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Shinji Yoshino, Masaru Higo, Masahiro Nakamura
2009 Volume 58 Issue 4 Pages
533-536
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We studied the results of treatment with the Ponseti method in patients who had subsequently attained an age of over two years. Twenty-one feet were treated in fourteen patients aged 2-5.5 years (mean age: 3 years and 4 months), consisting of eleven feet in eight boys and ten feet in six girls. We examined the presence of relapses and additional surgery, and compliance with orthosis treatment in these patients. Toeing-in gait was observed in eight feet, and equinus deformity in one foot. Additional surgery consisting of postero-medial release was performed on two feet, posteirior release on one foot, and medial-lateral release on two feet. Compliance with orthoses was poor in ten feet (47.6%), of which six showed relapses.
Early clubfoot treatment with the Ponseti method was effective, but a relapse of foot deformity after gait initiation was seen in some patients. In particular, toeing-in gait was common in patients with a poorly-fitted orthosis. Compliance with orthosis treatment needs to be adequately studied and addressed.
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Hisato Tanaka, Mitsunori Komine
2009 Volume 58 Issue 4 Pages
537-541
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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A 32-year-old femals was transported to ER in an ambulance after a motor vehicle accident, and visited our hospital with whiplash syndrome diagnosis three days later. Her main complaint was neck pain, and numbness of the index and middle fingers. We found a teardrop type fracture of the C 7 vertebral body and narrowing of the C 6/7 foramina by projecting fragments on X-ray. Retropharyngeal space was 2 mm and retrotracheal space was 13 mm. The left C 6/7 facet joint rode over on CT. Range of motion, was 30 degrees on flexion and 45 degrees on extension. Right rotation was 60 degrees, left rotation was 45 degrees, right bending was 30 degrees, and left bending was 10 degrees. In spine injuries evaluation of abnormal static architectonics on image is comparatively easy, but it is said that skull cervical vertebrae transitional region, neck thoracic vertebra transitional region, and sacral vertebrae region injuries are easily overlooked. In this case, dislocation fracture was overlooked due to comparative good mobility preserved in the first examination. However, although the left C 6/7 facet was actually locked, the upper cervical spine was able to move about 40 degrees, especially the O-C joint.
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Masahiro Shirahama, Kazuhisa Masuda, Keisuke Mori, Hiizu Hara, Kennsei ...
2009 Volume 58 Issue 4 Pages
542-546
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We reviewed 20 cases of pelvic ring fracture as the main factor of death for ten years. Cause of injury was traffic accident in 13 patients. Seven patients were type C, Seven were type B, and Six were type A according to the AO classification. The average age of type A patients was 76.8 years and that of type B was 74.6 years. They were associated with head, chest, or abdominal injury. Seven patients were brought to an emergency hospital, but they were transported to an emergency and critical care center because hemodynamic worsened. In addition, ISS was high in type C patients, and these patients were already in serious condition at admission. They were treated for massive blood transfusion and pelvic band or external fixation. We performed TAE, but hemodynamic did not improve in 16 patients. As for pelvic ring fracture with hemorrhagic shock, early start of treatment and initial treatment are important, and appropriate treatment should be performed for survival. In addition, careful attention is required to prevent hemorrhagic shock in elderly patients even if they are type A.
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Makoto Morita, Takashi Ikeda, Shinichi Miyazaki, Toru Tsuchida, Yasuhi ...
2009 Volume 58 Issue 4 Pages
547-550
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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From 2001 to 2007, 1492 cases of spinal surgery were performed in our hospital. Out of the 1492 cases, six cases (0.4%) had neurological complications after spine surgery because of postoperative epidural hematoma. All six cases underwent immediate removal of hematoma and their surgical outcome was good in five cases and poor in one. It is important to watch for neurological symptoms after spinal surgery, and the surgeon must not hesitate to decide removal of hematoma found.
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Kazuo Kimura, Hidetoshi Onoue, Yoji Murakami, Jyunji Maeda, Fumihiko Y ...
2009 Volume 58 Issue 4 Pages
551-554
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a case of pseudoaneurysm of the superior lateral genicular artery after supracondylar fracture of the femur. A 65-year-old female who had a traffic accident, was admitted to our hospital complaining of pain of her right knee. X-ray showed supracondylar fracture of her right femur. Next day, we performed osteosynthesis using a supracondylar nail. Blood transfusions were administered because anemia progressed after the operation. On postoperative days, her right knee was swollen externally but peripheral pulses were palpable. At 3 weeks, swelling of her right knee progressed and demonstrated a pulsation in this area after the surgery. Ultrasoundgraphy was performed and color Doppler echogram showed pseudoaneurysm of 25×16 mm in diameter outside her right knee. Computed tomographic-angiography showed pseudoaneurysm of the right superior lateral genicular artery, which we surgically resected. At follow-up five months later, no local recurrence had occurred.
