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Hideaki Hamanaka, Shinichiro Kubo, Hiroshi Kuroki, Shoji Hanado, Naoki ...
2010 Volume 59 Issue 1 Pages
1-7
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We performed 1307 spinal surgeries from January 2000 to February 2009, of which 11 developed surgical site infections (SSI) (0.8%). The distribution of pathogens isolated from SSI were MSSA (4 cases), MRSA (4 cases), MRSE (1 case), Serratia marcescens (1 case), and staphylococcus species (1 case). Five of the 11 cases had instrument operation. Five had cervical surgery, one thoracic surgery, and five lumbar surgery. Nine of the 11 cases had a medical history. In addition two had diabetes mellitus, two were on steroid therapy by RA and had asthma, two were undergoing fasts of a long duration due to acute peritonitis and acute pancreatitis, one was on hemodialysis, one had Down syndrome, and one had cerebral palsy. Extension of operation time, hemodialysis, increased bleeding during operation and instrument operation are significant SSI risk factors statistically. WBC and CRP were significantly high from four days to two weeks after operation in the infected group.
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Yasuhiro Ishido, Junichi Kamizono, Yoshiya Arishima, Hironori Kakoi, M ...
2010 Volume 59 Issue 1 Pages
8-13
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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It is important to achieve correct alignment of the acetabular component in total hip arthroplasty (THA), but this is difficult because of variation of pelvic tilt affected by lateral decubitus position and intraoperative leg position. We preoperatively measured pelvic lateral tilt by X-ray in the lateral decubitus position. We also evaluated the anatomical relationship between the correct placed acetabular cup and acetabular bony margin on the preoperative CT image. This detailed anatomical information from preoperative image supports the correct positioning of the acetabular cup. Manual procedures are not completely precise, and digital measuring devices or computer navigation systems are needed for the more precise positioning of the acetabular component.
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Shinichiro Kubo, Hiroshi Kuroki, Shoji Hanado, Hideaki Hamanaka, Naoki ...
2010 Volume 59 Issue 1 Pages
14-17
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Objectives
To evaluate the proper insertion techniques of C1 lateral mass screws.
Materials
Eighteen consecutive patients were examined after upper cervical fusion using twenty-nine C1 lateral mass screws. Screws were placed by three different techniques; Goel's technique (4), Tan's technique (20), Notching technique (5).
Methods
Pre and post-operative CT scans with multiplanar reconstruction were used to detect cortical breaches and direction of screws.
Results
No transverse foramen and vertebral groove violation was found in CT scans. Three had breached superior articular facet of the atlas. However, the R.O.M of atlauto-occipital joints had not changed postoperatively. Theses screws were inserted with Tan's technique and two of three were directed medially.
Conclusions
It is feasible to safely insert C1 lateral mass screws when correct insertion point and direction are considered preoperatively. However, care should be taken because screws can violate the atlanto-occipital joint especially with Tan's technique.
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Yusuke Takahashi, Hironobu Akune, Masakazu Kozuma, Naoshi Kikuchi, San ...
2010 Volume 59 Issue 1 Pages
18-22
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We describe a rare case who suffered from atlanto-occipital dislocation. A 53-year-old man was injured by a falling concrete block while working. C6 and C7 vertebrae and mandibular bone were fractured. He eceived mitral valve replacement operation and took warfarin tablets. After general conditions improved, he started wearing a halo vest three days after the injury. He developed complicated traumatic subarachnoid hemorrhage four days after the injury, pulmonary arrest and paralysis of all limbs appeared and he was placed on a mechanical ventilator. Twelve days after the injury, posterior spinal fusion with internal-fixation was performed. Because of improvement of paralysis and general conditions, mechanical ventilation was removed three days after the surgery. After one week, he started rehabilitation and no paralysis remained. Based on the concept of damaged control orthopaedics, internal fixation from an early period after injury was performed and was effective.
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Hisashi Serikyaku, Tetsuya Yara, Fuminori Kanaya
2010 Volume 59 Issue 1 Pages
23-27
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We reported two cases with calcified herniated nucleus pulposus in the thoracic spine which caused myelopathy. Case 1: A 42-year-old male complained of low back pain and gait disturbance after lifting heavy load. Roentogenograms showed calcified lesion in the spinal canal and intervertebal space at the T11/12 level. After anterior decompression and T11-L1 fusion, myelopathy improved. Case 2: A 54-year-old female presented with right leg pain and difficulty in standing after getting off the bus. Images revealed calcified lesion in the spinal canal at the T11/12 level and the dural tube was compressed severely. A herniated nucleus pulposus which contained sand-like calcifits was found after T11 laminectomy and total facetectomy on the left side. Six weeks after the removal of the herniated disc and posterior fusion using instruments, she was able to walk again and was discharged.
