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Kohei Kawaguchi, Hitoshi Iwanaga, Shinichiro Hara
2010 Volume 59 Issue 3 Pages
413-418
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We used two cannulated cancellous screws called cross screw fixation for 46 cases who underwent operation for undisplaced femoral neck fracture at our hospital between January 2006 and March 2009. Of these, we report the clinical results of 23 cases (3 males, 20 females) over 75 years old who were observed for over six months. The average age of these 23 patients at the time of injury was 81.6 years old. The average length of time from injury to fixation was 1.5 days. Sixteen patients were given local anesthesia and seven patients were given spinal anesthesia. We examined bone union rate, complications following surgery, and alternation of gait ability. All patients achieved bone union and none of them developed complications such as skin irritation, infection, and subtrochanteric fracture. Cross screw fixation is an effective surgical method for undisplaced femoral neck fracture in older adults.
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Sakura Uchiyamada, Shunji Matsunaga, Takayuki Nakajima, Shunsuke Nakam ...
2010 Volume 59 Issue 3 Pages
419-423
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The authors investigated the current situation of orthopaedic surgery for latter-stage elderly patients at our hospital, an acute stage disease clinical training hospital, to clarify the role of orthopaedists in the aging society. We investigated the change in the ratio of latter-stage elderly patients at the orthopaedic surgery department of our hospital from 2000 to 2008. It was found that both male and female latter-stage elderly patients at this department doubled from 2000 to 2008. The proximal fracture of the femur increased in women in particular, and about 50% of the female patients undergoing orthopaedic surgery were latter-stage elderly patients in 2008. Most of the surgery of the proximal fracture of the femur was performed by clinical trainee doctors. Orthopaedic surgery for latter-stage elderly patients is an important training problem. It is essential to learn not only the operative technique but also the management of pre-and post-operation.
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Masamori Shigematsu, Hirofumi Tanaka, Kenji Tsunoda, Hideki Ishii, Aki ...
2010 Volume 59 Issue 3 Pages
424-425
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report our approach for the standardization of hemiarthroplasty procedures for femoral neck fractures. Seventeen patients undergoing hemiarthroplasty for femoral neck fracture before standardization and 13 patients after standardization were included in this study. Operation time and duration of stay in the operating room shortened and the amount of blood loss decreased. No complications occurred after standardization. These results suggest that it is important to standardize surgical procedures used.
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Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Noboru Moriguchi, Mas ...
2010 Volume 59 Issue 3 Pages
426-431
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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More and more hospitals are introducing inclusive point evaluation based on the diagnosis group classification (DPC: Diagnosis Procedure Combination) in Japan.
DPC enables standardization and transparency of medical information, and it is aimed at as a tool for analyzing hospitals to enhance the quality of medical care.
Three years have passed since its introduction, and we investigated the preoperative waiting period (days), average length of hospital stay (days), medical treatment fees (points), and average age (years) of the patient.
We found that the average length of hospital stay (days) had decreased by 50%, preoperative waiting period (days) to about 30%, and medical treatment fees (points) to 70%.
These results confirm the effectiveness of DPC in terms of health care economics.
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Hideaki Hamanaka, Shinichiro Kubo, Hiroshi Kuroki, Naoki Inomata, Shui ...
2010 Volume 59 Issue 3 Pages
432-436
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We examined the surgical outcome of spinal surgery for hemodialysis patients. Twenty patients (twenty one cases) with hemodialysis who underwent spinal surgery were studied. There were 16 males and 4 females with an average age of 64 years. The mean duration of hemodialysis was 16.1 years. There were 14 cervical lesions, one thorasic lesion, and six lumber lesions. In 14 cervical lesions, we perfomed posterior fusion on six cases, laminoplasty on eight cases. In six lumber lesions, we performed spinal fusion on two cases, decompression on four cases. Intra-postoperative complications occurred in nine cases (41%), and two cases died of myocardial infarction and cerebral bleeding. The clinical results of cases undergoing fusion were good, but the results of those undergoing decompression worsened over time.
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Koji Sameshima, Yoshihisa Kawauchi, Shinji Yoshino, Natsuko Tomimura, ...
2010 Volume 59 Issue 3 Pages
437-441
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We investigated the surgical results of 30 hemodialysis patients with lumber disease from 2002 to 2008. The mean age was 61.8 years old [52 to 72 years old]. The mean duration of hemodiaylsis was 13 years 6 months (6 months to 31 years). The diagnosis was destructive spondyloarthropathy (DSA) in 12 patients, degenerative lumber spondylolisthesis in 10, lumber canal stenosis in four, lumber disc herniation in three, and isthemic spondylolisthesis in one. Twenty-four patients were treated by PLF, four patients were treated by PLF+PLIF, and two patients by anterior interbody fusion.
The operation results were excellent in 11 patients, good in 11, fair in five, poor in one, and death in two due to complications. The complications were infection in three, death after operation by postoperative hemorrhage in one.
As surgery on hemodialysis patient is accompanied by many complications, cooperation with hemodialysis medical specialists and anesthesiologists and sufficient informed consent from patients and their families are important.
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Masahito Nagata, Shinji Yoshino, Kohji Sameshima, Natsuko Tomimura, Yo ...
2010 Volume 59 Issue 3 Pages
442-445
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We evaluated the prognostic research and results in dialysis patients who had received cementless femoral head replacement (spongiosa metal 2) for femoral neck fracture.
The subjects were a total of 23 dialysis patients consisting of 7 men and 16 women who had undergone femoral head replacement for femoral neck fracture. Their mean age at the time of the operation was 72.5 years, and their mean duration of dialysis was 7.5 years with a mean follow-up of 1 year and 2 months.
Perioperative complications were infectious enteritis in 2 patients, gastrointestinal bleeding in 1, early deep infection in 1, and dislocation in 1. The patients' postoperative ADLs returned to the preoperative levels. Their mortality within 1 year postoperatively was 30%. X-ray evaluation showed no clear zone and sinking more than 2 mm.
