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Hironori Tanoue, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Hi ...
2011 Volume 60 Issue 4 Pages
601-607
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of salmonella osteomyelitis of the left distal tibia. An 30-year-old male was reffered to a nearby clinic with a chief complaint of a painful swelling of the left distal tibia without gastrointestinal symptoms and any other triggers. He was suspected with osteomyelitis and was treated with oral antimicrobial agents. Although once he recovered, he visited our hospital due to relapse. A localized lytic lesion was observed in the distal of the tibia on plain radiographs. MRI indicated chronic Brodie's abscess at first. He was successfully treated by surgical curettage, insertion of cement beads containing antibiotics, and administration of sensitive antibiotics. Culture of the surgical specimen grew Salmonella O8. The symptoms disappeared after surgery. At the 11-month follow-up, he was asymptomatic and there was no evidence of infection at present.
Salmonella osteomyelitis is usually caused by hematogenous spread following bacteremia. All salmonella infections begin with ingestion of organisms in contaminated food or water. Once salmonella reach the small intestines, they traverse the intestinal layer and disseminate throughout the body and colonize bone marrow. The authors bibliographically surveyed the literature published from 2000 to 2009 and found 32 Japanese patients with salmonella osteomyelitis. Seven were adult patients with osteomyelitis caused by salmonella is a rare event in adult patients. They all had no history of gastrointestinal symptoms before the onset of osteomyelitis.
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Yukihiro Furue, Hiroaki Tamura, Ikufumi Nagayoshi, Tatsuo Motoyama, Ma ...
2011 Volume 60 Issue 4 Pages
608-611
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report two rare cases of dislocation of the proximal interphalangeal joint requiring operative reduction because of interposition of the flexor tendons. A 39-year-old man injured his right middle finger while playing baseball. The condyles of the proximal phalanx protruded through the wound on the PIP crease. The flexor tendons had slipped behind the radial condyle, and made reduction impossible. After the flexor tendons and volar plate were replaced back into their normal position, the reduction was successful. Finally, the patient had full and painless motion of the digit. A 78-year-old man injured his left little finger while stumbling. He had no lacerations on the finger. Closed reduction was unsuccessful, so operative reduction was needed. Only the radial slit of the flexor digitorum superficialis remained on the volar side of the proximal phalanx, and the ulnar slit of the FDS and the tendon of flexor digitorum profundus had slipped dorsally. With reposition of these tendons, manual reduction was easy. Finally, he was able to use his hand normally without pain. We think this injury presents two characteristic symptoms, one is that the dislocated middle phalanx displaces more proximally on radiographs, another is that the dislocated middle phalanx cannot be flexed with resistance at the manual reposition.
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Yuya Imamura, Hiroki Irie, Tomohiro Horikawa, Issei Ishii, Tateki Sega ...
2011 Volume 60 Issue 4 Pages
612-616
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reported a case of subcutaneous rupture of the flexor pollicis longus tendon occurring in daily life. When a 49-year-old woman opened the cap of a jam can with her right hand, she felt acute pain in the right palm. After a few days, she realized she could not flex the IP joint of her right thumb. She visited our hospital two months later. We diagnosed the subcutaneous rupture of the flexor pollicis longus tendon and performed operation with an interlacing suture. After one year from the first operation, we performed tenolysis again and pulley reconstruction. She was satisfied with the results and returned to her original work. A number of causes of subcutaneous rupture of the flexor tendons have been described in literature: volar plate fixation of distal radius fracture, Kienbock's disease, scaphoid nonunion, and rheumatoid arthritis. Subcutaneous rupture of the flexor pollicis longus tendon without underlying disease and obvious history of trauma is rare. We reported an example of tendon injury caused by old trauma.
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Shuichi Eto, Manabu Taguchi, Tomoki Takahashi, Yoichi Hayashida, Seiko ...
2011 Volume 60 Issue 4 Pages
617-620
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We investigated the causes of redisplacement following closed reduction of distal metaphyseal radial fractures in children under the age of fifteen. Twenty patients who were treated with closed reduction and cast after sustaining a displaced distal radial fracture were reviewed. Angulation and translation were analyzed on lateral radiograph between 2007 to 2010. Redisplacement was considered when ≥ 10° of angulation or ≥ 30% of translation. Eleven redisplacements were seen, and complete displacement on admission was the most important risk factor for redisplacement. The presence of complete fracture of the distal radius should alert the treating surgeon to a significantly higher risk of redisplacement, and supplemental K-wiring should be considered.
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Sanshiro Inoue, Tomonori Nakanishi, Naoshi Kikuchi, Kousei Miyazaki, T ...
2011 Volume 60 Issue 4 Pages
621-625
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The volar locking plate system for distal radius fractures is becoming increasingly popular recently. We report three implant breakages, one was breakage of the SmartLock plate system (Stryker) and the rest were breakage of the distal lock pin or screw of the AcuLock system (Acumed). When using the SmartLock system, careful selection of the patient and postoperative management are necessary to avoid this complication. When using the AcuLock system, attention must be paid to the breakage of the ulnar lock pin or screw.
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Hiroaki Matsuo, Yoichi Miyazaki, Takashi Aoyama, Takayuki Nakamura, Sh ...
