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Tomohiro Narahara, Kenji Yoshida
2010 Volume 59 Issue 2 Pages
209-215
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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This study was conducted on 10 patients who suffered acute ankle sprain and were treated with a short leg cast with a slightly dorsiflexed position. The patients were aged from 14 to 59 years old with an average age of 33.7. Five of the patients were male and 5 female. The interval between injury and first visit ranged from the day the injury occurred to 2 days after, with the average interval being 0.9 days. The shortest immobilization period using a short leg cast was 26 days and the longest period was 44 days with the average being 37.6 days. The average talar tilt angle seen through the stress X-ray view was 17 degrees (10-25 degrees) on the first visit and the average was 4.6 degrees (0-10 degrees) on the final visit. These X-ray findings and further clinical results showed improvement from the use of this method.
The method itself is a relatively simple procedure and results in the patient being able to walk bearing their full weight without any support required.
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Takashi Manabe, Toshihiro Ohdera, Masaaki Katsuki
2010 Volume 59 Issue 2 Pages
216-219
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Recently, antithrombotic agents are generally used after arthroplasty, but anticoagulant treatment has the risk of bleeding complications. A retrospective study of 333 consecutive cases of total knee arthroplasty was conducted over a year and six months period. Fondaparinux was started the morning after operation and continued up to a maximum of 14 days. In the screening of deep vein thrombosis (DVT) of the lower limbs, ultrasonographic assessment was performed on all patients the morning after operation before anticoagulant treatment. Asymptomatic DVT showed an incidence of 39.0% (130 of 333), and no symptomatic DVT and no pulmonary thromboembolism were observed. Bleeding complications occurred in four out of 333 (1.2%), including three cases of bleeding gastric and duodenal ulcers and a case of calf hematoma. Antithrombotic agents should be used with great care after arthroplasty to prevent bleeding complications.
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Hiroki Irie, Teiji Kato, Issei Ishii, Katsuya Iwamoto, Takeshi Yamashi ...
2010 Volume 59 Issue 2 Pages
220-223
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A 25-year-old male, sustaining burus on the upper part of his body (third degree burns on both upper extremities and second degree burns on soma / face) due to kerosene ignition underwent counterincision, wound treatment, and dermanaplasty several times. Five months after the burns, he was introduced to our hospital for elbow joint contractures. The range of motion was 40-50 degrees at the right elbow, 45-50 degrees at the left elbow, and X-ray film and CT showed heterotopic ossification at the posterior humeroulnar joint.
After treatment for complicated nephritis, surgical mobilization of the left elbow joint was performed at 16 months after the burns and that of the right elbow joint at 19 months.
By the inside approach, the medial epicondyle was resected surgically, the ulnar nerve was transferred anterior, and the posterior oblique ligament was separated. By the outside approach, the posterior ossification was removed surgically.
The final range of motion improved 0-140 degrees bilaterally. Able to carry out daily activities independently, patient satisfaction was very high.
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Fumi Okada, Kazuhiko Ihara, Nobuharu Shimada, Tatsuya Beppu, Tsutao Ta ...
2010 Volume 59 Issue 2 Pages
224-227
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We performed the Sauve-Kapandji procedure for forearm contracture due to C6 spinal cord injury. The patient, a 40-year-old man, injured his spinal cord in a traffic accident four years ago and was diagnosed with complete C6 neurological lesion. He complained of upper extremity deformity caused by hematoma in his forearm formed by pushing his wheelchair. His supination contracture caused palmar dislocation of the distal radioulnar joint, which resulted in the formation of the hematoma. We carried out surgical treatment using the Sauve-Kapandji procedure. He is now able to push his wheelchair without hematoma.
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Seiji Sumiura, Manabu Yamamoto, Keisuke Ikeda, Kazushige Seki, Takashi ...
2010 Volume 59 Issue 2 Pages
228-230
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We treated two patients with traumatic ring finger degloving injuries. Degloving digital amputations are generally thought to have lower survival rate after replantation than other amputations. The main problem in these injuries is the extensive damage to long-segment of skin, digital arteries and veins. In such cases, vein graft and venous flap are applied. In our two cases, degloving amputations of the ring finger were successfully replanted using vein grafts and venous flap.
Venous flap is a useful alternative for the repair of severely avulsed skin, artery, and vein.
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Akio Matsuzaki
2010 Volume 59 Issue 2 Pages
231-234
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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305 operated cases of carpal tunnel syndrome were studied. The gap of the retinaculum after section was 4.4 mm (mean). In the sagittal section, the flexor retinaculum had a fusiform shape. Two-thirds of it was distally thicker than the proximal part. The thickest part of the retinaculum was 3.8 mm thick. The width of the retinaculum was 30.4 mm. In the majority of cases, thinning of the median nerve beneath hypertrophied retinaculum was observed. At the thinning part of the nerve, the volar and dorsal surfaces were concaved.
