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Hiroshi Nomura, Toshio Doi, Katsumi Harimaya, Yoshihiro Matsumoto, Yuk ...
2009 Volume 58 Issue 2 Pages
153-155
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Lumbar discal cyst is rare. We report a case with lumbar discal cyst who underwent resection using a microendoscopic discectomy (MED) system. A patient was 28-year-old man suffered from severe left lower-extremity pain and low back pain for 4 months, whose symptoms resembled those of lumbar disc herniation. Magnetic resonance images showed a cystic lesion connecting to intervertebral disc at the level of L4/5 with low signal intensity on T1-weighted and high on T2-weighted images, and the peripheral rim of the cyst was enhanced by intravenous injection of gadolinium on fat-suppressed T1-weighted images. As these images suggested a lumbar discal cyst, we performed tumorectomy using the MED system. In the operation, the cystic mass connecting to intervertebral disc at the level of L4/5 that strongly compressed the left L5 spinal nerve root was observed in detail by MED system. It was extirpated safely. Histopathological examination revealed that the cyst wall was composed of dense fibrous tissue without specific lining cells. The symptoms disappeared immediately after surgery with no post-operative low back pain. We suggest that the MED system is useful to treat lumbar discal cysts.
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Masayuki Nakahara, Kenki Nishida, Koichi Ogawa, Kenichiro Hanabusa, Yu ...
2009 Volume 58 Issue 2 Pages
156-160
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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From 2007, we have performed spinal instrumental surgery, using an intra-operative 3D-CT navigation system to treat cervical or upper thoracic lesions.
With this 3D-CT navigation system, implanation of the percutaneous pedicle screw and rod was started recently as minimally invasive posterior lumbar interbody fusion (PLIF). When using SEXTANT system, the 3D-CT navigation enables us to perform lumbar instrumental surgery more safely. We report our experience on this treatment, in terms of the surgery technique and problems.
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Yoshihiro Takamori, Jun Arimizu, Teruaki Izaki, Tatsuki Kobayashi, Ryu ...
2009 Volume 58 Issue 2 Pages
161-164
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We conducted a retrospective study on the surgical outcome of 15 patients with drop foot due to degenerative lumbar disorders, and assessed the factors influencing surgical outcome. All patients (8 men and 7 women, mean age 56.5 years) underwent operation, and were followed up for more than three months. The manual muscle test can be used to determine the muscular strength of the tibialis anterior. Drop foot is then defined as a score below 3 out of 5. The mean duration of drop foot symptoms before surgery ranged 34.8 days. The correlated factors studied were age at surgery, preoperative grade of muscle strength, grade of leg pain, duration of palsy before surgery, patient medical history (diabetes mellitus), and presence of cauda equina syndrome. In conclusion, significant factors that determine surgical outcomes are age at surgery, preoperative grade of leg pain, patient medical history (diabetes mellitus), and presence of cauda equina syndrome. The duration of symptoms before surgery and grade of muscle strength are not significant factors influencing surgical outcomes. Careful attention should be paid when operating on patients with drop foot due to lumbar degenerative disorders whose grade of leg pain whose leg pain has been relieved preoperatively.
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Akihiko Kobayashi, Kenki Nishida, Kouichi Ogawa, Yuichi Takahashi, Mas ...
2009 Volume 58 Issue 2 Pages
165-168
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We performed percutaneous vertebroplasty with 3D-CT navigation system Arcadis Orbic 3D+Stealth Station Navigation System for vertebral fractures expressing instability. From April 2007 to December 2007, we performed percutaneous vertebroplasty with 3D-CT navigation system on 31 unstable fractures. Progress was good in all cases, indicating that percutaneous vertebroplasty with 3D-CT navigation system is effective for vertebral fractures expressing instability.