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Mihoko Koga, Naoyuki Kuga, Hiroshi Hagihara, Masao Teramoto, Masuo Han ...
2009 Volume 58 Issue 4 Pages
555-557
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Percutaneous wiring for patella fractures is a less inavasive method but it has no prevalent indications.
Between April 1999 and May 2008, 36 patella fractures with percutaneous wiring of 19 males and 17 females aged 62.3 years on average (range: 19 to 84) were reviewed for type of fracture, complications, and range of motion. Four cases needed further surgery, because of nonunion or delayed union.
When the fracture is severely comminuted with considerable separation of bone fragments and displacement, open reduction and internal fixation are required, because of high nonunion rate with percutaneous wiring.
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Tomoyuki Taura, Takeshi Uchida, Shinichi Nakahara, Tadashi Tomonaga
2009 Volume 58 Issue 4 Pages
558-563
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We reviewed cases on whom we operated on using the RING PIN system for comminated patellar fracture. Amongst 27 patients who underwent surgery at our hospital for this fracture, we used the RING PIN system on four patients (three males and one female) . The average age of these four patients at the time of injury was 59.8 years old. The other 23 cases were operated using circumference wiring, tension band wiring, CCS, or Acutrak screw. The four patients using the RING PIN system were asked to wear knee brace after surgery, and were allowed full weight bearing from the next day surgery. We also started the patients on range of motion exercise from an early period postoperatively. Ten weeks after surgery, all four patients healed without knee range of motion showing laterality of over 10 degrees. None of the patients also developed complications such as skin irritation, radislocation, or infection due to postoperative damage of the pin and wire. These results suggest that the RING PIN system is an excellent surgical method resolving the problems of conventional techniques for treating comminuted patellar fractures.
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Takuya Ikuta, Futoshi Kuga, Shinsaku Ogimoto, Kennichi Yawatari, Koich ...
2009 Volume 58 Issue 4 Pages
564-566
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Seven children with tibial fracture were treated surgically using the locking plate. Their mean age at fracture was 13.0 years.
The mean time until partial weight bearing was 3.3 weeks. The mean duration of admission was 3.3 weeks. All cases had bone union without malunion or limb shortening.
Osteosynthesis using the locking plate is a useful method of treatment for tibial fractures in children from elementary school, allowing early crutch-assisted gait and early return to school.
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Ryuji Ichimura, Jun Arimizu, Teruaki Izaki, Tatsuki Kobayashi, Yoshihi ...
2009 Volume 58 Issue 4 Pages
567-570
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Subjects comprised 42 patients who underwent double door laminoplasty, between 1998 and 2006, with a minimum follow-up period of two years. Radiologic and clinical data were prospectively collected. Angle of cervical lordosis, cervical curvature index, and range of motion were diminished by gradation. 29 patients with over 50 percent in improvement rate of Hirabayashi were defined as good group, and 13 patients with less than 50 percent were defined as poor group. Postoperative cervical curvature index showed significant difference between the two groups. The attachment of the muscle to the C2 spinous process was preserved in 14 patients (C2 preserved group), restored in 14 patients (C2 restored group), and two patients were not operated (no operative group). There were no significant differences between the three groups. These result indicate that maintainance of cervical lordosis after laminoplasty is important. Restoration of the attachment of the muscle to the spinous process also plays an important role in preventing the progress of cervical kyphosis. We head to design a plan for maintaining cervical lordosis, and further investigate factors affecting postoperative alignment.
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Jun Tanaka, Yozo Shibata, Teruaki Izaki, Takeshi Teratani, Kazumitsu U ...
2009 Volume 58 Issue 4 Pages
571-575
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Clinical results were compared between open and arthroscopic resection of the lateral end of the clavicle. Clinical results of arthroscopic resection were as same as that of open resection. The former was average 92 points and the later was average 90 points, respectively. Although no distinct difference was seen in the clinical results, arthroscopic resection of the lateral end of the clavicle was vequired to prevent conspicuous operative scarring.
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Narihiro Okazaki, Takashi Miyamoto, Shiro Kajiyama, Akihiko Yonekura, ...
2009 Volume 58 Issue 4 Pages
576-580
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The Taylor Spatial Frame (TSF) is a modern circular external fixator, which is able to correct deformities easier than the Ilizarov system. The TSF consists of two rings connected by six telescopic struts. It is capable of correcting a six-axes deformity by adjusting the strut lengths. We report our experience of tibial fractures treatded by the TSF. Seven fractures were treated by TSF. They consisted of three open fractures and four closed fractures. The mean age at injury was 42.9 years. The average length of time from injury to TSF fixation was 10.2 days and the period of fixation was 98.9 days on average. There were four pin site infections but no deep infection, and two limitations in ankle dorsiflexion. All cases achieved union and anatomical alignment. The TSF can be applied easily in acute fracture situations. It provides a way to adjust the fracture site during the post operative period. It is stable enough to allow early functional weight bearing and range of motion exericse. The TSF is a valuable tool for the treatment of tibial fracture from the acute trauma phase to healing.