The mortality within 1 year after the operation in the dialysis patients who had undergone femoral head replacement was higher than that in nondialysis patients. In addition, infection was the most common perioperative complication in the dialysis patients. The cementless femoral head used in the present study was considered to be a useful model for femoral neck fracture in dialysis patients.
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Yoshihiro Kohashi, Yasuo Sonoda, Eiichi Ishitani, Hiroshi Harada, Taka ...
2010 Volume 59 Issue 3 Pages
446-449
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Less invasive transforaminal lumbar interbody fusion (LIS-TLIF) is becoming popular for degenerative lumbar disease. Various methods of LIS-TLIF are reported. The advantages of these methods are less invasive procedure of the nerve root and dura, less blood loss, short operation time, and minimal muscle trauma. A comparative study was performed on 65 patients who underwent LIS-TLIF and 20 patients who were treated with conventional TLIF for degenerative lumbar spondylolisthesis, lumbar scoliosis, lumbar kyphosis, lumbar canal stenosis, and lumbar disc herniation. Low invasiveness was shown by comparing surgical outcomes. In LIS-TLIF, blood loss was significantly lower and the values of post-operative CK and CRP were also low. But post-operative low back pain that persists for an extended period was found to remain. Whether or not back muscle damage can be improved by LIS-TLIF remains to be proven.
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Keigo Masuda, Hiromasa Miura, Shuichi Matsuda, Ken Okazaki, Yasutaka T ...
2010 Volume 59 Issue 3 Pages
450-453
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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[Purpose] To evaluate the advantages of minimally invasive total knee arthroplasty (MIS-TKA) over conventional TKA, we reviewed patients who had undergone both MIS-TKA and conventional TKA on different knees. [Material and Methods] Twenty-four knees of 12 patient were reviewed. All of the patients were female, 11 were diagnosed as osteoarthritis and one was diagnosed as rheumatoid arthritis. Their mean age at MIS-TKA and conventional TKA were 76.5 years and 74.4 years respectively. The mean follow-up period after MIS-TKA and conventional TKA were 22.6 months and 51.8 months. The Knee Society score was used to evaluate X-ray and clinical results. Finally, patients were interviewed about the degree of satisfaction with outcomes such as post-operative pain and period of rehabilitation. [Results] MIS-TKA provides significantly higher degree of satisfaction to patients with regard to skin incision length, post-operative pain, and period of rehabilitation. However, there was no significant difference between the two in X-ray and clinical results.
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Moritaka Nagayama, Masato Ishihara, Takashi Furugen, Satoshi Tomiyama
2010 Volume 59 Issue 3 Pages
454-460
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We have been performing primary total hip arthrolpasty with direct anterior approach (DAA) since September 2006 at our hospital.
In this study, DAA was applied on 25 hips in 23 patients (one hip in a man, 24 hips in 22 women) including OA of 23 hips, ION of 2 hips. One patient simultaneously underwent bilateral THAs with DAA. The BiCONTACT Systems made by AESCULAP was used for all patients.
The mean age of the patients was 62.1 years old (20 to 80 years old) with mean BMI of 24.5 (21.3 to 30.9). The average time of surgery was 119 minutes (70 to 246 minutes) with amount of bleeding of 901 ml (504 to 1611 ml). The average stay at hospital was 19 days (13 to 88 days). Postoperative CRP showed 10.0 mg/dl on the third day, 4.3 mg/dl on the seventh day, and 1.2 mg/dl on the 14th day. The operative complications revealed one fracture of the proximal femur, one cup setting failure, and two greater trochanteric fractures.
DAA might be less invasive and more useful than other conventional approaches for THA by checking the setting status of the cup and the stem using an image intensifier.
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Junichi Kamizono, Yasuhiro Ishidou, Kaneyuki Tsuchimochi, Youichi Kaga ...
2010 Volume 59 Issue 3 Pages
461-463
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We have been carrying out MIS (minimally invasive surgery) THA by the postero-lateral approach since 2006. Compared with conventional THA, shorter operational time and less blood loss can be achieved. We define MIS-THA as a method for achieving less invasiveness in patients by minimal skin incision, less invasiveness to deep layer tissues, decreased blood loss, shorter operational time, good post-operative pain controls and less complications. The final goal of MIS-THA is to accelerate post-operative rehabilitation, shorten hospital stay, and prompt return to routine activities. We have demonstrated some factors which make it difficult to perform THA with minimal skin incision. Since minimal skin incision is only one means of achieving MIS-THA, more general low invasive surgical approaches should be aimed at without focusing too much on minimal skin incisions.
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Masahiro Yokouchi, Satoshi Nagano, Yoshiya Arishima, Mikio Terahara, Y ...
2010 Volume 59 Issue 3 Pages
464-467
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Primary bone sarcomas of the pelvis represent the most challenging problem in limb-saving surgery, especially in its reconstruction. We report here the long-term results of a case with chondrosarcoma of the pelvis reconstructed with pasteurized autogenous bone grafting. We treated a 56-year-old female with conventional chondrosarcoma (Grade 2) of the pelvis by wide excision (ISOLS: P23). The resected bone was treated in saline at 60 degrees C for 30 minutes and reimplanted into the host bone with internal fixation. In the course of 10 years, no severe complication, such as graft fracture and infection, was observed. Union of the resected bone with the host bone was achieved at 12 months. The functional rating was 66.6% according to the Musculoskeletal Tumor Society System(MSTS). Our results indicated that pasteurized bone graft is a useful material for the reconstruction of massive bone defects.
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Ryuta Iwanaga, Keiichi Muramatsu, Toshihiko Taguchi, Koichiro Ihara
2010 Volume 59 Issue 3 Pages
468-471
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Background: Periacetabular reconstruction after malignant bone tumor resection for limb-saving is extremely challenging. We attempted a new reconstruction method with the combined use of free vascularized fibula graft and extracorporeally-irradiated autograft in two patients.
Case reports: A 14 year-old-boy with osteosarcoma and a 44 year-old-man with chondrosarcoma were treated with wide excision of the tumor, followed by periacetabular reconstruction with an autogenous extracorporeally-irradiated osteoarticular graft combined with a free vascularized fibula graft. Incorporation of the irradiated pelvic bone was achieved with no complications and limb functions turned out good. Osteoarthritis change was seen in both patients.