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Hisato Tanaka, Mitsunori Komine
2010 Volume 59 Issue 1 Pages
28-32
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A 80-year-old woman suffered from back pain and numbness of both lower extremities. She was treated with drug and blocking by a nearby doctor at the beginning for one month, but consulted our hospital because dysuria developed without effect. Examination findings were MMT3 and Barthel Index ten points. Th11 compressed the spinal cord due to the vertebral fracture, the posteriol wall which projected on image. The canalis vertebralis occupation rate was 49.5%. One week from admission, she started wearing a cross-band corset and began rising rehabilitation. The 1,500 ml residual urine found at the time of hospitalization improved with treatment in nine weeks. Increased bridging callus was present in front of the vertebral body after X-P treatment for four months. After one year of treatment, buttocks pain and numbness of both legs remained, but physical findings improved to MMT4, Barthal Index 85 points. Spinal cord compression remained on MRI but residual urine symptoms healed completely. These results suggest that stabilization of a fracture improves residual urine symptoms.
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Hiroki Yoshimatsu, Kenji Yoshida, Kotaro Jimbo, Kenji Tanaka, Kensuke ...
2010 Volume 59 Issue 1 Pages
33-35
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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In the clinical examination of emergency outpatients with cervical spine trauma, it is necessary to have a deep understanding of cervical spine injury. In this study, we investigated 6923 cases of cervical spine with blunt trauma who visited our emergency room according to the cause of injury. The causes of cervical spine injury included traffic injuries in 5325 cases, fall from <1 m in 490 cases, and fall ≥1 m in 318 cases. The breakdown of traffic injuries included 3401 cases due to accidents between four-wheeled vehicles, 472 cases due to accidents between a two-wheeled vehicle and a four-wheeled vehicle, and 454 cases due to accidents involving a single four-wheeled vehicle. Cervical spine injury, spinal cord injury, or both were observed in 136 cases. Among the causes, falls and accidents between four-wheeled vehicles were observed at a high frequency, and the rate was high in accidents involving a single bicycle and cases who suffered falls. The rates were particularly high in the group associated with accidents involving a single bicycle, and it was therefore believed that a reduced ability to sense and respond to danger was involved.
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Yoshitaka Yamashita, Yoshihisa Kawauchi, Koji Sameshima, Natsuko Tomim ...
2010 Volume 59 Issue 1 Pages
36-41
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Sacral fracture is an extremely rare complication of instrumented spinal fusion. We report a case of sacral fracture following lumbar fusion surgery. The patient was a 75-year-old female with lumbar spinal canal stenosis. We performed lumbar decompression and instrumented L2-5 fusion. She presented with a sudden onset of buttock pain 14 months after the surgery. X-ray showed no fracture line but MRI a transverse sacral fracture at the sacrum. Her symptoms improved with nonoperative treatment. Recurrence of low back pain or buttock pain after instrumented lumbar fusion may be related to a sacral fracture, difficult to diagnose on conventional radiographs. CT and MRI are useful for this fracture.
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Hiro Sato, Toshitake Yakushiji, Shigeta Yorimitsu, Kiyoshi Oka, Hirosh ...
2010 Volume 59 Issue 1 Pages
42-45
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Postoperative infections in surgery for malignant bone and soft tissue tumors are relatively frequent. We retrospectively reviewed 172 patients who consecutively underwent surgery for malignant bone and soft tissue tumors between January 2003 and November 2007, and assessed the incidence rate and risk factors. Risk factors for postoperative infection were determined with univariate analyses and multivariate logistic regression. Incidence rate was 8.1% (14 cases). Gram-positive coccus was the most common organism isolated. Multivariate logistic analyses revealed that the only independent risk factor for postoperative infection was operative duration. Elaborate preoperative planning and preparation, and administration of additional doses of an antibiotic for prophylaxis were thougut necessary.
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Shinji Tanishima, Chikako Yakura, Yuki Hamamoto, Akira Tanida, Yasumit ...
2010 Volume 59 Issue 1 Pages
46-49
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A 72-year-old male visited a previous clinic for fever and back pain, and was hospitalized there diagnosed with pyogenic spondylitis.
