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Akihiko Asami, Masamori Shigematsu, Hideki Ishii, Hirofumi Tanaka, Ken ...
2011 Volume 60 Issue 3 Pages
365-367
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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One hundred-forty two patients (156 elbows) who were treated by surgical methods were reviewed retrospectively for cubital tunnel syndrome. Results were graded as excellent in 58 elbows (37%), good in 73 (47%), fair in 25 (16%), and poor in 0 (0%). Of the 25 fair elbows, 17 patients (21 elbows) were reviewed in detail. All patients were rated as grade 3 according to McGowan's classification. Many of these patients were accompanied by osteoarthritis of the elbows, valgus deformity due to lateral epicondylar fracture or pseudoarthrosis of the humerus, pyogenic arthritis, diabetes mellitus, and cervical spondylosis. Minimal invasive surgery is recommended because cubital tunnel syndrome may occur post surgically in some cases.
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Shinichi Nakahara, Masao Eto, Kohei Kawaguchi, Koichiro Sakimura
2011 Volume 60 Issue 3 Pages
368-372
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The purpose of this study was to evaluate re-operated cases after rotator cuff repair. We treated 118 patients of rotator cuff tear for two years; arthroscopic rotator cuff repair (ARCR): 79 patients, open rotator cuff repair (ORCR): 39 patients. The number of re-operation were four shoulders after ARCR (Group A), and three shoulders after ORCR (Group O). In Group A, two cases with recurring impingement underwent arthoroscopic synovectomy, one case with dislocated anchor underwent revision surgery, and one case with re-teared rotator cuff and fistula underwent ORCR. In Group O, one case with re-tear of the fascia lata underwent performed arthoroscopic partial repair, two cases with re-tear and fistula underwent debridement. The clinical outcome of these patients was more or less satisfactory after re-operation.
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Yasuyuki Ishida, Etsuo Chosa, Hiroaki Yano, Keitaro Yamamoto, Katsuhir ...
2011 Volume 60 Issue 3 Pages
373-377
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Recently, good clinical outcomes of arthroscopic rotator cuff repair (ARCR) are reported, but the re-tear rate of massive and large rotator cuff tears is still high. The purpose of this study is to review the clinical outcome and postoperative cuff integrity of ARCR in our hospital. We evaluated 80 shoulders (61 males, 19 females), whose age rauged from 30 to 78 (average: 61.8 years old). The size of tears were 8 small, 22 medium, 36 large, and 14 massive. We evaluated the pre-and postoperative JOA scores, and MRI findings 12 months postoperatively. We evaluated the cuff integrity and fatty degeneration of the ruptured cuff by Goutallier's classification. Postoperative MRI findings showed complete repair in 56 shoulders (70%) and re-tear in 24 shoulders (30%). Postoperative JOA score was poor in cases with large re-tears. Retear rates were high in large and massive tears, tears with advanced fatty degeneration, and subscapularis tears. As this operation is not a replacement procedure, the quality of the ruptured rotator cuff is important. Further discussion on the operative indication and method is necessary.
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—Review of Poor Responders—
Toshiyuki Tsuruta, Hiroko Mine
2011 Volume 60 Issue 3 Pages
378-385
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Aim: This study was designed to evaluate the poor responders of mobilization of elbow joints in patients with osteoarthritis of the elbow.
Subjects and Methods: Twenty-six patients [20 men (20 elbows) and six women (six elbows), mean age: 54.0±16.9 years, mean follow-up period: 49.7±28.3 months] with osteoarthritis of the elbow underwent mobilization of elbow joints.
Results: In the last examination, the pain and range of motion of elbow joints significantly improved in all of patients. Poor responders (flexion ≤110 degrees, and/or extension ≤-20 degrees, and/or pain in JOA score ≤20 points) were observed in 6/26 elbows. The reduction of bone fenestration was not associated with improvement in the range of motion. However, the frequency of poor responders showed a tendency to be higher patients without insufficient incised medial osteophyte (45.5%).
Conclusions: These results suggest that full incision of the medial osteophyte is important to obtain good operative results regardless of the presence of bone fenestration in patients with osteoarthritis of the elbow joint. Based on these results, we have been able to well incise the anterior, posterior, and medial osteophytes, while retaining as much anterior oblique ligament as possible in the medial collateral ligament after opening the cubital tunnel by medial approach.
