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Masanori Sakaino, Taketoshi Kanazawa, Yomihito So, Akio Inoue
2008 Volume 57 Issue 2 Pages
171-176
Published: 2008
Released on J-STAGE: May 23, 2008
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An important factor for obtaining good results after Chiari's pelvic osteotomy for adult coxarthrosis is the age of the patient.
We have followed up patients in their thirties and forties (47 hips in advanced stages) for over two years, investigated the results (JOA hip score), and compared with patients in their fifties (60 hips).
Painless hip could be obtained in more than 90% of the patients in their thirties and forties in contrast with about 80% of the patients in their fifties.
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Masamori Shigematsu, Riki Tanaka, Masaaki Mawatari, Takao Hotokebuchi
2008 Volume 57 Issue 2 Pages
177-181
Published: 2008
Released on J-STAGE: May 23, 2008
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We studied 72 patients before and after bilateral total hip arthroplasty (THA), and using gait analysis, we compared them with 253 patients who had undergone staged unilateral THA. The average age of the patients was 59 years at the time of the first operation. The mean follow-up period was 40.5 months for the unilateral THA group and 40.2 months after the second THA for the bilateral THA group. The average interval between the first and second THA was 3 weeks. Using a force-measurement platform, we characterized the functional results of both groups. The platform allowed measurement of free-walking speed, step frequency, stride length, step length, and single- and double-support durations. The patients with bilateral THA successfully achieved optimal function similar to those with unilateral THA, except with respect to the step length at 2-6 months after the second THA. The patients in the bilateral THA group briefly demonstrated short-step walking. The 3-week interval between the THAs and early weight-bearing did not affect the improvement in gait when cementless THA was conducted.
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Takanao Sueyoshi, Koji Akasaki, Takaaki Sagara, Makoto Kimura, Takumi ...
2008 Volume 57 Issue 2 Pages
182-186
Published: 2008
Released on J-STAGE: May 23, 2008
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We studied the short-term results of 55 total hip arthroplasties using JMM PerFix HA stem. The average duration of follow-up was 3.7 years (range: 3 to 6 years).
All radiographs were examined for canal filling rate, incidence of spot welds, and clear zone.
Canal filling rate was high on the anteroposterior radiographs, but it was under 80% on the lateral radiographs. The incidence of the clear zone was high at the immediate postoperative period especially on lateral radiographs, but decreased over time. Spot welds appeared in 91% of the cases at one year after the operation and appeared in 95% of the cases at final observation. These were classified as bone-ingrown fixations.
The canal filling rate of the PerFix HA stem tended to be low on lateral radiographs, but spot welds appeared in some parts of the HA coating in early period. The clear zone was therefore supposed to decrease with the improvement of stem fixation.
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Hironori Kakoi, Hideyuki Kawabata, Kosei Ijiri, Setsuro Komiya, Fumito ...
2008 Volume 57 Issue 2 Pages
187-190
Published: 2008
Released on J-STAGE: May 23, 2008
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Total hip arthroplasties with acetabular bone grafting were performed on 22 hips for rheumatic hip and followed up for an average of 6.6 years. The mean age was 56.3 years. Acetablar defects were classified lateral type, central type, cranial type, and cranio-central type according to Itoman's classification. We grafted autogenous bone in all cases. Kerboull plate was used in 3 hips. Two revisions were performed because of infection and recurrence of dislocation of the hip. The mean overall distance of central migration was 1.06 mm and that of the superior migration was 0.67 mm. All grafts appeared to have united radiologically with no clear zone between the grafted bone and socket. The average JOA hip score was 32 points preoperatively, and 70.7 points at the time of follow-up. The clinical results of total hip arthroplasty in rheumatic hip with bone grafting were satisfactory. Our method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with rheumatoid arthritis.
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Hisataka Goto, Juei-tang Chang, Toshio Kawahara
2008 Volume 57 Issue 2 Pages
191-193
Published: 2008
Released on J-STAGE: May 23, 2008
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We treated four cases of Vancouver Type B1 periprosthetic femoral fractures from May 2006 through February 2007. All patients were female, and the average age was 85.3 years (range: 73 to 93 years). The previously implanted prostheses included three cementless bipolar hemiarthroplasties and one HMRS system. The time from placement of the endoproshesis to the fracture averaged 7.3 years (range: 2 to 15 years). All patients underwent open-reduction and internal-fixation (three cable plate systems and one locking plate plus cable). The average follow-up period was 6.8 months (range: 4 to 13 months). The fracture healed in three of the four patients with median time to union of 3.7 months. Appropriate selection of fracture implants and methods of fixation minimizes soft tissue disruption for each fracture.