Due to continuous high fever exhibited in spite of antibiotic administration, the patient was transferred to our hospital. Next day, left leg paralysis was recognized. Staphylococcus aureus was detected by culture of blood. Discitis in the third and fourth lumbar vertebra and epidural abscess were found by MRI. Although spinal fluid paracentesis was performed considering the association with meningitis, spinal fluid was not suctioned and the association could not be determined. Paralysis did not improve even though irrigaton and drainage procedure were performed for epidural abscess on the next day of changing hospital. Since upper left leg paralysis also appeared, cephalic MRI was performed and meningitis and brain abscess were recognized. As a result of craniotomy dorainage procedure performed after changing hospital, inflammatory reaction turned into negative 30 days later. As of now, seven months after the onset of symptoms, flare-up of spondylitis has not occurred. Even though association of bacterial meningitis and pyogenic spondylitis is rarely seen, it is necessary to pay considerable attention if it occurreds, because correct diagnosis is difficult and this can cause some delay in treatment in some cases.
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Yuhei Yahiro, Fumihiro Miyaguchi, Yasuhiro Tsuneyoshi, Nobuhiko Sunaha ...
2010 Volume 59 Issue 1 Pages
50-53
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a case of a rare suppurative arithritis of the facet joint we removed surgically. A51-year-old female using human monoclonal antibody for rheumatoid arthritis, complaining of low back pain and high fever, consulted a nearby doctor who gave her antibacterial drug. As her symptoms did not change, she consulted our department. Her left muscle strength was weaker than right, and hypesthesia in left lower extremity was found. MRI showed a mass in the left L2/3 facet joint. We performed centesis of the L2/3 facet joint and found MSSA in blood culture. Medical therapy was not effective for her, so we removed the abscess by endoscope. Her symptoms got better and her abscess disappeared on MRI.
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Takuya Uryu, Kenji Yoshida, Hisashi Yamashita, Kenji Tanaka, Kensuke S ...
2010 Volume 59 Issue 1 Pages
54-59
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We reviewed the results of femoral trochanteric fractures including basicervical fracture operated with dynamic hip screw (DHS) and trochanteric stabilizing plate (TSP). We examined 59 cases (male: 8 cases, female: 51 cases) that were followed up for three months or more. The average age was 82.8 years, and the average follow-up period was 14.8 months. The average operation time was 84 minutes, the average amount of blood was 129 g, and the average telescoping was 6.9 mm. In 57 cases, bone union was achieved. Five cases developed postoperative complications, of which two cases needed re-operation. On the whole, results were comparatively good, but there three cases were found to be outside the scope of application of this method when we reevaluated the preoperative images of cases developing complications, suggesting that correct preoperative diagnosis is necessary.
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Shinjiro Moriwaki, Kenji Kido, Yoshihiko Kunishi, Yasuhiro Ochi, Masah ...
2010 Volume 59 Issue 1 Pages
60-63
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report the clinical results of femoral innnntertrochanteric fractures treated with Proximal Femoral Nail-Antirotation (PFNA) between June 2005 and February 2009.
The subject was 38 patients, including seven males and 31 females, with an average age of 84 years. As for the fracture type, 16 patients were classified as A1, and 19 as A2 according to AO classification. The average time between onset of fracture and operation was 6.5 days, and the average operation time was 40.6 minutes.
In postoperative radiographs, the TAD (Tip-Apex Distance) was 22.9 mm (13-33 mm). In 23 patients, UCLA activity score after operation was same as that before fracture, but in 15 patients, their score was worse than that before fracture. There were no cases with the breakage or cutout of implants and postoperative varus deformity.
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Takuya Ikuta, Futoshi Kuga, Koichi Kiyota, Shozo Kanezaki
2010 Volume 59 Issue 1 Pages
64-66
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Five cases with distal femoral partial articular fracture were treated surgically using plate. They were classified into B1 (2 cases), B2 (2 cases), B3 (one case) according to AO classification.
All cases achieved good bone union. No implant-related complications were observed.
Plate osteosynthesis can provide stable fixation for distal femoral partial articular fractures.
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Koichiro Sakimura, Tatsuya Fukushima
2010 Volume 59 Issue 1 Pages
67-71
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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High-energy periarticular fractures present challenges in treatment because of local soft tissue damage or complex fracture patterns. We reviewed the outcome of temporary fixation in complex periarticular fractures with local soft tissue damage followed by conversion to definitive fixation. Ten patients with fractures of the lower extremity were treated using staged management. The region of the 10 fractures were: two distal femur, four proximal tibia, and four distal tibia. All patients underwent temporary bridging external fixation on the day of admission. Definitive fixation using the MIPO technique was performed after the soft tissue had recovered. The llizarov external fixator was used on some patients with massive bone defect or skin defect. All patients achieved bone union without wound complications. We conclude that the initial treatment of high-energy periarticular fractures with bridging external fixation, followed by planed conversion to internal fixation is a safe option.