Conclusion: Our reconstruction method was safe and reliable in primary limb-sparing surgery. This procedure is best indicated when the femoral head can be preserved and mechanical strength of the affected acetabulum is still maintained.
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Susumu Yoneda, Hiroki Maehara, Yasunori Tome, Kazuhiro Tanaka, Fuminor ...
2010 Volume 59 Issue 3 Pages
472-475
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of osteosarcoma in the distal femur reconstructed with a liquid nitrogen-treated autograft. A 9-year-old boy was referred to our hospital complaining of pain of the left knee for two weeks. The roentgenogram revealed a sclerotic lesion with irregular thickened cortex in the lateral distal femur. MRI revealed a tumor in the lateral distal femur with extraskeletal lesion, which was low-intensity on T1WI, high-intensity on T2WI, and enhanced by gadolinium. The histological diagnosis by open biopsy was osteoblastic osteosarcoma. After preoperative chemotherapy, wide excision and reconstruction with liquid nitrogen treated autograft, fixation with locking plate were performed. At six months after surgery, callus formation could be seen at the osteosynthesis site with satisfactory function, and he was free from recurrence and metastasis.
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Yasunori Tome, Hiroki Maehara, Kazuhiro Tanaka, Fuminori Kanaya
2010 Volume 59 Issue 3 Pages
476-480
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Kyocera limb salvage system® (KLS system) is a modular tumor prosthesis developed in Japan. We retrospectively reviewed nine patients with malignant bone tumor of the femur, who received limb salvage with KLS system. There were two men and seven women. Their age ranged from 16 to 83 years. The follow-up period ranged from three to 97 months. The histological diagnoses included osteosarcoma, Ewing sarcoma, and metastatic bone tumor in three cases each. The sites of reconstruction included total femur in one case, proximal femur in three cases, and distal femur in five cases. We evaluated oncological outcomes, complications, cumulative prosthetic survival rate, functional scores according to the classification system of Musculoskeletal Tumor Society (MSTS score). Oncological outcomes at the final follow-up were CDF in four cases, NED in three and DOD in two. Severe infection occurred in two patients. No prosthesis-related complications were observed. Cumulative prosthetic survival rate were 87.5% in three years and 58.3% in five years, respectively. Mean MSTS scores were 81%. We achieved favorable clinical outcomes using the KLS system in a short term. Infection was a major complication, and further improvement of the prosthesis design and surgical skills are required to resolve this problem.
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Masato Tomita, Kenji Kumagai, Yoshihiro Nozaki, Hiroyuki Shindo
2010 Volume 59 Issue 3 Pages
481-485
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We treated eight malignant bone tumors of the distal femur using the KLS system. Their mean age at operation was 34.9 years old. The mean follow-up period was two years and seven months. Local recurrence and distal metastasis were not observed. The breaking of the femoral stem was observed in one case. Clinical results were evaluated with Enneking's functional evaluation system.
The mean functional evaluation was 68.8%, which was more and less good functional results. Reoperation cases showed worse results than primary operation ones. Furthermore, cases with resection of two-muscles of the quadriceps femoris muscle showed worse functional results than one-muscle resection cases.
In order to increase postoperative functional results using the KLS system, we have to restore quadriceps muscle as well as we could in operation. We hope the change of the design of cementless femoral stem of the KLS system improve mechanical strength.
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Naohiro Tanaka, Shinichi Nakahara, Takeshi Uchida, Tadashi Tomonaga
2010 Volume 59 Issue 3 Pages
486-488
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Pathological fractures with metastatic bone tumor are not rare. We report 10 cases of pathological fractures of long bones with metastatic bone tumor. Metastases from primary tumors in the following locations: lung (three patients), kidney (two patients), liver (two patients), breast (two patients), and multiple myeloma (one patient). All patients were treated by intramedullary nail fixation. All patients had excellent or good pain relief.
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Makoto Sakurai, Hiroshi Nakagawa, Fumihiko Yamaguchi, Koji Hara, Hirof ...
2010 Volume 59 Issue 3 Pages
489-492
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The case was a 15-year-old male whose chief complaint was feeling of coldness in his right ring finger. He had three years of experience playing baseball. In early July 2009, he bruised his right hypothenar area against the floor. He began feeling coldness in his right ring finger three weeks after the injury and thus visited our hospital. The right ulnar artery tested positive in the Allen test and the temperature of the fingertip area of the right ring finger was 28.0°C, which was a low value, namely 4.5°C lower than on the unaffected side, and the temperature of each remaining finger had also decreased, although only mildly. An ultrasound examination revealed an aneurysm in the ulnar artery at a slightly distant level of the hamate bone, and while blood flow was observed in the periphery of this region, blood flow was observed to become weak when the radial artery was compressed. A decrease in the amplitude of the fingertip pulse wave was observed in the right ring finger. An angiographic examination revealed advanced stenosis on the peripheral side of the ulnar artery and contrast delay was observed. Compared to the stenosed area, the peripheral blood vessels were relatively smooth, but no blood flow toward the superficial palmar arch was observed. Based on the above findings, the patient was diagnosed to have right hypothenar hammer syndrome and an aneurysmectomy and revascularization were performed. As of approximately one month after the surgery, the temperature and pulse wave of the fingertip area were found to have improved and the symptoms had disappeared.
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Kunihide Muraoka, Hidetoshi Onoue, Kazuo Kimura, Hikaru Saita, Takeshi ...
2010 Volume 59 Issue 3 Pages
493-496
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We treated 22 cases of scaphoid fractures using the DTJ screw from February 2005 to December 2008. All achieved good results as reported below. The mean age at operation was 26 years, ranging from 16 to 80 years. Their fractures were classified according to Herbert's classification: type A2, 17; type B1, 1; type B2, 1; type C, 3 fractures. The mean operating time was 18 minutes, ranging from 10 to 44. All cases achieved radiographic union in 11 weeks on average, ranging from 4 to 34. The average period of immobilization was three weeks, ranging from 1 to 7.