This deformation of the nerve suggests that the nerve, bending around the hypertrophied flexor retinaculum in wrist flexion, is subjected to compression against the retinaculum by tensed overlying FDS tendons to the index and middle fingers.
Repetitive hand activities involving pinch and grasp during wrist flexion may be a contributing factor in most instances of carpal tunnel syndrome. Synovitis of the ulnar and radial bursa act as a cause of carpal runnel syndrome due to decreasing volume of the tunnel, furthermore adhesion of the bursa on the dorsal surface of the retinaculum may act as an precipitating factor of the disease by blocking the mobility of the median nerve in the tunnel.
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Koji Yoshida, Keiichi Muramatsu, Toshihiko Taguchi
2010 Volume 59 Issue 2 Pages
235-237
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A 31-year-old man and 17-year-old woman visited our hospital for evaluation and treatment of pain in their right thumb. On clinical examination, there were positive Tinel's sign at the level of metacarpo-phalangeal joint, and decreased sensation in two-point discriminaition was found in one case. Both patients underwent operation for correct diagnosis and remaining thumb pain.
The surgical procedure of one case involved careful neurolysis of the extraneural and epineural scar, while that of the other case involved the same procedure and excision of the synovial mass which seemed to be chronic, proliferative synovitis arising from the sheath of the flexor pollicis longus tendon. Three months after operation, they were able to perform all daily activities and bowl without pain.
Perineural fibrosis and scarring of the digital nerves in the hand can result from chronic compression and repetitive trauma. When conditions are severe, surgery will never provide complete restoration, so early diagnosis is most important.
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Hidetoshi Ihara, Sayuri Oka, Masanobu Takayama, Takahiko Fukumoto, Chi ...
2010 Volume 59 Issue 2 Pages
238-241
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The aim of this study was to investigate the influence of shoe on an unstable board through evaluation of postural control ability on an unstable board. The evaluation was carried out on 12 female members of a university handball team. The subjects underwent assessments of dynamic balance in the monopodal stance and in the perturbation of an unstable board under three conditions: (1)barefoot, (2)in school shoes, and (3)in handball shoes. Accelerometers were attached to the skin on both knees and to the unstable boards. First, the subjects were instructed to stand on a small unstable board on one leg with their eyes open and maintain their balance for 10 seconds against the sway of the board until three successful trails were accomplished. The movement of their lower limbs was recorded using the accelerometers. Maximal amplitudes of acceleration were used as a parameter of body sway. The number of failures was also recorded. Next, the subjects were asked to stand both legged on a large unstable board with their eyes open. A therapist applied sudden tilt to the board by pushing it from the rear end for a total of 10 times. The subjects were instructed to maintain their balance. Maximal amplitudes were used as indicators of the strength of stepping power. There were no significant differences between subjects with and without shoes in the maximal amplitudes of acceleration. Barefoot was superior in the number of failures of one leg posture control ability compared to when school shoes were worn shoes.
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Satoshi Nagano, Masahiro Yokouchi, Ichiro Kawamura, Michihisa Zenmyo, ...
2010 Volume 59 Issue 2 Pages
242-245
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We reviewed the outcome of osteosarcoma patients older than 30 years. Eight patients were treated in our department since 2001 to 2008. The median age of the group was 47 years (range: 30 to 67 years), and locations of the primary tumor was in the extremity in all patients. No patients presented metastatic lesion at the diagnosis. Six patients underwent neoadjuvant chemotherapy followed by surgical treatments. Three patients had amputation and four patients had limb-salvage surgery. Histological evaluation of the neoadjuvant chemotherapy was grade 0 in three patients, grade 1 in two patients and grade 2 in one patient. Three patients developed lung metastases nine months after the surgery on average, and died of the disease. One case was alive with disease and four patients were disease free at average three years and five months of observation. The effects of neoadjuvant chemotherapy were found to relate to good prognosis, however, completion of the chemotherapy was difficult in most cases because of the poor general conditions or side effects.
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Masato Tomita, Kenji Kumagai, Yumiko Kanamaru, Hiroyuki Shindo
2010 Volume 59 Issue 2 Pages
246-249
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a case suffering from breakage of the femoral stem of tumor prosthesis (KLS system). The case, a 39-year-old woman, had a mass in the right popliteal region, diagnosed as parosteal osteosarcoma of the femur histopathologically by open biopsy. In the first operation, her lower limb was reconstructed with a KLS system cementless femoral stem (12 mm in diameter), after wide resection of the tumor. Her condition after operation was quite good, and she could walk with or without a cane. After three years and one month, she felt thigh pain, and visited our outpatient clinic. X-ray showed breakage of the femoral stem and screws. Revision surgery was performed. After difficult removal of the femoral component, her knee joint was reconstructed with a 13 mm cemented femoral stem. Six months after revision surgery, she can walk with a cane and feels no pain. Cementless stem has three screw holes for anti-rotation mechanism. These screw holes are thought to be the locus minoris of the stem mechanically. In order to prevent breakage of the femoral stem especially in active young patients, cemented stem for the femur, and cementless component for the tibia are recommended, if the KLS system is to be used after resection of the bone tumor.