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Hidetoshi Onoue, Kazuo Kimura, Yoji Murakami, Junji Maeda, Fumihiko Ya ...
2009 Volume 58 Issue 4 Pages
581-583
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Two rare cases of Achilles tendon rupture involving avulsion fracture of osteophyte of the calcaneus were encountered. The cases differed by the appearance of the rupture site. The first case was a 43-year-old male. The rupture occurred when he dashed from first base to second base during a softball game. The superficial fiber of the Achilles tendon was attached to the osteophyte fragment and no rupture was observed in the deep fiber of the Achilles tendon. The second case was a 60 year-old male with rupture caused as a result of losing his footing on stairs. The deep fiber of the Achilles tendon was attached to the fragment and the superficial fiber had ruptured at 5 cm from the attachment point on the osteophyte fragment. In both cases, the fragment was reduced to its original position and fixed with AO 6.5 mm cancellous screw with washer. Rehabilitation walking exercise was carried out after four weeks of casting. No symptoms were observed six months after surgery in both cases.
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Seiji Higuchi, Tomomi Matsuoka, Akihiro Kawano, Ryuma Mitsuhashi
2009 Volume 58 Issue 4 Pages
584-589
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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[Case 1] A 54-year-old man was caught inside heavy equipment during work and sustained injury. His talus broke the skin and protruded out. Simple X-ray revealed left talus open dislocation fracture. After washing, open reduction was performed.
[Case 2] A 37-year-old woman was injured in a traffic accident. Deformation of the foot joint was seen. Simple X-ray and CT indicated right subtalar inside the dislocation fracture. Close reduction was performed but due to remaining sub-dislocation of the subtalar, open reduction was performed.
[Case 3] A 13-year-old girl visited out hospital due to difficulty in walking and stumbling over steps. Her left foot was fixed in the plantar flexion, and Xp indicated dislocation of the left talus. She was treated with a plastic cast for preservation.
[Discussion] Neither re-dislocation nor avascular necrosis of the talus were seen for talus dislocation in the patients experienced this time after reduction. Details are reported including reference to some literature.
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Yu Fukao, Etsuo Chosa, Shotaro Nozaki, Yoshihiro Nakamura
2009 Volume 58 Issue 4 Pages
590-597
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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In our hospital which has an ER department, patients with polytrauma are treated mainly by doctors in charge of the diagnosis and treatment of severe injuries. However with polytrauma patients with both limb and pelvic fractures, the orthopaedics department often faces the dilemma of not being able to provide treatment at the ideal timing due to the priority given to life-saving treatment. In recent years, damage control orthopaediscs (DCO) which focuses on temporary fixation in the aim to improve life and functional prognosis in the initial treatment strategy of polytrauma patients is being recognized mainly by trauma surgeons. However, it is not familiar to general orthopaedists and have yet to become a common treatment. Based on the concept of DCO, since 2006 we have been enthusiastically carrying out temporary fixation in the initial treatment of polytrauma patients with both limb and pelvic fractures, followed by definitive treatment. We have been achieving good functional prognosis, and report the results of two cases including discussion of some literature.
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Jun Tanaka, Yozo Shibata, Teruaki Izaki, Takeshi Teratani, Kazumitsu U ...
2009 Volume 58 Issue 4 Pages
598-603
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Two cases of proximal humeral fracture were reported.
Case 1 was a 60-year-old man. Antero-posterior and scapular outlet view revealed a 3-part fracture. Osteosynthesis with plate was done. One month after the surgery, plain X-ray showed the displaced lesser tuberosity impinged to the glenoid. Although he was capable of range of motion exercise, restriction of horizontal flexion did not recover. Six months later, the displaced lesser tuberosity was ressected arthroscopically. His JOA score increased from 67.5 points to 90 points.
Case 2 was a 39-year-old man. He had a 3 part fracture of the humerus. In the first operation, ostheosynthesis was performed with locking plate for surgical neck fracture and No.5 ethibond suture fixation was performed on the lesser tuberosity fracture. Because of low compliance, he discarded the sling and bandage following non-union of the lesser tuberosity. As second surgery, the lesser tuberosity was fixed with screw and No.5 ethibond suture. But this second surgery failed. Finally, small locking plate and wiring fixation were performed. This third operation achieved union of the fracture.
When treating lesser tuberosity fractures, the orthopedic surgeon needs to consider the degree of displacement and patient compliance.
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Katsuhiko Ishibashi, Gentaro Hanaishi, Kenichiro Nakai, Masato Nagashi ...