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Yuji Doi, Eiji Yoshimoto, Masami Tokunaga, Takaaki Yoshimoto, Satoshi ...
2008 Volume 57 Issue 2 Pages
194-199
Published: 2008
Released on J-STAGE: May 23, 2008
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CentPillar GBHA is an anatomical stem designed for Japanese patients of Hip. We evaluated the clinical and radiological results of 100 joints in 92 total hip arthroplasties operated in our hospital. The average follow-up period was 18 months (6 to 33 months). The post-operative JOA score was good as 83 points, but there were seven intraoperative fractures. We regarded the intraoperative fracture as associated with canal flare index (CFI), and the proximal design of the stem was considered a factor of these fractures. The incidence of intraoperative fracture was 20% when CFI<3.0, 7% when 3.0≤CFI<4.0, and 0% when CFI≥4.0. The medullary canal filling ratio of the stem was low, but if it was hammered stronger, the incidence of fracture became higher. The proximal-anterior aspect of the stem had 9° anterior inclination, and it had narrow contact area adjacent to the cortical bone, so it underwent concentration of the hammering force to the anterior aspect. Bony fixation was achieved in 90% of the cases according to Engh's fixation/stability score, but post-operative varus displacement of the stem more than 2° was found in 36 joints. We found no factors associated with these results.
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Yoshitake Oshiro, Tetsuya Yara, Tomohiro Nakasone, Wataru Oshiro, Fumi ...
2008 Volume 57 Issue 2 Pages
200-204
Published: 2008
Released on J-STAGE: May 23, 2008
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Adult T cell leukemia (ATL) is a T cell neoplasm etiologically associated with human T lymphotropic virus type 1 (HTLV-1) infection.We present a rare case of ATL which affected the spinal bone and caused paralysis. A fifity-eight-old male was suffering from progressive weakness of the extremities and admitted to our hospital after he could not walk. X-ray images showed an abnormal mass in the right lung and disappearance of the 5
th cervical vertebral body. MRI revealed occupied lesion at the 5
th cervical vertebra which extended into the spinal canal and compressed the spinal cord severely. Anterior decompression and fusion for the cervical spine were performed and halo brace was applied after the surgery. Lymphoma cells were found in the specimen from the cervical spine lesion. Further investigation also revealed ATL cells in the blood and that the serum HTLV-1 antigen was positive. Antibiotics were administered after the culture of sputum revealed Candida albicans which probably caused pneumonia. Paraplegia improved immediately after the surgery but worsened again. Regardless of chemotherapy to the ATL, he died 10 months after hospitalization.
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Satoshi Kamura, Kazumasa Terada, Nobuo Kobara, Kiyoshi Miyazaki, Shige ...
2008 Volume 57 Issue 2 Pages
205-210
Published: 2008
Released on J-STAGE: May 23, 2008
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In surgical treatment of cervical intradural-extramedullary tumor, cervical laminectomy is usually utilized as an approach to tumor. We report a case of cervical intradural-extramedullary tumor extirpated with double-door cervical laminoplasty and investigated the results. A 63-year-old female, complaining of severe numbness and difficulty in movement of bilateral hands and fingers, was diagnosed with "cervical spinal cord tumor" at the level of C4 by MR image. CT myelo-gram revealed that it was intradural-extramedullary tumor. In operation, we approached the tumor by double-door opening of the lamina and placed hydroxyapatite spacer after extirpating the tumor. It was diagnosed as "Shwannoma" pathologically. Here, we report the usefulness of the proposed method such as intraoperative safety, postoperative stability of our surgical approach, double door laminoplasty to the intradural extramedullary tumor.
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Seiji Higuchi, Naoki Inomata, Riki Kiriya, Hideaki Hamanaka, Shoji Han ...
2008 Volume 57 Issue 2 Pages
211-217
Published: 2008
Released on J-STAGE: May 23, 2008
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We mainly applied Magerl method to fix round epistropheus for treating its rootlessness. However, the procedure may cause artery damage during screw implantation in cases of run abnormality such as high riding VA. It is Goel (Har for such an artery run abnormality example ms). Good results were obtained for round epistropheus fixation by this technique (C1 lateral mass, C2 pedicle screw fixation) and the results are reported below.
Objectives: Five patients with RA (average age: 53.6 years) who underwent round epistropheus fixation by the Goel (Harms) technique were followed up from October 2004 to February 2006. The mean time to follow-up assessment after the fixation was 1 year and 9 months.
Methods: Sharp pain was evaluated according to Ranawat's classification and by neurological function evaluation. In X-ray study, Ranawat value was measured in terms of atlantodental interval, an index of perpendicular dislocation for level dislocation.