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Minoru Kashihara
2009 Volume 58 Issue 2 Pages
169-172
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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This paper presents a 46-year-old man undergoing hemodialysis with calcification simulating tumoral calcinosis of the wrist and shoulder joint. Tumoral calcinosis is a rare condition first defined by Inclan in 1943 and is characterized by a large calcified mass occurring predominantly in the juxta-articular lesion of the extremity. Histopathological examination reveales deposits of amorphous calcified material surrounded by dense fibrous material. In hemodialysis patients, it is called calcification simulating tumoral calcinosis. The features of radiological findings and histopathological findings are quite typical of tumoral calcinosis. The etiology of ectopic calcification in hemodialysis patients is secondary hyperthyroidism and hyperphosphatemia. Surgical excision was performed on this patient because of pain and disturbed range of motion of wrist and shoulder joint.
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Kenji Horikiri, Chojo Futenma, Goichi Okahara, Tomohiro Isa, Yoshiyuki ...
2009 Volume 58 Issue 2 Pages
173-178
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Plexiform schwannoma is a rare benign neurogenic tumor, often arising from skin and subcutaneous tissue. It is very rare that the tumor arises from the peripheral nerve. We report a case of plexiform schwannoma arising from the left median nerve. The patient was a 54-year-old female, who complained of tumor in the left palm with a 20-year history and left forearm with a 5-year history. Physical examination revealed a 4 × 5 cm soft elastic and poor mobility mass, located in the palm and a 10×17 cm one size located in the volar aspect of the forearm. MRI revealed multiple tumors in the median nerve, which was low-intensity on T1WI, high and low-intensity on T2WI, and was rim enhanced with Gd-DTPA. The tumor was multinodular, and was composed of seven tumors in the recurrent branch of median nerve, five tumors in the median nerve, and four tumors in the anterior interosseous nerve. It consisted of multiple nodules surrounded by a perineurium-like tissue. The histological feature was identical with Antoni-A and B type schwannoma. At four months after resection of the tumors, the patient was free from recurrence.
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Katsuhiko Murakami, Katsutoshi Sunami
2009 Volume 58 Issue 2 Pages
179-182
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report a rare case of posterior dislocation of the tibia after primary posterior-stabilized total knee arthroplasty. A 54-year-old female, suffering from rheumatoid arthritis, was treated with left total knee arthroplasty with NexGen LPS-Flex (Fixed) at our hospital in 2007. Two weeks after operation, she had sprained her left knee during rehabilitation. Severe knee pain with a swollen and obviously deformed knee, which she was unable to straighten. We found posterior dislocation of the tibia and manual reduction was performed. Extending the knee joint and traction was applied, easily reduced left knee joint with no anesthesia. But posterior drawer test was positive and flexion instability was apparent, for that reason we applied a knee brace for three months. One year after operation, she was able to walk without a knee brace and instability was not present. Knee replacement dislocation is a rare complication. The causes of posterior dislocation are multifactorial. Factors that may contribute include component malposition, extensor mechanism and patella dysfunction, prosthesis design and increased flexion laxity. Our case demonstrates the common pitfalls that can produce posterior dislocation of PCL-sacrificing knee replacements. Some of these can be predicted preoperatively. Patients at risk include those with pre-existing valgus deformity or extensor mechanism deficiency. Attention to operative detail is essential and tibial malrotation must be avoided. The flexion/extension gap must be carefully balanced to avoid laxity in flexion.
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Yusuke Uehara, Eiichi Nakamura, Azusa Tanaka, Yasunari Oniki, Hiroaki ...
