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Minoru Kashihara
2008 Volume 57 Issue 4 Pages
523-526
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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The purpose of this study is to compare the results between compression hip screw and short femoral nail for the treatment of trochanteric femoral fractures. 101 patients were treated with compression hip screw, and 53 patients were treated with short femoral nail (25 with Gamma AP-J nail and 28 with MIJ nail). Fracture types were 52 stable/49 unstable and 17 stable/36 unstable for compression hip screw and short femoral nail, respectiverly. There was no significant differences in the degree of deterioration of postoperative walking ability between the two groups. The average telescoping of lag screw for unstable fractures was 16 mm and 7 mm for compression hip screw and short femoral nail, respectively. Postoperative complications were five cases of lag screw cut out, one case of non-union, and two cases of distal cortical screw breakage in the compression hip screw group. Complications in the short femoral nail group included one case of femoral shaft fracture and five cases of varus deformity of the femoral head by more than 10 degrees. However, complications such as lag screw cut out and non-union did not occur. We recommend the use of short femoral nail for unstable trochanteric femoral fractures.
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Wakana Togami, Noburo Hashimoto, Tetsuya Fukumoto, Satoshi Maeda, Haru ...
2008 Volume 57 Issue 4 Pages
527-531
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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«Purpose»We evaluated the results of osteosynthesis of femoral neck fractures in the past five years. «Object»We treated 66 cases which we could follow-up for more than postoperative six months. Internal fixation procedures were performed using 30 CHS, nine CHS+screws, 10 Twin Hooks, and 17 Hansson pins. According to the modified Garden's classification, there were 13 stage I, 41 stage II, 12 stage III. «Method» Clinical evaluation was based on the operation time, fracture union rate, complications, GAI and bone fracture type, and relations with the complication. «Result» The Hansson pin group had the shortest operation time of 42 minutes on average. Clear significant differences were not seen in GAI between bone union cases and complication cases. As for complications, it was accepted 16% in Garden stage II (retroversion type) and 45.5% in Garden stage III. For the Twin Hook group and Hansson pin group, complication were mainly due to technical errors. «Conclusion» It is very important to have sufficient understanding of bone fracture stages including axial view of X-rays and manual operation skills.
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Takahiro Ushijima, Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, ...
2008 Volume 57 Issue 4 Pages
532-537
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Femoral peritrochanteric fracture is a major traumatic disorder in elderly patients. We have been using intramedullary hip screw (IMHS) for surgical treatment since November 2001. Asian IMHS (A-IMHS) is a more low profile and less invasive implant. Between April 2005 and March 2007, 108 consisting of 25 males and 83 females with the mean age of 83.5 years underwent osteosynthesis using A-IMHS. We investigated the radiological results and complications for these patients.
Radiographycally, the tip of the lag screw was located at the inferior-middle of the femoral head in 47.2% of the patients. After an average follow-up period of 3.0 months, the mean sliding distance of the lag screw was 1.82 mm. Post-operational cut out of the lag screw was noted in four cases, and dislocation of the screw sleeve from lateral cortex in one case out of the 108 patients.
Although many intramedullary fixation systems for this fracture have been developed, we prefer the A-IMHS as it offers a beneficial sleeve mechanism. The advantages of the sleeve mechanism include easy compressive fixation and prevention of excessive sliding and back out of the lag screw. We conclude that A-IMHS is a very useful fixation system for femoral peritrochanteric fractures.
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Masahiro Matsuda, Satoshi Shidahara, Hideyuki Senba, Takahiro Kitamura ...
2008 Volume 57 Issue 4 Pages
538-540
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We performed osteosynthesis/femoral head prosthesis replacement for proximal femoral fractures occurring in patients undergoing chronic hemodialysis and analyzed the outcomes. The subjects were 14 patients (15 hips) who received operational treatment at our hospital from April 2001 to June 2007. There were four hips with trochanteric fracture, three hips with basi-cervical fracture, and eight hips with neck fracture. The osteosynthesis for the three hips with basi-cervical fracture and two hips with neck fracture did not achieve bone union in two hips. Femoral head prosthesis replacement was performed on six hips with neck fracture and no post-operative complications were seen such as slack during follow-up. However, dislocation occurred in two hips. In all cases, hemorrhaging in the operative period and serious complications such as post-operative infection did not occur. In addition, a one-third (five patients) died within post-operative three years. Use of osteosynthesis for femoral neck fracture must be considered carefully for patients on chronic hemodialysis.