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Chojo Futenma, Masaki Kinjo, Kenji Horikiri, Hirota Kohama, Fuminori K ...
2011 Volume 60 Issue 3 Pages
386-390
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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When non-constrained total elbow prosthesis is used for RA elbow with a large condyle defect, a postoperative dislocation sometimes occurs as surgical complication. We performed non-constrained total elbow arthroplasty (Kudo Elbow or K-Elbow) for 16 painful RA elbows with condyle defects and evaluated the relation between the degree of condyle defect and the dislocation retrospectively. Age at the operation ranged from 32 to 80 year old (average 55 y-o). Follow-up period ranged from 12 to 127 months (average 50.4 months). The patients were divided into 3 groups: trochlea defects (5 elbows), capitulum and trochlea defects (5 elbows) and complete condyle defects (6 elbows). After the operations, pain relief was obtained in all patients. There was no dislocation in the first 2 groups which kept the lateral epicondyle. On the other hand, dislocation occurred in 5 of 6 total condyle defect. Of 5 dislocation, 2 were caused by external rotation contracture of the shoulder and was treated by shoulder rehabilitation with external fixator of the elbow. Other 3 were caused by weak soft tissue tension. Of them, 2 required revision with semiconstrained and 1 denied surgery and required continuous brace application.
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Kuniyoshi Tsuchiya, Kenichi Kawaguchi, Daisuke Hara, Takuro Yara
2011 Volume 60 Issue 3 Pages
391-394
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Total two-hundred and twenty-one cases were operated on for cervical disorders at our institute from 2006. Of these, seven cases showed early neurological deterioration. Four cases developed postoperative hematoma, all of whom underwent surgery and recovered. One Ossification of Posterior Lougitudinal Ligament (OPLL) case deteriorated after laminoplasty, followed by anterior decompression and fusion. Postoperative C5 root palsy were observed in two cases, both of whom recovered spontaneously. All of these neurological complications occurred within three days after surgery. Presence of substantial OPLL with disruption of ossification, disc herniation are considered risk factors for postoperative deterioration after cervical spine surgery.
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Koichi Yoshikane, Akihiro Nishii, Mitsumasa Hayashida, Kazunobu Tsunod ...
2011 Volume 60 Issue 3 Pages
395-398
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report the short-term clinical results of interlaminar approach percutaneous endoscopic lumbar discectomy in 20 early introduction cases. All the 20 patients showed improvement in their symptoms immediately after surgery. Herniated discs were successfully removed in 17 cases (85%). There were no significant major complications. Minor complications occurred in nine cases (45%) due to temporary numbness or dysesthesia provoked by irritation of the traversing root during the operation. This occurred frequently, especially in the initial stage of the introduction. As the number of PELD operations increased, we were able to carefully treat the nerve root. The occurrence of nerve root disorder decreased in the latter term (learning curve). There was one case of recurrence of disc herniation at two months after operation. The half-year improvement rate of JOA score was 84% (preoperative 12.4/ postoperative 26.3). This method may serve as an optional lumbar disc herniation treatment as a more minimally invasive surgery in the future.
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Hiroko Mine, Mitsunori Komine, Takahiko Aoyagi, Mitsuhiro Katoku, Tosh ...
2011 Volume 60 Issue 3 Pages
399-404
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Since March 2007, we have been providing medical support to a non-professional company baseball team once a week by physical therapy, by accompanying the team to inter-city baseball games and national non-professional baseball matches. Here, we present details of these efforts, morbidity of sports injuries since starting the treatment, current problems, and future prospects. Since starting the medical support, the morbidity of sports injuries has decreased from 31 cases in 2007 to 13 cases in 2010 (shoulder joint injuries decreased from 10 to six cases, and elbow joint injuries from seven to three cases). The medical support also seems to have changed in the awareness of team members towards conditioning, and efforts by players to correct physical problems by themselves are seen. Presently, even when no players complain of injuries, etc., the team manager and coaches come to us for advice, and this mind-set of the team leaders has enabled early discovery of injuries and preventing them from becoming serious. However, there is still a tendency to give importance to games and training, so efforts to deepen mutual understanding of all involved parties and further building of trust relationship are essential.
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Mayuki Taketa, Hideaki Kubota, Yutaka Oketani, Makoto Ryu, Noriko Uran ...
