagnosis of postoperative spondylitis. MRI is widely used in the diagnosis of infectious diseases of the spine, but signal intensity changes in the vertebral body or endplates are not specific for spondylitis. Eighteen consecutive patients who underwent posterior lumbar interbody fusion (PLIF) were evaluated with MRI 2-3 weeks after operation. Signal intensity changes were frequently observed in asymptomatic patients. In conclusion, MRI is not sufficient in itself for early diagnosis of spondylitis.
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Masaya Mizutamari, Akira Sei, Toshitake Yakushiji, Toru Fujimoto, Taku ...
2007 Volume 56 Issue 1 Pages
60-64
Published: 2007
Released on J-STAGE: June 01, 2007
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We report three patients diagnosed with schwannomatosis with intraspinal lesion. Case 1: A 44- year-old male presented right plexus schwannoma, and underwent operation. During observation, MRI showed an abnormal lesion at C7/ Th1. The tumor was extirpated. Pathological diagnosis was schwannoma. Case 2: A 34-year-old male complained of low back pain and right thigh numbness. Right thigh schwannoma had been resected at age 33. MRI showed an abnormal lesion at Th12/L1. The tumor was extirpated. Pathological diagnosis was schwannoma. Case 3: A 36- year-old female complained of back pain and right buttock pain. Right calf and back schwannoma had been resected between age 19 and 32. MRI showed four abnormal lesions from L1 to S1. The tumors were extirpated. One year after the operation, the remaining tumor increased and was extirpated. Pathological diagnosis was schwannoma.
All three cases showed no auditory disorder, no blurred vision, no Cafe au Lait spots and no family history.
Schwannomatosis is rare. If multiple lesions of neurioma are found, general investigation is needed suspecting potential schwannomatosis, NF 1 and NF 2. In case of rapidly increasing lesions, a follow-up MRI is needed. We experienced a case whose tumor had to be extirpated in the first operation.
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Masahiro Kubo, Osamu Kawano, Keiichiro Shiba, Masazumi Tsuneyoshi, Hir ...
2007 Volume 56 Issue 1 Pages
65-68
Published: 2007
Released on J-STAGE: June 01, 2007
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We report a case of osteoid osteoma of the pedicle of the seventh cervical spine. A 14-year-old boy was admitted for neck pain. Diagnosis by radiographs was difficult, but CT showed Nidus in the pedicle of the seventh cervical spine. We performed tumor extirpation and posterior spinal fusion of C6/7. Neck pain improved after surgery.
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Hironobu Koseki, Koumei Baba
2007 Volume 56 Issue 1 Pages
69-72
Published: 2007
Released on J-STAGE: June 01, 2007
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Ion implantation shows promise as a durable, and wear- and corrosion-resistant treatment for biomedical implants. We carried out carbon ion implantation and diamond-like carbon (DLC) film deposition on cobalt-chrome alloy (Co-Cr-Mo) substrate by plasma source ion implantation (PSII), which can be used to treat three-dimensional substrates. The aim of this study was to analyze and characterize three types of surface, such as untreated substrate, carbon ion implantation, and DLC film deposition, with Auger electron spectroscopy, micro-Raman spectroscopy, Nano-Indentation, and laser and scanning electron microscopy. The results showed that implanted carbon penetrated into the substrate resulting in a complete interfacial mixing layer. The surface modification by carbon ion implantation and DLC film deposition hardened the surface of the Co-Cr-Mo alloy but microscopy revealed irregularity of the surface of DLC.
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Shunji Matsunaga, Yoshimi Nagatomo, Fumihiro Miyaguchi, Ryodai Kawabat ...
2007 Volume 56 Issue 1 Pages
73-75
Published: 2007
Released on J-STAGE: June 01, 2007
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Psychological characteristics of super healthy elders were examined with the Maudsley Personality Inventory (MPI). Two groups of subjects over 80 years of age were selected: 50 super healthy elders who still lead independent, healthy lives without receiving any aid and 50 patients with cervical symptom. The two groups were compared according to MPI. Twenty-three (46%) subjects of the cervical symptom group were rated as abnormal pattern (introverted type, 3; emotional instability type, 8; neurosis type, 9; adaptive type, 3). Twenty-four (48%) of the super healthy subjects were also rated as abnormal, of which 21 (88%) were rated as adaptive type. Super healthy elders with ideal personality are able to get rid of external stress, and this may be a key to maintaining healthy lives.
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Makoto Morita, Junji Ide, Akinari Tokiyoshi, Takahisa Sato, Hiroshi Mi ...