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Kanehiro Matsuyama, Masahiro Yokouchi, Satoshi Nagano, Ichiro Kawamura ...
2010 Volume 59 Issue 2 Pages
250-253
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Soft part sarcoma is well known it in itself is not usually accompanied with pain, and it is diagnosed as painless tumor as chief complaint. Therefore, it is difficult to suspect sarcoma just frompain in cases with tumors that are not palpable because they are located in deep parts. We reported two cases of sarcoma with groin pain as the chief complaint. The sarcoma was proved to be a tumor after conservative therapy at a clinic. There are many diseases causing cause groin pain, and general orthopaedists find it difficult to suspect sarcoma only from groin pain because sarcoma with groin pain is unusual. However, soft part sarcoma can be diagnosed swiftly and accurately, and it influences the prognosis of the patient by starting treatment early. Adult soft tissue sarcoma occurs often extending from the femur to groin. It is therefore desirable to perform MRI early in cases resisting conservative therapy.
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Fuminari Uehara, Hiroki Maehara, Yasunori Tome, Fuminori Kanaya
2010 Volume 59 Issue 2 Pages
254-258
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Small cell osteosarcoma, a subtype of conventional osteosarcoma, is rare. We report a case of small cell osteosarcoma in the shaft of the radius. The patient was a 16-year-old female, who had been complaining of a mass and pain in the left forearm for two months. Roentgenogram revealed a lytic lesion and irregular thickened cortex in the shaft of the radius. MRI revealed a 9×11 mm sized tumor-like lesion in the cortex of the radius, which was low-intensity on T1WI, high-intensity on T2WI, and enhanced by gadolinium. Histological diagnosis by open biopsy was small cell osteosarcoma. After chemotherapy, wide excision and reconstruction with non-vascularized fibular graft, tendon transfers, and rotation flap were performed. At one year and two months after surgery, the patient did not show recurrence nor metastasis, but showed satisfactory function of the forearm and hand.
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Arisa Tsuru, Ichiro Kawamura, Masahiro Yokouchi, Satoshi Nagano, Kaneh ...
2010 Volume 59 Issue 2 Pages
259-262
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We evaluated the clinical results of seven patients who uuderwent trepanation for simple bone cysts with active phase in childhood.
From January 2001 to March 2009, we performed trepanation, on five men and two women, and followed them up for an average of 67.6 months. Three of seven patients had recurrence of simple bone cyst (43%). We operated on the patients for trepanation again, and the clinical outcome was good (85.7%). Postoperative complications were one pathological fracture. No other complications were seen. Trepanation has low stress and is useful for active phase simple boue cysts, but has a high rate of recurrence. We may therefore need to establish a new treatment with low stress and lower rate of recurrence.
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Soshi Ideta, Kazunari Maeda, Masafumi Torigoshi, Kenji Taguchi, Takayu ...
2010 Volume 59 Issue 2 Pages
263-267
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Bone Paget's disease is a comparatively rare disease in Japan. We experienced three cases of bone Paget's disease and discuss them referring to literature in this report. The location of occurrence differed in the three; right hip joint, low back and knee joint. But all cases had high serum ALP values, and were diagnosed with bone Paget's disease through examination such as simple X-rays, bone scintigraphy, and biopsy. After diagnosis, we started the patients on bisphosphonates. Currently, inspection values have normalized with improvement of symptoms. Generally, prognosis of bone Paget's disease said to be comparatively good. However, in some rare cases, there is a risk of complications such as pathological fracture, malignancy change, and degenerative arthritis, so early checkup, early treatment, and long-term follow-up are necessary.
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Kuniyoshi Tsuchiya, Hisashi Sakamoto, Osamu Tomishige, Hideya Kawamura
2010 Volume 59 Issue 2 Pages
268-270
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Thirty early cases of microendoscopic surgery were reviewed. Twenty-one had posterior decompression for lumbar canal stenosis (LCS), and nine had discectomy for lumbar disc herniation (LDH). All cases recovered well clinically. Five cases switched to microscopic surgery, of these three had dural tears repaired under microscope. One case of LDH changed to microscopic surgery due to difficulty in locating the exact margin of nerve roots, and one case of LCS for loss of orientation. Both were finally treated successfully by microscopic surgery. Microendoscopic surgery is obviously a less invasive method, but has a steep learning curve.
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Ryusaku Nagayoshi, Kosei Ijiri, Hikaru Sakamoto, Takuya Yamamoto, Kazu ...