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Kohei Yamasaki, Hideki Kawamura, Ryoki Nojiri
2008 Volume 57 Issue 4 Pages
541-543
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We present a case with femoral head necrosis due to osteosynthesis. The case was a 77-year-old woman who suffered an intertrochanteric bone fracture by falling off a chair. We treated the fracture instrumentally. A little over twelve weeks after surgery, the femoral head developed osteonecrosis and we performed bipolar head arthroplasty. Pathological examination of the sample removed from the femoral head indicated osteonecrosis. Causes of femoral osteonecrosis were suspected to be the following three: (1) diabetes mellitus, adiposis, venous thrombosis, hypercholesterolemia as risk factors of the patient, (2) high energy trauma comminuted fracture, dislocation of isolated bone, and circumflex artery damage as risk factor of osteonecrosis suffered at the time of injury, and (3) damage to the femoral neck due to force fracture. The percentage of osteonecrosis occurring after surgery for intertrochanteric fracture is said to be 0.5%. Femoral head necrosis occurring after osteosynthesis for trochanteric fracture is therefore rare. There is a possibility that intertrochanteric fracture causes osteonecrosis of the femoral head, so the clinical course should be considered carefully.
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Yoshika Kawamura, Hiroshi Hagihara, Naoyuki Kuga, Masao Teramoto, Tomo ...
2008 Volume 57 Issue 4 Pages
544-547
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Pseudomembranous enterocolitis caused by administration of antibiotic prophylaxis is a serious complication for elderly patients. We reviewed 95 cases who had surgery for proximal femoral fracture between September 2006 and August 2007. The mean age of the cases was 80.8 years (65 to 98). Eight cases were post-operatively diagnosed with pseudomembranous enterocolitis, of which six were cured with oral administration of vancomycin and metronidazol, and two died with progressive systematic infection. We suspect CPZ/SBT was associated with the prevalence of pseudomembranous enterocolitis.
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Tomoyuki Taura, Masao Noguchi, Seiji Tsuji, Hirofumi Dokawa, Ai Mori, ...
2008 Volume 57 Issue 4 Pages
548-552
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We experienced a case in which the femoral head size measured at surgery was markedly different from that measured by radiography before surgery. We used a metallic ring for measurement and reviewed whether it is more accurate. The subjects were twelve patients (twelve hip joints) who had underwent hemiarthroplasty for femoral neck fracture. We placed the metallic ring on the lateral skin of the femur greater trochanter part, and performed radiography to determine the femoral head size to be ehlarged to. We reviewed the physique and position of the cassette to deterwine the factors influencing the enlargement ratio of the femoral head. We prepared a prosthesis of the appropriate size by using this metallic ring. No significant differences in the enlargement ratio were seen by physique. The distance from the femoral head to the cassette influenced the enlargement ratio greatly.
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Minoru Kashihara
2008 Volume 57 Issue 4 Pages
553-556
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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This paper presents a 78-year-old woman with spontaneous resolution of acute cervical epidural hematoma. She complained of sudden occipital, nuchal, shoulder girdle pain, and numbness of the right upper extremity. Physical examination revealed mild motor weakness and sensory disturbance of the right upper extremity and long tract sign. MRI showed epidural mass situated to the right side of the spinal cord from the C2 to C3 vertebral body. Neurological symptoms except occipital and nuchal pain did not recover and operation was planned at five weeks after onset, considering the possibility of intraspinal cystic lesion or spinal cord tumor. Preoperative MRI revealed disappearance of the epidural mass, spontaneous resolution of acute cervical epidural hematoma was diagnosed, and the symptoms recovered gradually. Patients should be treated conservatively in the case of mild paralysis or in the case of severe paralysis if they demonstrate rapid and progressive improvement.
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Hisato Tanaka, Mitsunori Komine, Kazuyoshi Uchihashi
2008 Volume 57 Issue 4 Pages
557-562
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We observed spinal epidural hematoma after a spinal compression fracture in MRI and its natural course. (Case) Case 1 was a 67-year-old man. He had 1 st lumbar vertebra compression fracture of Type III-1, no motor palsy, and spinal canal occupation rate (A) was 65%. The spread range (B) was five vertebras, so A/B was 13%. Hematoma disappeared after four weeks. Case 2 was a 72-year-old woman. She had 3 rd lumbar vertebra compression fracture of Type I-2, no motor palsy, and spinal canal occupation rate (A) was 46%. The spread range (B) was three vertebras, so A/B was 15%. Hematoma disappeared after six weeks. Case 3 was a 87-year-old woman. She had 1 st lumbar vertebra compression fracture of Type I-2, no motor palsy, and spinal canal occupation rate (A) was 31%. The spread range (B) was two vertebras, so A/B was 15.5%. Hematoma disappeared after four weeks. In these three cases, the time in which hematoma disappeared ranged from four to six weeks after receiving injury. Even if the spinal canal occupation rate of a hematoma is large, symptom may improve if pressure of a hematoma is diffused to the head and tail sides. Conservative therapy is therefore recommended when the spinal canal occupation rate of a hematoma is less than 15%.