2007 Volume 56 Issue 1 Pages
76-78
Published: 2007
Released on J-STAGE: June 01, 2007
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In the case of massive rotator cuff tear, a type of side-to-side suture technique can be used arthroscopically with a contracted immobile rotator cuff and a deficient rotator interval. This technique allows for the partial closure of the rotator cuff defect along with the proximal advancement of the posterior cuff by securing the posterior leaf of the cuff tendon to the tendon of the long head of the biceps brachii. The purpose of this study was to evaluate the results of patients who underwent this procedure. There were five males and one female, whose mean age was 60 years (range, 55-69 years). Four patients had supraspinatus and infraspinatus tears and two had supraspinatus, infraspinatus, and subscapularis tears. The mean follow-up period was 28.3 months (range, 6-38 months). After the surgery, the mean JOA score significantly improved from 56.0 points (range, 47-68 points) to 88.5 points (range, 85-92 points), and the mean range of elevation significantly improved from 73 degrees (range, 30-120 degrees) to 156 degrees (range, 120-170 degrees). There were no complications. Arthroscopic rotator cuff repair augmented with the long head of the biceps tendon is a safe and reliable procedure in patients with a contracted immobile rotator cuff and deficient rotator interval.
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Shizuo Maeda, Haruhito Uezono, Koichi Fukushima, Toshie Haruhana, Kenj ...
2007 Volume 56 Issue 1 Pages
79-81
Published: 2007
Released on J-STAGE: June 01, 2007
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The purpose of this study was to compare the clinical outcomes of treatment for rotator cuff tears between open procedure and ARCR, and between postoperative zero-position and abduction fixation.
From 2003 to October 2005, 80 cases of rotator cuff tears (mean age: 63 years) were treated by McLaughlin procedure (46 cases) and ARCR (34 cases). Post-operative rehabilitation was started from zero-position (42 cases) and abduction fixation (38 cases). The average follow-up period was 7.3 months. The average JOA score improved from 47.8 points to 88.8 points. The average JOA scores of McLaughlin procedures, ARCA, zero-position, and abduction fixation were 88.1 points, 89.8 points, 90 points, and 87.6 points. There were no statistical differences between the two operation groups and between two rehabilitation groups.
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Takahisa Sato, Junji Ide, Akinari Tokiyoshi, Makoto Morita, Hiroshi Mi ...
2007 Volume 56 Issue 1 Pages
82-84
Published: 2007
Released on J-STAGE: June 01, 2007
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We performed arthroscopic treatment on patients with shoulder pain and dysfunction after at least three months of conservative treatment without progress. We released the long head of the biceps tendon with intraarticular cautery in older patients with significant partial tear (>50%). We evaluated the efficacy of arthroscopic tenotomy in seven patients with recalcitrant tendonitis of the long head of biceps brachii. Patients with rotator cuff repair and/or subacromial decompression were excluded from this study. There were two males and five females. Their mean age was 69 years (range, 51-78 years). Mean follow-up period was 25.0 months (range, 13-33 months). After surgery, the mean JOA score significantly improved from 52.0 points (range, 37-67 points) to 90.0 points (range, 86-91 points). Popeye muscle deformity was noted in only one patient; no muscle weakness of elbow flexion was found. Arthroscopic tenotomy is a safe and reliable procedure in patients with recalcitrant tendonitis or significant partial tear of the long head of biceps brachii.
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Hitoshi Shirachi, Yozo Shibata, Takafumi Kumano, Tsuyoshi Shinoda, Mas ...
2007 Volume 56 Issue 1 Pages
85-91
Published: 2007
Released on J-STAGE: June 01, 2007
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We performed arthroscopic Bankart repair on two re-dislocated adults who underwent the Oudard procedure.
Case 1: 34 year old man. His right shoulder re-dislocated 16 years after the Oudard procedure as soon as he resumed judo. Because he complained of severe apprehension on his right shoulder, we performed arthroscopic Bankart procedure.
Case 2: 21 year old man. His right shoulder re-dislocated while throwing a large garbage bag one year after the Oudard procedure, although he took care not to abduct and externally rotate his shoulder for one year. We performed arthroscopic Bankart repair.
Case 2 revealed a distinct deformity of the coracoid process due to a large iliac bone graft. Both cases successfully achieved Bankart repair.
Both cases did not re-dislocate or complain of disability after the arthroscopic Bankart procedure (36 months and 18 months).