2010 Volume 59 Issue 2 Pages
271-274
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Recently, new surgical procedures with minimam invasion for lumbar canal stenosis (LCS) are beeing reported. We investigated the short-term clinical outcomes of muscle-preserving interlaminar decompression (MILD) for the lumbar spine at our department.
Since 2006, 18 patients with LCS were included in this study. They consisted of five women and 18 men, and the mean patient age was 71.6 years. The mean post-operative follow-up period was 18.1 months. The mean 1.8 intervertebral levels were decompressed by the MILD method. The pre- and postoperative Japanese Orthopedic Association scores (JOA scores) , recovery rate, operation time, intra-operative blood loss, surgical complication, and radiological instability were evaluated.
The mean operation time was 104 minutes per level, and mean intra-operative blood loss was 32 g per level. Dural tear occurred in one patient. The mean JOA scores improved from 13.3 points preoperatively to 18.1 points post-operatively and the recovery rate calculated with JOA scores was 39.6%. Three patients had undergone re-operative surgery because of aggravation of neurological symptoms.
Considering the surgical damage to the supra- and interspinous ligaments with the MILD method, it might be important to select the indication strictly for lumbar canal stenosis.
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Katsuhiko Fukushima, Keisuke Goto, Atsushi Inoue, Naoya Tajima, Shinic ...
2010 Volume 59 Issue 2 Pages
275-278
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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[Purpose] PLIF is a good operative method for decompression and interbody fusion for lumbar spine diseases with instability. The factors of obstruction to bone union after PLIF, were studied and are reported below.
[Subjects and Method] 58 cases who underwent surgery of PLIF one year ago during February 2005 and April 2007 were studied. For these cases, factors of obstruction to bone union were studied. The factors were age, sex, disc level of fusion, time required for oparation, amount of bleeding, amount of removed disk, perioperative Hb change, height, weight, and BMI. For analysis method, a univariate analysis was performed for an individual explanation variables. A logistic multivariate analysis of whether or not there were obstructions to bone union was also performed as objective explanation variable.
[Results] 89% of the 52 cases achieved bone union after the first postoperative year. From the univariate analysis/logistic multivariate analysis between each group, there was a statistically significant difference in obstruction to bone union and bone union was poor at the position of L5/S fusion. There was no significant difference in other studied items.
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Tadatsugu Morimoto, Hiroaki Konishi, Kenshiro Inatomi, Tsuyoshi Okudai ...
2010 Volume 59 Issue 2 Pages
279-281
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The purpose of this investigation was to demonstrate the possible association between the presence of rib anomalies of the thoracolumbar junction and lumbosacral transitional vertebrae.
The subjects of this study were 411 (283 men and 128 women) adults (18-50 years) treated by herniotomy due to lumbar disk hernia.
The patients were classified into three groups according to the existence of lumbosacral transitional vertebrae: 1) N group; as a control, without lumbosacral transitional vertebrae 2) L4/TV group (sacralization), and 3) L5/TV group (lumbarization). Rib anomalies of the thoracolumbar junction were assessed with 12th short rib and lumbar rib at L1 in the thoraco-lumbar spine on the radiographs. The frequency of 12th short rib in the L4/TV group (46%) was significantly higher than in the N group (6.4%) and L5/TV group (2.7%) (P<0.05).
The frequency of lumbar rib in the L5/TV group (32.5%) was significantly higher than in the N group (3.2%) and L4/TV group (0 %) (P<0.05).
Based on the fact that 12th short rib is fairly common with L4/TV and lumbar rib is fairly common with L5/TV, the lumbar spine may be modal with a constant count of five because there may be audition and subtraction in the thoracic and lumbar spine.
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Minoru Kashihara
2010 Volume 59 Issue 2 Pages
282-284
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a case of lumbar facet cyst. A 71-year-old woman suffered low back pain and left lower extremity pain. MRI revealed intraspinal cyst around the left facet at L5/S1. Conservative therapy was not effective and resection of the cyst was performed. Histologically the cyst did not contain synovial lining cell, and cystic cavity and myxoid change as in the ganglion cyst were not observed. However, it was diagnosed as synovial cyst arising from the facet joint. A synovial cyst and ganglion cyst was found to arise from the juxta-articular region in the spine. It is not clear whether they are two completely separate entities, because the lining of the synovial cyst is often denuded and a series of discontinuity of ganglion cysts from the facet joint by facet arthrography has not been presented. Both synovial and ganglion cysts share a common pathogenesis, being closely associated with degenerative joint disease and rising from the facet joint.
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Chikako Yakura, Yuki Hamamoto, Masako Hayashibara, Shinji Tanishima, A ...