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Katsuhiko Ishibashi, Takafumi Tajima, Gentaro Hanaishi, Kenichiro Naka ...
2010 Volume 59 Issue 1 Pages
72-76
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Quadriceps tendon rupture caused by knee extension is a relatively uncommon injury that requires immediate surgical repair. We present a case of quadriceps tendon rupture without any trauma.
A 51-year-old man with untreated diabetes mellitus injured himself while going up the stairs. From clinical evaluations, X-ray and magnetic resonance imaging, we diagnosed quadriceps tendon rupture. Six days after injury, we sutured the tendon by transosseous technique. One day after operation, we started mild range of motion exercise and weight bearing unless he felt any pain. Three months after operation, satisfactory result was obtained with knee active ROM 0-130° without extension lag.
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Masakazu Murata, Itaru Furuichi, Noriaki Miyata, Noboru Moriguchi, Ita ...
2010 Volume 59 Issue 1 Pages
77-81
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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When compartment syndrome is treated with the wrong primary care, necrosis of the tissue occurs, and amputation may be inevitable.
We examined lower limb compartment syndrome and the indication of surgical decompression in nine patients. Three cases had proximal tibial fracture, three cases were soft tissure injury, and three cases were postoperation of circulation reconstructive surgery for acute arterial oblicanse.
We measured the intracompartmental pressure at emergency in all cases and performed decompressive fasciotomy in eight cases.
Deep infection and necrosis occurred in one case which needed skin graft and foot arthrodesis.
We were able to leave the diseased limb in all cases.
Although the preoperative intracompartmental pressures was 30-120 mmHg, we determined the indication of surgical decompression from strong pain and swelling.
Muscle pressure measurement by A-line is very useful and can be performed during operation. Surgical decompression is added or extended aiming at less than 20 mmHg.
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Hidetoshi Onoue, Kazuo Kimura, Yoji Murakami, Junji Maeda, Fumihiko Ya ...
2010 Volume 59 Issue 1 Pages
82-85
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A rare case of shoulder dislocation was observed. A 2-part surgical neck fracture was treated with percutaneus closed reduction using K-wire and subsequent internal fixation applied using Fox tail nail.
The patient was a 68-year-old woman with shoulder injury resulting from a fall at home. Manual reduction of her shoulder was attempted under venous anesthesia in the emergency department without success. Perctaneous reduction with K-wire was thus performed under general anesthesia in the operating theater on the same day. The reduction procedure was followed by an internal fixation with a Fox tail nail five days after the injury. The clinical outcome was excellent one year after surgery.
If perctaneous reduction of the dislocated shoulder is possible, the choice of subsequent surgery could be beneficial, allowing higher accuracy and less invasive surgery. It is believed that percutaneous reduction of the dislocated shoulder is valuable for any type of dislocated shoulder fracture.
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Kunichika Shin, Kenjiro Ooe, Toru Asakura, Koumei Matsuura
2010 Volume 59 Issue 1 Pages
86-92
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The cut ends of Kirschner wires (K-wire) often irritate tendon, nerve, and skin. So, we developed a device for bending the cut ends of K-wires to avoid such complications using the Ender nail. With this device, an another hole (diameter 2 mm) is made by the original hole (diameter 4 mm) and the opposite side of the nail is bent into a triangle shape. This device can bend 3.0 mm Steinman pins, and is useful for fractures of distal radius, clavicle, metatarsus, calcaneus, etc.
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Kenichi Seo, Shinji Tomari, Yasumasa Ito, Katsuhiko Kikuchi, Tomonari ...
2010 Volume 59 Issue 1 Pages
93-96
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We studied the results of 13 unstable distal radius fractures in older than 60 with the Acu-Loc distal radius plate system. We assessed the short-term radiographic and clinical outcomes of this treatment. The mean age was 70.5 years (61-84 years). The mean follow-up period was 5.8 months (2-11months). The results were evaluated based on Cooney scores and the following X-ray parameters: radial inclination (RI), volar tilt (VT), ulnar variance (UV). Cooney scores were excellent in seven, good in five, and fair in one. Radiographic alignments were maintained between the postoperative and final follow-up examinations. The targeting guide of Acu-Loc enables orthopedic surgeons to precisely locate the locking screws immediately under the subchondral bone and toward the tip of the radial styloid.
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Yukio Abe, Yasuhiro Tominaga, Hideaki Fujimoto, Yasuhiro Yamaoka, Kazu ...
2010 Volume 59 Issue 1 Pages
97-101
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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TFCC injury is well known to be definitely associated with distal radius fractures to a certain extent. However, there is no guideline of the treatment for TFCC injury caused by distal radius fracture. We reported three cases that complained of ulnar side wrist pain due to TFCC injury associated with the uneventful healing of distal radius fracture.