The DTJ screw shorteus the period of immobilization, due to its firm fixation.
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Takashi Matsumoto, Toshio Inoue, Nobuhiro Ikari, Hitoshi Shirachi
2010 Volume 59 Issue 3 Pages
497-500
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We performed volar locking plate fixation on 19 patients (8 men and 11 women, mean age 60 years) with distal radius fracture. The mean follow-up period was 4.8 months (range: 3 to 12 months). We measured the radiographic parameters at the time of injury, immediately after surgery, and at final follow-up. At final follow-up, the mean ulnar variance was 0.9 mm, the mean radial inclination was 22.6°, the mean volar tilt was 9.3°, and the loss of correction was minimal. According to Saito's Score, the results were excellent in 14 cases and good in five cases.
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Shizuka Muraoka, Makoto Sasaki, Takaaki Oda, Yukihiro Furue, Masayuki ...
2010 Volume 59 Issue 3 Pages
501-505
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Epiphyseal separation of the medial end of the clavicle is a rare injury. We report two cases. Both cases involved an 11-year-old boy each sustaining injury to his medial clavicle while playing judo. Radiographs and computed tomography confirmed the posterior displacement of the medial clavicle. Because closed reductions were unsuccessful, open reduction was perfomed. The prognoses were excellent at three months after the operations.
It is impossible to differentiate epiphyseal separation of the medial end of the clavicle from sternoclavicular dislocation by clinical symptoms and imaging findings. Most epiphyseal separations of the clavicle that have been reported are posterior displaced type needing open reduction. When patients injure their sternoclavicle joint before the epiphyseal of the medial end of the clavicle unites, it is better to consider the possibility of epiphyseal separation and posterior displacement, and perform open reduction.
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Choko Kondo, Masao Noguchi, Seiji Tsuji, Hirofumi Dokawa, Ai Mori, Hir ...
2010 Volume 59 Issue 3 Pages
506-509
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The purpose of this study is to evaluate the results of surgical treatment using the Scorpion plate and Hook plate. We experienced seventeen cases of distal clavicle fractures between 2003 and 2008. All cases obtained bone union. In particular, the results of using Scorpion plates were excellent.
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Takehiro Nagata, Junji Ide, Kenshi Kikukawa, Hiroshi Mizuta
2010 Volume 59 Issue 3 Pages
510-514
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Posterior dislocation of the shoulder is rare and missed sometimes. We report a surgically treated case with chronic posterior fracture-dislocation of the shoulder. A 64-years-old woman fell down on her right hand and was diagnosed with right proximal humeral fracture. Her right shoulder was immobilized using a sling for four weeks, after which she started rehabilitation. But she was unable to elevate her shoulder at four months after the injury. She underwent MRI and was diagnosed with chronic posterior fracture-dislocation of the shoulder. Physical examination at our hospital showed osseous prominence in the right shoulder with restricted range of motion of right shoulder; flexion was 5°, external rotation −40°, and internal rotation was not possible. Her JOA score was 26 points. Radiographs and CT showed posterior dislocation of the shoulder with malunion of the tuberosity fracture. Since she had pain and ADL disorder, surgical reduction was performed at five months after injury. Using the deltopectoral approach, we performed osteotomy of the malunited tuberosities, resected soft tissues, and reduced the humeral head to the glenoid. We fixed the tuberosities with screws and shifted the posterior capsule superiorly using a suture anchor. After surgery, her right shoulder was immobilized in a shoulder brace for six weeks. At five months after surgery, she had no pain and the range of motion of her right shoulder had improved; flexion was 150°(passive), external rotation 30°, internal rotation L5 rebel. Her JOA score was 83 points.
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Shinjiro Moriwaki, Kenji Kido, Yoshihiko Kunishi, Yasuhiro Ochi, Masah ...
2010 Volume 59 Issue 3 Pages
515-518
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report the treatment of the fracture of the humeral distal end in elderly patients between June 2004 and July 2009. The subjects were nine female patients, with an average age of 79.2 years (66 to 87). As for the fracture type, seven patients were classified as A1, one as B2, and one as C3 according to AO classification. As for the operation methods, five patients underwent ONI plate fixation, two HS, one cannulated screw, and one K-wire. The average postoperative external fixation period was 22.8 days (0 to 64). Coalition was present in eight out of nine patients. Postoperative complications consisted of radial nerve palsy in one patient, and pulmonary infarction in patient. In the last elbow joint range of motion (the average postoperative observation period was 12.2 months), extension was −21°(−30 to −5), and flexion was 101.1°(90 to 125). Early tophaceous internal fixation is necessary with an elderly patients using the cannulated screw, tension band wiring, etc. Early range of motion exercise was achieved using ONI plate fixation, and comparatively good outcome was obtained.
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Shinichiro Mitsutake, Tsutomu Hannita, Motonori Sato, Yasunao Miyai
2010 Volume 59 Issue 3 Pages
519-522
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Distal humerus fracture is a typical fracture we have difficulty in treating. We report our experience of nine patients (four males and five females), who were treated by invasive osteosynthesis with LCP Distal Humerus Plate. According to the AO classification, three cases were Type 13-A2, one A3, two B1, one C1, one C2 and one C3. We performed invasive osteosynthesis with double plate for seven out of the nine cases. As a result, all cases achieved synostosis. Their average JOA score was 90.4, and Jupiter evaluation rated excellent in six, good in two, fair in one at the final examination. DHP is an anatomical locking plate that has enough stability to stand early range of motion exercise in cases with comminuted fracture or poor bony tissue. Therefore it will be our first choice internal fixation device for distal humerus fracture in the future.
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Haruhiko Chuma, Kazutoshi Nomura, Noburo Hashimoto, Tetsuya Fukumoto, ...