2010 Volume 59 Issue 2 Pages
285-288
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A case: An one-year-old girl had caught a cold, was taking medicine from one month ago, and had febricula intermittently. One day, her mother noticed that her daughter did not move her left upper limb voluntarily, so she took her to our hospital. The doctor on duty diagnosed her with pulled elbow. The next day, she was admitted to our hospital for treatment for pneumonia. Her left upper limb had not yet moved voluntarily after hospitalization, so two days later, she was examined by our orthopaedic surgeon. Her left shoulder had rubor heat and swelling. Articular fluid accumulated in her glenohumeral joint on MR imaging. We diagnosed her with septic arthritis of the shoulder joint by clinical findings. We performed operation immediately such as articular dissection and drainage. We started giving PAPM/BP by drip. Post operation, her inflammation finding had improved. She left our hospital fifteen days later after operation. We prescribed CCL internal medication for three months. Irregular line of head of humerus on X-ray appeared one month postoperativery. But motion of left shoulder was good, and MR imaging of her left shoulder joint showed no infection as of seven months postoperativery.
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Shogo Tahata, Tokushige Nishizato, Kuniaki Hatake, Kiminori Sakamoto, ...
2010 Volume 59 Issue 2 Pages
289-292
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Congenital dislocation of the knee is a rare deformity, occurring in approximately one out of a hundred thousand live births or at the frequency of 1% in developmental dysplasia of the hip. We experienced two cases of three knees with congenital dislocation of the knee. Case 1; A newborn baby had grade 3 dislocation of Drehmann's classification. The right knee was manually repositioned and applied with a splint by an obstetrician. Fourteen days after birth, reduction of the right knee was performed after which the knee was fixed by plastercast. Case 2; Seven days after birth, both knees were grade 3 dislocation of Drehmann's classification. Both knees were gently repositioned and fixed with plastercast. When the plaster was removed, the Riemenbugel apparatus was attached. Both cases had no functional deficiency and good results were obtained by early treatment with conservative therapy.
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Taiichiro Yanagizono, Seiji Higuchi, Risa Kondo, Yoko Katsushima, Ichi ...
2010 Volume 59 Issue 2 Pages
293-295
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We have been using the three-dimensional gait analysis system on cerebral palsy patients in our center. The Gillette Gait Index (GGI), formerly called the Normalsy Index, has been proposed as a summary measure that takes into account 16 clinically important kinematic and time distance parameters. The purpose of this study was to report the results using the GGI. Two patients with cerebral palsy underwent gait analysis, and their GGI was calculated. More involved patient (Group 4, Winter's classification) indicated higher scores. The GGI decreased after the surgical intervention. The GGI is a very useful and objective score when analyzing gait in patients with cerebral palsy.
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Yoko Katsushima, Risa Kondo, Seiji Higuchi, Ichiro Kadouchi, Akihiro K ...
2010 Volume 59 Issue 2 Pages
296-300
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Equinus gait is the most common problem in patients with cerebral palsy, and Z-lengthening of the Achilles tendon is a useful operation. We performed the operation ou patient with spastic hemiplegia and evaluated his pre and postoperative states. Three -dimensional gait data was collected with the ANIMA motion analysis system (MA2000). Four force plates (MG1090) were used for kinematic analysis.
The data of a 7-year-old boy was compared to our data for normal adults before operation, at four months after surgery, and one year later. Four months after treatment, pattern of power and moment of ankle joint had normalized kinematically and those of his knee joint had improved. Time distance parameter and kinetic peak of moment and power of ankle and knee joint were improved one year after treatment.
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Yuji Kishimoto, Toru Okano, Hiroshi Hagino, Ryota Teshima
2010 Volume 59 Issue 2 Pages
301-305
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report three cases of rheumatoid arthritis (RA) in which various imaging methods such as MRI, FDG-PET, and ultrasonography were useful for diagnosis and management. The first patient was a 66-year-old man with monoarthritis at the left wrist joint. Rheumatoid factor and anti-CCP antibody were negative, and X-ray showed only non-specific findings. However, MRI showed significant synovitis, bone erosion, and bone marrow edema, therefore the case was diagnosed as monoarticular RA. The second patient, a 44-year-old woman had polyarthralgia without joint swelling. Because she had suffered from Sjögren syndrome two years ago, it was difficult to distinguish between RA and arthralgia as an extraglandular manifestation. FDG-PET suggested polyarticular synovitis because it showed many uptakes that were consistent with tender joints. We therefore diagnosed the case as RA associated with Sjögren syndrome. The last case was a 41-year-old woman suffering from polyarthritis in the finger joints. The problem in this case was a lack of objective indicators, because laboratory tests including CRP and ESR were not significant for elevation. We performed ultrasonography of the finger joints to assess joint inflammation and concluded it was very useful for evaluating disease activity, particularly RA of which arthritis is confined to small joints.
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Takayuki Yamauchi, Tsugukazu Toma, Satoshi Kinjo, Goichi Okahara, Fumi ...