2009 Volume 58 Issue 2 Pages
183-187
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report here a rare case with the postoperative infection of Mycobacterium fortuitum after total knee arthroplasty (TKA). The patient was a 72-year-old woman. She had been treated for rheumatoid arthritis at the onset of 38 years old with the administration of predonizorone and for diabetes mellitus from 71 years old. In the previous hospital, she underwent a TKA for pain in her right knee. One month later, she had complained of swelling, redness, local heat, and severe pain in her operated knee. After that, she was urgently admitted to our hospital because fistula also appeared at the proximal medial aspect of her right lower leg. She underwent arthroscopic debridement and continuous irrigation with sterile saline. The organ culture of synovium in her right knee showed Mycobacterium fortuitum infection. Due to persistent symptoms, in the second operation, the prostheses were removed and a cement spacer containing medicative antibiotics was placed in her right knee. In addition, multiple antibiotics were also administered. Approximately six weeks later, the symptoms disappeared and her C-reactive protein value became within normal range.
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Teruaki Izaki, Yozo Shibata, Takeshi Teratani, Koichi Kiyota, Jun Tana ...
2009 Volume 58 Issue 2 Pages
188-191
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The purpose of this study was to evaluate of the clinical results of elderly patients with recurrent anterior shoulder dislocations treated with arthroscopic surgery. All four patients were women, aged 53 to 78 years (mean 65.3 years) with a mean follow-up of 20.5 months (range, 7-89 months). All patients had a Bankart lesion associated with complete cuff tears. Arthroscopic Bankart repair and rotator cuff repair were performed at the same time. The Japanese Orthopaedic Association shoulder scores improved, from a mean score of 55.3 points preoperatively to 90.9 points postoperatively. The Japan Shoulder Society Shoulder Instability Scores improved, from a mean score of 30.8 points preoperatively to 89.3 points postoperatively. Recurrent anterior shoulder dislocation in elderly patients is more common than generally believed. Operation is needed to repair the torn cuff or to stabilize the shoulder. Patients with a Bankart lesion associated with complete cuff tears require both procedures.
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Shihoko Yamaguchi, Keitaro Yamamoto, Hiroaki Yano, Katsuhiro Kawahara, ...
2009 Volume 58 Issue 2 Pages
192-198
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Cases of ACL reconstruction in the middle-aged persons (older than 40) have increased qmongst those receiving conservative treatment.
The purpose of this study is to investigate the comparative results between the middle-aged female patients who have been received ACL reconstruction and those of young patients. Forty-three female patients (14 to 54 years) were operated on. The age of average was 29.8±11.9 years old.
The course of ACL injury, waiting period until operation, complicating meniscus injury, OA change, JOA score, knee ROM, preoperative knee flexor and extensor muscle strength ant that 12 months after the operation were studied.
JOA score and knee ROM were improved 12 months after operation. And there was no difference between the middle-aged women and women of other age groups.
The waiting period tends to increase with age. 58% of the middle-aged women had meniscus injury. OA changes were seen in 91.7% of the middle-aged women and 16.7% in women of other age groups, indicating increased OA changes.
Knee flexor muscle strength tends to decrease in middle age, but improves 12 months after surgery in other age groups as shown in our study. We also found that even though ACL reconstruction is an effective method, time to healing tends to be long in middle age, with prone ness to meniscus injury and decreasing knee flexor muscle strength.
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Kentaro Okamoto, Kazuhiko Fukushima, Yoshihiko Tasaka, Tatsuya Yufu, A ...
2009 Volume 58 Issue 2 Pages
199-202
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Patella tendon donor site healing after patella tendon autograft evaluated by magnetic resonance imaging and ultrasonography is reported. However, there are only a few reports on patella tendon donor site healing evaluated by 3D-CT. In this study, we performed 3D-CT on 23 patients (11 males and 12 females) who received reconstruction of anterior cruciate ligament with bone-tendon-bone autograft in our hospital. The average age at the time of operation was 30.3 years, and the average duration of follow-up was 47 months. In 13 of these patients, 3D-CT was performed on both knees for comparative analysis. 3D-CT examination revealed that patella tendon healing after harvested autograft occurred within three years after operation, and healing continued. There were not any length or width differences between operated and non-operated knees.
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Eiji Suenaga, Takahiro Kitamura, Hideyuki Senba, Masahiro Matsuda, Sat ...