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Tetsuya Tanaka, Taichi Saito, Isao Saikawa, Tsutomu Irie, Junya Ogata, ...
2008 Volume 57 Issue 4 Pages
563-566
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a case of intracranial hemorrhage following an incidental dural tear during lumbar spine surgery. The case was a 65-year-old female who had severe right leg pain. She had received lumbar spine surgery about 15 years ago. The current lumbar MRI revealed disc herniation in the right side of L4-5 level. She underwent revision posterior lumbar interbody fusion. During operation, a dural tear was made, resulting in a little outflow of CSF. But at the time of wound closure, leakage of the CSF was not seen. The next morning, she suddenly lost consciousness following headache and vomiting. A computed tomography scan of the head was performed and revealed subdural hematoma.
Open head operation was urgently performed. Eventually, she became fully alert and oriented, and was able to leave hospital walking on her own. In the head operation findings, there was no evidence of traumatic and idiopathic subdural bleeding. It is guessed that loss of CSF volume caused intracranial hypotension, leading to the brain hernia. Caudal brain displacement may cause characteristic subdural vein bleeding.
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Takeshi Kojima, Hiroshi Kuroki, Hideaki Hamanaka, Shinichiro Kubo, Sho ...
2008 Volume 57 Issue 4 Pages
567-571
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a rare case of lumbar spinal canal stenosis caused by hematoma of the ligamentum flavum. A 69-year-old man complained of back pain, leg pain, and intermittent claudication. Clinical examination revealed right L4 nerve root disorder and cauda equina lesion. MRI demonstrated severe spinal canal stenosis at the L4 level caused by a posterolateral mass. This was shown as low to iso intensity by T1WI and high intensity by T2WI. The patient underwent L4/5 fenestration for decompression of the spinal canal and resection of the mass lesion that contained dark brownish mass. Histological diagnosis was old hematoma with granulomatous change in the ligamentum flavum.
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Ken Miyaoka, Isao Saikawa, Taichi Saito, Tsutomu Irie, Tetsuya Tanaka, ...
2008 Volume 57 Issue 4 Pages
572-576
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report four cases of pyogenic lumbar facet joint arthritis at our institution from February 2004 to September 2007. Two males and two females were included in this study. The average age of the four patients was 67.0 years (range: 55-73). The predisposing conditions of the patients were diabetes mellitus (1 case), alcohol-related liver injury (2 cases), old brain infarction (1 case), hypertension (2 cases)and infective endocarditis associated with valvular disorder (1 case). Affected facet joints were L3/4 (2 cases), L4/5 (1 case) and double lesion of L3/4 and L4/5 (1 case). All of these were involved unilaterally. Fat suppressed T2 weighted MR image was very effective for diagnosis. We performed the operation and subsequent antibiotic administration in one case, and antibiotic therapy alone in three cases. In the latest follow up assessment, all the patients remained afebrile and had a marked reduction of low back pain.
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Taisei Matsumoto, Junichi Shida, Shigekazu Kaminomachi, Takahiro Hamad ...
2008 Volume 57 Issue 4 Pages
577-580
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a case who suffered nonclostridial gas gangrene. A seventy-year-old man who complained of right lower arm pain, went for medical examination and received steroid injection. The next day, he had severe pain and swelling of his lower arm. Although he was treated with antibiotics, swelling of his lower arm increased. The next day, he lost consiousness and was carried to our hospital.
X-ray and CT showed gas formation between the upper and lower arm. Although he was treated with surgical debridement, he died the next morning after the operation.
It is reported that 25% of patients with nonclostridial gas gangrene die, however early treatment can prevent adverse poor result of this life threatening disease. Awareness of this disease and careful examination are most important in early diagnosis.
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Hiroaki Tanaka, Yoshihisa Miyazaki, Masato Nagashima, Takuya Tokashiki ...
2008 Volume 57 Issue 4 Pages
581-584
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Septic dislocation of the hip is relatively common in children, but is extremely rare in adults. We report a 47-year-old Japanese man with septic dislocation of the hip.