2011 Volume 60 Issue 3 Pages
405-408
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Deformities, motor dysfunctions, and secondary disorders caused by cerebral palsy maybe improved by releasing spastic muscles selectively. We present three patients who underwent Orthopaedic Selective Control Surgery (OSSCS) for secondary cervical myelopathy due to athetoid cerebral palsy (ACP). Their age at the time of surgery was forty-nine years on average (from 45 to 51). Two were male and one was female. Though myelopathy improved in all three patients, posterior cervical fusion was added to one patient at five months after OSSCS for further improvement. OSSCS and selective release of spastic muscles were effective for myelopathy caused by ACP, although bony spinal surgery was needed in patients with severely instable cervical spine.
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Takeaki Ishii, Shinji Fukuoka, Kiyoyuki Torigoe, Takashi Matsuo
2011 Volume 60 Issue 3 Pages
409-416
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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This report presents the medium- to long-term outcomes after orthopaedic selective spasticity control sugery in the neck of patients with athetosic cerebral palsy. A total of 46 cases were treated between 1990 and 2009. Their mean age at the time of surgery was 38.5 years (range 13 to 56 years). The mean duration of follow-up was 7.2 years (range from 2 years to 19 years). A total of 31 cases were followed for more than two years. Twenty-eight of those cases underwent surgery for myelopathy. They were assessed according to Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and classified into 3 groups (good, fair and poor). Twenty-five patients were improved shortly after surgery. The long-term follow-up showed that those classified as level II according to the gross motor function classification system (GMFCS) and those who received secondary bony surgery were likely to have a poor outcome. Patients who are classified as GMFCS level II are therefore recommended to undergo Orthopaedic selective spasticity control surgery together with primary bony surgery.
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Kohei Kawaguchi, Shinichi Nakahara, Koichirou Sakimura, Masao Eto
2011 Volume 60 Issue 3 Pages
417-421
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Fractures of the odontoid process of the axis are rare in children. We present a 10-year-old boy with hypotonic cerebral palsy who was injured from behind in a car accident. He did not have neck pain, but CT showed fracture of the odontoid process of the axis (Anderson Type 2). He wore a neck protector for eight weeks and achieved bone union. Fractures of the odontoid process of the axis are rare in children beca use their spine is flexible and physiologically movable area is larger. In this report, we discuss this case by reviewing available literature, etc.
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Yuki Oto, Akane Maeda, Takeshi Kinjo, Atsuo Aguni, Toshinori Uehara
2011 Volume 60 Issue 3 Pages
422-423
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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It is sometimes hard to diagnose cervical myelopathy due to the lack of symptoms of the upper extremities. We report cases of cervical myelopathy requiring surgical treatment at our hospital.
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Hisato Tanaka, Takaki Kasahara, Nanae Akiyama
2011 Volume 60 Issue 3 Pages
424-428
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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In general practice, disc hernia is increasingly being questioned about its relation with traffic injuries. In this study, we examined the image findings of cervical disc herniation for findings indicative of traumatic hernia. In 2008, we examined 35 cases of cervical disc herniation at our hospital by MRI. The patients were divided into two groups; patients with trauma history (19 cases) and those without (16 cases), and their images were compared. Disc herniation in the trauma group showed high intensity at T2, with some of the patients in this group also indicating continuous high intensity of the internal and herniated discs. Traumatic force was found to cause swelling under the laryngeal soft tissue. Cases with further flexion injury showed interspinous ligament hemorrhage. These findings strongly suggest the involvement of injury. But given that some younger patients in the non-trauma group also show high intensity at T2*, attention must be paid not to confuse swelling below the larynx with inflammation of the longus colli muscle.
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Chieko Noguchi, Hideo Baba, Atsushi Tagami, Shinji Adachi, Takeshi Hiu ...
2011 Volume 60 Issue 3 Pages
429-434
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report the use of an MRI-based navigation system in the brain surgery for recurring schwannoma in a patient who had underwent occipitocervical fusion for upper cervical tumor. The patient, a 79-year-old man, suffered recurring cervical schwannoma/tumor surrounded by important structures. The MRI-based navigation system was used to aid posterior approach to the spine and found to be useful.
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Atsushi Matsumoto, Taichi Saito, Tsutomu Irie, Tetsuya Tanaka, Eiji Su ...