2011 Volume 60 Issue 4 Pages
626-629
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report the clinical results of the distal humerus fracture using LCP distal humerus plate (LCP-DHP). From December, 2007 to April, 2010, we treated five cases, consisting of one man and four females whose average age was 68.8 years old. The cause of injury were three cases fell and two cases slipped. According to the AO/ASIF classification, there were three types of C 2, two types of C 3. Four cases showed complications of other fractures (the one of with 3.4th metacarpus fracture, two with distal radius fractures, and one with distal radius fracture and proximal humeral fracture). Range of motion training began three days after the osteosynthesis. These osteosynthesis and clinical results were determined using the JOA score and examined. The JOA score was 90.8 points (77 to 96 points) on the average after the operation. All cases did not develop complications and regained daily life functions except for the case with is multiple bone fractures. Treatment results of LCP-DHP to the distal humerus fracture are excellent, and seem effective for fixing the distal humerus fracture.
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Makoto Era, Keizo Furukawa, Shiro Kajiyama, Toshiyuki Sakimura, Hiroyu ...
2011 Volume 60 Issue 4 Pages
630-633
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of Monteggia fracture in a child with heterotopic ossification.
A 7-year-old girl, who had fell down in her house, was introduced to our hospital because of heterotopic ossification, radial head dislocation, and limited range of motion in her left elbow. X-ray and 3 DCT showed ossification around the radial head. Thirty-three days after the injury, closed reduction was unsuccessful and open reduction with excision of heterotopic ossification was necessary to reduce the radio-humeral joint. After the reduction, her affected elbow was immobilized using a long-arm plaster cast in 90° flexion and 90° supination.
Five days after operation, re-dislocation of the radial head was pointed out in X-ray. We performed closed reduction and percutaneous pinning of the proximal radioulnar joint using a K-wire. A month later, we removed the K-wire and started ROM exercise.
After two years, in the latest medical examination, there was a slight limitation of pronation in her left forearm but she had no limitation in her daily life.
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Ayako Kurogi, Masao Noguchi, Seiji Tsuji, Hirofumi Dokawa, Kazuhisa Ku ...
2011 Volume 60 Issue 4 Pages
634-636
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Capitellum fracture, which contains only anterior articular surface of the humeral capitellum, is very rare. We report a case of capitellum fracture treated with a bioabsorbable pin. A 14-year-old man had left elbow pain and swelling after he fell backwards while playing tennis. X-ray and CT showed anterior and superior displaced fracture of the humeral capitellum and a portion of the trochlea. The operative procedures performed were internal fixation using bioabsorbable pins two days after the injury. The postoperative casting which held the elbow in 90 degrees of flexion was applied for three weeks. Afterwards, active motion was initiated. Five months after the surgery, clinical outcome was excellent. Bioabsorbable pin appears to be a useful material for the fixation of small intra-articular fractures.
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Shinsaku Ogimoto
2011 Volume 60 Issue 4 Pages
637-640
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The purpose of this study is to evaluate the surgical treatment of arthroscopic rotator cuff repair without suture anchor. We experienced two cases of rotator cuff tears. All cases obtained good clinical results and tendon healing. We discuss the results of a salvage operation for bone loss caused by the use of suture anchor.
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Yumiko Kanamaru, Hiroyuki Kitahara, Takeshi Miyaji, Keiichi Tsuda, Yos ...
2011 Volume 60 Issue 4 Pages
641-644
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The purpose of this study is to evaluate the outcome of arthroscopic rotator cuff reconstruction with patch graft for irreparable rotator cuff tears. Between April 2007 and March 2010, we performed arthroscopic rotator cuff reconstruction with patch graft on four patients. For the patch graft, we used the fascia lata in three patients, and teflon felt in one patient. First, we performed arthroscopic partial repair, and then fixed the patch graft arthroscopically in order to strengthen the partial repair. Among the three fascia late cases, one healed and the other two re-ruptured. However, JOA score (pain, function, and elevation) improved in all patients. The rotator cuff tear which healed regained remarkable muscular strength.
We regard patch graft as important for strengthening partial repair. We usually use the fascia lata for patch graft for younger patients who require strength, and think the teflon felt can yield adequate satisfaction without excessive stress in older patients who do not require that much strength.
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Katsunori Yazawa, Junji Ide, Hiroshi Mizuta
2011 Volume 60 Issue 4 Pages
645-648
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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14-year-old right-handed boy experienced sublaxity of right shoulder on pitching and sustained pain instantenously. Physical examination revealed limitation of flexion on the right shoulder at 100 degrees with pain and pain in anterior apprehension test. He showed positive impingement signs and active compression in test. He showed positive impingement signs and active compression in tests. There was no abnormality in plain radioagraphs, but detachment of superior and anterosuperior portion of the labrum was suspected on MRI. Detachment from the superior glenoid tubercle and bucket-handle tear of the superior labrum were also confirmed in arthroscopic examination. The backet-handle tear was debrided and the type II SLAP lesion was repaired using an absorbable suture anchor with two non-absorbable sutures. Four months after the surgery, pain and limitation of flexion on the right shoulder completely disappeared and he was able to play baseball again.
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Kenshi Satomura, Teruaki Izaki, Yozo Shibata, Motoyuki Fujisawa, Tsuyo ...
2011 Volume 60 Issue 4 Pages
649-653
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of bone graft for glenoid component loosening in total shoulder arthroplasty. A 59-year-old man underwent total shoulder arthroplasty in May 2002 due to osteoarthritis with alkaptonuria. He had pain and decreased range of motion after eight years. Xp showed osteolysis of the left glenoid. After removal of the glenoid component, the tricortical bone graft was impacted into the bone defect with the cortical surface positioned laterally. At three months follow-up, the patient had no pain, and active forward elevation was improved to 100 degrees. If implantation of a new glenoid component is not possible, iliac tricortical bone graft is considered useful.
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Yasuhiro Mizuki, Mikihito Tamai, Hidehiko Yuge, Yoshiteru Shida, Masuo ...