2009 Volume 58 Issue 4 Pages
604-608
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Recently the plate and intramedullary nail with locking system is being developed, and improvement of the operative treatment for proximal humeral fractures and good treatment results are reported from many people. We used intramedullary nails with locking system for all 11 cases who underwent operation for proximal humeral fracture regardless of the fracture type at our hospital between January 2003 and March 2006 and, for all 10 cases who underwent operation for a period between April 2006 and March 2008, we used the locking plate. We recognized significant difference in cutout rate when we compared an intramedullary nail with locking plate for treatment results about bone union, varus transposition, whether cutout and backout of screw was used or not on X-ray and based on clinical symptoms such as sharp pain and excursion. But the treatment results were approximately the same, and it was thought with good without recognizing significant difference for a clinical symptom.
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Hiromichi Yasuoka, Tetsuo Nakano, Ryuya Ochi, Daisuke Inaba, Yoshikazu ...
2009 Volume 58 Issue 4 Pages
609-613
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report two rare cases of ulnar nerve neuropathy.
A 70-year-old man and a 68-year-old man complained of ring and little finger numbness and medial elbow pain which appeared acute onset.
Adduction disorder of the little finger, sensory disturbance in the ring and little fingers, Froment sign and Tinel sign on the ulnar nerve were observed.
Magnetic resonance imaging showed an osteophyte contacted with the ulnar nerve and a high signal intensity longitudinal lesion on the T2-Weighted image in the first case, and a cystic lesion with low signal intensity on the T1-Weighted image and high signal intensity on the T2-Weighted image in the second case.
Operation was performed to release the cubital tunnel.
In the first case, a free osteophyte was observed, compressing the ulnar nerve strongly.
In the second case, a cystic tumor connected with the humeroulnar joint capsule was observed entering into the ulnar nerve. A bone fragment was seen in the cystic tumor.
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Daisuke Tanino, Kimiko Tsuda, Masaru Kuwamoto
2009 Volume 58 Issue 4 Pages
614-618
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We used volar locking plates for distal radius fractures in 29 cases with a mean age of 67.2 years (range: 19 to 92 years) and assessed the radiographic and clinical results using the Mayo scoring system. Significant postoperative reduction loss and arthritis were not observed. All fractures healed uneventfully. Excellent results were obtained in 19 cases (66%), good in 6 cases (20%), fair in 4 cases (14%), and none was poor. To conclude, the clinical results of the treatment with the volar locking plate in this study were successful, suggesting that the longer the observation period, the better are the results in one year follow-up. We therefore think that clinical evaluation should be carried out about one year after surgery.
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Jo Hasei, Meguru Inoue, Yuji Moriya, Naoaki Kahara, Tadashi Miyamoto, ...
2009 Volume 58 Issue 4 Pages
619-622
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report the clinical results of surgical and conservative treatment for unstable distal radius fractures in older adults. During the period between 2004 and 2007, eight cases in seven patients (one male and six females, mean age: 69.4 years) were treated surgically treatment (four external fixation, two pinning, and two using both external fixation and pinning). Nine cases in nine patients (all females, mean age: 70.1 years) were treated conservatively. The average follow-up period of the surgical group was one years ten months, and that of the conservative group was one year two months.
The fracture of all cases was of the unstable type. The radiological evaluations were ulnar plus variance (UV), volar tilt (VT), and radial inclination (RI). The clinical results were evaluated using Cooney's score and Saito's point system. Though good reduction was obtained in the surgical group, shortening deformity of the radius had gradually progressed to the UV level in the preoperative state. The scores of the subjective symptoms were excellent or good at 87.5% in the surgical group, and 88.9% in the conservative group according to the Saito's point system. In our study, the acceptable range of distal radius fracture deformity was wide in case of older adults, and even if mal-union remained, they expressed satisfaction without trouble in ADL. Consequently, the treatment proved better for older adults based on their lifestyle.
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Tomoka Sanno, Tsuyoshi Takenouchi, Eiji Taketomi, Yasuhiro Tsuneyoshi, ...
2009 Volume 58 Issue 4 Pages
623-626
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The treatment of osteoporotic vertebral compression fracture is still controversial. In the present study, we reviewed cases with nonunion of vertebral compression fractures treated by percutaneous vertebroplasty. We reviewed six cases treated from March 2007 to April 2008. Clinical results were evaluated by pre-operative and post-operative JOA scores on activities of daily living, VAS (visual analog scale), and cuneate rate-anterior/posterior height of vertebra×100(%). There were no cases with cement leakage, vessel injury, and pulmonary embolism. Their JOA score increased post-operatively from 3.4/14 to 7.7/14, cuneate rate decreased, and VAS improved from 10 to 3.8. Although the results were satisfactory, we need to perform further studies on the results in long term follow-up of a larger number of cases.
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Yuichiro Yazaki, Masaaki Imabayashi, Hirofumi Osako, Katsuro Fukuyama, ...
2009 Volume 58 Issue 4 Pages
627-629
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The purpose of this study is to evaluate the results of surgical treatment for using acromioclavicular plate. We treated twelve cases of displaced fractures of the distal clavicle between October 2002 and February 2008. All cases obtained bone union and satisfactory clinical results in this study. It is essential to place the hook at an appropriate posterior position in the acromion and to bend the plate to fit the clavicle.