2010 Volume 59 Issue 2 Pages
306-309
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A case of volar dislocation of the metacarpophalangeal joint (MPj) requiring open reduction in a 28-year-old man is reported. The patient suffered from dislocation of the right thumb while training in the police academy. He initially visited another clinic, and was diagnosed with volar dislocation of the thumb MPj. Closed reduction was attempted but failed, then he was referred to our hospital.
Open reduction revealed rupture of the dorsal capsule and ulnar collateral ligament. A stump of ulner collateral ligament was found superficial to the adductor tendon same as Stener lesion. Volar dislocation was easily reduced, and capsule and ligament were repaired. Thumb spica casting was applied for three weeks.
Four months after the surgery, no instability was found and ROM of right MPj was the same as the contralateral thumb.
Volar dislocation of the thumb MPj is rare. Open reduction may be required in cases with interposition of the dorsal capsule or rupture of the collateral ligament.
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Tomoyuki Oshiro, Takeyuki Miyazato, Shinichi Shirota, Muneyuki Hayashi ...
2010 Volume 59 Issue 2 Pages
310-313
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Range of motion (ROM) of knee joints after total knee joints arthroplasty (TKA) influences activity of daily living (ADL). We analysed age, gender, and preoperative ROM as factors influencing postoperative ROM. We reviewed 99 knees (right 49, left 50) in 75 patients (14 men, 61 women) who received TKA for osteoarthritis. The mean age was 72.8 years old (range 56-85). The average duration of follow-up was 21.1 months (range 6-37).
We found that preoperative ROM had positive influence on postoperative ROM, however, there was no significant influence with age and gender. It seems important to keep satisfactory ROM before TKA.
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Azusa Hojyo, Hidetomo Nakamura, Kenji Yosida, Kenji Tanaka, Toshiharu ...
2010 Volume 59 Issue 2 Pages
314-318
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Congenital dislocation of the knee is a relatively rare disorder. We experienced nine cases in ten years between 1995 and 2005. Gentle reduction of the dislocation was carried out and external immobilization was followed in five cases. Surgery was performed on one case with Larsen syndrome. In three cases, no treatment was needed. They were followed up for about three years. In four cases, dislocation of the hip was also evident. In one case, dislocation occurred during treatment. Dislocation of the knee did not recur thereafter, but instability of the knee remained after the operation in Larsen syndrome case. For the other cases, their prognoses have been excellent so far, but the further intensive follow-up will be required for a long time.
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Tadatsugu Morimoto, Masamori Shigematsu, Motoki Sonohata, Masaaki Mawa ...
2010 Volume 59 Issue 2 Pages
319-322
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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A diagnostic support tool (ST) to identify lumbar spinal canal stenosis (LCS) was developed. The ST consists of items related to medical history, physical information, and diagnostic test. Since LCS and osteoarthritis of the hip (OAH) demonstrate similarities with regard to age group and initial symptoms, both diseases may often lead to incorrect diagnosis. The purpose of this investigation was to evaluate the predictive value of DST in patients with OAH. The subjects of this study consisted of 169 patients (28 men and 141 women) with OAH. The positive rate for the ST in the OAH was 33%. As a result, if this ST is applied to patients with OAH, then 33% of the OAH patients may be suspected of having LCS. This finding suggests that we should therefore include OAH in the differential diagnosis of LCS. In general, the above described ST places more emphasis on sensitivity and less on specificity. Considering that the specificity of the ST was 72%, 28% of positive patients for the ST were concluded to not have LCS. From this standpoint, the positive rate of the ST for OAH patients was thus determined to be 33%.
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Takanao Shimabukuro, Hideki Asato, Fuminori Kanaya
2010 Volume 59 Issue 2 Pages
323-327
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We experienced three patients who had complex regional pain syndrome (CRPS) type I after 97 rotator cuff repairs. We performed stellate ganglion block after they were diagnosed as CRPS type I . Two cases were treated with success, one case had relieved pain, suggesting that early diagnosis and treatment of CRPS are beneficial after surgery.
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Noboru Moriguchi, Juei-Tang Chang, Hisataka Goto, Toshio Kawahara, Mas ...
2010 Volume 59 Issue 2 Pages
328-332
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Twenty-one dorsally displaced fractures of the distal radius were treated by intramedullary pinning without external fixation. The average age at the time of injury was 73 years. The average follow-up period was 17 months. In the majority of cases, the final radiographic and clinical results were satisfactory. The therapeutic results were evaluated according to the Cooney classification system. 17 cases had excellent, three had good and one had fair result. Intramedullary pinning can be an effective technique for the treatment of distal radius fractures.
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Takeshi Hayashi, Nobuhiro Ikari, Teruaki Izaki, Takashi Shitama, Hikar ...