2011 Volume 60 Issue 4 Pages
654-657
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Conservative treatments for minimally displaced greater tuberosity fractures usually yield good results, but some paients may have prolonged shoulder pain regardless of conservative treatment. We report a case treated arthroscopically for subacromial impingement syndrome with minimally displaced greater tuberosity fracture who achieved good results. In July 2009, a 67-year-old female patient fell on her left hand. She vistied our hospital for the first time five day after the injury. We found a minimally displaced greater tuberosity fracture and treated it conservatively. Her symptoms did not improve, so we performed arthroscopy six months after the injury. Operative findings showed a small tear of the rotator cuff with minimally displaced greater tuberosity. We repaired the rotator cuff and formed the greater tuberosity arthroscopically. Her symptoms disappeared ten months later. JOAscore improved from preoperative 65 points to 92 points. With greater tuberosity fracture, even if the dislocation is small, symptoms may remain. Careful observation is required especially if there is elevation in front of the greater tuberosity.
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Akira Maekawa, Kenjiro Nishida, Ryohei Yokoyama
2011 Volume 60 Issue 4 Pages
658-660
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We present a patient with malignant peripheral nerve sheath tumor (MPNST) of mediastinum arising from the vagus nerve which developed seven years after the initial treatment. A 46-year-old woman underwent chemoradiotherapy followed by surgery for the primary tumor under the incorrect diagnosis of non-small lung cell carcinoma. The patient developed local reccurence 86 months after the first treatment. The reccurent tumor occurred in the operation scar over the clavicle adhering to the periosteum of the clavicle. Although it is quite rare for MPNST to reccur more than five years after the initial treatment, long term follow-up should be necessary in MPNST as well as other soft tissue sarcomas.
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Kenjiro Nishida, Akira Maekawa, Ryohei Yokoyama
2011 Volume 60 Issue 4 Pages
661-663
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Prognosis of metastatic sarcoma remains dismal regardless of response to chemotherapy. There were only a few patients surviving after complete remission of tumors. Herein, we present a 61-year-old male with undifferentiated pleomorphic sarcoma, so-called malignant fibrous hisiocytoma (MFH) of the back. Local recurrence and multiple pulmonary metastases developed two months after definitive surgery. Local and distant lesions responded completely to chemotherapy consisting of mesna, doxorubicin, ifosfamide, and dacarbazine (MAID). Radiation therapy at a dose of 60 Gy was added to the site of local recurrence. The patient's conditions improved and no recurrence was seen even five months after completion of treatment.
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Tomoyuki Miyoshi, Keiichi Muramatsu, Koichiro Ihara, Toshihiko Taguchi
2011 Volume 60 Issue 4 Pages
664-666
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reviewed the results of treatment for synovial sarcoma in 15 patients who were treated between 1990 and 2010. They comprised 11 men and four women with a mean age of 45 years and mean follow-up period was six years. We analized prognostic factors including size, stage, tumor site and location, microscopic status of surgical margin using log-rank test. Prognostic factor was tumor size > 5 cm, site in trunk and femoral, site near the major vessels, Stage II B+III. The survival rate determined by the Kaplan-Meier method was 55.7% at five years and ten years and local recurrence free survival was 91% at five years. It is important to control distant recurrence for better prognosis.
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Hiroki Yoshimatsu, Yasumitsu Kaieda, Kenji Yoshida, Kotaro Jimbo, Kenj ...
2011 Volume 60 Issue 4 Pages
667-670
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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A study was performed on 16 cases of MRSA pyogenic spondylitis. The characteristics of MRSA pyogenic spondylitis include the presence of many compromised hosts, rates of antecedent infection being high, the presence of many cases of complications of abscess, paralysis developing easily, and high mortality. In this study, at the time of diagnosis, 31% of the subjects had severe sepsis, and because surgical treatment could not be performed on them, they eventually died. On the other hand, among cases in which subjects did not have severe sepsis at the time of diagnosis, although the recurrence rates and incidence of paralysis were high, there were no mortality cases. As indicated by reports so far, although treatment was limited in cases in which the subjects had severe sepsis at the time of diagnosis, among the cases in which the subjects did not have severe sepsis, the treatment results were comparatively satisfactory, and among the cases in which general anesthesia was difficult to perform, cases in which percutaneous suction and drainage were effective were observed. It is believed that in the presence of resistance to conservative therapy, minimally invasive treatment should thus be considered at an early stage by observing the general conditions of such patients.
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Masatsugu Tsukamoto, Itaru Furuichi, Masakazu Murata, Noboru Moriguchi ...
2011 Volume 60 Issue 4 Pages
671-674
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reported 24 patients with pyogenic spondylitis who were treated between 2007 and 2010. Their age ranged from 55 to 91 years (mean: 74 years).
The causative organism was isolated in 14 patients (71%). Methicillin-resistant Staphylococcus aureus (MRSA) was present in four cases, methicillin-sensitive Staphylococcus aureus (MSSA) in three cases, and Citrobacter koseri in two cases. Positive rate of blood cultures was 58%, and the needle biopsy culture was 60%. Eleven patients had complications such as infective endocarditis, meningitis, and pseudomembranous enteritis. Positive blood culture and CRP level at hospitalization was a risk factor of the complications. Eiguteen patients were treated conservatively and six were treated surgically.
These vesults suggest that it is necessary to take careful note of complications in pyogenic spondylitis.
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Shintaro Hara, Akira Sei, Toru Fujimoto, Takuya Taniwaki, Tatsuya Okad ...