He suffered brain infarction due to right leg monoplegia two years ago and has been bedridden from January, 2007. He was admitted to our hospital with high fever and decubitus ulcers on his back, sacrum, and left great trochanteric area on February 22, 2007. His right hip was contracted severely in flexion and adduction position, but roentgenogram did not show dislocation of the hip. Debridement of the decubitus was performed as well as antibiotics administration. Four weeks after admission, he had septic shock and laboratory examination revealed re-elevation in his white blood count and titer of C- reactive protein. CT of the hip obtained at the time showed right hip dislocation with abscess. The joint was drained and irrigated for two weeks through drainage tubes as well as antibiotics administration. After these treatments, the infection subsided in the right dislocated hip.
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Ryodai Kawabata, Yoshiya Arishima, Masahiro Yokouchi, Hideyuki Kawabat ...
2008 Volume 57 Issue 4 Pages
585-589
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We seldom encounter cases of osteoarticular tuberculosis, and this sometimes leads to a delay in diagnosis. In the category of bones and joints, Mycobacterium tuberculosis tends to involve the spine, and it is relatively rare for the tarsometatarsal joint (Lisfranc joint) to be affected. Foot and ankle involvement is equivalent to about 5% of all cases of tuberculosis of bones and joints. In our case, at first in November 2003, she consulted a hospital and was diagnosed with metatarsal bone fracture. She was treated with immobilization of her right ankle, but the symptoms did not improve. So, she was diagnosed with CRPS (RSD) and prescribed 10 mg prednisolone. But in May 2004 (five months after the first diagnosis), her foot became swollen and osteolysis and osteopenia were seen around the Lisfranc joint. Debridement and curettage were performed on the right foot, and examination of the granuloma specimen for acid fast bacilli was smear positive, Gaffky 2. Chest X-ray showed infiltrative shadows in the bilateral lung, and sputum examination for acid fast bacilli was also smear positive, Gaffky 2. After a few months of treatment with antituberculous chemotherapy, osteolysis continued, so reoperation with bone graft was needed. Osteoarticular tuberculosis should be suspected in cases of long-standing pain.
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Kazuhiko Mutou, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Azu ...
2008 Volume 57 Issue 4 Pages
590-594
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We investigated the strategy of treatment and outcome in patients with postoperative infected total hip and knee arthroplasty. Seven patients with infected total hip and knee arthroplasties from January 2002 to June 2007 were enrolled in the present study. Three patients had underwent a total hip arthroplasty (THA) and the remaining four with total knee arthroplasty (TKA). Two of the seven patients had underwent the primary arthroplasty in our hospital. We reviewed the patients' background, clinical course from onset of infection, organisms, and outcome after treatment. Subsequently, one knee joint was cured by exhaustive debridement and retained prosthesis. Two-stage reimplantations were performed on two hip joints and one knee joint. The remaining three joints were followed up for future reimplantation. Finally, all patients had no reccurences of infection. In the patients with infected THA however, we had to perform multiple operations for the infection to subside because a long time had paused since the onset of infection.
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Yohei Masuda, Hiroshi Tada, Masatomo Miyamoto, Goro Motomura, Yoichi Y ...
2008 Volume 57 Issue 4 Pages
595-598
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We experienced two cases of osteomyelitis of the finger. The treatment was based on the application of antibiotic-loaded bone cement beads. In Case 1, after cutting off the ring finger proximal phalanx due to ring finger necrosis, the finger developed osteomyelitis by Serratia. All devitalized bones and soft tissues were removed and dibekacin (DKB)-loaded bone cement beads were detained for eight weeks. Then the cement beads were removed. Case 2, a chip of wood stuck in the middle finger resulted in distal phalanx MRSA myelitis. Although vancomycin (VCM) and dibekacin (DKB)-loaded bone cement beads were detained for 13 weeks, removed. There are various methods for treating osteomyelitis with antibiotics locally. We think that antibiotic-loaded bone cement beads is an effective treatment.
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Yudai Baba, Takako Baba
2008 Volume 57 Issue 4 Pages
599-602
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Case: A 70-year-old man, with painful nodules on the posterior surface of the right lower leg left untreated for 10 years, visited our hospital for significant right lower leg tenderness. We observed no growth of the nodular mass. The mass with slightly swollen surface was dark red and 15×13 mm in size, showing an elastic-hard, clear-cut nodular lesion. X-ray examination found no abnormality in soft tissue or bone, and magnetic resonance imaging (MRI) showed an internally uniform, clear-cut tumor, characterized by low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, located in subcutaneous tissue. The tumor was resected with the nodular lesion of the skin and diagnosed as glomus tumor. Now, the patient has no recurrent tumor or pain.