2010 Volume 59 Issue 3 Pages
523-527
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report the clinical results of osteosynthesis of elderly distal humerus fracture using the LCP Distal Humerus Plate (LCP-DHP). From July 2008 to July 2009, we treated eleven cases (all females, mean age: 76.5 years) according to the AO/ASIF classification, there were seven type A2, one type A3, B1, B2, and C2. Internal fixation was perfomed using single plate for five cases, double plates for three, and single plate +cannulated screw for three. Ten cases archieved bony union without the loss of reduction form, but cut-out of the screws was seen in one case.
LCP-DHP is the anatomical locking plate developed for the fixation of distal humerus fractures. This plate provides rigid fixation even for osteoporotic fractures for which the best osteosynthesis method is difficult to determine, and enables early start of ROM exercise postoperatively. But cut-out rarely occurs in severe osteoporotic fractures. We need to provide postoperative rehabilitation carefully.
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Takahiko Aoyagi, Toshiyuki Tsuruta, Hiroko Mine, Mitsuhiro Katoku
2010 Volume 59 Issue 3 Pages
528-532
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The purpose of this study was to evaluate the one-year follow-up results of arthroscopic stabilization in athletes with traumatic anterior instability of the shoulder. The subjects included 32 athletes [23 males and 9 females, mean age 20.1 years (16 to 32 years)] with traumatic anterior instability of the shoulder. We evaluated the rate of return to preoperative sports activities and the rate of recurrences after surgery. Clinical evaluations were performed using the JSS-shoulder instability score (SIS) and JSS-shoulder sports score (SSS). One year after surgery, 29 cases (90.6%) could return to their preoperative sports, and recurrence rate was 6.3% (2 of 32). The JSS-SIS and JSS-SSS scores improved from 42.6 to 84.2 points and from 33.9 to 80.5 points, respectively. Moreover, 23 cases could return to their sports at the preinjury level or with minimal restriction, and six cases could not return to their sports at their preinjury level. These results suggest that arthroscopic stabilization for traumatic anterior instability of the shoulder is a reliable procedure for athletes, but it did not work very well for throwers, and dominant arm and contact sports athletes.
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Tomomi Sakihama, Yasuyuki Ishida, Hiroaki Yano, Keitaro Yamamoto, Kats ...
2010 Volume 59 Issue 3 Pages
533-535
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report the short-term clinical results of arthroscopic surgery for osteoarthritis of the elbow with elbow pain or limitation range of motion.
Five patients (five males, mean age: 54.0 years) were reviewed with minimum follow-up of four months after the operation. The average follow-up period was 14.2 months. The clinical results were Japanese Orthopaedic Association (JOA) elbow function score, range of motion before and after the operation. The presence of coexisting illness was evaluated.
Their JOA score elbow function score increased from a mean of 69.0 points to 91.2 points. Flexion increased from a mean of 106.4 degrees to 115.6 degrees. Extension increased from a mean of -12.4 degrees to 3.6 degrees. But patiens with high limitation range of motion showed a tendency for low improvement level. There were no coexisting illnesses.
Arthroscopic surgery for osteoarthritis of the elbow is a low invasive and effective procedure. But further study is necessary for patiens with high limitation range of motion.
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Akihiro Yanagisawa, Eiichi Nakamura, Azusa Tanaka, Yasunari Oniki, Hir ...
2010 Volume 59 Issue 3 Pages
536-540
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of avulsion fracture of the calcaneal insertion site of the Achilles tendon. A 34-year-old woman with Type 1 diabetes mellitus experienced pain in her left heel after falling down on the stairs. Her heel became swollen due to bony bulging and subcutaneous bleeding. Radiographs showed avulsion fracture with two bony fragments of the calcaneal insertion site of the Achilles tendon. She was admitted into our hospital immediately, and underwent osteosynthesis using screws. Four days after the surgery, she tripped beside her bed and her left leg was forced into weight-bearing resulting in the proximal fragment detaching with the distal fragment remaining as it was. She underwent osteosynthesis again using suture wire and postoerative ultrasound therapy. Because of a skin ulcer at the inscision of her heel at six weeks after reoperation, she underwent salvage operation of skin flap and postoperative hyperbaric oxygen therapy. At six months after the surgery, bone fusion was achieved and the skin ulcer healed.
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Katsuro Fukuyama, Masaaki Imabayashi, Hirohumi Ohsako, Yuichiro Yazaki ...
2010 Volume 59 Issue 3 Pages
541-544
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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In the treatment of two cases of extremely undermined wounds on feet following injuries moist wound healing method using wound dressings brought about excellent results.
A 50-year-old male with untreated DM underwent drainage and debridement for the infection of the bruise wound on his dorsal foot. A 7 cm×6 cm skin defect remained but healed in 12 weeks as a result of applying moist wound healing method using hydro fiber.
The other 66-year-old female with DM and RA demonstrated subcutaneous hematoma on her foot after injury, leading to 6 cm×5 cm skin defect as a consequence of debridement. Hydro fiber method using polyurethane film sealing with punched holes was employed, and complete healing took 12 weeks.
Conclusions: Polyurethane film dressing with punched holes is favorable for treating difficult cases of highly-exudative skin defects.
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Kenzo Fujii, Keiichi Muramatsu, Hiroyoshi Ogasa, Mitsunori Shigetomi, ...
2010 Volume 59 Issue 3 Pages
545-548
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Complications following the harvesting of vascularized fibula grafts are rare. Here we present our results on patients who developed claw deformity of the great and lesser toes. We discuss the etiology of claw toe deformity and the surgical correction of this condition. Seven patients developed claw toe deformity in the donor side foot after harvesting of a vascularized fibula graft. They comprised five males and two females with an average age of 29 years (range 6 to 59 years). The affected toes in six patients were 1 and 2, or 1, 2 and 3. All toes were affected in the remaining patient. Four patients underwent Z-lengthening of the flexor hallucis longus at the medial malleolus of the ankle, while three underwent cutting of the tendons. Claw deformity of the affected toes was successfully corrected in all patients by the release of the flexor hallucis longus. Full extension of the affected toes was achieved by the time of final follow-up. Flexion of the interphalangeal joint was preserved in all patients except one who underwent cutting of the tendon beneath the metatarsophalangeal joint. Even after cutting the tendon, flexion of the great toe was possible by interconnection with the flexor digitorum longus tendon.