Results: Bone union was achieved in all cases and there were no serious complications such as blood vessel damage and nervous system damage, indicating that this method is useful for artery run abnormality.
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Yasuhiro Ishidou, Fumito Tanabe, Eiji Taketomi, Takuya Yamamoto, Kosei ...
2008 Volume 57 Issue 2 Pages
218-220
Published: 2008
Released on J-STAGE: May 23, 2008
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Lateral approach, osteoplastic laminectomy or facetectomy, and spinal fusion were available for conventional surgical intervention of lumbar radiculopathy at the intra- or extraforaminal lesion. We performed microendoscopic disectomy on three cases of lateral disc herniation. All cases had little bleeding, less wound pain, no complications, and good results. Microendoscopic spinal surgery was less invasive and very useful for surgical treatment of lateral disc herniation. Preoperative imaging studies were important to identify the location of herniated disc.
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Kanehiro Matsuyama, Fumito Tanabe, Eiji Taketomi, Yasuhiro Ishidou, Ta ...
2008 Volume 57 Issue 2 Pages
221-224
Published: 2008
Released on J-STAGE: May 23, 2008
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Microendoscopic discectomy for lumbar disc herniation is a minimally invasive spinal surgery and used extensively. We endoscopically removed the herniated disc from two intervertebral sites through one skin portal in two cases of extremely migrated lumbar disc herniation with bi-radicular lesion. Both cases had a good outcome. Microendoscopic discectomy is less invasive and very useful for these cases.
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Masayuki Nakahara, Kenki Nishida, Koichi Ogawa, Yuichi Takahashi, Akih ...
2008 Volume 57 Issue 2 Pages
225-230
Published: 2008
Released on J-STAGE: May 23, 2008
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Between 2000 and 2006, we had 335 cases of lumbar disc herniation that required surgical removal. Three cases required transdural approach, of which two had hernia that was prominent towards the middle. One patient had hernia that was prominent to the subdural space. Since it was very hard to remove hernia by the usual Love's approach, we opted for the transdural hernial approach. During the operation, as use of laminectomy to remove the suprasupinal ligament and interspinal ligament may cause lumbar instability to recur due to loss of posterior supporting structures, lumbar spinal fusion (PLIF or PLF) was added.
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Taiichiro Yanagizono, Daisuke Yoshikawa, Hajime Fukuda, Kazumasa Yamag ...
2008 Volume 57 Issue 2 Pages
231-233
Published: 2008
Released on J-STAGE: May 23, 2008
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Winter's Classfication is a very useful method for evaluating gait analysis data in patients with hemiplegic cerebral palsy, but sometimes classification is not possible. We therefore evaluated. 12 patients with spastic hemiplagia secondary to cerebral palsy by using gait analysis system including sagittal pelvic motion. Two patients indicated limitation of hip extension in the terminal stance, and sagittal pelvic motion analysis showed increased range of motion. Of four patients with no limitation of hip extension, two patients indicated increased range of motion in pelvic tilt. These four patients with increased pelvic tilt range of motion seem to have spasticity in the hip flexoers that induce pelvic anterior tilt due to hip extention.
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Hajime Fukuda, Taiichiro Yanagizono, Kazumasa Yamaguchi
2008 Volume 57 Issue 2 Pages
234-237
Published: 2008
Released on J-STAGE: May 23, 2008
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Cerebral palsy causes dyskinesia such as spasticity, muscle weakness, and hyperreflexia due to the early development of cerebral aberrant lesion. Hemiplegic cerebral palsy patients have unilateral dominant dyskinesia and few disorders at the contralateral side. There are many reports of gait analysis evaluation of the involved side of hemiplegic cerebral palsy patients, but there are few reports about the uninvolved side. We evaluated 12 hemiplegic cerebral palsy patients who did not undergo surgical therapy. Adding discussion from literature, we report them below. The patients consisted of four males and eight females. Average (age was 14 years and six months) (range: 9 years and 10 months to 22 years and 4 months). Three-dimensional gait data were collected with the ANIMA motion analysis system (MA2000). Four force plates (MG1090) were used for kinetic analysis. When we compared the non-paralysis side of the cerebral palsy patients with normal gait, kinematic evaluation showed increase in range of motion in hip, knee, ankle and characteristic angle change patterns in some of the patients. In addition, it was suggested that functional leg length discrepancy has an influence on gait in the uninvolved side of cerebral palsy.