2009 Volume 58 Issue 2 Pages
203-205
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Large cysts of the medial meniscus are relatively rare. If mechanical symptoms are absent, conservative treatment may be offered, but this is likely to fail as most cysts are associated with an underlying meniscal tear. In large cysts that are not decompressed arthroscopically, open cystectomy is usually selected. We have treated a 52-year-old man with symptomatic medial meniscal cyst sustaining a meniscal horizontal cleavage tear. Arthroscopic partial menisectomy was performed to find the opening of the track to the cyst, after which blue dye was injected into the cyst. To treat the meniscal cyst, we created an adequate passage between cyst and main knee compartment. Gelatinous fluid escaped into the joint as the cyst was decompressed. Three months after the operation, the patient was asymptomatic with no clinically detectable recurrence of the cyst. We speculate that creating an adequate passage may be a useful therapy even for meniscal large cyst.
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Takuto Tsuchiya, Yoshinori Takeuchi, Naoki Toba
2009 Volume 58 Issue 2 Pages
206-209
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Hand osteoarthritis (OA) is an age-related disorder. Numerous cross-sectional studies have shown the association between hand OA and osteoporosis, but there have been few longitudinal studies. The aim of this longitudinal study was to examine the association between the progression of hand OA and the loss of bone mineral density (BMD). The subjects in this study were 35 elderly women. Their mean age was 69.6 years at the initial examination. They had radiographs of the left hand, and osteoporosis was assessed by DIP (Digital Image Processing) method at the second metacarpal bone. At least five years (average 7.9 years) later, they were examined again. Radiographic OA was defined as Kellgren-Lawrence grade 2 or higher. Fifteen joints of the left hands were investigated for radiographic OA. We compared the loss of BMD between two groups; one was a group with increased number of OA joints and the other a group without. In conclusion, the number of OA joints at the initial examination was significantly correlated with age, but not with BMD, and there was no significant difference in loss of BMD between the two groups with and without OA progression.
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Hiroki Irie, Teiji Kato, Hiroshi Mizuta
2009 Volume 58 Issue 2 Pages
210-213
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report on three patients with calcific periarthritis that occurred in the finger and wrist. Calcification is often present in the shoulder and knee, but calcification occuring in the finger is comparatively rare.
[Case 1 ] A 43-year-old male. Sudden swelling and pain appeared in the right thumb without a motive. The radial MP joint of thumb showed redness, swelling and heat sensation. X-ray film revealed calcareous deposition on the radial MP joint of the thumb.
[Case 2 ] A 42-year-old female. She developed acute wrist pain developed without reason one week ago and came for a checkup because symptoms did not improve. X-ray film revealed an oval-shaped calcareous deposition on the distal end of the ulna.
[Case 3 ] A 73-year-old female. Sudden swelling and pain appeared in the right thumb without reason from several days ago. The ulnar IP joint of the thumb showed redness, swelling and heat sensation. X-ray film revealed calcareous deposition on the ulnar IP joint of the thumb.
All patients were diagnosed with calcific periarthritis and injected with steroid. Pain and calcification disappeared in all.
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Goichi Okahara, Chojo Futenma, Kenji Horikiri, Yoshiyuki Akamine, Tomo ...
2009 Volume 58 Issue 2 Pages
214-217
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report a case by nonunion of the hook of hamate, and satisfactory treated with tension-reduced early active mobilization after bridge tendon graft.
The patient was a 66-year old man. He hit himself on the ground and had pain in his left palm at a golf driving range. He visited a clinic, but no fracture was diagnosed. He noticed difficulty in flexing his little finger one month after injury, and his grip strength and driving distance in golf decreased gradually. Three months after injury, he was referred to our clinic, and we diagnosed him with FDP tendon rupture due to nonunion of the hook of hamate. We removed the hamate fragment, and performed bridge tendon grafting with palmaris longus tendon. Early active mobilization was started with buddy taping, keeping the little finger volar to the ring finger for three weeks. At three years after surgery, his grip strength and golf driving distance had recovered. The percentage of total active motion was 84% which was classified as good in the functional evaluation of the hand of the Japanese Society for Surgery of the Hand.