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So Minokawa, Ichiro Yoshimura, Kazuki Kanazawa, Akinori Takeyama, Taka ...
2010 Volume 59 Issue 3 Pages
549-555
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We reported lateral column lengthening and distal lineal metatarsal osteotomy in two cases of adult flatfoot with hallux valgus.
Case 1: A 68-year-old female had severe hallux valgus (HV angle 40°, M1M2 angle 17°) and adult flat foot of Johnson classification stage II . Case 2: A 64-year-old female had severe hallux valgus (HV angle 50°, M1M2 angle 21°) and adult flat foot of Johnson classification stage II . We performed lateral column lengthening and distal lineal metatarsal osteotomy on both cases. HV and M1M2 angle improved in both at the final follow-up .
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Koichiro Ihara, Takatomo Mine, Yoshikazu Kuwabara, Yukata Ito
2010 Volume 59 Issue 3 Pages
556-559
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Kabuki make-up syndrome (KMS) was first reported in Japan, but is now known to occur in many countries. It is a multiple malformation/mental retardation syndrome, and skeletal anomalies are one of its many characteristic features. Dislocation of the hip and patella as well as generalized ligamentous laxity have also been reported. We experienced a patient with KMS who suffered from dislocation of multiple joints. The patient was a 24-year-old female, and she was referred to our clinic due to the dislocation of her right patella at age 20. In the four years from then, she underwent multiple surgeries for bilateral knees, wrist joints, and left hip. Distal realignment was the initial procedure for both knees, and reconstruction of the medial patellofemoral ligament was finally performed after patella dislocation recurred in both sides. Hui's procedure using half slip of FCU tendon was the surgery of choice for both distal radioulnar joints. Snapping hip was resolved after Z-plasty of the iliotibial band. At present, there has been no recurrent dislocation after the multiple surgical intervention. Orthopaedic surgeons should be aware of such possible complications in patients with KMS.
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Risa Kondo, Masanori Matsumoto, Koichi Honbu, Hiroshi Murakami
2010 Volume 59 Issue 3 Pages
560-563
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The fracture of the lateral epicondyle of the humerus in a child is a rare injury, making it difficult to diagnose roentegenographically and to evaluate the instability of the elbow joint. Complications such as nonunion of the fracture and recurrent posterolateral rotatory instability (PLRI) of the elbow have been reported in association with relatively displaced fractures of the lateral epicondyle of the humerus in children. Our case was a 13-year-old boy. He sustained an injury of the left upper extremity while playing basketball. Following the injury, he experienced pain and swelling in the left elbow. Radiographs of the left elbow showed a displaced fracture of the lateral epicondyle of the humerus with an avulsion distal fragment. Under the fluoroscope, instability of his elbow could be demonstrated by varus stress test and PLRI test. He was operated using tension band wiring. Operative repair of the fixation of the reduced fracture fragments resolved the instability of the elbow. Four month later, bone union was achieved, there was improvement of ROM in the left elbow joint and no motion pain.
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Takuya Uryu, Kensuke Sakai, Kenji Yoshida, Hisashi Yamashita, Kenji Ta ...
2010 Volume 59 Issue 3 Pages
564-568
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We reviewed the results of surgically treating lateral condyle fracture of the humerus in children using the tension band wiring method. Between 2000 and 2007, 88 lateral condyle fractures of the humerus in children (average age 5.3 years) were treated in our hospital. We examined 40 cases (male: 33, female: 7) out of these 88 cases who had been followed-up for one year or more and were without any additional injuries. The average period from operation to the removal of implants was 17.7 weeks, with a follow-up period of 29.3 months. Bone union was achieved in all cases, and there was no significant loss in the elbow joint range of motion or carrying angle. The width and length of the lateral condyle had increased compared with the other elbow, which appears to be due to overgrowth. Two cases suffered mild cubitus varus, but additional operations were not required. There were no complications such as infection, ectopic ossification, epiphyseal arrest, or neuroparalysis. In conclusion, the tension band wiring method is an effective and encouraging method for treating lateral condyle fractures of the humerus in children.
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Daisuke Noda, Hidetoshi Onoue, Kazuo Kimura, Hikaru Saita, Takeshi Hay ...
2010 Volume 59 Issue 3 Pages
569-572
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Reduction treatments for radial neck fractures in children include manual, percutaneous, and opened. Manual and percutaneous reductions should be attempted first for cases with angulation of the radial head below 60°. Opened reduction is associated with a high incidence of severe complications such as avascular necrosis and radio-ulnar synostosis, and should therefore be limited in case.
We report six cases of radial neck fractures in children treated by percutaneous intrafocal pinning using relatively thick 2.4 mm Kirschner wires, who obtained excellent results.
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Yukihiro Furue, Hiroaki Tamura, Makoto Sasaki, Ikufumi Nagayoshi, Tats ...
2010 Volume 59 Issue 3 Pages
573-577
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We treated five children with ipsilateral supracondylar fractures of the humerus and fractures of the diatal forearm. They consisted of three males and two females with an average age of 6.8 years (range; 2 to 9). There were one Abe type-2, one type-3 and three type-4 supracondylar fractures of the humerus. All were treated by closed reduction and percutaneous fixation. There were one epiphyseal fracture and four metaphyseal fractures of the radius with dorsal displacement. Two greenstick fractures were treated conservatively, and three displaced fractures by closed reduction and percutaneous fixation. In addition, four greenstick ulnar fractures were treated conservatively. Three cases could be evaluated by modified Flynn's criteria after an average of 3.7 years (range; 2.4 to 5.1). All cases showed excellent results for functional factors. As for cosmetic factors, one case had poor results because of cubital varus deformity. With this injury, how to treat supracondylar fracture of the humerus without complications is a important factor.
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Atsushi Matsumoto, Ichiro Katsuki, Naohisa Tayama, Kaoru Hirano, Hidek ...