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Masaru Higo, Shinji Yoshino, Masahiro Nakamura, Arisa Tsuru
2008 Volume 57 Issue 2 Pages
238-241
Published: 2008
Released on J-STAGE: May 23, 2008
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Four patients with severe leg-length discrepancy due to overgrowth of the femur after open reduction for developmental dysplasia of the hip were treated surgically. During the long-term follow-up, hip joint radiographs showed coxa magna, widening and valgus deformities of the femoral neck, and overgrowth of the proximal femur. Two patients (8-year-old and 4-year-old girls) with 18 to 10 mm overgrowth of the femur underwent femoral derotational varus osteotomy for concentric adaptation of the hip and shortening of the femur. At 4 to 5 years after the femoral osteotomies, 30 to 35 mm overgrowth of the femur recurred, and they underwent contralateral femoral lengthening. During the follow-up period, they had no leg-length discrepancies. The other two patients (8-year-old and 9-year-old girls) with 21 to 22 mm overgrowth of the femur underwent temporary distal femoral epiphyseal stapling. Increased vascularity in the proximal growth plate after open reduction can cause overgrowth of the proximal femur. Regular follow-up and radiographic evaluation of leg-length discrepancies in children who have undergone open reduction for developmental dislocation of the hip are essential.
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Yuka Komaki, Etsuo Chosa, Takerou Sakamoto, Tomohisa Sekimoto, Shinji ...
2008 Volume 57 Issue 2 Pages
242-247
Published: 2008
Released on J-STAGE: May 23, 2008
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We treated seven congenital dislocations of the hip in six patients.
The average age of the patients at the first visit was 1 year (range: 5 months to 1 year 10 months), and the average age of the beginning the treatment with overhead traction (OHT) was 1 year 2 months (range: 9 months to 2 years). The average follow-up period was 8 years (range: 5 months to 15 years). The average period of traction was 65 days (range: 51 to 74 days). All hips were corrected successfully by OHT.
Subsequent operations were performed on two out of the seven hips. OHT treatment was started when subjects were more than 1 year of age. We concluded that congenital dislocation of the hip is best treated by closed reduction, especially when Riemenbugel method fails in children above 1 year and children of walking age.
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Shogo Tahata, Tokushige Nishizato, Hirokazu Shimizu, Yoshihisa Anraku
2008 Volume 57 Issue 2 Pages
248-251
Published: 2008
Released on J-STAGE: May 23, 2008
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We performed arthroscopic debridement on two knees of two children. The patients were taken to the operating room in emergency situations and underwent arthroscopic treatment. The treatment was determined by the macroscopic appearance of the joint pathology. We used Seara's classification to distinguish macroscopic stage of septic arthritis. These two patients presented early macroscopic stage (I, II), therefore we only performed arthroscopic debridement, and continuous irrigation drainage was not required. The infection was cured in these two patients with no recurrence. They also did not have any dysfunction and growth impairment.
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Hidetoshi Onoue, Kazuo Kimura, Kazutaka Matsunaga, Kenji Hamada, Fumih ...
2008 Volume 57 Issue 2 Pages
252-255
Published: 2008
Released on J-STAGE: May 23, 2008
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We utilized a trochanteric nail, which has its entry point on the greater trochanter, for three children with femoral shaft fracture. The subjects were two 13 year-old males and one 14 year-old female. All three cases demonstrated a horizontal fracture (AO Type A3). The nails were removed six to 12 months after the surgery. All cases showed excellent bony union. As this nail entry point is on the greater trochanter, the risk of damage to the nutritional vessels is decreased. This can prevent the onset of femoral head necrosis, which is a devastating complication of femoral nail insertion. On the other hand, when the nail is inserted from the greater trochanter, a large impacting pressure is required to the nail as the femoral canal is extremely narrow in children. Greater attention should be paid when inserting the nail.
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Natsuko Tomimura, Koji Sameshima, Yoshihisa Kawauchi, Eiji Taketomi, S ...
2008 Volume 57 Issue 2 Pages
256-259
Published: 2008
Released on J-STAGE: May 23, 2008
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A 79-year-old female was admitted to our hospital for high fever and lumbago. Lumbar X-ray photograph showed abnormal gas occupying the L5 vertebral body and it had spread inside the iliopsoas. MRI revealed epidural abscess at the L4/5 level. We found that the gas was produced by
E. coli cultured from pus. At first we started chemotherapy and hyperbaric oxygen therapy, but the epidural abscess extended to the C2 level. We performed operation three times. Early diagnosis and the timing of the operation are important for spinal epidural abscess.
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Takuto Tsuchiya, Satoshi Ikeda
2008 Volume 57 Issue 2 Pages
260-264
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of acute osteomyelitis in bilateral femoral condyle with difficulty of early diagnosis. A 11-year-old boy had high fever and bilateral knee pain. However, he had no limitation of range of motion (ROM), local heat and swelling in the bilateral knee. Three days later, high fever still continued and limitation of ROM occurred. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values had increased, but not the white blood cell (WBC) count. Bilateral medial femoral condyle showed low-signal intensity on the T1-weighted image and high-signal intensity on the T2-weighted image by magnetic resonance imaging (MRI).