Discussion: This rare case of glomus tumor occurred in the lower leg with skin lesion. Painful soft tissue tumor always requires careful medical treatment because of the possibility of glomus tumor.
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Haruki Odagiri, Toshitake Yakushiji, Hiroo Sato, Shigeta Yorimitsu, Ki ...
2008 Volume 57 Issue 4 Pages
603-606
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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The purpose of this study was to evaluate the MRI findings of well-differentiated liposarcoma. Ten well-differentiated liposarcomas surgically excised with histologic diagnosis were included in this study. The subjects consisted of five men and five women, with an average age of 62.5 years (range: 43-79 years). Six cases occurred in the thigh, two in the forearm, one in the shoulder, and one in the chest wall. Thickened septa (generally ≥ 2 mm) of low T1 signal and high T2 signal, and prominent area of enhancement were suspicious for well-differentiated liposarcoma. So we checked these lesions and compared with the pathologic findings of these lesions.
Thick septa and prominent area of enhancement were identified in all cases except one case who could not use Gadolinium. Pathologically, these lesions were composed of a relatively mature adipocytic proliferation in which, in contrast to benign lipoma, significant variation in cell size is easily appreciable.
So we consider that thick septa and prominent area of enhancement are evidently suspicious lesions for well-differentiated liposarcoma.
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Naohiro Uezono, Masahiro Yokouchi, Yasuomi Kawasoe, Naohiro Shinohara, ...
2008 Volume 57 Issue 4 Pages
607-610
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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A case of chondromyxoid fibroma occurring at the proximal of the right fibula of a 16-year-old male is reported. Initial objective symptom was transient pain at the knee joint and radiological appearance was a relatively eccentric and expansile lytic lesion in the proximal of the right fibula with a sclerotic margin. There was no periosteal reaction. Computed tomography (CT) showed an expansile lesion of the proximal fibula with a soft tissue component in the medullary cavity. The cortex was thinned and partially destructed. Magnetic resonance imaging (MRI) showed intermediate signal intensity on T1-weight images and high signal intensity on T2-weight images in the Intramedullary space. The radiological features suggested a benign lesion. Open biopsy and curettage of the right fibula lesion were then performed and pathological findings revealed a chondromyxoid fibroma. Local recurrence was not observed for seven months after the operation.
There have been reports that the incidence of recurrence of chondromyxoid fibroma varies from 15% to 26%. The tendency for local recurrence is higher in children. Chondromyxoid fibroma of the fibula, although rare, must be considered as a differential diagnosis.
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Masato Tomita, Kenji Kumagai, Tomayoshi Hayashi, Kuniko Abe, Seisuke N ...
2008 Volume 57 Issue 4 Pages
611-614
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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A case of extraskeletal myxoid chondrosarcoma arising around the ankle joint is reported. A 68-year-old woman noticed a mass lesion on the lateral aspect of her left ankle joint about one year ago. Because she had no pain, she neglected this mass. At her first visit, the elastic hard mass of 6 × 5 cm in size was palpable on the lateral aspect of her left ankle joint. No symptoms, tenderness, knock pain, and Tinel's sign were observed of the lesion. X-ray showed no calcification on the extra-articular region. MR imaging showed this tumor multinodular pattern, and low signal intensity in T1 weighed image and high signal intensity in the T2 weighed image. Open biopsy was performed, a tan-gray colored gelatinous specimen were obtained. Histopathologically, round cells, which had eosinophylic cytoplasm, grew in a cord-like and/or nest. The tumor stained positively in S100 protein and chromogranin-A, immunohistochemically. From these findings, this tumor was diagnosed as extraskeletal myxoid chondrosarcoma easily. It was difficult to resect this tumor with curative margin, so amputation below knee was performed. After three months of operation, she has no recurrences and metastases, and she can walk with below knee prosthesis.
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Masahiro Yokouchi, Yoshitaka Yamashita, Yasuomi Kawasoe, Junichiro Iri ...
2008 Volume 57 Issue 4 Pages
615-618
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We evaluated the short-term clinical results of patients with bone tumors using interconnected porous calcium hydroxyapatite ceramics (IP-CHA). Since 2005, a total of 23 patients with bone tumors were treated at our department using IP-CHA. The study group included thirteen men and ten women with an average age of 29 years. The mean follow-up was fifteen months. All the patient were implanted with IP-CHA for bone defects after resection or curettage of bone tumors. Postoperative radiological assessment revealed that the mean period for the radiolucent area between the implanted IP-CHA and the surrounding cancellous bone to disappear was 2.6 months. There were no allergic complications or pain associated with IP-CHA. Although local recurrence of the tumor was seen in one case, no patient developed postoperative fracture or infection.