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Hidetoshi Onoue, Kazuo Kimura, Kazutaka Matsunaga, Tetsu Yamaguchi, No ...
2007 Volume 56 Issue 1 Pages
92-95
Published: 2007
Released on J-STAGE: June 01, 2007
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The clinical outcome of surgical treatment for humeral shaft nonunions was evaluated. A total of four cases were treated by plate fixation with iliac bone graft. The range of age at the time of surgery was between 27 and 60 years. One male and three female cases were investigated in the study. Two fractures were previously treated conservatively, and the remaining two fractures were treated by Ender nails. The time from fracture to plating with bone graft ranged from three to 63 months. All of the cases obtained union within six months after surgery. Strong compression fixation and early motion exercises after surgery without damaging the shoulder and elbow joint are the greatest advantages of utilizing the plate for the treatment of humeral shaft nonunions.
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Shinichi Nakahara, Masao Eto, Keizo Furukawa, Hideo Baba, Hiroyuki Shi ...
2007 Volume 56 Issue 1 Pages
96-99
Published: 2007
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We report three cases of MRSA septic arthritis of the shoulder.
Case 1 was a 61-year-old man who underwent osteosynthesis for his shoulder. Due to resulting pain and malunion, he was admitted to our hospital. We performed curettage several times on the MRSA developing as a result of joint aspiration. Osteomyelitis and dead cavity were found, for which we performed the latissimus dorsi flap.
Case 2 was 68-year-old woman with dislocation of the shoulder which occurred after rotator cuff repair. We performed open reduction, but MRSA infection resulted. Despite repeated debridement and continuous irrigation, no clinical improvement was obtained. We removed the head of humerus and filled up the dead cavity with musculus pectoralis major.
Case 3 was a 57-year-old man suffering pain after steroid injection of the shoulder. MRSA due to joint aspiration was found, and we performed arthroscopic debridement and continuous irrigation.
It is useful to treat septic arthritis of the shoulder by arthroscopic debridement and continuous irrigation. In the case of osteomyelitis and dead cavity, it is necessary to perform musculocutaneous flap.
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Shizuo Maeda, Harohito Uezono, Koichi Fukushima, Etsuko Nakamura, Mido ...
2007 Volume 56 Issue 1 Pages
100-103
Published: 2007
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From April 2003 to July 2005, 810 orthopaedic operations were performed at our hospital, of which the overall incidence of surgical site infections (SSIS) was only 0.37% (3 cases). A low rate may depend upon the following prophylaxis: 1) 1 or 2-day perioperative antibiotic, of which 562 cases were 1 day and 120 cases were 2 days; 2) no shaving; 3) new ampule, which must be disinfected before use; 4) washing site of operation just before surgery; 5) not disinfecting the wound after operation; 6) 3-day administration of Cephemes and Aminoglycosides for open fractures; 7) use of an iodophor-incorporated antimicrobial plastic adhesive wound drape; 8) use of double latex gloves during operation; 9) use of cleaning forceps and needle; and 10) use of steri-shield filtered exhaust helmets for arthroplasty.
Our surgical prophylaxis is effective and perioperative antibiotic was only required for one day.
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Katsutoshi Hara, Nobuhiro Kaku, Hiroshi Tsumura
2007 Volume 56 Issue 1 Pages
104-107
Published: 2007
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It is important to prevent surgical site infection in patients using antibiotics, which however may cause certain postoperative problems themselves. We report 14 patients who developed pseudomenbranous colitis after orthopedic surgery from 1996 to 2005. They consisted of five men and nine women, with a mean age of 64.4 years. One patient was treated with cessation of antibiotics alone, and other patients were placed in oral vancomycin in addition to it. A mean duration of 4.9 days was spent from initiation of antibiotics to onset of symptoms, and a mean duration of 3.4 days was required between onset of symptoms and diagnosis of pseudomembranous colitis. Diarrhea improved in five patients within one week, however, five patients required treatment for a period of one month or more. Although one patient had to undergo abdominal surgery for treatment but, she died one month after orthopedic surgery. As perioperative antibiotic therapy may sometimes cause pseudomembranous colitis, general conditions and symptoms of colitis must be carefully monitored, and efforts made for immediate and appropriate diagnosis and treatment.