2011 Volume 60 Issue 4 Pages
675-679
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Isolated iliacus muscle abscess, a rare disease, has shown an alarming increase in the number of infective diseases of the spine recently. We report a case of iliacus muscle abscess with concomitant sacroiliitis, who obtained good results by CT-guided percutaneous drainage. The case was a 46-year-old woman with general malaise experiencing left buttock muscle pain which spread to the whole left leg. Five days after, she become frail and was hospitalized. MRI revealed left sacroiliitis and an iliacus muscle abscess 4 cm in size. Antibacterial medication was started, but CRP indicated 20s. Fifteen days later, she visited our hospital. In this first visit, CT showed a multilocular low density area in the iliacus muscle 11 cm in size. We performed CT-guided percutaneous drainage. Fluid leakage surrounded the sacro-iliac joint and extended posteriorly. Microscopic test indicated GPC, so we administered VCM. MSSA was confirmed by culture. Ten days after the operation, CT revealed a decrease in size of the abscess, and improved inflammatory response. In patients showing resistance to antibacterial medication, CT-guided percutaneous drainage for iliacus muscle abscess is the first-line treatment.
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Kei Yamada, Kimiaki Sato, Mamoru Mitsukawa, Takuya Watanabe, Masaru Ya ...
2011 Volume 60 Issue 4 Pages
680-684
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Surgical site infection (SSI) is a devastating complication in spinal surgery. However, preventive measures have yet to be established. Two-hundred and eighty-six patients who underwent spinal surgery in our department between June 2009 and September 2010 were followed prospectively. They underwent preventive measures such as: prophylactic antibiotics for two to three days, irrigation of the surgical site just before surgery and prophylactic administration of vancomycin if the patients had several risk related factors of methicillin-resistant Staphylococcus (MRS) infection. The risk related factors of MRS infection are administration via emergency ward, spinal instrumentation and skin lesion such as atopic dermatitis. The incidence of SSI during this period was compared with previous period between May 2005 and April 2009.
SSI occurred in nine patients out of 286 patients (3.1%) during this period, and in 21 out of 795 patients (2.6%) during the previous period. There were no statistically differeuces between the two periods for SSI incident rate. Although the rate of SSI did not decrease, the incidence of SSI by MRS decreased. These results suggest that prophylactic use of vancomycin for some cases and irrigation of the surgical site just before surgery are effective preventive measures for MRS-induced SSI after spinal surgery.
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Chikashi Yamakawa, Hisashi Serikyaku, Tetsuya Yara, Fuminori Kanaya
2011 Volume 60 Issue 4 Pages
685-688
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report our experience with a patient with infective endocarditis complicated by an extensive epidural abscess. The patient was a 55-year-old man who visited the internal medicine department with chief complaints of fever (≥38 °C) and back pain and was hospitalized. Mitral valve vegetation was observed on transesophageal echocardiography, and the patient was given antibiotics based on a diagnosis of infective endocarditis. He was referred to our department after developing lower back pain and pain in both thighs on day 5 of hospitalization. Although he did not have sensory disturbance or reduced leg muscle strength, body movement was difficult due to radiating pain in the legs. MRI revealed an epidural abscess extending from T4 to S1. As symptoms did not improve, surgery was performed. Intervertebral fenestration was performed from T6-7 to L3-4 alternately. The dura mater was compressed by inflammatory granulation tissue, and pale red pus was observed in the dural membrane. The symptoms improved following surgery, and the patient regained his ability to walk independently and was discharged.
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Satoshi Nagano, Masahiro Yokouchi, Mitsuhiro Kaieda, Arisa Tsuru, Mich ...
2011 Volume 60 Issue 4 Pages
689-691
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reviewed cases with osteosarcoma in our institution and analyzed the factors affecting limb-salvage rate of osteosarcoma patients. Out of a total of 27 cases, five cases underwent amputation at initial surgery, resulting in 82% limb-salvage rate. The reasons for amputation were pathological fracture (two cases), neuro-vascular involvement (two cases) and poor general condition. An additional two cases underwent amputation because of local recurrence, which reduced the final limb-sparing rate to 74%. Five-year survival were 57% and 64% in the amputation group and limb-salvage group respectively, indicating no statistically difference between the two groups (p=0.54). The limb-salvage rate in our study was similar with recent reports. However, more effective chemotherapy would improve the limb-salvage rate in the future.
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Naoko Miyamoto, Hiroaki Yano, Keitaro Yamamoto, Yasuyuki Ishida, Takuy ...
2011 Volume 60 Issue 4 Pages
692-696
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Chondroblastoma is a comparatively rare tumor. It appear more commonly in many teens in the epiphyseal region of the long bones. We report one case of chondroblastoma, adding bibliographical discussion.
The case was a 15-years-old woman. Pain in the right shoulder and limited range of motion were seen. After a year, right shoulder elevation became difficult. Because callus had been admitted in the humeral neck on X-rays, rehabilitation was enforced by diagnosing the fracture. Tumor was then detected in the right shoulder. Right dorsal was damaged by the physical education. Because the bone become transparent in the humeral on X-rays, MRI was done. Bone tumor was suspected as a result, and the case was introduced to this department. Biopsy indicated chondroblastoma, and bone tumor curettage and artificial bone grafting were carried out. There was no limitation of the range of motion of the right shoulder in the last follow-up.
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Sumitada Imamura, Akio Sakamoto, Yoshihiro Matsumoto, Katsumi Harimaya ...
2011 Volume 60 Issue 4 Pages
697-700
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Bizarre parosteal osteochondromatous proliferation (BPOP) is a benign lesion that predominantly involves the hands and feet. BPOP is characterized by a heterogeneous mixture of cartilage, bone and fibrous tissue histologically. Recently, translocations of t(1;17) (q32;q21) are reported in BPOP. In this study, we report a BPOP case, in which computed tomography and magnetic resonance imaging depicted continuity of the central part of the lesion to the underlying bone marrow, which is considered to be not typical in BPOP. It must be contirmed if this feature is unique or common general. Further analysis of further BPOP cases by CT or MRI is necessary.