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Masamichi Onaga, Hideki Asato, Takanao Shimabukuro, Hiroaki Komesu, Hi ...
2009 Volume 58 Issue 2 Pages
218-223
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The purpose of this study was to evaluate the surgical outcome of arthroscopic Bankart repair, using suture anchor for traumatic anterior shoulder instability. We studied 32 shoulders. There were 31 males and a female. The average age at surgery was 28 years old. The mean interval from the time of the surgery to the final follow-up evaluation was 12.5 months.
Preoperatively there were significant differences in flexion, abduction, and external rotation between the normal and injury side. Postoperatively abduction were significantly improved but external rotation remained unchanged. The Japan Shoulder Society (JSS) Shoulder Instability Score improved from 54.3 to 94.7 after surgery.
In 20 patients performing sports activity preoperatively, 19 returned to sports activity and the mean interval from the time of surgery to return to sports activity was 5.9 months. The JSS Shoulder Sports Score improved from 43.9 to 86.7 after surgery.
Clinical results of arthroscopic Bankart repair were satisfactry. Relocation occurred in a rugby player suffering from a tackle. The cause of the relocation was violent injury resulting from bony Bankert lesion which may occur due to the short distance of suture anchors.
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Kenjiro Nakama, Masafumi Goto, Yasuhiro Mitsui, Shinichi Ito, Yumiko I ...
2009 Volume 58 Issue 2 Pages
224-227
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Suprascapular nerve palsy caused by ganglion cysts is traditionally treated by open cyst excision and aspiration. We present a case of suprascapular nerve entrapment by a ganglion cyst, treated by arthroscopically-assisted injection of autologous fibrin sealant. A 26-year-old woman presented with a 3-month history of continuous right shoulder weakness and dull pain. There was mild atrophy of the right infraspinatus fossa. Magnetic resonance images (MRI) of the right shoulder demonstrated a ganglion cyst in the suprascapular fossa. First, we attempted ganglion cyst aspiration/steroid injection under sonographic guidance. However, three months after the treatment, MRI of the right shoulder demonstrated recurrence of the ganglion cyst. We therefore employed arthroscopic surgery. No glenoid labrum tears were observed. From the anterior portal, a 18G needle was inserted into the suprascapular fossa, after which the ganglion cyst was readily aspirated, followed by autologous fibrin sealant injection. Three years after arthroscopic surgery, she is free of shoulder pain. Follow-up MRI revealed no recurrence of the ganglion cyst in the suprascapular fossa. Injection of autologous fibrin sealant is a useful option for the treatment of ganglion cysts in the suprascapular fossa.
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Akinari Tokiyoshi, Junji Ide, Jun Hirose, Hiroshi Mizuta
2009 Volume 58 Issue 2 Pages
228-230
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Purpose: To evaluate the accuracy of ultrasonography in the detection of full-thickness rotator cuff tear.
Materials and Methods: Preoperative ultrasonography with 8 MHz linear-array transducer was performed in 28 shoulders on 28 hospitalized patients. All patients were operated arthroscopically. We have diagnosed cuff tears on subscapularis, suprasupinatus, and infrasupinatus tendon. The presence of a full-thickness rotator cuff tear demonstrated by arthroscopy was recorded as the final diagnosis.
Result: Ultrasonography correctly diagnosed three full-thickness subscapularis tendon tears with 100% sensitivity, 92.0% specificity, and 92.9% accuracy, 14 of 15 suprasupinatus tendon tears (93.3% sensitivity, 84.6% specificity, and 89.3% accuracy) and four of 11 infrasupinatus tendon tears (36.4% sensitivity, 100% specificity, and 75% accuracy).