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Joji Noguchi, Gishichirou Shimoyama, Toshiro Shinozaki
2007 Volume 56 Issue 1 Pages
108-111
Published: 2007
Released on J-STAGE: June 01, 2007
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Eighteen dorsally displaced fractures of the distal radius were treated by open reduction and internel fixation using the Dorsal Radius Volar (DRV) plating system. The average age at the time of injury was 69 years and the average follow-up period was 24 months. In the majority of cases, the final radiographic and clinical results were satisfactory. According to the Saito Point System, 13 cases had excellent results, and five had good results. The DRV plating system can be an effective technique for the treatment of the fracture of the distal radius.
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Kazutaka Matsunaga, Hidetoshi Onoue, Kazuo Kimura, Tetsu Yamaguchi, No ...
2007 Volume 56 Issue 1 Pages
112-115
Published: 2007
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We report two cases of isolated volar dislocation of the distal radioulnar joint. Case1 was a 44-year-old male who injured his wrist when he tried to support a man who fell on his own left hand. He felt pain immediately and was unable to extend the forearm. X-ray with CT revealed volar dislocation of the distal radioulnar joint. Fifteen days after the injury, closed reduction was performed under general anesthesia. After reduction, the arm was immobilized in pronation below the elbow cast for a period of six weeks. Case2 was a 29-year-old male who sprained his right wrist while refereeing a football game. He felt pain immediately and was unable to extend the forearm. X-ray with CT revealed volar dislocation of the distal radioulnar joint. Three days after the injury, closed reduction was performed under general anesthesia. After reduction, the arm was immobilized in pronation below the elbow cast for a period of four weeks. During the last follow-up, neither cases complained of pain, nor limitation of the wrist and forearm. It is important to diagnose the isolated volar dislocation of the distal radioulnar joint early to enable early closed reduction and cast.
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Minoru Kashihara
2007 Volume 56 Issue 1 Pages
116-118
Published: 2007
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Isolated gouty tophus in the hand is rare. We report a case of gouty tophus involving only the DIP joint of the index finger. An 85-year-old woman experienced pain and localized swelling of the DIP joint of the index finger. Radiograph revealed punched out lesion involving the DIP joint. Laboratory studies revealed BUN of 29 mg/dl, creatinine of 1.37 mg/dl and uric acid of 11.0 mg/dl. She had a long history of hypertension and angina pectoris, and had been treated with diuretic for 11 years. Conservative treatment with oral anti-inflammatories for three weeks prior to operation did not provide any improvement. At operation, chalk-like matter and osteolytic articular surface were curetted out and the DIP joint was fixed with Kirschner wires. Polarized light microscopy of the chalk-like matter showed variable-sized needle-shaped crystals. After the operation, oral administration of allopurinol reduced blood uric acid within normal limits. At the postoperative follow-up at eight months, the patient was asymptomatic. Renal dysfunction and 11-year oral diuretic there by is considered to be the main etiology of the gouty tophus of the finger.
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Yoshiya Arishima, Kohei Yamasaki, Masahiro Yokouchi, Takao Setoguchi, ...
2007 Volume 56 Issue 1 Pages
119-122
Published: 2007
Released on J-STAGE: June 01, 2007
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With the current spread of minimum invasive surgery, successful results have been reported for endoscopic surgery of the hand such as triangular fibrocartilage complex, carpal tunnel syndrome, etc. This study discusses four cases of enchondroma in the hand, which was treated with endoscopic curettage and α-TCP grafting. Regarding the short term results (10 months after surgery on average), no recurrence of tumor was observed and full range of motion of the digit was gained within one month after surgery in all patients. In one patient, grafted α-TCP leaked out extraskeletally, but it was absorbed within three months and no clinical defecits such as pain and loss of range of motion were seen. This procedure has several advantages such as minimum skin incision, early exercise of range of rehabilitation and expanded visual field with endoscope. In our cases, good results were obtained with this procedure.
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Taiichiro Yanagizono, Katsuhiko Fukushima, Daisuke Yoshikawa, Kazumasa ...
2007 Volume 56 Issue 1 Pages
123-127
Published: 2007
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Equinus gait is the most common problem in patients with cerebral palsy. We evaluated five patients with spastic hemiplegia secondary to cerebral palsy by using the gait analysis system. Comparisons between our normative data indicated equinus during swing phase in four cases and diminished first rocker in four cases. According to Winter's Classification, one patient was normal, three were in group 1, and one was in group 3. Kinetic analysis showed increased ankle plantar flexion moment during mid stance and decresed ankle plantar flexion moment during terminal stance in two cases. All caces indicated normal timing of peak ankle power.
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Daisuke Yoshikawa, Katsuhiko Fukushima, Taiichiro Yanagizono, Kazumasa ...