2010 Volume 59 Issue 2 Pages
333-336
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Pigmented villonodular synovitis (PVS) is an uncommon disease and occurs in the knee more frequently than other joints. This report describes a patient who presented PVS in the knee associated with locking symptom. The patient was a 60-year-old woman who immediately complained of left knee locking symptom after the distortion. We therefore suspected meniscus damage. Magnetic resonance imaging (MRI) examination showed a neoplastic lesion in the intercondylar space. The lesion could be resected arthroscopically and histologic examination confirmed the diagnosis of PVS. The patient maintained an asymptomatic status during the eight-month follow-up period.
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Yoshihiro Imamura, Osamu Soejima, Hiroshi Nakagawa, Shizu Yanagi, Jun ...
2010 Volume 59 Issue 2 Pages
337-340
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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This report discusses our experience with ligament reconstruction using the Eaton-Littler technique for unstable 1st carpometacarpal (CM) joints of both thumbs with general joint laxity. After the surgery, instability of the CM joint of both thumbs disappeared with improved CM joint pain and pinching power to the extent that everyday life was not affected. However, hyperextension and pain of both metacarpophalangeal (MP) joints appeared. In cases with general joint laxity, instability of the MP joint is found more postoperatively than preoperatively, indicating that compensatory hyperextension of the MP joint may occur after correction of the CM joint. This suggests that there may be a need to treat the MP joint simultaneously as the CM joint.
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Hirotaka Okubo, Yoshiyuki Akamine, Kenji Horikiri, Goichi Okahara, Cho ...
2010 Volume 59 Issue 2 Pages
341-345
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The carpal boss is a bony prominence arising on the dorsal side of the second and third carpometacarpal joints. We report a symptomatic carpal boss. A left-handed 11-year-old girl, who had no history of trauma or infection on her right hand, complained of tenderness and motion pain at the base of third metacarpal bone in the right hand. A computed tomography revealed a bony prominence at the site. She did not respond to conservative treatment including splint. The prominence was excised surgically. Tenderness and motion pain disappeared three months after surgery. Histopathological examination revealed fibrocartilaginous tissue connecting the third metacarpal bone to the capitates. Marked vascular and mesenchymal cell proliferations were seen at the boundaries between the bone and the fibrocartilaginous tissue. These findings are similar to that of non-osseous tarsal coalition.
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Akira Nabeshima, Toru Yamaguchi, Jyunichi Shida, Shigekazu Kaminomachi ...
2010 Volume 59 Issue 2 Pages
346-348
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Spinal epidural cavernous hemangiomas without primary origin in the vertebral body are rare. A 49-year-old male was admitted with numbness of the lower limbs. MRI showed a dumbbell-shaped epidural tumor at the T5-7 level extended through to the right intervertebral foramen. The tumor was removed by a laminectomy and his symptoms quickly improved. The histological diagnosis was cavernous hemangioma. Because only a few specific signs of spinal epidural cavernous hemangioma can been seen on MRI, preoperative diagnosis is difficult.
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Yasunari Oniki, Eiichi Nakamura, Hiroaki Nishioka, Azusa Tanaka, Hiros ...
2010 Volume 59 Issue 2 Pages
349-352
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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Generally, the reactive arthritis (ReA)is a disease triggered by several infections, such as gram-negative bacteria, including the species Chlamydia, Shigella, and Campylobacter. We reported a case of ReA after rubella and measles vaccination. Six weeks after rubella and measles vaccination was administered, a 17-year-old man presented with pain, acute swelling, and decreasing joint motion of the right hip. He developed a fever of 38°C. Laboratory findings included an erythrocyte sedimentation rate of 54 mm/hour and C-reactive protein (CRP) of 3.88 mg/dl; turbid synovial fluid was aspirated from the joint and contained 5.7×10
9/l leucocytes. Radiophotographs and MRI did not show any abnormal findings. We suspected septic arthritis of the right hip and performed drainage from the right hip under general anesthesia. After the operation, his joint symptoms subsided, but his fever and CRP kept rising. Up to two days later, his right knee was swollen, all bacterial and viral culture was negative, and human leukocyte antigen B-27 was positive. Her arthritis improved with the administration of nonsteroidal anti-inflammatory drugs. One week later, the knee swelling and pain had settled. This case demonstrates that ReA may occur after rubella and measles vaccination.
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Takeharu Sasaki, Kei Yamada, Jin Soo Park, Kimiaki Sato, Hidetake Inou ...
2010 Volume 59 Issue 2 Pages
353-357
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The degree of postoperative pain in 97 patients who underwent spinal surgery was evaluated according to Wong & Baker's Face scale. Thirty-six patients, 22 of whom were one male and 14 female, were treated for postoperative pain using continuous subcutaneuous fentanyl (SCF). Forty-three patients, 30 of whom were male and 13 female, were treated using continuous subcutaneous morphine. Eighteen patients, whom were male 10 and 8 female, were treated using diclofenac sodium or pentazocine (DP). SCF was better than DP in terms of postoperative analgesia immediately after the operation to 18 hours. SCM was better than DP in terms of postoperative analgesia six to 18 hours. In SCF, the frequency of complications which were nausea, vomiting, trouble of injected skin and constipation was less than SCF significantly. However, respiratory complications in SCF were observed more often than in SCM significantly. In two of 11 patients with respiratory distress, subcutaneous injection of fentanyl was ceased. Fentanyl was effective for postoperative analgesia in acute stage, but respiratory rate and peripheral oxygen saturation levels should be monitored carefully.