As acute osteomyelitis was mostly suspected, we started treatment with intravenous antibiotics and hyperbaric oxygen. A few days later, we diagnosed the condition as acute hematogeneous osteomielytis due to methicillin-susceptible staphylococcus aureus by blood culture examination before treatment. In this case, early diagnosis of acute hematogeneous osteomielytis was difficult because of normal serum WBC value and multifocal lesion. At 6 months follow-up, no local recurrence had occurred.
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Daisuke Kawano, Ayahito Kawabata, Yasuaki Suruga, Yoshihito Yukita
2008 Volume 57 Issue 2 Pages
265-268
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a rare case of pyomyositis with gas production in the right adductor magnus. The patient was a 51-year-old man with type 2 diabetes mellitus. In January, 2007, he was admitted because of fever and chill. Thereafter, he developed right thigh pain and received medical treatment for cellulitis. Three days after starting antibiotics therapy, CT images revealed a low-density area with gas production in the muscles. He was referred to our hospital, and we immeadiately performed drainage of the area, antibiotics therapy, and hyperbaric oxygen therapy. These therapy significantly improved his outcome. The cultured purulent yielded Streptococcus constellatus.
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Hiroshi Kawasoe, Shuichiro Fukushima, Haruki Mori
2008 Volume 57 Issue 2 Pages
269-271
Published: 2008
Released on J-STAGE: May 23, 2008
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Post operative infection is a complication that we have to avoid most. Preventive dosage antibiotic and sterilization are therefore performed habitually. However, the excessive use of antibiotic multidrug resistance bacteria. In addition, there are many reports that sterilization of postoperative wound is not necessary. Taking this into consideration, we use antibiotics only on the operative day or next day according to the operation performed and do not perform sterilization in principle. So far, we have not experienced outbreak of serious infections after operation. This indicates that opportunities of infection do not increase even if we shorten the period of use of antibiotics and do not perform sterilization.
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Tomohiro Horikawa, Takeshi Yamashita, Tateki Segata, Kensuke Yonemura
2008 Volume 57 Issue 2 Pages
272-275
Published: 2008
Released on J-STAGE: May 23, 2008
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We used the proximal femoral nail antirotation (PFNA) [Synthes, Tokyo, Japan] technique for femoral peritrochanteric fracture of 48 patients. We examined 19 patients (male: 3 patients, female: 16 patients) that were followed up for more than postoperative four weeks.
The average age was 87.1 years, and the average follow-up period was 97 months. The fracture type of 10 patients was A1 of AO classification 31, and that of nine patients was A2. The average operation time was 29.5 minutes. There was little operative haemorrhage in all patients, and 12 cases needed postoperative blood transfusion (63%).
Radiographically, the average tip-apex distance (TAD) was 21.9 mm, and the average telescoping of the blade was 4.16 mm (type A1; 4.88 mm, type A2; 3.37 mm). Although, the lateral cortex fracture of the blade insertion occurred in one patient at operation, there were no postoperative complications such as varus of neck or cutout of the blade.
Fixation by PFNA was good, and initial gait exercise was possible. We conclude that PFNA is a very useful fixation system for femoral peritrochanteric fractures.
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Yohei Masuda, Hiroshi Tada, Masatomo Miyamoto, Goro Motomura, Yoichi Y ...
2008 Volume 57 Issue 2 Pages
276-278
Published: 2008
Released on J-STAGE: May 23, 2008
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We treated intertrochanteric hip fracture (Evans type 1-stable) with AS hip screw. The feature of AS hip screw is that the angle of the lag screw is variable (125°-145°), and the angle guide head not be used. This implant is separable into two parts: lag screw and plate. Fifty-eight patients were treated with the usual method and 53 patients were treated with MIS. The mean length of skin incision in the usual method group and MIS group was 7.7±1.9 cm and 4.1±1.0 cm (p<0.05) respectively. The mean blood loss was 42.1±54.7 cc and 27.5±21.1 cc (p>0.05). The mean operation time was 67.8±20.9 min and 62.3±15.9 min (p>0.05). There was significant difference between the usual method group and MIS group for the mean length of skin incision. We concluded that the AS hip screw is useful for MIS.
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Yasuhiro Tominaga, Yukio Abe, Kenzo Fujii, Tetsu Tsubone, Kazunari Tsu ...
2008 Volume 57 Issue 2 Pages
279-282
Published: 2008
Released on J-STAGE: May 23, 2008
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We have performed osteosynthesis of the femoral neck fracture on 24 patients since 2004, and experienced three failure cases (12.5%).