2010 Volume 59 Issue 3 Pages
578-580
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We experienced a case of a 9-year-old male child who had left sacroiliac joint dislocation fracture. He was run over by a car and taken to our hospital. His injury was diaguosed as left sacroiliac joint dislocation fracture on CT and X-ray. Retroperitoneal active arterial hemorrhage was not observed on angiography. We treated him conservatively for the sacroiliac dislocation fracture, and found callus formation after two weeks. After ten weeks, full weight bearing was started. This patient obtained early callus formation, and could be treated without any remaining pain.
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Shuichi Eto, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Noboru M ...
2010 Volume 59 Issue 3 Pages
581-585
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We investigated the treatment and complications of children with femoral shaft fracture who may have problems in medical treatment. The average age of the patients was 6.1 years (range; 3 to 10 years) and the average follow-up was 15 months (range; 4 to 48 months). We treated three patients with traction and casting, one with external fixation, three patients with plating, and two patients with percutaneous pinning. Complications included pin track infection, refracture, and hyper callus in one patient, and malunion and refracture in one patient. All patients achieved bone union but hyper callus remained. Percutaneous pinning and cast fixation can prevent malunion and relieve stress in patients and their families.
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Tadatsugu Morimoto, Katsuhiro Aita, Motoki Sonohata, Masaaki Mawatari, ...
2010 Volume 59 Issue 3 Pages
586-589
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The objective of this study was to analyze the correlation between lumbar scoliosis (LS) and leg length discrepancy (LLD) in unilateral hip osteoarthritis patients (HOA). The subjects were 437 patients (40 to 82 years) treated by total hip arthroplasty due to unilateral HOA. We investigated the LLD and the Cobb angle (maximum) on erect posture radiographs and assessed the frequency of LS (Cobb angle of more than 5 degrees) (LS rate) and that of the convexity of LS occurring on the HOA side (凸 rate). The patients were classified into four groups according to the degree of LLD: including under 10 mm group, 10 mm group (over 10 mm and under 20 mm), 20 mm group (over 20 mm and under 30 mm), and over 30 mm group. The LS rate and 凸 rate were 40%, and 26% respectively in all cases. The frequencies of the two rates in the over 30 mm group were 70%, and 63% respectively, which was significantly higher than those in other groups (P<0.05). Based on the fact that the 30 mm LLD was found to be a significant factor influencing the LS rate and 凸 rate, compensating for LS may help maintain body balance in unilateral HOA.
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Tetsuya Kubota, Ichiro Owan, Yasunari Ikema, Hirotaka Shinjyo, Takayuk ...
2010 Volume 59 Issue 3 Pages
590-593
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We used the Greater Trochanteric Reattachment System (GTR) for the reattachment of the greater trochanter in revision hip arthroplasty and evaluated the results on radiographs. The subjects consisted of seven hips using GTR from October 2002 to March 2008. There were one male and six females, their mean age at revision THA was 68 years, and the mean follow-up time was three years and seven months. Trochanteric union, cable breakage, and osteolysis around GTR were evaluated on radiographs. Five of the seven cases achieved union. One case with non-union showed complete broken cables fraying, fragmentation, free-floating metallic debris at the distal femur, and extensive osteolysis. When fraying and fragmentation are seen, removal of the GTR should be considered.
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Katsuhiko Murakami, Katsutoshi Sunami
2010 Volume 59 Issue 3 Pages
594-596
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Many methods have been described to stabilise periprosthetic fractures around a hip arthroplasty. A Cable system & Periprosthetic screws offers increased angular stability and, theoretically better fixation in osteoporotic bone. This study presents our results with the use of cable system & periprosthetic screws for Vancouver type B1 periprosthetic fractures following hip arthroplasty.
There were two women with an average age of eighty-five years at the time of fracture. The main follow-up was five months later. The fracture healed with a medium time to union in three months. There were no implant failure and no infections. They returned to their previous level of mobility.
Our experience encourage us that cable system & periprosthetic screws have a role to play in managing periprosthetic fractures around a stable femoral stem, especially in patients with poor soft tissue and osteoporosis.
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Hisato Tanaka, Mitsunori Komine, Nanae Akiyama
2010 Volume 59 Issue 3 Pages
597-600
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Bone metabolism markers serve as a basis in the selection of treatment drugs , but the measurement variability of urine NTX is considered large. We measured the NTX of 30 patients receiving inpatient care at our hospital using both urine and serum, in an investigation conducted from January to April 2009. They consisted of 22 women and eight men, whose age ranged from 51 to 95 (mean age: 80.2 years).
Eight patients (26%) had values higher than the 54.3 cutoff value for bone fracture risks in the case of urine NTX, but below the 24.0 cutoff value for that for serum NTX. On the other hand, there were no cases with high serum NTX but normal urine NTX. Although there are no scientific grounds indicating that urinary markers are inferior to serum markers, the results of this study clearly demonstrates the large variability of urine NTX. Urine analysis is suitable for outpatients, but detection of bone diseases except primary osteoporosis and re-examination of serum NTX are recommended for patients showing abnormally high urine NTX levels.
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Yumiko Kanamaru, Seisuke Nishimura, Takuma Inoue, Seiichiro Shimauchi, ...
2010 Volume 59 Issue 3 Pages
601-605
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Purpose: We investigated the mortality of patients over 65 years after surgical treatment of hip fracture.
Methods: We performed a retrospective study of 627 patients with hip fractures who were operated in our hospital from 2003 to 2008.
Results: The five-year mortality after operation was 63.5%, and the one-year mortality was the highest (14.1%). 83.5% of the causes of death were complications which appeared after operation, and pneumonia was the highest. The patients were divided into two groups: one with complications before operation, and the other without. There were no significant differences in mortality between the two groups, and surgical delay did not affect mortality. A comparative study was conducted every operation year, and the one-year mortality was found to decrease significantly, correlating with the shift of internal fixation implants. Compression hip screw type (CHS type) mortality was 1.4 times as high as the short femoral nail type (γ type). Patients who were operated by the CHS type were mobilized out of bed later than the γ type.
Conclusions: The mortality of patients after surgical treatment of hip fracture was high, with the one-year mortality being the highest. Complications before operation and surgical delay did not affect mortality. Early physical therapy may decrease the one-year mortality after surgical treatment of hip fracture.