We concluded that IP-CHA is a useful and safe bone-graft substitute in surgery for bone tumors.
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Jun Tahara, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Azusa T ...
2008 Volume 57 Issue 4 Pages
619-622
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Popliteal cysts occur commonly, but those causing compressive neuropathy are unusual. We report a case with compressive neuropathy of the common peroneal nerve by a popliteal cyst. A 45-year old woman with a two month history of an asymptomatic popliteal mass in her left lateral knee visited our outpatient clinic due to persistent symptoms. Physical examination revealed an approximately 4 cm soft elastic mass on the postlateral aspect of her left knee and she complained lateral cruris numbness during full flexion of her knee. Radiographs were normal, but magnetic resonance imaging showed a cystic mass measuring 5 × 3 × 3 cm in the popliteal fossa. That cyst was located between the popliteal tendon and the lateral head of the gastrocnemius through to the fibular collateral ligament and the common peroneal nerve went along the interval. Arthrography showed no communication between the cyst and joint. We performed surgical excision of the cyst directly, and the histologic diagnosis was a politeal cyst. Postoperatively she had no numbness during flexion of her knee.
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Hiroshi Nomura, Keishi Kondo, Ryuji Nagamine, Yoichi Sugioka
2008 Volume 57 Issue 4 Pages
623-628
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report two cases of screw failure with no traumatic episode after vastus lateralis release and screw placement for treatment of painful bipartite patella. Case 1 was a 26-year-old man with left painful bipartite patella categorized into Saupe III and treated with vastus lateralis release and screw placement to attach the accessory bone. After three months, the screw failed with no traumatic episode. Case 2 was a 14-year old man with bilateral painful bipartite patella categorized into Saupe III and treated with vastus lateralis release and screw placement to attach the accessory bones. After two or six months, the screw on the left or right side failed with no traumatic episode, respectively. We speculate that the screws may have failed due to the following reasons; first, releasing the vastus lateralis loosened an accessory bone tethered by vastus lateralis, then, the accessory bone was attached with a cancellous screw to the main portion of the patella. Afterwards, it was gradually driven forward by the peak of the femoral lateral condyle based on the configuration of the patella-femoral joint. Eventually, the screw placed in the accessory bone failed.
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Hiroshi Nagatomi, Shuta Shin, Hirokazu Yano
2008 Volume 57 Issue 4 Pages
629-634
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Knee arthroplasty is a popular orthopedic operation. The more knee replacement surgery becomes popular, the longer will durability need to be. Satisfactory outcome of knee arthroplasty has been generally attained by improvement of prosthetic knee design, material, surgical equipment, and surgical technique. However, some cases require second knee revision surgery after a very long period.
We herein report the revision of bilateral total knee revision arthroplasty (AMK) at 15 years after first sugery.
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Tetsuya Fukumoto, Kazutoshi Nomura, Noburo Hashimoto, Satoshi Maeda, H ...
2008 Volume 57 Issue 4 Pages
635-638
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Between December 2002 and May 2007, 28 Oxford prostheses were implanted at our hospital. Twenty eight knees (27 patients) were reviewed clinically at a minimum of 6 months postoperatively using the JOA score, range of motion, radiographic review, and complications.
JOA score improved from a mean of 56.2 to 92.0. The range of motion (ROM) improved from a mean of 124.4° to 137.4°. All components were installed permissibly. But there was wide variation in the position of high flex type. There was loosening and subsidence of tibial component in one case. There were no cases, of dislocated bearing and tibial fracture.
This study demonstrates that the Oxford unicompartmental knee replacement is a reliabile and effective procedure.
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Kimiaki Sato, Kensei Nagata, Jin Soo Park, Kei Yamada, Kimiaki Yokosuk ...
2008 Volume 57 Issue 4 Pages
639-642
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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Microendoscopic discectomy (MED) has become popular recently for treating lumbar disc herniation (LDH). The technique involves a shorter incision and considerably less tissue trauma than traditional open-surgery techniques. However, there is a steep learning curve to performing this procedure efficiently and safely, due to the very limited working space within the (19 mm external-diameter) 18 mm internal-diameter of the tubular retractor. Here we describe in detail the MED technique for LDH using the METRx Microscopic Discectomy (MD) system (Medtronic Sofamor Danek, Memphis, TN). This system offers variable tubular retractor lengths and increased available working space within the tubular retractor. The potential complications however are similar whether using a standard 93 mm length retractor or other lengths in this system, but the increased diameter offers some advantages in the working space.