Conclusion: The accuracy of full-thickness rotator cuff tears in the suprasupinatus and subscapularis tendons was as high as previously reported rates. It was difficult to detect tears in the infraspinatus tendon because of the limitation of ultrasonography. We plan to perform the ultrasonography in other outpatients to enhance the accuracy of the diagnosis of rotator cuff tears.
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Hideki Asato, Hiroaki Komesu, Takanao Shimabukuro, Masamichi Onaga, Hi ...
2009 Volume 58 Issue 2 Pages
231-236
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The purpose of this study was to compare the functional and structural outcomes of arthroscopic rotator cuff repair using suture bridge (B) fixation and dual-row (D) fixation with suture anchors. Functional outcomes were evaluated with the Japanese Orthopedic Association (JOA) score and structural outcomes were evaluated with postoperative MRI T2 findings based on Sugaya's classification. We repaired 15 shoulders with (B) fixation and 41 shoulders with (D) fixation. The size of rotator cuff tear was small in one, middle in 10, large in three, massive in one in (B) group and small in three, middle in 17, large in 14, massive in seven in (D) group. The average follow-up from surgery to final evaluation was seven and 14 months respectively. Average JOA score improved from 64.3 to 95.3 in (B) group and from 63.8 to 94.4 in (D) group. Postoperative MRI were seven type I, six type II, one type III, one type V in (B) group and 14, 11, 11, one respectively in (D) group. The clinical outcomes of arthroscopic rotator cuff repair were satisfactory and comparable in two groups. A suture bridge fixation can reduce the number of threads and potentially facilitates surgical procedure.
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Hiroki Yoshimatsu, Toru Wakioka, Kenji Yoshida, Hisashi Yamashita, Ken ...
2009 Volume 58 Issue 2 Pages
237-240
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We report four cases of spontaneous spinal epidural hematoma in the cervical area. The duration from pain to the appearance of paralysis was 67 minutes on average. The spinal epidural hematoma was located in 6.8 vertebral segments on average, and all existed in the posterior of the spinal cord. Two patients were treated non-operatively, while the other two patients were treated operatively. All four patients improved after the treatment. Moreover, it was found that the percentage of early symptom improvement within six hours from onset is high in this investigation on non-operative treatment for spontaneous spinal epidural hematoma in the cervical area. These results suggest that careful observations of symptoms are required for spontaneous spinal epidural hematoma in the cervical area while preparing for surgery giving consideration to neurological conditions.
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Shinichiro Mitsutake, Takafumi Inoue, Tsutomu Hannita, Masamichi Fujii ...
2009 Volume 58 Issue 2 Pages
241-244
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Calcification of yellow ligaments is a disease that deposits various calcium crystal phosphates in the elastic fibers of denatured yellow ligaments, and causes neurotic symptoms. We experienced a case of Brown-Sequard syndrome of the cervical vertebrae.
[Case] A 66-year-old male had a history of cerebral infarction. He had numbness in the left upper and lower extremities. We found left thermohypesthesia, left hypalgesia, right bathyhypoesthesia below C8, motor paralysis in the right upper and lower extremities, and spastic gait. We performed vertebral arch plastic operation and resected the CYL at the C5/6 level due to ossification of the posterior longitudinal ligament (OPLL) from C4 to C5 on MRI and CT myelography, and spinal cord compression from CYL at the C5/6 level. We did not see any changes in esthetic affection, but slight improvement in her gait. Brown-Sequard syndrome caused by CYL is rare, and we discuss this case including study of some literature.
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Risa Kondo, Shinichiro Kobo, Hiroshi Kuroki, Shoji Hanado, Hideaki Ham ...