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Masato Tomita, Yoshihiro Nozaki, Noriaki Miyata, Tomayoshi Hayashi, Hi ...
2011 Volume 60 Issue 4 Pages
701-704
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report an extremely rare case of myoepithelioma arising from the metacarpal bone. She was a fifty-nine-year old woman. She noticed the swelling on the dorsal side of the right hand, but because she had no pain, she did not go to the hospital. Later, she experienced paresthesia on both the ring and little fingers, of her right hand, and visited a nearby hospital. She was diagnosed with bone tumor, and was introduced to our outpatient clinic. X-ray examination showed irregulary expansion and sclerotic change on the 4 th metacarpal bone. MRI showed low signal intensity on T1WI, high signal intensity with fluid-fluid level formation on T2WI. This legion was enhanced with Gd only in the marginal region. We performed open biopsy. Microscopically, a clear round to short spindle cell grew as a nest. There were no mitotic figure and necrosis. We could not obtain histopathological diagnosis, and thus consulted Dr. Fletcher. He diagnosed this lesion as myoepithelioma of the bone. One year after the open biopsy, the tumor showed no apparent change clinicaly, on X-ray and in MRI examination. Myoepithelioma of the bone is an extremely rare tumor. We know only of ten cases of myoepithelial tumor of the bone in the world including this case. Furthermore, three cases of benign myopepithelioma are also included in the ten. One year after operation, the tumor showed obvious change, but we have to follow her up very carefully.
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Yujiro Oyama, Toshitake Yakushiji, Hiroo Sato, Kiyoshi Oka, Hiroshi Mi ...
2011 Volume 60 Issue 4 Pages
705-707
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of solitary osteochondroma in the distal femur that healed spontaneously. A 12-year-old boy was discovered to have osteochondroma of the right femur after an injury. Radiographs demonstrated a bony prominence lesion of the distal femur. MR image showed cartilage cap in the surface. We diagnosed the tumor as a solitary osteochondroma. The patient was asymptomatic and continued to be monitored without any treatment. Lateral plain radiographs of the right knee two years after the initial diagnosis indicated reduction in size those three years after demonstrated regression of the tumorous lesion. We identified Only 19 cases of spontaneous regression of a solitary osteochondroma have been reported in the past.
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Shingo Ota, Masato Tomita, Yoshihiro Nozaki, Noriaki Miyata, Naoe Kino ...
2011 Volume 60 Issue 4 Pages
708-713
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Abstract: We experienced and report a case of chondroblastoma of patella, an uncommon site for this bone tumor.
Case: A 27-year-old man had gonalgia in the left knee from two years ago. He visited our outpatient clinic in December 2009 complaining of left knee pain and knock pain in the left patella. X-ray showed radiolucent area with marginal sclerosis in the left patella. The tumor showed low signal intensity in T1WI, and high signal intensity in T2WI on MRI. We suspected the tumor to be benign chondroblastoma or giant cell tumor based on the imaging, and performed curettage and artificial bone implantation. Pathological diagnosis was chondroblastoma. After the operation, his knee pain disappeared immediately. Ten months after the operation, he showed no recurrence and metastasis.
Discussion: Chondroblastoma is relatively rare bone tumor. It commonly occurs at the epiphysis of long bones, but is seen to occur in the Patella in same cases. For this reason, we need to suspect chondroblastoma as a differential diagnosis in cases complaining of knee pain and showing radiolucency of the patella on X-ray.
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Ryuta Imamura, Shuichi Matsuda, Ken Okazaki, Yasutaka Tashiro, Hiroaki ...
2011 Volume 60 Issue 4 Pages
714-717
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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There are many reports about accuracy of conventional, digital, and 3D templating in total knee arthroplasty. However no method can completely predict intraoperative component's size. The purpose of this study was to evaluate the influence of error in the sagittal angle of the femoral distal cut on femoral antero-posterior sizing. Fifty osteoarthritic knees in 43 patients, were evaluated using 3D templating software. We cut the distal femur perpendicular (standard procedure), in extension of 3° and 5°, in flexion of 3° and 5° to the distal anatomical femoral axis in the sagittal plane. The position of the component was determined so that the anterior notch could be avoided. The antero-posterior position of the femoral component when the femur was cut in flexion and extension was compared to that of standard procedure. The average distance from standard procedure was 1.9±0.6 mm (0.8 to 3.1) in 3° extension, 3.1±0.4 mm (2.0 to 4.2) in 5° extension, -1.4±0.3 mm (-3.4 to -0.6) in 3° flexion, and -2.4±0.3 mm (-4.3 to -1.6) in 5° flexion. These results suggest that the minor error in sagittal angle of femoral distal cut can cause differences in the size of the femoral component.
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Keiichi Kondo, Ryuji Nagamine, Weijia Chen
2011 Volume 60 Issue 4 Pages
718-721
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Gap angles of 31 knees with PS-TKA were measured during operation and post-operatively by means of soft tissue balancer and fluoroscopy respectively. The correlation between these two methods was accessed to verify the reliability of the soft tissue tensor/balancer. The gap angles measured by the soft tissue tensor/balancer during operation were varus 0.9±1.4 at full extension and valgus 0.3±3.2 degree at 90 degree flexion. The difference of the gap angle between extension and 90 flexion was 2.3±1.8 mm. The gap angles measured by fluoroscopy were varus 0.1±0.6, varus 0.6±2.4 respectively. Varus/valgus flexibility was 1.6±1.3 at full extension and 3.9±3.3 at 90 flexion. The results showed high reliability of the tensor/balancer. Furthermore, stable varus/valgus flexibility of the knees post-operatively also showed that gap angels can be well controlled by using the tensor/balancer during operation.