The three cases consisted of one man and two women, whose age ranged from 56 to 71 years old. They complained of ulnar side wrist pain after the healing of distal radius fracture with normal alignment, and underwent wrist arthroscopy five to ten months after injury.
Arthroscopic findings showed slit tears of TFCC and synovitis around TFCC in all patients. Furthermore TFCC tear from the ulnar styloid process, septa formation, and partial lunotriquetral interosseous ligament tear were also observed. Although two cases showed non-union of the tip of the ulnar styloid process, all cases achieved pain relief with only soft tissue treatment.
There exists no strategy of treatment for TFCC injury associated with distal radius fracture. We conclude that arthroscopic surgery is mandatory at initial surgery for distal radius fracture and associated slit tear of TFCC should be treated to prevent postoperative ulnar wrist pain.
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Takeshi Okamura, Hiroshi Tada, Takashi Matsuzaki, Yoichi Yoshimura, Yo ...
2010 Volume 59 Issue 1 Pages
102-106
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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In recent years, there have been reports on bone fracture treatments using locking plates for distal radius fractures. Since August 2007, we have also been using the Steller plate for such treatments at our hospital. Out of 22 cases using the Steller plate for distal radius fracture with intra-articular fracture from August 2007 to March 2009, 13 cases with dorsally displaced distal radius and who could be followed-up for more than six weeks were studied. The 13 subjects consisted of one male and 12 females with an average age of 69. Four right hands and nine left hands were examined. The average follow-up period was 175.3 days. The average preoperative Radial inclination (RI) of 10.4 degrees improved to 21.5 degrees immediately after surgery, and maintained at 22.9 degrees even in the last follow-up. The average preoperative Volar tilt (VT) of -11.2 degrees also improved to 8.2 degrees immediately after surgery, and maintained at 10.5 degrees in the last follow-up. Except for one case with dorsally displaced distal radius seen postoperatively to the final follow-up, most cases maintained reduction to the final follow-up after surgery. With adequate reduction of distal radius fractures, the Steller plate is considered useful for distal radius fractures with intra-articular fracture.
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Keishiro Yoshino, Osamu Shigemori, Taihei Koguchi, Shinya Matsumoto, A ...
2010 Volume 59 Issue 1 Pages
107-114
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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From January to December 2008, we performed internal fixation for four cases of femoral neck fractures in young adults. The average age at surgery was 51.3 years (range: 22 to 63), and the average follow-up was 9.8 months (range: 6 to 14).
All four cases underwent manual reduction on traction table under general anesthesia and obtained anatomical reduction. Displacement occured in one case again during screw fixation, while the another cases obtained anatomical reduction within internal fixation.
All cases achieved bone union. One case developed appeared osteonecrosis of the femoral head 14 months after surgery.
This report discusses the reduction method used on, and present reduction techniques.
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Akira Hozumi, Masakazu Murata, Noriaki Miyata, Shoichi Kuba, Kazumasa ...
2010 Volume 59 Issue 1 Pages
115-119
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The purpose of the present study was to evaluate the early results of the tapered stem following pneumatic broaching and manual broaching for neck fractures in elderly patients. Forty primary femoral neck replacements were performed in 40 patients. Pneumatic broaching was used in nineteen patients. Post-operative stem subsidence (>3 mm ) occurred in three hips within two weeks following manual broaching. The filling rate of implants (zone 2-6, A-P view of X-ray) in both groups were 80.62±8.99% (M group) vs 84.62±% (W group). Complications occurred in one case, one in cervical calcar fracture during operation in the manual broaching group.
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Takuya Ikuta, Mitsuru Sakaguchi
2010 Volume 59 Issue 1 Pages
120-125
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We evaluated the clinical and radiographic results of hip hemiarthroplasty for femoral neck fracture in 37 cases using the Exeter type system. We followed them up for a period of more than five years (average 6.9 years).
The survival rate of femoral component for aseptic loosening at the endpoint was 97.3%, and that for any cause at the endpoint was 94.6%.
Our findings show that implant of the Exeter stem by proper cementing technique has excellent mid-term results.
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Hidefumi Honke, Masaaki Mawatari, Shunsuke Kawano, Masamori Shigematsu ...
2010 Volume 59 Issue 1 Pages
126-130
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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This study evaluated the clinical and radiographic short-term results of cementless total hip arthroplasty less than forty years old.
Sixty-four total hip arthroplasties were performed in fifty patients who were younger than forty years of age (average age; thirty-three years). Mean duration of follow-up was thirty-four months. The cause diseases, complications, clinical and radiographic outcomes were assessed.