2009 Volume 58 Issue 2 Pages
245-248
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The purpose of this study was to evaluate the surgical outcome of microsurgical posterior foraminotomy with laminoplasty for cervical spondylotic amyotrophy. The subjects were seven male patients. The average age at the time of surgery was 63.7 years old. Foraminotomy was performed at the C4/5 level in five cases, the C5/6 level in four cases, and the C6/7 level in one case. The average operation time was three hours and 52 minutes. The average blood loss was 105 g. The therapeutic results were evaluated according to the JOA score, manual muscle test (MMT), cervical alignment, and cervical range of motion. The clinical results of microsurgical posterior foraminotomy with laminoplasty for cervical spondylotic amyotrophy were favorable.
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Jiro Ooba, Kenji Yamada, Hirofumi Inoue, Eiichi Mihara, Shiro Kajiyama ...
2009 Volume 58 Issue 2 Pages
249-253
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We present a rare case of slipped capital femoral epiphysis (SCFE) in natural infancy. A 6-year-old boy complained chiefly of right hip pain and thigh pain. Radiographs of the right hip revealed severe SCFE and the posterior tilt angle (PTA) of 30°. The left side had not slipped. The patient was treated by in situ pinning. Additional surgery was performed 12 months after initial pinning. Three years after initial pinning, the patient had no hip pain and regained normal gait. Osteonecrosis, chondrolysis, and progressive slippage were not detected radiographically. However careful postoperative management is required in such cases.
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Satoshi Kuroshima, Hirokazu Nohara, Taketsugu Gaja, Takayoshi Rokkaku, ...
2009 Volume 58 Issue 2 Pages
254-260
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We treated two cases of progressive cervical myelopathy caused by retro-odontoid pseudotumor associated with non-rheumatoid atlanto-axial instability.
The first case is a 77-year-old man with bilateral clumsy hands and gait disturbance.
Radiographs showed atlanto-axial instability. Magnetic resonance imaging (MRI) showed retro-odontoid pseudotumor that compressed the spinal cord and high signal intensity on T2-weighted images in the spinal cord was observed at the C4/5 level. We performed posterior fusion from the occiput to C3 and laminoplasty from C4 to C7. MRI after 11 months operation demonstrated reduction of the retro-odontoid pseudotumor.
The second case is a 70-year-old woman with bilateral clumsy hands and inability of gait. Radiographs showed atlanto-axial instability. Computed tomography (CT) showed pseudotumor with calcification. MRI showed retro-odontoid pseudotumor that compressed the spinal cord. We performed posterior atlanto-axial fixation with removal of the posterior arch of the atlas and partial laminectomy of C2 lamina. CT after 14 months operation demonstrated reduction of the pseudotumor and calcification.
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Shoichiro Higa, Goichi Okahara, Chojo Futenma, Fuminori Kanaya, Satosh ...
2009 Volume 58 Issue 2 Pages
261-265
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The locked metacarpophalangeal joint of a finger is a clinical entity characterized by loss of extension with little or no loss of flexion, and is not commonly seen in the daily clinic. We experienced a 31-year-old woman suffering from locking of the left index finger. When she was rolling a tablecloth, the metacarpophalangeal joint of her left index finger was suddenly locked in the flexed position and she could not straighten it. When she visited our hospital, she showed full active flexion of the left index finger, but active and passive extension was limited to −40 degrees. X-ray films showed a bony prominence on the radial palmar side of the condyle of the second metacarpal head. She was diagnosed with locked metacarpophalangeal joint of the index finger. Mobility was not restored by manual reduction and open reduction was done. At surgery, there was a bony prominence on the radial palmar side of the condyle, and a fan-like portion rode outo the bony prominence and was fixed. After resection of a part of the fan-like portion and the bony prominence, mobility was restored. Four months after the surgery, there is neither limitation of range of motion nor recurrence.
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Koji Sakuraba, Hiromasa Miura, Shuichi Matsuda, Ken Okazaki, Shinji Fu ...