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Kosuke Tabuchi, Tetsuya Hamada, Michihisa Zemmyo, Koji Hiraoka, Kensei ...
2008 Volume 57 Issue 4 Pages
643-646
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We experienced two cases of osteomyelitis which needed to be differentiated from bone tumor. These two cases had poor local inflammation signs and systemic inflammation findings. Although they were considered bone tumor on MRI findings, they were diagnosed with osteomyelitis as a result of biopsy. The prognosis of subacute osteomyelitis is comparatively good, but differential diagnosis of malignant bone tumor must be most carefully done. For this reason osteomyelitis should be considered one of the differential diagnosis of bone tumor, and an early biopsy is required when diagnosis is difficult after various examinations.
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Tadatsugu Morimoto, Shoji Yabuki, Yasutaka Kugimoto, Akihiko Asami
2008 Volume 57 Issue 4 Pages
647-651
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a case of paroxysmal itching related to syringomyelia with Chiari malformation. A 16-year-old female was admitted with the chief complaint of pain in her right upper extremity. MRI showed a syringomyelia between the C2 and T5 vertebrae levels. The patient underwent foramen magnum decompression (FMD). After the operation, her pain improved. MRI showed a decrease in the size of the syrinx. However, she continued to complain of paroxysmal itching without any eruptions in her right upper extremity. The area of itching was the same as the area that had demonstrated pain. She could not tolerate the urge to claw and scratch this itching area even though such scratching caused no relief of itching. She complained of no pain and no itching at two years after surgery. MRI showed a further decrease in the size of the syrinx. Although paroxysmal itching associated with multiple sclerosis (MS) is well known, it has not been thought that itching is associated with neurological problems. Based on the similar characteristics of itching between syringomyelia and MS, the pathomechanism of itching of syringomyelia may be similar to that of MS. Itching caused by syringomyelia may be a neurological symptom.
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Yukiyoshi Tsuda, Junichi Fukushi, Koji Matsumoto, Taishi Sato, Katsuhi ...
2008 Volume 57 Issue 4 Pages
652-655
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a case of triceps tendon rupture. A 69-year-old female, who was a paraplegic crutch ambulator, was presented complaining of right elbow pain after falling. Physical examination, X-ray, and MRI demonstrated rupture of her right triceps tendon. The tendon was repaired primarily, but re-ruptured after voluntary flexion of the elbow on post-operative day 17. Reconstruction of the tendon was performed using Leeds-Keio artificial ligament. The clinical course was satisfactory, and the right elbow recovered almost full range of motion in eight weeks. Triceps tendon rupture is rare, and sometimes overlooked when the injury is acute because of swelling and pain. Surgical treatment is the mainstream of treatment for most acute triceps tendon ruptures, and provides satisfactory outcome in most cases.
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Yosuke Matsumura, Takao Mae, Kei Yatsuda, Hiroshi Nomura, Kenichi Kawa ...
2008 Volume 57 Issue 4 Pages
656-659
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report a patient of open fracture with massive bone defect and injury of soft tissue. The patient was a 25-year-old male. He was injured in a traffic accident riding a motorbike. We realized open fracture on the his left knee, grading Gustilo III b, Tscherne Fr.OIII (with defect of the lateral condyle of the femur, defect of one third of the patella, paralysis of the common fibular nerve, severe injury of the soft tissue, and tibia plateau fracture). We performed debridement and washing as soon as possible, administered sufficient antibiotics to the patient, and then performed debridement and washing twice again. Successfully preventing severe infection in the patient. Through early passive ROM training, he achieved permissible ROM of knee. He was able to walk by himself wearing DonJoy brace in the last observation. Further close follow-up is important.
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Hideya Kawamura, Tomotaro Yamaguchi, Osamu Tomishige, Tetsuya Toshimit ...
2008 Volume 57 Issue 4 Pages
660-664
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We allowed patients after of HTO surgery early weight bearing using Surfix lock plate system and obtained satisfactory clinical result. We performed HTO surgery on eighty-eight patients (ninety-two knees) from October 2002 to December 2005. We allowed the patients partial weight bearing several days after the surgery and full weight bearing four weeks after the surgery, if tolerated by patients. Short term clinical results of the surgery were acceptable, but some patients showed delayed union when allowed full weight bearing earlier. Some patients showed opening at the medial tibial cortical bone after interlocking wedge osteotomy, and these patients and some osteoporotic patients showed delayed union. We changed the osteotomy line oblique to keep close the medial tibial cortical bone at the osteotomy and reduce delayed union. This new oblique osteotomy caused load distribution and increased the contact area of the osteotomy, so the osteotomy gap contacted more closely when the plate was screwed on. We investigated patients who underwent this new osteotomy from February. 2006 and they showed the excellent clinical results and no delayed union.