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Dai Murata, Tetsuo Kojima, Tomoyuki Mizoguchi, Kenji Goto, Yoshifumi U ...
2009 Volume 58 Issue 4 Pages
630-633
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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A 31-year-old man was assaulted on his left upper arm on February 16 2006. At that time, no fracture was indicated. He was then assaulted again on March 6 2006 and his left elbow was hyperextended. He had a fracture of the distal shaft of his humerus and very extensive ossification of the brachium. Long arm splint was applied for four weeks, and he was prescribed with etidronate. He came to our hospital on June 21 2006 for a second opinion. There was remarkable limitation of ROM in the left elbow joint, and strong motion pain. X-ray showed very extensive ossification in the distal anterior region of the upper arm. Hoping that inflammation would calm down, we decided to wait without operation. He did not come to our hospital after that. About two years later, he visited our hospital again, there was improvement of ROM in the left elbow joint, and no motion pain. On X-ray, there was reduction of the ossification, allowing daily activities without hindrance.
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Ai Mori, Masao Noguchi, Seiji Tsuji, Hirofumi Doukawa, Takayuki Shida, ...
2009 Volume 58 Issue 4 Pages
634-638
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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It is difficult to treat fracture of distal end of humerus in adults. We need strong fixation for early rehabilitation. We summarized the outcomes of plate fixation for these patients.
[Objectives and methods] 10 patients (two males, eight females)underwent osteosynthesis from January 2006 to May 2008. The average age of the patients was 67.2 years old. The mean observation period was 11.8 months. Fracture types (AO classification) were outlined below: type A2: six cases, type B2: one case, type C1: one case, type C3: two cases. We treated fracture with anatomical plate and limited contract humerul plate (made by Synthes), ONI TRANSCONDYLAR Plate (ACUMED), Mayo clinic Congruent Elbow Plate.
[Results] The mean range-of-motion at the endpoints was flexion: 118°, extension: −16.5°, Complications were ulnar nerve palsy in one case, ectopic occification in one case, and loosening of screw in one case.
[Discussion] Plate fixation is also useful for intraarticular fractures and elderly patients.
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Katsuhiko Kunitake, Kimiaki Nishida, Yoshihisa Anraku, Yosuke Kawatani ...
2009 Volume 58 Issue 4 Pages
639-642
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Distal humerus fractures in adult, because of their rarity and are often associated with significant displacement, comminution, and osteopenia, can lead to difficult management decision. We treated six cases of this fracture, and evaluated their clinical results. There were five females and a male; whose average age was 67 years (range: 46 to 89). According to the AO classification, there were two type A fractures, two type B, and two type C fractures without severe comminution. All cases were treated operatively with open reduction and internal plate fixation using the LCP-Distal Humerus Plate (Synthes). At a mean follow-up of 10.2 months (range: 6 to 16), three results were excellent, two good, and one fair. The LCP-Distal Humerus Plate can serve as an effective technique for the fracture of the distal humerus.
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Ryosuke Otsuka, Meguru Inoue, Yuji Moriya, Naoaki Kahara, Tadashi Miya ...
2009 Volume 58 Issue 4 Pages
643-646
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We reported the results of distal radiaus fractures in children. Between 2006 and 2008, a total of 23 patients (19 males, four females) underwent conservative treatment or pinning method. The patients' average age at the time of the injury was 11.2 years old. In this study, we measured angulation and translation using X-ray lateral view for both groups. At the time of injury, the translation rate of the pinning group was significautly larger than the conservative group. Even, in the case of mild displacement, two patients with dorsal cortical comminution had re-displacement after reduntion. Consequently, we should consider the choice of pinning at the first examination not only for severe displaced cases but also mild cases with dorsal comminution.
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Sanshiro Inoue, Masakazu Kozuma, Naoshi Kikuchi, Yoshikazu Saita, Hide ...
2009 Volume 58 Issue 4 Pages
647-649
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We investigated extremity fractures in children under 15 years old treated at our hospital from April 2006 to November 2007. The subjects were 97 children and 99 fractures. The ratio between male and female was 4.4: 1 . Seventy-two fractures were introduced from their primary doctor or ambulance. The cause was sports in 38 fractures. There were 69 upper extremity fractures, 26 lower extremity fractures, and four pelvic fractures. The fractures consisted of 23 epiphyseal injuries and six open fractures. 63 fractures were treated surgically. Compared with other reports, most of our patients were treated with surgery. This is because many of the patients were introduced from their primary doctor or ambulance.
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Shozo Kanezaki, Takuya Ikuta, Mitsuru Sakaguchi, Kunihiko Tomoda, Futo ...