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Takuro Yara, Kosuke Sasaki, Junichi Arima, Soichiro Nakano, Takayuki T ...
2010 Volume 59 Issue 2 Pages
358-361
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a difficult case of treatment for MRSA infected total knee arthroplasty (TKA). The case was an 86-year-old man who underwent TKA for osteoarthritis. Eleven weeks after the TKA, MRSA induced periprosthetic infection was found, and we performed the first debridement. Four months after the first debridement, recurrence of the infection was found. We performed the second debridement as well as continuous irrigation. However, the infection did not improve. Therefore, we removed the implant, and then inserted cement spacer impregnated with vancomycin to suppress the infection. Massive bone defect was found in the distal femur after the removal of implant. Because the infection healed completely four months after the removal of the implant, we performed a two-stage revision TKA. We replaced the bone defect with a metal augmentation and artificial bone. In the operation, the patella tendon ruptured, and we repaired it, and immobilized the knee in the full extension until three weeks after surgery. At the latest follow-up, recurrence of the infection was not found 1 year and 5 months after the revision TKA. The knee extension and flexion were −5° and 95°, respectively, the extension lag was 5°, and the patient was walking with a cane.
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Takeaki Ishii, Atsushi Shiranita, Takayoshi Hiramoto
2010 Volume 59 Issue 2 Pages
362-367
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We treated a case with Freiberg disease by osteochondral fixation with a cancellous bone graft and bone peg and performing a distal metatarsal osteotomy (Weil osteotomy). A 13-year-old male had been suffering from right second MTP joint pain for half a year after he had joined the tennis club at his junior high school. He had tenderness and swelling on a dorsal side of the second MTP joint. X-rays showed a crushed metatarsal head. We diagnosed him to have stage 2 Freiberg disease, according to the Gauthier & Elbaz classification criteria. Five-months of conservative treatment were unable to achieve a symptomatic improvement. X-rays showed a deteriorating crush injury. We therefore performed osteochondral fixation and a distal metatarsal osteotomy in order to reduce the metatarsal head and not to damage the remaining epiphyseal line. At 1 year after the operation, the patient had achieved good bone union and metatarsal head reduction with no symptoms. Our operative procedure is therefore considered to be an effective way to treat people with progressive Freiberg disease before epiphysis closure.
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Shoichi Kuba, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Akira H ...
2010 Volume 59 Issue 2 Pages
368-371
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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The purpose of this study was to evaluate the poor prognosis factor in patients with vertebral compression fractures. We radiologically investigated the degree of vertebral collapse and kyphotic curves in 43 patients. Patients complaining of back pain were found to have significantly lower vertebral height and progressive kyphotic deformity. Early MRI findings suggested that the existence of posterior vertebral damage was correlated with vertebral collapse, kyphotic deformity, and continuous back pain.
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Toru Asakura, Toshio Doi, Katsumi Harimaya, Yoshihiro Matsumoto, Yukih ...
2010 Volume 59 Issue 2 Pages
372-375
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
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We report a case of closed wedge vertebral osteotomy for kyphosis in ankylosing spondylitis. A 49-year-old man, diagnosed with ankylosing spondylitis at 25 years old, underwent L4-S1 PLIF at 42. After the surgery, he had compression fracture in L2. He gradually developed spinal kyphotic deformity and lost horizontal gaze. We performed closed wedge vertebral osteotomy in L2 and instrumentation from T8 to S1. The patient regained horizontal gaze. This method does not open the anterior edge of the vertebra but shortens the vertebral body posteriorly. It is a relatively safe method because it is not accompanied by serious vascular complications.
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Hidetoshi Yano, Kazuhiko Ihara, Nobuharu Shimada, Tatsuya Beppu, Koji ...
2010 Volume 59 Issue 2 Pages
376-378
Published: March 25, 2010
Released on J-STAGE: May 25, 2010
JOURNAL
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Most patients with snapping hip do not experience severe pain and respond favorably to conservative therapy. However in a minority of patients, the pain is persistent and requires surgical treatment. During the period from 1997 to 2003, we experienced three patients who were treated surgically. They consisted of two men and one woman. Their average age was 25 years. All were treated by Z-plasty under regional anesthesia. All achieved pain relief, snapping disappeared, and there were no recurrences. Regional anesthesia is useful for reproducing snapping hip during surgery.
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