In comparison with all primary total hip arthroplasty cases, the rate of arthroplasty after osteotomy and osteonecrosis as a cause of disease was high in patients under forty. The Japan Orthopaedic Association score improved with all cases. No component was radiographically seen to be loose at the time of final follow-up. Four patients (five hips) showed dislocation.
The short-term results of cementless total hip arthroplasty in patients under forty were good clinically and radiolographically.
However, problems such as liner wear, osteolysis, loosening, and revision are seen, so it will be necessary to observe progress in the long-term.
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Katsuhiko Murakami, Katsutoshi Sunami
2010 Volume 59 Issue 1 Pages
131-134
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a case of subtrochanteric femoral shortening oblique osteotomy in high dislocation of the hip with total hip arthroplasty. A 71-year-old female, suffering from dislocated hip (Crowe type IV ), was treated with a modular femoral component (S-ROM-A). The operation was carried out through a posterior approach. The acetabular component was placed at the level of the true acetabulum. The lengthening of the operated limb was 40mm. At follow-up, she reported significant pain relief and functional improvement. The osteotomy appeared to be healed on radiograph by 3 months. This technique minimizes the potential complications, allows for correction of severe femoral neck anteversion, and gives excellent rotationary stability, while preserving the proximal femur for better press-fit cementless fixation. THA for Crowe type IV developmental hip dysplasia is a safe and effective procedure, able to improve not only hip function, but also lumbosacral and knee pain owing to a dramatic correction of static body balance. This procedure poses a wide spectrum of difficulties however, and can represent a serious risk of complications. A successful result depends on a complete preoperative assessment of the patient, attention to the details of the surgical procedure performed with an adequate prosthesis, and a reasonable selection of indications.
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Akira Hashimoto, Shunsuke Kawano, Masamori Shigematsu, Motoki Sonohata ...
2010 Volume 59 Issue 1 Pages
135-140
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The purpose of present study is to report the short-term results of revision total hip arthroplasty (revision THA) without cement. Sixty-six hips of 64 patients who underwent revision THA from September 1998 to September 2005 and could be followed up for three years or more were enrolled in the study. There were eight men nine hips and 56 female 57 hips, and mean age was 69.9 years. According to the Endo-Klinik classification, seven hips were grade 1, twenty-nine hips were grade 2, twenty-three hips were grade 3, five hips were grade 4, there was one fracture, and one that could not be classified. Cementless long stems (PerFix HA LONG) were used in 20 hips. Almost all the hips achieved stem stability except for four hips in grade 3. There was no hip with serious stress shielding. One hip required re-revision, but there were no other serious complications.
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Shinichi Motomatsu, Takashi Shimauchi, Yoshiyasu Aya, Osamu Nakagawara ...
2010 Volume 59 Issue 1 Pages
141-145
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We present a case with the neck fracture of the AML plus stem. In 2000, a 72-year-old woman with osteoarthrosis was treated with cementless total hip arthroplasty. In 2006, she sustained neck fracture of the stem occurred without trauma, and unable to walk. At revision, we performed extended trochanteric osteotomy, and then separated the medial side of the stem and bone with a T-saw. Postoperative course was good. An external investigation was performed to assess the potential cause of neck fracture, but no conclusions could be drawn. It has been found that two other neck fractures of the AML plus stem have occurred in Japan after our case.
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Kenta Kamo, Kazushi Haraguchi, Kazuhiro Yamaoka, Manabu Irie, Toshiaki ...
2010 Volume 59 Issue 1 Pages
146-148
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We experienced bilateral total hip arthroplasty (THA) in an ankylosing spondylitis (AS) patient who had been treated by only NSAIDs and suffered from hip remarkable distraction. A 51-year-old man had suffered from AS for 22 years. His first X-rays in our hospital showed distraction bilateral hip joints including joint space narrowing, axial migration of the femoral head, and protorusio acetabuloi. He underwent left THA on 27 November 2008, Methotrexate from 12 December 2008 and right THA on 29 January 2009. Both surgeries were done under general anesthesia with an airway block to intubate. In surgery, intra-articular synovitis was remarkable with bone invasion. After acetabular reaming, auto-graft bone implantation was done with chips of the femoral head. THA provided improvement in gait from almost a wheelchair-bound state to use of a cane.