2009 Volume 58 Issue 4 Pages
650-653
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Between 1998 and 2008, thirteen cases of Jones' fracture were treated and followed up at our hospital. Ten of the 13 subjects were men and three were women. The age of patients ranged from 16 to 22 (mean 18.3). All were athletes; seven basketball players, three handball players, two rugby football players, one football player, and one badminton player. Four patients were treated conservatively before visiting our hospital (3 to 12 week) and nine visited our hospital within one week of onset. We treated two patients conservatively and delayed union occurred in both patients. Eventually, both patients underwent surgeries. The other 11 patients were treated surgically. All, including five patients treated conservatively at onset obtained union (mean 8.9 weeks) and median time to return sports was 7.9 weeks. We recommend early osteosynthesis especially in athletes.
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Go Takayama, Toshihiro Ohdera, Masami Tokunaga, Eiji Yoshimoto, Syusak ...
2009 Volume 58 Issue 4 Pages
654-658
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We investigated the results of arthroscopic healing of conservatively treated medial meniscal tears combined with anterior cruciate injury.
There were 55 medial meniscal tears in 280 patients who had anterior cruciate reconstruction. Second look arthroscopy was performed in 45 patients a year after the reconstruction. Partial excision of the meniscus was seen in 23 patients and the meniscus was conserved in 32. We examined these 32 patients with conserved meniscus. The meniscus remained in situ in 15, it was rasped in 9 and sutured in 8. All of these 32 patients with healed meniscus were evaluated arthroscopically as completely healed, partially healed (good) and not healed (poor) one year after anterior cruciate reconstruction. We evaluated 12 menisci (80.0%) as good in the remained in situ group, five (55.6%) in the rasped group, and five (62.5%) in the sutured group. Overall, 22 menisci (68.8%) were judged as good in the 32 conserved menisci.
Lateral meniscal tears seen in anterior cruciate injuries are known to show good results, but results of medial meniscus remain controversial. This study suggests that the stability of knee joints gained by anterior cruciate reconstruction could also provide medial meniscal healing, but suture should be discussed for unstable meniscal tears considering limitation of post-operative activities.
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Kazumasa Maeda, Katsuhiro Aita, Masaru Kitajima, Takao Hotokebuchi
2009 Volume 58 Issue 4 Pages
659-661
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The purpose of this study was to evaluate lumber spine scoliosis and sacroiliac joint in osteoarthritis of the hip. We investigated 45 patients who underwent primary THA in our hospital between January 2002 and May 2004. The subjects had a mean age of 63 years. The rate of scoliosis was 56%, 68% of whom had osteoarthritis of the hip. The rate of sclerotic sacroiliac joint was 67%, 57% of which was at the intact side. We think that both changes were compensatory.
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Takayuki Shima, Yasutsugu Yamashita, Ryota Teshima
2009 Volume 58 Issue 4 Pages
662-664
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We experienced a case of cubital tunnel syndrome involving the epitrochloeanconeus muscle. The patient was a 17-year-old female student of a vocational high school. She noted numbness of the right ring and little finger. As internal treatment by a local doctor was ineffective and claw finger deformity appeared, she was referred to our department. She had difficulty in adduction of the little finger, and the symptoms exacerbated by playing the keyboard and at the Wright test position. Nerves were trapped under the epitrochloeanconeus muscle due to fibrous connective tissue-type adhesion. The epitrochloeanconeus muscle and Osborne ligament were cut, and subcutaneous anterior transference of the ulnar nerve was performed. Adduction of the little finger became possible on the day after surgery. In this patient, cubital tunnel syndrome is considered to have been caused by a dynamic factor, i.e., entrapment, as well as static factors. When the length of the ulnar nerve was determined as the distance between the medial epicondyle of the humerus and styloid process of the ulna, a significant difference was observed, suggesting effects of the limb position.
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Shozo Kanezaki, Katsutoshi Hara, Masanori Kawano, Ichiro Itonaga, Nobu ...
2009 Volume 58 Issue 4 Pages
665-667
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Rectus sheath hematoma is relatively rare, and should be included in the differential diagnosis of patients with acute abdominal pain and abdominal mass. We describe a patient with rectus sheath hematoma caused by coughing. A 77-year-old man was admitted with abdominal pain and mass. 10 days before admission, he presented with intense coughing and sputum due to bronchitis, followed by fever and sharp abdominal pain two days later. Ultrasonography and CT scan revealed a hematoma inside the right upper rectus sheath. The patient responded to conservative therapy. The hematoma almost disappeared in the course of three months.
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Masamichi Onaga, Goichi Okahara, Tomohiro Isa, Wataru Oshiro, Chojo Fu ...
2009 Volume 58 Issue 4 Pages
668-672
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We reported two cases of giant cell tumor of the tendon sheath (GCTTS) with intraosseous invasion of the carpal and metacarpal bones.