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Yuji Kishimoto, Toru Okano, Ryota Teshima
2010 Volume 59 Issue 3 Pages
606-609
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a patient with Paget's disease of bone complicated a pathological fracture of the femur. A 74-year-old female who had been diagnosed with Paget's disease of bone at the age of 65 years visited our hospital due to thigh pain. We found a shaft fracture of the femur which had remarkable bowing deformity. She underwent osteosynthesis using Ender nail, but developed an established non-union. Seven months later, we performed cable plate fixation with iliac bone graft. However, bone union was not complete, thus another procedure using anatomical intramedullary nailing with peroneal bone graft was required 23 months after the primary surgery. Inadequate stability of osteosynthesis and the bowing deformity of the femur were the causes of non-union. This case suggests that sufficient stabilization with proper implant is important for treating fractures with bone deformity in Paget's disease of bone.
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Yuki Oto, Akane Maeda, Madoka Moriya, Takeshi Kinjo, Shigeyuki Yoshida ...
2010 Volume 59 Issue 3 Pages
610-612
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of a 36-year-old woman who had multiple spinal fracture. She had C2 hangman fracture, L1 burst fracture, spinal cord injury (Frankel type C), and unstable pelvic fracture.
Eleven days after the accident, C2 hangman fracture stabilized through a posterior approach using C1 lateral mass screw, C2 pedicle screw and rods. At the same time, L1 burst fracture stabilized through a posterior approach using pedicle screws and rods, and unstable pelvic fracture stabilized using M-Shaped Transiliac Plate.
At one week after operation, she started ambulant. At three months, she could walk on the parallel bars, and at six months, she could walk with a single cane.
We concluded that internal fixation at an early stage after trauma provides good results.
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Itaru Yoda, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Noboru Mo ...
2010 Volume 59 Issue 3 Pages
613-618
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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[Background] We feel a difference for understanding among surgeons about bone union evaluation time, and decided to investigate an actual difference. [Methods] 1.The X ray which tried the intramedullary nail to a femoral shaft fracture is used. The e-mail questionnaire about union was carried out. 2. Process the X ray used for the questionnaire with picture software, and evaluate the area and density of a callus. [Result] 1.43 replies and years of experience are an average of 13.6. The difference between surgeons was seen in which time. 2. The callus hyperplasia became a maximum at strong time, and a density and area accepted the depression gradually. [Consideration] The union evaluation by Xray is influenced by a subjective factor and photography conditions, and there is also a report that an orthopedist and a radiologist also produce a difference, and the determination was accepted by this survey.
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Renpei Matsumoto, Eiichi Nakamura, Yasunari Oniki, Hiroshi Mizuta, Kou ...
2010 Volume 59 Issue 3 Pages
619-622
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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[Case report] A 17-year-old female felt a sudden onset of pain in her right hip joint while playing basketball without any traumatic episode. She visited another hospital and radiographic examination indicated no abnormal findings. Although she rested for two weeks, her pain increased gradually. She thus visited the outpatients' clinic in our hospital. At her visit, she showed a limp and had tenderness on the medio-anterior aspect of her right thigh. Her ragiographic and CT images demonstrated no abnormal findings, but MR images showed periosteal edema in the STIR, low signal lesion in T1-weighted, and high signal lesion in T2-weighted images on the femoral neck. She was diagnosed with stress fracture of the right femoral neck and was admitted into our orthopaedic department immediately. She underwent conservative treatment with complete bed rest for two weeks. Partial and full weight-bearing was allowed after four and eight weeks, respectively. Four months later she returned to playing basketball without any symptoms.
[Discussion] Femoral neck stress fracture is uncommon, representing 1 to 2% of all stress fractures. Recent studies in MR imaging show stress fractures with an abnormal signal area in the bone marrow, even if there are no obvious fracture lines and sclerotic lesions on the radiographic images of the bone. In this case, MRI findings enabled diagnosis of a grade 3 stress fracture of the femoral neck according to Ferco's classification.
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Takuya Tokunaga, Takuya Taniwaki, Takayuki Nakamura, Masaya Mizutamari ...
2010 Volume 59 Issue 3 Pages
623-627
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We present a 33-year-old woman, who had a sudden onset of low back pain and weakness in both lower extremities without any obvious causes. She was admitted to our hospital three days after the onset for further examination and treatment. Physical examination showed hyperesthesia below T11 dermatome, incomplete paraplegia, and bladder function disturbance. Her senses of vibration and position were intact.
MRI indicated a high signal intensity area in the spiual cord from T11 to L1 level on T2WI and DWI. We diagnosed spinal cord infarction. Contrast-enhanced computed tomography showed blood clots at the vein of bilateral lower legs. In spite of anticoagulant therapy with heparin and warfarin, she developed PTE. Thrombolytic therapy with urokinase was begun immediately after the onset of PTE. The clots in the pulmonary artery disappeared. Though relation of the spinal infarction and thrombotic predisposition was suspected, Protein C, Protein S and anticardiolipin antibody level were within normal limits.
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Hirokazu Takai, Toshio Kitamura, Yoshiki Matsumoto, Atsuhiko Nakamura, ...
2010 Volume 59 Issue 3 Pages
628-630
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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It is said that pulmonary thromboembolism (PTE) occurs after lower extremity surgery. On the other hand, PTE is not common after upper extremity surgery. We report a rare case of PTE after open rotator cuff tear repair.
A 69-year-old woman had calcified tendinitis and small rotator cuff tear. Removal of the calcifications and rotator cuff tear repair were done by anterior lateral approach and minimum incision (2.5 cm) under general anesthesia. No problems were seen postoperatively, and her arm was immobilized by slingshot. The next day after her operation, she suddenly felt chest pain when she was changing her clothes. She was diagnosed with PTE by contrast chest CT. Heparinization was started immediately, and the thrombosis disappeared the next day. She has been in good condition to date. The origin of the thrombosis was not clear even though we checked her operative situation. This case suggests that PTE way occur after open rotator cuff tear repair.
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