2007 Volume 56 Issue 1 Pages
128-131
Published: 2007
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Gait kinematics of children has been reported to be similar to that of adults since three years ago, while kinetic patterns have been reported for seven years. In the aim to establish normal data using our three-dimensional gait analysis system, joint angles, moments, and strength obtained in six children (mean age: 6 years 3 months) were compared to data from six adults (mean age: 23 years 10 months). The pediatric kinematic data resembled those of normal adults. However children demonstrated a diminished peak ankle plantar flexion moment during late stance. It is important to understand gait maturation in the clinical decision making process for children with pathological gait.
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Takahiro Ida, Ichiro Yoshimura, Kazuki Kanazawa, Akinori Takeyama, Mas ...
2007 Volume 56 Issue 1 Pages
132-136
Published: 2007
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We performed osteochondral grafting on a patient diagnosed with late stage Freiberg's disease. The patient was a 30-year-old woman who experienced second MTP joint pain in the left side about 15 years ago. When she visited our hospital, second MTP joint pain was excruciating. X-ray films showed stage 4 lesion according to Gauthier's classification. CT scan showed free bodies and osteochondral lesion from metatarsal head dorsal to plantar. We performed osteochondral grafting after ablation of free bodies and osteophyties. Good results were obtained eight months later. Osteochondral grafting seems useful in salvage treatment for late stage Freiberg's disease.
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Takuya Ikuta, Futoshi Kuga, Mintaku Yo, Yasunori Toume
2007 Volume 56 Issue 1 Pages
137-140
Published: 2007
Released on J-STAGE: June 01, 2007
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Six cases of lateral malleolar fracture were treated with tension band wiring using cannulated screws. Six were classified into SER stageII (4 cases) and SA stageII (2 cases) according to the Lauge-Hansen classification.
All cases achieved good bone union. No implant-related complications were observed.
Tension band wiring using cannulated screws can provide stable fixation for small lateral malleolar fractures.
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Kaori Mishima, Satoshi Ikeda, Shinobu Arita, Shinya Tanaka
2007 Volume 56 Issue 1 Pages
141-144
Published: 2007
Released on J-STAGE: June 01, 2007
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We present a case of lateral process fracture of the talus with lateral malleolus avulsion fracture of the ankle. A 67-year-old woman lost her gait and was diagnosed with lateral malleolus avulsion fracture of the ankle at the first hospital she visited. She was then admitted to our hospital, where we diagnosed her condition as lateral process fracture of the talus with lateral malleolus avulsion fracture of the ankle by CT. Lateral process fracture of the talus was displaced. We performed open reduction and internal fixation on each fracture by cancellous screws. She has had no complication in daily living after the operation. Lateral process fracture of the talus is thought to be relatively uncommon, sometimes over looked in the first examination. In particular, lateral process fracture of the talus with lateral malleolus fracture is rare. In this case, CT was useful for diagnosis.
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Kazuki Kanazawa, Ichiro Yoshimura, Takahiro Ida, Akinori Takeyama, Mas ...
2007 Volume 56 Issue 1 Pages
145-148
Published: 2007
Released on J-STAGE: June 01, 2007
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We performed a retrospective study of patients (six adult men) who underwent open reduction and screw/K-wire/plate fixation for Lisfranc joint injuries during a nine-year period. According to Hardcastle's classification, three cases were type A, two cases were type B, and one case was type C. The average JSSF midfoot scale was 77 points. Open reduction and internal fixation can be a good choice for the treatment of Lisfranc joint fracture-dislocations. Incongruity of Lisfranc joint was due to persistent ache.
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Akinori Takeyama, Kazuki Kanazawa, Ichiro Yoshimura, Takahiro Ida, Mas ...
2007 Volume 56 Issue 1 Pages
149-152
Published: 2007
Released on J-STAGE: June 01, 2007
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We report a case of avulsion fracture of the calcaneus in a young woman. The subject was a 28-year-old healthy woman. After falling during running, she visited our hospital due to difficulty in walking. She had swelling and prominence like bone at her heel. Radiograph indicated avulsion fracture of the calcaneus. We performed operation on the day of injury. We performed reduction proximal dislocated bone using 2.4mm K-wire percutaneously, and fixed it with a 6.5mm AO cancellous screw through a small incision. In the follow-up, necrosis of skin was seen at the back of her heel, different from the operation scar. We treated the wound after debridement, after which recovery took 12 weeks.
It is important to treat this type of fracture because of the high risk of post-operative complications (skin necrosis and/or re-dislocation etc.)
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