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Takuya Ikuta
2011 Volume 60 Issue 4 Pages
722-724
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We treated seven patients with failed KU type total knee arthroplasty due to loosening occurring six years and one month postoperatively on average.
Prosthesis was KU4 in all cases, and the failure was associated with femoral component debonding from the cement mantle. The cause of loosening is thought to be due to the change in configuration and material from KU3 to KU4 type.
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Kohei Ishihara, Toshihiro Ohdera, Shusaku Matsuda
2011 Volume 60 Issue 4 Pages
725-729
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Articular cartilage damage coexisting in the anterior cruciate ligament (ACL) injury in young athletes is not rare. We evaluated the conditions of the articular cartilage using MRI T2 mapping method and compared the vesults with the findings of arthroscopy. From June to August in 2010, we performed ACL reconstruction in 31 patients. We selected 17 cases (eleven men and six women, mean age 19.1 years old), all of whom were athletes and the under 29 years old. Articular cartilage damage was observed in six out of 10 cases, and their T2 values were high on MRI T2 mapping. On the other hand, damage was observed only in one out of seven cases, and T2 values were in the normal level of the mapping. Using MRI T2 mapping, we can evaluate the articular cartilage at an early phase noninvasively. MRI T2 mapping is useful and effective for athletes.
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Tatsuo Motoyama, Yukihiro Furue, Ikufumi Nagayoshi, Masayuki Kawashima ...
2011 Volume 60 Issue 4 Pages
730-733
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Radial tears of the posterior horn of the medial meniscus are often seen in middle-age patients and older, and are characterized by severe pain. We report a rare case of the radial tear of the posterior horn of the medial meniscus occurring in a 15-year-old boy. He fell off a cradle type swing and twisted his right knee. Because he experienced right side gonalgia and could not walk easily, he visited our clinic the next day. His right knee showed swelling and floating patella. On puncturing his right knee, there was over 50 cc of hematoma. Nine days after the accident, we investigated his right knee by arthroscopy, and detected radial tear of the posterior horn of the medial meniscus, but did not excise the meniscus. The day after arthroscopy, he started to walk under half weight bearing. Ten days after arthroscopy, his right knee was held in place using a gypsum splint in the extended position. After that, he used a simple brace on his right knee for about two months. His right side gonalgia decreased gradually, and he was able to walk normally. Three months after the arthroscopy, he received a second-look arthroscopy, which showed that the radial tear had healed firmly with fibrous tissue.
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Hideya Kawamura, Yasuhide Urakami, Yasunari Urakami, Youichi Urakami, ...
2011 Volume 60 Issue 4 Pages
734-738
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Chiba developed a new tibial osteotomy method in 1992 called it tibia condylar valgus osteotomy for patients with varus-valgus instability of the knee joint not indicated for conventional high tibial osteotomy. Some orthopedic surgeons in Kyushu use this method for patients indicated for arthroplasty of the knee joint. However, the results are not good compared with arthroplasty of the knee joint, so it is not used by most orthopedic surgeons. We attempted this osteotomy method for younger patients with varus-valgus instability of the knee joint indicated for conventional high tibial osteotomy, and performed it using locking plates. In this study, we investigated X-rays and clinical results of these patients to determine its usefulness.
We performed it on patients with over five degrees of valgus knee joint instability with good mobility of the knee joints. Ten patients and eleven knee joints were studied. Arthroplasty of the knee joint is usually indicated in elderly patients but since most dislike the procedure, patients with good mobility of the knee joint were selected in this study. Results at three years after the surgery were good. Good mobility of the knee joints was maintained, and the patients were satisfied with the surgery results. This method thus proved useful in the selected patients.
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Hidetoshi Ihara, Yoko Komatsu, Masanobu Takayama, Chizuko Ikenaga, Miy ...
2011 Volume 60 Issue 4 Pages
739-743
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The aim of this study was to test limb non-dominant (supporting leg) as a supportive role in static and dynamic postural control. Posture control was evaluated in 29 university handball club members. Four athletes reported that their supporting leg was their right leg, and 25 reported that it was their left leg. The static tasks were balancing on a single limb on the balance-pad with eyes open for five seconds and eyes closed for three seconds. Dynamic tasks were a 40-cm single-legged drop landing on three different unstable floors and balancing for three seconds. Three types of unstable floors were used; the balance-pad, large unstable board tilting laterally, and large unstable board tilting anteroposteriorly. Subjects were required to complete five successful trails for each leg. The number of failures was also recorded. Triaxial accelerometers were attached to both the subject's knees. The calculated values of the maximal amplitudes of forward and reverse acceleration were used as the maximal amplitudes for acceleration (MAA). The MAA was compared between the dominant and supporting legs. Results showed that the MAA was smaller for the supporting leg than the dominant leg when landing on the balance-pad. No significant differences in the MAA were found between the two legs neither in the static tasks, nor when landing on the two large unstable boards. The failure rate showed no significant differences between the two legs in static and dynamic tasks. Supportive role on the supporting leg should be considered for training in athletes and rehabilitation program.
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Atsuhiko Nakamura, Hidetoshi Onoue, Kazuo Kimura, Ryota Iwamoto, Kunih ...
2011 Volume 60 Issue 4 Pages
744-746
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reported the results of the treatment for lateral malleolar fractures using tension band wiring techniques.