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Taketoshi Kanazawa, Masanori Sakaino, Akio Inoue
2010 Volume 59 Issue 1 Pages
149-152
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We studied the outcome of Chiari's pelvic osteotomy for cases of coxarthrosis with ossification fragment in the joint capsule. Twenty-three of 32 these hips were followed up for over two years. The average age was 50 years (34 to 59 years) at the time of operation. The preoperative stage of coxarthrosis was two hips in the advanced stage, and 21 hips in the terminal stage. Pain was successfully cured in 20 hips. The success rate of Chiari's pelvic osteotomy is considered higher in cases with the ossification fragment in the joint capsule even in the fifties.
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Shoichiro Higa, Hideki Asato, Chinatsu Azuma, Kazunobu Arakaki, Fumino ...
2010 Volume 59 Issue 1 Pages
153-159
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Roatator cuff repair often provokes continuous pain after surgery. Continuous pain causes not only contracture of the shoulder which disturbs motion exercise but also causes complex regional pain syndrome. We performed arthroscopic rotator cuff repair in 32 patients; 16 patients received continuous scalene block (SB) and 16 patients received joint injection (JI) in order to reduce postoperative pain. Both groups were compared with visual analog scales, post-op elevation angles of the shoulder and the number of patients requiring dicrofenacnatrium suppository for post-op pain control. For the visual analog scales, the SB group was significantly lower than the JI group at 3 to 5 days after surgery. For the elevation angles of the shoulder, the SB group was significantly higher than the JI group at two weeks after surgery. In the number of patient using dicrofenacnatrium suppository after surgery, and the SB group was significantly lower than the JI group. No complications occurred in both groups. The continuous scalene block was therefore found to be a useful technique for pain control after arthroscopic rotator cuff repair.
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Mikio Terahara, Naohito Oshima
2010 Volume 59 Issue 1 Pages
160-164
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Traumatic fracture-dislocation of the shoulder account for <3% of all shoulder dislocations. We report the case of a 78-year-old man who fell down from his bed and sustained a posterior dislocation fracture of the right shoulder.
Under general anesthesia, we performed open reduction and internal fixation. At 10 months after surgery, avascular necrosis of the humeral head was not observed and his JOA score was 80 points.
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Kenshi Kikukawa, Junji Ide, Jun Hirose, Hiroki Irie, Hiroshi Mizuta
2010 Volume 59 Issue 1 Pages
165-167
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A 65-year-old male who underwent surgery for chronic anterior dislocation of the left shoulder is reported. He had been treated conservatively for 1.5 years after a traumatic event before visiting our hospital. He had deformity of the shoulder and pain at shoulder motion. Active forward elevation was limited to 55 degrees. External and internal rotations were -40 degrees and L2, respectively. Preoperative JOA score was 40 points. Routine radiographs, CT scanning, and MRI showed anterior dislocation of the left shoulder. The humeral head was replaced in a routine shoulder hemiarthroplasty. After that, Bankart repair and coracoid transfer were performed. Gentle active assisting range of motion exercises were started four weeks after surgery. At one year and six months follow-up, the patient had no pain. Active forward elevation was improved to 80 degrees, and external and internal rotations were 0 degree and Th12 respectively. The postoperative JOA score was 82 points.
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Yohei Masuda, Takeshi Nishijima, Takeshi Okamura, Takashi Matsuzaki, H ...
2010 Volume 59 Issue 1 Pages
168-173
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Two cases of comminuted patella fracture were treated with the sunflower method using the AI-wiring system consisting of a self-locking pin and circumferential wiring. Both cases showed satisfactory results, and achieved bone union. This method is very useful for patella fractures.
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Yasutaka Tashiro, Ken Okazaki, Hiromasa Miura, Shuichi Matsuda, Toshia ...
2010 Volume 59 Issue 1 Pages
174-177
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Introduction: Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Methods: Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10: 00 to 10: 30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Results: Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. Conclusion: ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function.
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Yu Fukao, Keitaro Yamamoto, Hiroaki Yano, Katsuhiro Kawahara, Yasuyuki ...
2010 Volume 59 Issue 1 Pages
178-182
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The combined ligament injury of the knee is caused by traffic accidents and high-energy-sports etc., and often the choice of treatment for combined ligament injuries involving the posterior cruciate ligament of the knee is difficult. Posterior cruciate ligament injury is usually treated by conservative management, but recently combined ligament injuries involving the posterior cruciate ligament are treated by the surgery as that for other ligament injuries of the knee. Five knees treated by combined ligament reconstruction involving the posterior cruciate ligament between June 2005 and July 2008 are reported with bibliographical consideration.
Two cases were injured by judo, and the other three cases were injured by skiing, traffic accident and falling respectively. All cases are male. Their mean ago was 29.0 years old (range: 17 to 42). Two cases injured PCL+ACL+MCL, and the other three cases injured PCL+ACL, PCL+MCL and PCL+LCL. These cases were treated by combined ligament reconstruction and repair. PCL was reconstructed with autogenic hamstring in all cases. The indication, method of reconstructions and postoperative results are discussed.