2009 Volume 58 Issue 2 Pages
266-270
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The short-term results of medial patellofemoral ligament (MPFL) reconstruction were reviewed. MPFL reconstruction surgery was performed on 13 patients (13 knees, three male, five female, mean age 24.1 years) with recurrent and habitual dislocation of the patella. After average 18.5 month follow-up, there has been no recurrence of dislocation and limitation of range of motion except for one case. The mean Kujula score was 60±20.2 preoperatively and 91±15 postoperatively. According to the Crosby and Insall grading system, six ceses were excellent, six cases were good, and one case was fair to poor. On axial radiographs, the mean congruence angle was 31.3±21.4° preoperatively and −3.65±20.72° postoperatively. The mean tilting angle was 32.1±7.9° preoperatively and 21.9±8.39° postoperatively. The mean lateral shift was 41.6±9.7% preoperatively and 24.5±9.9% postoperatively. These results demonstrate the short-term effectiveness of MPFL reconstruction.
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Takanao Shimabukuro, Hideki Asato, Takeya Higa, Fuminori Kanaya
2009 Volume 58 Issue 2 Pages
271-275
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Posterior dislocation of the shoulder is uncommon, accounting for 1.5-3.8% of all shoulder dislocations. Those associated with fractures are less common. We experienced a patient who had a posterior dislocation fracture of the shoulder associated with fracture of the lesser tuberosity of the right humerus by convulsive seizure. The patient was a 66-year-old woman and we performed open reduction in the shoulder dislocation, bone graft to the bone defect, and internal fixation with osteosynthesis to the lesser tuberosity fragment. Six months after the surgery, avascular necrosis of the humeral head was not observed and JOA score was 81.5 points.
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Takeya Higa, Hideki Asato, Takanao Shimabukuro, Fuminori Kanaya
2009 Volume 58 Issue 2 Pages
276-282
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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Infraspinatus muscle transfer (modified Patte's procedure) was performed on two patients unable to elevate their shoulder joint due to massive tear of the rotator cuff. Case 1: A 72-year-old female with massive tear of the rotator cuff showed abduction of 40 degrees and JOA score of 42.5 points in her right shoulder. Infraspinatus muscle transfer was performed. Abduction and JOA score improved to 175 degrees and 90 points at 15 months after surgery. Case 2: A 74-year-old male with Bankart lesion and massive tear of the rotator cuff after shoulder dislocation showed abduction of 40 degrees and JOA score of 18 points. Arthroscopic Bankart repair and infraspinatus muscle transfer were performed. He obtained abduction of 165 degrees and JOA score of 93 points at 14 months after surgery.
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Shoichi Kuba, Itaru Furuichi, Masakazu Murata, Takeshi Miyaji, Noriaki ...
2009 Volume 58 Issue 2 Pages
283-286
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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The purpose of this study was to evaluate the clinical and functional outcomes of volar locking plate fixations for distal radius fractures. We investigated the final radiological correction losses and functional scores of 20 patients with Saito point system. All cases acquired bone union. No final radiological correction losses were seen. The clinical and functional results of 12 cases were excellent, and eight cases were good. There were no fair or poor cases. Fixation using the volar locking plate is effective for distal radius fractures.
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Isao Saikawa, Taichi Saito, Tsutomu Irie, Tetsuya Tanaka, Junya Ogata, ...
2009 Volume 58 Issue 2 Pages
287-292
Published: March 25, 2009
Released on J-STAGE: June 02, 2009
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We performed posterior lumbar interbody fusion (PLIF) using Ceratite Spacer® (hydroxyapatite-tricalciumphosphate composite) on three cases of spinal canal stenosis associated with dialysis-related destructive spondyloarthropathy (DSA). The patients underwent posterior decompression by medial facetectomy, insertion of Cerataite Spacer®, and grafting of autologous strut bones into the disc space. The construct was secured with pedicle screw instrumentation. Neurologic recovery was obtained after surgery and successful spinal fusion was obtained in all patients estimated by dynamic radiographs or reconstructed CT images. Our results suggest that Cerataite Spacer® is useful for PLIF in patients with DSA.
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