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Hiroo Sato, Toshitake Yakushiji, Eiichi Nakamura, Kiyoshi Oka, Shigeta ...
2008 Volume 57 Issue 4 Pages
665-670
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report two cases using bone transport method for reconstruction after the resection of malignant bone tumors. The first case was a 8-year-old girl with osteosarcoma of the proximal tibial metaphysis. The length of the bone defect after resection of the lesion was 6.0 cm. Bone union was obtained fifteen months postoperatively. At present, at the second postoperative year, she walks with a knee brace and no crutches. The external fixation index was 31.8 days/cm. The functional score according to the functional evaluation system of the International Society of Limb Salvage (ISOLS) was 77%. The second case was a 4-year-old boy with an Ewing's sarcoma/PNET of the right tibial diaphysis. The length of the bone defect after resection of the lesion was 9.0 cm. At present, at the sixth postoperative month, lengthening continues.
Bone transport method is thought to be a useful option for the reconstruction of bone defects after resection, which can regenerate the living bone identically to the native bone although it takes a long time to achieve bone union.
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Hirokazu Nohara, Taketsugu Gaja, Satoshi Kuroshima, Shinji Miyoshi, Fu ...
2008 Volume 57 Issue 4 Pages
671-676
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We report the sargical outcome of spinal subpial lipoma in four cases without adult-onset spinal bifida. [Case 1] A 20-year-old female complained of mild weakness (MMT [4]) of the left lower extremity and urinary hesitancy. MRI revealed spinal subpial lipoma. Laminectomy from T3 to T8 was performed. After tumor biopsy, duraplasty using autologous fascia lata was performed. Postoperatively, MMT for the left lower extremity improved to [5]. Independent ambulation became stable, and urinary hesitancy disappeared. [Case 2] A 46-year-old female complained of weakness of the right lower extremity. The patient was diagnosed with spinal subpial lipoma with thoracic scoliosis. Laminectomy from T1-T9, biopsy, and duraplasty using artificial dura mater were performed. After surgery, ambulation became stable and she returned to her previous job as a waitress 10 months after surgery. [Case 3] A 27-year-old female complained of numbness and weakness in both lower extremities. Laminectomy from T8 to T12, biopsy, and duraplasty using artificial dura mater were performed. Numbness and weakness in both lower extremities improved. [Case 4] A 48-year-old female complained of numbness in the left upper and lower extremities. Partial tumor resection at C1-C2 was done, but position sense disturbance manifested postoperatively.
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Tetsuo Hayashi, Takayoshi Ueta, Osamu Kawano, Keiichiro Shiba, Eiji Mo ...
2008 Volume 57 Issue 4 Pages
677-680
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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We previously reported good clinical results of anterior spinal fusion with removal of neck collar in three months, however long wearng cause discomfort in patients. We tried shortening the period of wearing neck collar (four to five weeks).
Fifteen patients who underwent anterior spinal fusion were included in this study. Neck collar was removed within four to five weeks after operation. Fusion rate, subsidence of graft bone, alignment of fusion segment, and JOA score were evaluated before and after surgery.
Bony fusion was observed in 14 cases (93.3%). Disassembly of graft bone was not observed. Subsidence of graft bone was 2.2 mm on average, change of alignment of fusion segment was 1.1 degree on average, JOA score was recovered from 11.2 points to 15.0 points.
This study shows early removal of the neck collar at one month after anterior spinal fusion with rigid fixation is possible and provides good clinical outcome.
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Yoshihiro Kohashi, Eiichi Ishitani, Hiroshi Harada, Sachio Masuda, Mas ...
2008 Volume 57 Issue 4 Pages
681-683
Published: September 25, 2008
Released on J-STAGE: November 20, 2008
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PLIF/TLIF are popular methods of fusion in posterior lumbar spinal surgery. However the problems in PLIF/TLIF include not only an increase of bleeding and neuropathy, but also soft tissue damage. We report a new LIS-TLIF method using a 4.5 mm rod and extra-low profile pedicle screw systems. Ten patients were underwent less invasive TLIF using a tube retractor. We selected patients who were female and over sixty. The diagnosis was degenerative spondylolisthesis in all. There were no instrument breakage and bone union rate was 100%. The preoperative % slip changed just after operation and postoperative 6 months as follows, 16.4 to 8.7 and 9.0%. This procedure has a great advantage in terms of preventing muscle damage during posterior lumbar fusion.
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