The first case, a 89-year-old woman, underwent osteosynthesis with a Hannson pin five days after injury. Two months later, segmental collapse was found on X-ray. The femoral head had completely collapsed at six months after osteosynthesis.
A 58-year-old man with medical history of chronic renal failure was injured with Garden type 3 fracture and fixed with a Hannson pin. However loss of reduction developed into nonunion, and we performed Bipolar prosthesis replacement seven months after the osteosynthesis.
The third case was a 76-year-old woman who injured femoral neck and trochanteric fractures of the ipsilateral femur. Osteosynthesis was performed with CHS seven days after the injury. Three and a half months later, trochanter major was displaced and the lag screw cut out.
Prediction of late segmental collapse was important. The choice of procedure when treating dialysis patients, and an ipsilateral intertrochanteric and subcapital fracture needs careful consideration.
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Tateki Segata, Takeshi Yamashita, Tomohiro Horikawa, Kensuke Yonemura
2008 Volume 57 Issue 2 Pages
283-286
Published: 2008
Released on J-STAGE: May 23, 2008
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A consecutive series of 15 patients (15 hips) with femoral neck fracture were treated with Bipolar End Prosthesis by the anterior approach. This is the so called short Smith-Peterson approach. Eleven cases were female and four were male. The mean age at the time of operation was 77.5 years. (54 to 92 years). The mean follow-up period was 5.7 months. (2 to 11 months). There were no major complications during the operation, except in one patient who sustained femoral shaft fracture. No patient had nerve pulsy nor limping gait. Two cases showed stem sinking after surgery. All cases were satisfied with this operation by the anterior approach.
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Minoru Kashihara
2008 Volume 57 Issue 2 Pages
287-289
Published: 2008
Released on J-STAGE: May 23, 2008
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Avascular necrosis of the femoral head (ANF) after treatment of intertrochanteric fracture is a rare complication. We report two cases. Case 1: An 88-year-old woman became ANF three years after internal fixation using the Ender nail. Total hip replacement was performed for this patient. Case 2: An 86-year-old woman became ANF one year after internal fixation by compression hip screw. At operation, subtrochanteric comminuted fracture occurred, so two weeks later total hip arthroplasty by KLS tumor hip prosthesis was performed. The etiology of ANF after intertrochanteric fracture are high energy injury, vascular injury by excessive rotation during drilling of the femoral head, more proximal fracture line near the femoral neck, inadequate position of the lag screw in the femoral head, valgus reposition, vascular anomaly, etc. The superior retinacular artery which is most important for blood supply to the femoral head may be injured due to trauma or the operation. In our cases, a possible etiology was excessive valgus reposition of the femoral head. Although the rate of ANF after treatment of the intertrochanteric fracture is very low, intertrochanteric fracture is a risk factor of secondary ANF.
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Takako Nishihata, Toshiyuki Dokai, Michiya Nose, Yasushi Momota
2008 Volume 57 Issue 2 Pages
290-295
Published: 2008
Released on J-STAGE: May 23, 2008
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We compared the postoperative outcomes and range of flexion between patella-resurfacing total knee arthroplasty (TKA) and non-resurfacing TKA. We operated on 50 knees of 39 patients, using NexGen® LPS-Flex TKA. The patella was resurfaced in 35 knees of 27 patients (3 males and 24 females; mean age, 77.5; follow-up period, 15.5 months), but not in 15 knees of 12 patients (2 males and 10 females; mean age, 77.9; follow-up period, 7.1 months).
The flexion angle, the Japanese Orthopaedic Association (JOA) score, and plain radiographs were evaluated. In the resurfacing group, the changes of patellar thickness were analysed.
There were no significant differences between the two groups. In both groups, the postoperative flexion angle correlated with the preoperative one, and the JOA score improved statistically. The changes in patellar thickness did not have a significant effect on postoperative flexion angle in the resurfacing group.
Consequently, we recommend patellar resurfacing only in cases of severe osteoarthritis in the patellofemoral joint.
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Toshiyuki Dokai, Michiya Nose, Yasushi Momota
2008 Volume 57 Issue 2 Pages
296-299
Published: 2008
Released on J-STAGE: May 23, 2008
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We report the short-term results of 34 knees in 24 patients with ostheoarthritis treated by NexGen CR-Flex total knee arthroplasty (TKA). Patients received clinical and radiological evaluation. One male and 23 females with a mean age of 74.3 years were followed up for a period of five to 21 months (mean follow-up 10.0 months). Preoperative mean flexion angle improved after the procedure from 113.4 to 123.2. In addition, the mean Japanese Orthopedic Association knee rating score improved from 46.8 to 81.1 points. Clinical complications were not observed. There was no radiographic evidence of loosening or sinking. Correlation between preoperative/postoperative flexion angle and tibial component angle (beta angle)/postoperative angle were statistically significant. In our cases, the CR-Flex system provided deeper knee flexion angles than the CR system.