The cases were 10 patients (eight males, and two females) who underwent operative treatment from 2002 to 2010. The average age at the time of injury was 41 years old (15-65). Acording to the Lauge-Hansen classification, they were classified into SA stage I (seven cases), SA stage II (one case), SER stage II (one case), SER stage III (one case). In all patients, the reduction obtained was maintained and bone union was achieved. There were no wound infections or complaints of pain from the wiring.
Tension band wiring can serve as a stable fixation method for small fragments of lateral malleolar fractures.
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Satoshi Miyake, Hidetoshi Onoue, Kazuo Kimura, Atsuhiko Nakamura, Ryot ...
2011 Volume 60 Issue 4 Pages
747-749
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We treated five cases of avulsion fracture of the calcaneus using an AO 6.5 mm cancellous screw with a medial incision from December 2007 to May 2010. The subjects were five male patients, with an average age of 46 years (30 to 61). Weight bearing and range of motion were initiated after short leg casting for three weeks. In all cases, bone union was achieved and wound complication and limitation of ROM did not occur at all.
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Yoshiteru Shida, Naoyuki Kuga, Yasuhiro Mizuki, Masuo Hanada, Hiroshi ...
2011 Volume 60 Issue 4 Pages
750-753
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We performed a retrospective study on the clinical results of 11 Lisfranc joint fracture-dislocation (LFD) patients for 31 months. All patients (eight men and three women, mean age; 43.8 yr.) received surgical therapy under lumber anesthesia. According to Hardcastle's classification, eight cases were type B and the other three were type C. The surgical intervention was closed reduction and internal fixation (CRIF) for two type B cases, and open reduction and internal fixation (ORIF) for the other nine cases. The average JSSF midfoot scale was 82.0±6.6 points. Patients with better reduction showed better clinical scores. In conclusion, we recommend early ORIF for fresh LFD to achieve proper reduction and good clinical results.
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Yoichi Koga, Yukihiro Furue, Hiroaki Tamura, Ikufumi Nagayoshi, Tatsuo ...
2011 Volume 60 Issue 4 Pages
754-755
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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A 30-year-old man injured his left foot in a traffic accident. X-rays showed dorsal dislocation of the second, third, and fourth metatarsophalangeal joints. Closed reduction under local anesthesia failed, so we carried out open reduction under lumbar anesthesia through dorsal transverse incision on the next day. The plantar plates and deep transverse metatarsal ligament had ridden onto the metatarsal heads dorsally, waking reduction impossible. By the replacement of these obstructions, reposition was successful. Postreduction, the joints were immobilized for four weeks. After that, the patient has had no subsequent difficulties.
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Ayumi Matsunaga, Ichiro Yoshimura, Kazuki Kanazawa, Takahiro Ida, Masa ...
2011 Volume 60 Issue 4 Pages
756-759
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Osteochondral lesions of the distal tibia occur much less frequently than those of the talus, and treatment guidelines have not been established. We reported a case of osteochondral lesion of the distal tibia treated by arthroscopic bone marrow stimulation, who obtained excellent results in a short term.
The patient was a 28-year-old female, and she experienced pain in the right ankle.
Radiography, CT, and MR imaging showed subchondral cyst formation of the distal tibia. It was diagnosed as osteochondral lesion of the distal tibia. We performed debridement, curettage, and transmalleolar drilling of the lesion. JSSF score increased from 72 preoperatively to 100 postoperatively. Osteochondral lesions of the distal tibia are rare lesions with little reports on arthroscopic bone marrow stimulation, and long-term follow up is necessary.
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Tomonobu Hagio, Ichiro Yoshimura, Kazuki Kanazawa, Masatoshi Naito
2011 Volume 60 Issue 4 Pages
760-762
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Arthroscopic removal of loose bodies in various joints has been reported to produce good results except in the ankle joint. We report nine patients with loose bodies in the ankle that were extracted arthroscopically. The patients had swelling, catching, locking, or range of motion limitation preoperatively. We removed loose bodies via anterolateral, anteromedial and posterolateral portals of the ankle. Patients were allowed weight bearing as tolerated and range of motion immediately after the operation. Loose bodies were found and removed from the anterior gutter of two patients, from the lateral gutter of three patients, and from the posterior gutter of four patients. The mean JSSF scale was 75.0±16.6 points before operation and 96.7±5.0 points at the most recent follow up. Arthroscopic removal of loose bodies in the ankle yields good results with minimal surgical morbidity.
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—A Multicenter Study—
Takao Mae, Akihiko Asami, Hideyuki Semba, Shinichiro Hara, Itaru Furui ...
2011 Volume 60 Issue 4 Pages
763-767
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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This study was conducted to investigate the healing of tubular bone fracture. We studied the process of callus formation in 152 fractures collected from five facilities belonging to the SAGA Society for Fracture Repair.
Callus formation was monitored by radiological assessment defined by our original criteria. As a result, we recognized a statistical significant difference in several factors such as, fracture site, implant, age, and classification. We are planning to compile a database on this research as an index for fracture treatment.