The first case was a 26-year-old female. She noticed an asymptomatic mass on the dorsal aspect of her left wrist. Radiographs showed bony erosion like a punched-out lesion of the fourth and fifth carpometacarpal joints. MRI showed intraosseous invasion of tumor. Needle biopsy revealed that the tumor was GCTTS. Simple resection and bone curettage were performed. At 1 year and 5 months after the surgery, no recurrence was seen.
The second case was a 60-year-old male. Resection of the tumor at the volar wrist was performed six years ago and its diagnosis was GCTTS. Three years after the previous surgery, he noticed soft mass on the volar and dorsal aspects of the left wrist. The mass increased in size gradually. He was referred to us and radiographs showed bony indentation of the third and fourth carpometacarpal joints. We diagnosed this tumor as a recurrence of GCTTS and performed a second resection. At two years and two months after the second surgery, no recurrence was seen.
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Kyota Nishifuru, Tadatsugu Morimoto, Satoshi Ikebe, Yuki Uesugi, Masar ...
2009 Volume 58 Issue 4 Pages
673-677
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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There are various methods for evaluating general joint laxity. In this study, we used typical methods such as Carter's, Beighton's, and Tokyo University's on 40 male students of the Sports Department of Saga University. We used intraclass correlation coefficient (ICC) for statistics. The intra-observer reliability of each method was good, with the Tokyo University's method being the best. The ICC value differed vastly according to the joint. The values of thumb, shoulder, and spine were great, but those of elbow, knee, and ankle were low. Those of wrist, little finger, and hip were intermediate. In the future, there is a need to set criteria for measuring general joint laxity, and determine the joint to be measured, number of joints measured, and measurement method according to purpose.
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Jouji Morinaga, Masamori Shigematsu, Satomi Nagamine, Shunsuke Kawano, ...
2009 Volume 58 Issue 4 Pages
678-681
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We had been using the Alumina Bearing Surface Total Hip Arthroplasty (ABS THA: Kyosera) system from September 1998 to July 2000. However, because of ABS liner dissociation, use of the implant is stopped presently. This time, we investigated the risk factors of liner dissociation in ABS THA. The sujects consisted of 218 hips that underwent ABS THA, 24 hips with liner dissociation, and 194 hips without no liner dissociation. We compared the liner dissociation group with the no dissociation group with regard to sex, age, BMI, preoperative arc, period of sickness, state of opposite hip, preoperative dislocation and measurements on X-ray. Period of sickness, preoperative arc on flexion-extension, and preoperative dislocation showed significant differences. Short period of sickness, good preoperative arc on flexion-extension and preoperative dislocation may be risk factors of liner dissociation due to increased rubbing of the ceramic surface.
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Masaki Yoh, Yoshihisa Kawauchi, Koji Sameshima, Natsuko Tomimura, Osam ...
2009 Volume 58 Issue 4 Pages
682-687
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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[Introduction]
We are already reporting on the the midline spinous process-splitting approach using the METRx-MD system. We acquired excellent results by applying it to the MED system.
[Subjects and Methods]
The subject group consisted of 14 patients (eight men and six women) who underwent the midline spinous process-splitting approach using the METRx-MED system between September 2006 and July 2007. The mean age of the subjects was 68.3 years. The mean follow-up observation period was 203.6 days.
[Surgical techniques]
After making a 2 cm skin incision, we split the spinous process using a mini-bonesaw and chisel. We then inserted an 18-mm tubular retractor with a dilator after opening the spinous process at the base to the left and right with an osteotome and chisel. Following bilateral decompression through a median line, we sutured the spinous process.
[Results]
Mean JOA scores improved from 14.4 points to 25.4 points after surgery. The mean blood loss for one level was 67.4 g, and the mean time for one level was 116 minutes.
[Conclusion]
The midline spinous process-splitting approach using the METRx-MED system is capable of preserving not only the facet joint even at the narrow lamina, but the lever arm function of the spinous process. The procedure also provides symmetrical visual fields and ease of orientation. This procedure is recommended for lumbar canal stenosis at all the lumbar levels.
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Shozo Kanezaki, Chikahiro Takita, Tsutomu Higashi, Toyomi Yoshiiwa, Hi ...
2009 Volume 58 Issue 4 Pages
688-692
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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A 37-year-old woman had a 10-year history of lower lumber pain. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a giant tumor within the lumbosacral spinal canal. The patient underwent subtotal resection. Since histological diagnosis was myxopapillary ependymoma (MPE), she had additional radiotherapy. Nine months after operation, no reccurence was detected. According to WHO classification, MPE is a grade I histologically benign tumor. But, this tumor may occasionally behave in a less benign fashion. Therefore, Gross total resection must be chosen. If patients receive subtotal resection, postoperative radiotherapy is recommended for controlling tumors.