The use of CR-Flex in our short-term evaluation is associated with an improvement of flexion accompanied with good clinical outcome.
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Yasutaka Kugimoto, Akihiko Asami, Tadatsugu Morimoto
2008 Volume 57 Issue 2 Pages
300-302
Published: 2008
Released on J-STAGE: May 23, 2008
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Kimura's disease (KD) is a rare, benign, chronic inflammatory disease with unknown etiology and is seen more frequently in Asia. The typical presentation consists of painless papules or nodules with a predilection for the head and neck region, associated with lymphadenopathy, parotid gland involvement, peripheral blood eosinophilia and raised immunoglobulin E. We report a young man with KD involving the elbow and upper arm. Magnetic resonance imaging showed a soft-tissue mass of irregularity infiltrative strands in the brachioradialis muscle and beside the median nerve of the upper arm region. Fine-needle aspiration cytology was not useful in diagnosis, and surgical excision of the lesions was performed. Histological examination of the excised specimen showed the proliferation of lymphoid tissue and the infiltration of eosinophilic cells. Differential diagnosis should be considered for upper and lower extremity masses even in the orthopaedic field.
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Norihiro Kawagoe, Hideki Asato, Takeya Higa, Hiroki Maehara, Fuminori ...
2008 Volume 57 Issue 2 Pages
303-306
Published: 2008
Released on J-STAGE: May 23, 2008
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A case of neural fibrolipoma of the digital nerve is described. A 21-year-old female noticed a soft mass in her right little finger. The mass increased in size for two months, but she was asymptomatic and there was no loss of function. Magnetic resonance imaging showed low signal intensity on both T1 and T2-weighted images in both radial and ulnar sides around the PIP joint. Surgical resection revealed white tumor surrounding the neurovascular bundle. Pathological diagnosis was neural fibrolipoma. At 10 months, no evidence of recurrence was detected after the surgery.
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Etsuko Nakane, Osamu Soejima, Masatoshi Naito, Tadayoshi Fujita, Hiroy ...
2008 Volume 57 Issue 2 Pages
307-310
Published: 2008
Released on J-STAGE: May 23, 2008
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We herein report our clinical experience of using the fascia fat flap to perform an ulnar neuroparalysis, in a patient who suffered a heat press injury on the medial part of the elbow. A 25-year-old male who attempted suicide with a briquette and suffered a heat press injury around the medial part of the elbow. The patient's overall status settled down one month after the injury, when he visited our clinic complaining of pain from the left forearm to the hand on the ulnar side and a slight deformity of the fingers as his chief complaints. Claw hand deformity, a loss of sensation in the little finger and an undetermined nerve conduction velocity were observed, and he was thus diagnosed to have ulnar neuroparalysis. With the aim of promoting blood circulation around the area, we simultaneously performed neurolysis of the ulnar nerve, as well as nerve coating, using the ulnar recurrent fasciocutaneous island flap. We were thus able to obtain good results in which the pain subsided in the early postoperative period, while an improving trend in the claw hand deformity was seen about one month later, and subsequently, the patient demonstrated an improvement in sensation.
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Takeya Higa, Hideki Asato, Norihiro Kawagoe, Fuminori Kanaya
2008 Volume 57 Issue 2 Pages
311-315
Published: 2008
Released on J-STAGE: May 23, 2008
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Vacuum assisted closure (VAC) is a wound treatment using negative pressure created with a sponge, film drape, and suction tube. Continuous negative pressure was applied to the wound. We reported three cases of intractable ulcer of the lower limb improved by VAC. Two cases had diabetes mellitus and one case had HTLV-1 associated myelopathy (HAM). It took 35 days, 18 days, and 60 days respectively for VAC treatment to heal these ulcers.
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Kazumasa Maeda, Satoru Motokawa, Takeshi Miyaji, Hideki Ishii, Kiyofum ...
2008 Volume 57 Issue 2 Pages
316-318
Published: 2008
Released on J-STAGE: May 23, 2008
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We evaluated the effect of early operation on complications and medical expenses in hip fractures. This study includes 94 subjects over 60 years of age operated between 2004 and 2005. The subjects consisted of 69 females and 25 males, whose mean age was 80.2 years. Fifty cases were femoral neck fractures, and 44 femoral trochanteric fractures.
We found that perioperative complications delayed the timing of surgery, and increased hospitalization and medical expenses. Our results suggest that earlier surgical repair without perioperative complications lead to shorter length of hospital stay and reduction of medical expenses.