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Kazuhiko Yoshikawa, Hiroo Matsuse, Toyoaki Yamanouchi, Naoto Shiba
2011 Volume 60 Issue 4 Pages
768-772
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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It is known that high serum concentrations of undercarboxylated osteocalcin (ucOC) have been associated with increased risk of hip fracture. We examined vitamin K insufficiency in patients with hip fracture in elderly women by the measurement of serum ucOC. We studied 29 elderly fewale patients with hip fracture (age 59 to 95), and elderly female outpatients as the control group (n=30, age 70 to 99). Blood samples were collected on the hospital day for the fracture group, and on the day of the first examination for the control group. Serum ucOC, serum N-terminal cross-linking telopeptide of type I collagen, serum albumin, serum calcium, and total alkaline phosphatase were measured. Bone mineral density at the non-dominant forearm was measured by dual-energy X-ray absorptiometry. Unpaired t-test was employed to make comparisons between the fracture group and control group. Serum ucOC of the fracture group was 8.46±6.2 ng/mL and about 76% of the patients had vitamin K insufficiency in bone, significantly greater than the control group (4.77±2.8 ng/mL) (p<0.01). These results indicate that vitamin K insufficiency in the bone may cause hip fracture. Measurement of serum ucOC seems to be useful for preventing hip fracture.
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Go Kato, Taichi Saito, Isao Saikawa, Tsutomu Irie, Tetsuya Tanaka, Kun ...
2011 Volume 60 Issue 4 Pages
773-779
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Pedicular transvertebral fixation (PTSF) is one of the various posterior interbody fusion techniques for degenerative or lytic L5-S1 spondylolisthesis using posterior instrumentation with conventional pedicle screws (PS) and firstly reported by Abdu et al in 1994. In this procedure, lumbosacral fixation is obtained by trans-L5/S1-discal screws (TDS) inserted through S1 pedicles. This procedure is thought to provide several advantages, such as 1) TDSs provide more rigid fixation at the lumbosacral junction by greater bone purchasing, resulting in increased strength against pull out, 2) there is no risk to the anterior anatomical structures (e.g., common iliac arteries), because they are protected by the anteriorly displaced L5 vertebral body, and 3) TDS insertion is technically easier especially with high grade slips compared with conventional PLIF or PLF, because the direction of the TDS tends to be more perpendicular. In our department, four patients (n=2, L5-S1 spondylolisthesis; n=1, L4 and 5 spondylolysis; n=1, L4 and 5 lamina deformities) have been treated by using PTSF since 2007. We couclude that this is a beneficial surgical technique compared to conventional PLIF of PLF because it is simpler to perform and good clinical and radiographic results were achieved in all these cases.
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Yusei Funakoshi, Hideki Asato, Hideo Kinjo, Mika Takaesu, Fuminori Kan ...
2011 Volume 60 Issue 4 Pages
780-784
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Infraspinatus muscle atrophy is sometimes seen in volleyball players. We report a case of infraspinatus muscle atrophy which was treated by arthroscopic suprascapular nerve decompression. The patient was a 16-year-old male volleyball player complaining of right shoulder pain and fatigue. Infraspinatus muscle atrophy and scaplar descent were observed. In MRI, there were no space occupying the lesion around the suprascapular nerve but obvious infraspinatus muscle atrophy. We diagnosed suprascapular nerve entrapment caused by spike motion. Right hand spike was prohibited and stretching of parascapula muscles was instructed in conservative treatment. Right shoulder pain and muscle atrophy improved after three months of conservative treatment, so we allowed right hand spike. Four months after retuning to play volleyball, the patient had the same symptoms as before the conservative treatment. Also infraspinatus muscle atrophy became worse in MRI. Therefore we performed arthroscopic suprascapular nerve decompression. One month after surgery, the patient returned to play volleyball. Five months after surgery, he could play volleyball like before and infraspinatus muscle atrophy recovered in MRI.
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Mika Takaesu, Ichiro Owan, Masato Ishihara, Masamichi Onaga, Takashi T ...
2011 Volume 60 Issue 4 Pages
785-788
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We investigated the epidemiological data of patients with hip fractures from September 2009 to January 2010. A total of 21 hospitals with orthopedic wards in Okinawa were enrolled in this study. Patients aged 50 years and older were included, and data collected were age, gender, body mass index, fracture type, injury location, complicating disease, previous insufficiency fractures, and osteoporosis medication.
The number of hip fractures was 311 in total, 64 men, and 247 women with a mean age of 82.4 years. Of all hip fractures, 155 cases were cervical, and 153 cases were trochanteric fractures, 160 fractures occurred indoors, and 69 fractures outdoors, and 79 fractures occurred in hospitals or nursing homes, 264 fractures had some complicating disease, such as dementia, hypertension, and cerebral vascular disease in descending order of frequency. His fractures most frequently occurred for 6 to 11 am. Thirty-five% had previous osteoporotic fractures, and only 12.8% of patients received medication for their osteoporosis. Orthopedic surgeons and general practitioners have the opportunity to improve this situation by treating their patients, and appropriate countermeasures are required for aged individuals with dementia to decrease hip fractures.
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Tasuku Kiyuna, Ichiro Owan, Masato Ishihara, Mika Takaesu, Masamichi O ...
2011 Volume 60 Issue 4 Pages
789-792
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The aim of this study was to investigate the pre-fracture activities of daily living (ADL) level including ambulatory status and cognitive status of patients with hip fractures. ADL level was measured by Barthel index, and cognitive status was measured by the revised Hasegawa Dementia Scale (HDS-R). A total of 21 hospitals with orthopedic wards located in Okinawa were enrolled from September 2009 to January 2010. The number of patients was 310 (64 men and 246 women), and the age of patients ranged from 50 to 102 years old with a mean age of 82.4 years old. The percentage of patients who scored 60 points or more on the Barthel Index was 64%, and that of patients who scored 14 points or less on HDS-R was 52%. HDS-R score correlates positively not only with the score of Barthel index but also with gait ability. Therefore, we can conclude that the characteristics of patients with hip fractures were relatively higher ADL level without cognitive impairment or relatively lower ADL level with cognitive impairment.
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