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Kazuki Chagawa, Hiroshi Tanaka, Jyunichi Isobe, Toshihiko Taguchi
2009 Volume 58 Issue 4 Pages
693-698
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Synovial Osteochondromatosis is a disease which forms osteochondroma in the synovial membrane, and free bodies. The disease breaks out in the knee and elbow joint mainly but rarely in the hip joint. The classification of Milgram is famous. We experienced two men and one woman which had the disease and their age range was 24 to 44 years old. All patients were treated by removal of the free bodies and synovectomy and classified Stage 2 of Milgram. Only a 24-year-old patient felt pain again due to left free bodies. For diagnosis of the disease, CT, MRI, and arthrography are more useful. Conservative treatments are not effective, and operative treatments are selected in general. A treatment that removes free body completely and resects synovium adeduately is desirable. Dislocation of the femoral head is considered necessary for this treatment, but should be avoided because it may cause avascular necrosis of the femoral head. We experienced three cases of synovial osteochondromatosis and treated by operation without dislocation of the femoral head. This method can prevent complications of the avascular necrosis of the femoral head.
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Shuichi Eto, Kazuyasu Uemichi, Masamori Shigematsu, Shuya Ide, Jun Ito ...
2009 Volume 58 Issue 4 Pages
699-702
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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It is known that severe osteoarthritis of the hip joint develops onto secondary osteoarthritis of the knee joint. Twenty-three patients with severe dislocation of one side hip joint were studied for etiology, morphology, and alignment of the lower extremity. The mean age was 65.4 years (from 54 to 80 years). We categorized the patients into two groups, one had formed new acetabulum (Crowe IV a, 12 patients) and the other did not form new acetabulum (Crowe IV b, 11 patients). In the Crowe IV a group, ipsilateral knee joint (short side of lower extremity) was in the normal position in six patients (50%). In the Crowe IV b group, the ipsilateral knee joint (short side of the lower extremity) was in the valgus position in nine patients (82%). Windswept deformity was found in six patients (55%). There is a tendency for the development of the valgus deformity of the knee joint in the short side and varus deformity of the knee joint in the long side with Crowe IV b.
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Kazunobu Tsunoda, Yoshiyasu Aya, Shinichi Motomatsu, Takashi Shimauchi ...
2009 Volume 58 Issue 4 Pages
703-707
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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It is rare to develop femoral head necrosis after intertrochanteric fracture. As we experienced one such case this time, we report it along with consideration from literatures. The case was a 49-year-old male who got hurt by falling in a bathroom. As right intertrochanteric fracture without the dislocation was found, operation was performed using CHS. From the tenth week after the operation, right coxalgia occurred. In the thirteenth week, collapse of the femoral head was found, necrosis of the femoral head was diagnosed, and CHS was removed. The collapse continued to progress, and in the eighteenth week, femoral head replacement was performed. There are various existing reports on femoral head necrosis after intertrochanteric fracture. High energy injuries such as crush are mainly attributed to vascular injuries caused by improper internal fracture fixation at the time of dislocation or reduction. While the incidence is reported to be 0.07 to 0.81%, it is necessary to bear in mind the possibility of femoral head necrosis as a complication when treating intertrochanteric fracture.
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Kouichiro Toyoda, Eiichi Shiigi, Akihito Sakka, Yasuhiko Tanigawa, Shi ...
2009 Volume 58 Issue 4 Pages
708-711
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We studied spinal disorders of hematopoietic malignant disease. We treated nine cases, five malignant lymphoma cases, and four myeloma cases (average 60 years). Diagnosis was most useful for transpedicular spinal bone biopsy. A long time (average: 107 days) passed after diagnosis before visiting our hospital. Six cases had back pain and eight cases had sciatica. Most myeloma cases indicate increasing M protein and total protein, and most lymphoma cases have increasing LDH and s-IL2 receptor. CT and MRI findings revealed extraskeletal mass for both diseases, but no cortex breakage for lymphoma. We also need to take into consideration for staging of the spinal disease of both diseases.
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Makoto Sasaki, Masayuki Kawashima, Hiroaki Tamura, Ikufumi Nagayoshi, ...
2009 Volume 58 Issue 4 Pages
712-716
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We examined knee joint sounds using an Electronic Stethoscope. 4000 model (ES 4000: 3M Littmann
TM). The stethoscope was set on the medial, lateral and suprapatellar sides, and joint sounds were recorded during flexion-extension motions. The joint sound recordings were converted to phonographs displaying sound oscillations or sound frequencies using proprietary software. The objects investigated were 12 joints of grade-0 (a physically unimpaired person), 12 joints, grade-1, 10 joints of grade-2, 16 joints of grade-3, and 8 joints of grade-4 by the Kellgren & Lawrence grading system. The sounds recorded at the suprapatellar side were the most audible. The K-L grading system was thought to be relative to the production of joint sound. In osteoarthritis knees, the phonographs showed that there was a high incidence of high frequency sound. The highest frequency recorded was less than 1 kHz. We concluded that joint auscultation with the ES4000 stethoscope was useful as a method for the early detection and dynamic joint function estimation for gonarthrosis.
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