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Yoichi Hayashida, Kazushige Maeda, Takafumi Torigoshi, Takeshi Hiura, ...
2008 Volume 57 Issue 2 Pages
319-323
Published: 2008
Released on J-STAGE: May 23, 2008
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We report the epidural amyloidoma of lumbar spine in long-term peritoneal dialysis patient. A 69-year-old man treated with long-term peritoneal dialysis suffered from left lower limb pain without exciting causes. MRI of the lumbar spine revealed a 10 mm×12 mm cystic lesion, compressing the theca at the L4 level. This had low signal intensity in T1-weighted images and was enhancing heterogeneously in T2-weighted images. In enhanced MRI, the lesion was also contrasted heterogeneously, and other enhancing lesions were found at the outside of the vertebral arch. Because we suspected epidural abscess or malignant tumors, we performed resection of the masses with L4 hemilaminectomy. Acidophilic amorphous deposits were seen in the specimens by Hematoxylin-Eosin stain, and they were contrasted by Congo-red stain, which led to the diagnosis of amyloidosis. The patient had relieved symptoms completely.
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Masashi Kamikawa, Toshitake Yakushiji, Hiroo Satoh, Kiyoshi Oka, Hiros ...
2008 Volume 57 Issue 2 Pages
324-327
Published: 2008
Released on J-STAGE: May 23, 2008
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Resection of abdominal wall soft tissue tumor may result in abdominal wall defects, recquiring abdominal wall reconstruction. To avoid serious complications, and intestinal hernia, appropriate reconstruction is needed. Four patients were treated for abdominal wall defects resulting from resection of soft tissue tumor. Subjects consisted of three males and one female with the mean age of 37 years (range: 29 to 54 years). Histopathological diagnoses were synovial sarcoma, malignant peripheral nerve sheath tumor, abdominal desmoid, and granular cell tumor. We selected direct closure to small defects of the anterior or posterior rectal sheath, reconstructed to posterior large defects by composite mesh and to anterior large defects by Marlex mesh. Mean follow-up was 19 months (range: 8 to 29 months). There were no late complications, incisional hernia, infection of mesh, seroma, or intestinal fistura.
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Norihiro Kawagoe, Hideki Asato, Takeya Higa, Fuminori Kanaya
2008 Volume 57 Issue 2 Pages
328-331
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a 49-year-old man with rotator cuff tear including the subscapularis tendon tear and dislocation of the long head of the biceps tendon. He suffered shoulder injury when his sleeve got caught on the edge of the drum as he jumped off the drum from a height of 1.5 m. He refused operation of his shoulder, so we rehabilitated him for eight weeks. However, he eventually underwent operation due to severe pain in his shoulder after picking up heavy baggage. We repaired the supraspinatus tendon rupture by arthroscopy, and the subscapularis tendon rupture and dislocation of the long head of the biceps tendon using these metallic anchors directly. He returned to work at six months after surgery.
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Hirokazu Saiwai, Tosihiko Hara, Shigekazu Kaminomachi, Keita Miyanishi ...
2008 Volume 57 Issue 2 Pages
332-336
Published: 2008
Released on J-STAGE: May 23, 2008
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We measured changes in acetabular roof obliquity and CE angle along with the retroversion of the pelvis in twenty normal hips and twenty dysplastic hips. Computer-based three dimensional template software was used to analyze MPR CT images. The line connecting the central points of the bilateral femoral heads was defined as reference line in the coronal plane. Acetabular roof obliquity and CE angle were measured in the coronal plane by rotating the pelvis posteriorly 5 degrees around the reference line up to 35 degrees. Acetabular roof obliquity tended to increase and CE angle tended to decrease as the pelvic retroversion progressed both in the normal hip and dysplastic hip groups. This method using MPR image is useful to evaluate hip joint in clinical cases.
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Hirokazu Saiwai, Toshihiko Hara, Shigekazu Kaminomachi, Atsushi Shiran ...
2008 Volume 57 Issue 2 Pages
337-341
Published: 2008
Released on J-STAGE: May 23, 2008
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Percutaneous fixation of calcaneal intra-articular fracture is a popular procedure. However, complications such as pin track infection, wound necrosis, and pin loosening occur. To solve these problems, we invented a new screw system (RS screw). The purpose of this study was to introduce the technique of percutaneous fixation using RS screw and report the clinical and radiological results of the RS screw. We used the RS screw in 13 feet (12 patients) from February 2005 to March 2006. Postoperative complications such as infection and pin loosening were not experienced. This procedure using the RS screw is not only simple but also effective for the treatment of calcaneal intra-articular fracture.
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