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Go Takayama, Toshihiro Ohdera, Masami Tokunaga, Eiji Yoshimoto, Shusak ...
2010 Volume 59 Issue 1 Pages
183-186
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We investigated the factors of flexion contracture in total knee arthroplasty (TKA) using a prospectively collected database of 37 knees of osteoarthritis (OA) patients for two months. We used all the same posterior stabilized type of prosthesis.
We surveyed probable factors influencing postoperative flexion contracture of patients including their age, sex, BMI, JOA scores, etc. We measured extension of the knees by means of X-ray photographs of lateral knee views at maximal extension. We further examined their OA stage, alignment, and tibial inclination. Furthermore, we measured gaps and soft tissue balances using the knee balancer intraoperatively. We investigated these results statistically.
First, we found a strong correlation between preoperative and postoperative extension of the knees. Among the possible factors, we hypothesized that the factors of sex and tibial inclination are important for postoperative knee extension.
This study suggests that maximal extension must be achieved intraoperatively in TKA for prevention against postoperative flexion contracture except genu recurvatum.
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Tateki Segata, Takeshi Yamashita, Katsuya Iwamoto, Kensuke Yonemura, I ...
2010 Volume 59 Issue 1 Pages
187-190
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) is inevitable and several methods to reduce perioperative blood loss have been reported. We evaluated the effects of the drain-clamped method with tranexamic acid for reducing blood loss after TKA. We classified our TKAs into the following groups, Group A: Cemented TKA was performed utilizing the drain clamped method with intra-articular infusion of saline. Group B: Cemented TKA was performed utilizing the drain clamped method with intra-articular infusion of tranexamic acid and saline. Group C: Cementless TKA was performed utilizing the drain clamped method with intra-articular infusion of tranexamic acid and saline. The knees were compared for the amount of postoperative blood loss. The average amount of total blood loss was significantly less in the tranexamic group (Groups B and C) compared with the only drain-clamped group (Group A). The drain-clamped method with intra-articular infusion of tranexamic acid is simple, and effective for reducing blood loss in TKA.
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Tsutomu Motooka, Hirofumi Tanaka, Takao Hotokebuchi
2010 Volume 59 Issue 1 Pages
191-194
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Abnormal weight-bearing for a long time leads to the deformity of leg joints. We inquired the ankle arthritis of cases with great leg length discrepancy and hence walk in an equinus gait pattern extending over a long period of time. Thirty patients with unilateral coxarthrosis (mean leg length discrepancy was more than 5 cm for more than 20 years) were analyzed in terms of the rate of ankle arthritis, and JSSF score. The results were as follows; most cases did not complain of ankle pain, but prevalence rate of ankle arthritis was 37 % (many cases were early stage), the score of JSSF ankle / hindfoot scale was 71.4±6.7 (out of 77). From this investigation, it would appear that equinus gait over a long time contributes to early stage ankle arthritis.
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Kazuki Kanazawa, Ichiro Yoshimura, Tomonobu Hagio, Akinori Takeyama, M ...
2010 Volume 59 Issue 1 Pages
195-201
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report two cases of surgical treatment of diabetic Charcot foot. Case 1: A 37-year-old man had type I diabetes and Charcot foot (Brodsky type I and Sammarco pattern 2). We treated him with 1st tarsometatarsal arthrodesis and exostectomy for repeated foot ulcer. Case 2: A 52-year-old woman had type II diabetes and Charcot foot (Brodsky type I and Sammarco pattern 1). We treated her with 1st to 5th tarsometatarsal arthrodesis for severe flat foot deformity. The aim of two cases was to maintain plantigrade, ulcer-free infection-free feet capable of functional walking after operation.
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Yuzo Honda, Toshiyuki Tsurumoto, Narihiro Okazaki, Takeshi Miyaji, Hir ...
2010 Volume 59 Issue 1 Pages
202-207
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Pathological dislocation of the second toe with rheumatoid arthritis is not a rare condition, but it is rare when there is no anamnesis. We report three cases of hallux valgus with dorsal dislocation of the second metatarsophalangeal joint.
Before surgical treatment, the hallux valgus angle (HVA) of the three cases was 40° to 62°.
We performed the Michell procedure for hallux valgus, and additionally fixed the metatarsophalangeal joint using a K-wire in the first case. For the other two cases, we performed resection of the second metatarsal head by the Michell procedure. Pain at the bottom of the forefoot improved in all cases, but the hallux valgus relaspsed in one case.
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