2011 Volume 60 Issue 3 Pages
435-439
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We experienced a case of delayed spinal cord paralysis caused by transverse fracture of the thoracic spine in ankylosing spinal hyperostosis. A 71-year-old man complained of back pain after falling. He had been treated conservatively as for the Th10 compression fracture at another hospital. One month later, he reported muscle weakness and numbness of the bilateral lower extremities and was referred to our hospital. CT scan showed transverse fracture of the Th10 spine and MRI demonstrated spinal cord compression at the same level. Consequently, he underwent spinal decompression and fixation surgery. With transverse spinal fractures in ASH patients, mechanical stress concentrates on the fracture site resulting in pseudoarthrosis followed by delayed neurological deficit. Therefore, early surgical fixation after injury is strongly recommended.
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Naoki Inomata, Hiroshi Kuroki, Hideaki Hamanaka, Hiroshi Masuda, Shuic ...
2011 Volume 60 Issue 3 Pages
440-445
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a study on five cases undergoing emergency surgery for lumbar disc herniation with cauda equina syndrome. The subjects (three males and two females, mean age 37 years) were reviewed for clinical picture, surgery-related items, and postoperative results. Two cases had acute onset of bladder and rectal disturbance and three had subacute. Three of the five cases were severely disabled patients with urinary retention. The duration between appearance of disturbance and surgery was two days or less in two cases and three days or more in three cases. All cases underwent surgery within 24 hours after their first visit to our hospital. Both JOA score and urinary disturbance improved. In three cases, improvement was insufficient in terms of defecation. It has been reported that it is significantly advantageous to treat patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome, and that there is significant improvement in sensory and motor deficits as well as urinary and rectal functions in patients who underwent decompression within 48 hours versus after 48 hours. It is of great clinical importance to detect not only lower-extremity symptoms but also bladder and rectal disturbance as early as possible.
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—Report of Two Cases—
Kenichi Kawaguchi, Kuniyoshi Tsuchiya, Daisuke Hara
2011 Volume 60 Issue 3 Pages
446-449
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Two cases of cranially migrated lumbar disc herniation were treated successfully by translaminar approach.
Case 1 with L4/5 disc herniarion had a double lesion (L4 and L5 radiculopathy), and the combined approach of interlaminar and translaminar was applied. Case 2 with L4/5 disc herniation had predominant L4 radiculopathy, and was treated by translamilar approach only.
Both two patients showed excellent recovery within a few days.
With the translaminar approach, large bone resection can be avoided and fracture of the inferior articular process prevented.
Although the indication of surgery and location of hole through the lamina should be carefully considered, the translaminar approach is a treatment of choice in cases with cranially migrated lumbar disc herniation.
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Shinjiro Tomita, Nobuhiro Urakawa, Masakazu Kan
2011 Volume 60 Issue 3 Pages
450-452
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Percutaneous vertebroplasty (PVP) is known as a common and minimum invasive therapy for osteoporotic vertebral fractures. But recently, severe postoperative complications of PVP have been reported. We report a case who underwent re-operation for foraminal stenosis after PVP.
A 75-year-old woman complained of severe back pain with no trauma. Clinical diagnosis was L2-L3 vertebral wedge compression fracture with posterior wall injury. As the fractured vertebra was losing its height despite conservative therapy, PVP was performed. After the operation, no routine rigid orthosis was reported by the patient. The operated vertebra however started to gradually lose its height with foraminal stenosis and delayed nerve root disorder appeared. She therefore underwent re-operation five months after PVP.
The re-operation technique consisted of L2 partial pediculotomy, L2 laminectomy, and re-PVP of L2. She could walk by picker after the re-operation. We also analyzed the incidence of nerve root disorder. It is important to carefully review the mental state of the patient, characteristics of augmentation, suitability of operation, and postoperative therapy.
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Toshio Hori, Taichi Saito, Tsutomu Irie, Tetsuya Tanaka, Eiji Suenaga, ...
2011 Volume 60 Issue 3 Pages
453-456
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of hematoma of the lumbar ligamentum flavum. A 61-year-old man presented with pain and numbness of the lateral aspect of the left leg. Although his symptoms improved once by conservative treatment, they recurred four months after his first visit and he could hardly walk due to muscle weakness of the left foot. MRI findings demonstrated an extradural mass at the left side of the L4 level which showed high signal intensity in T1WI. In surgical operation, the mass was revealed to be a hematoma that continuously progressed from the left L4-5 ligamentum flavum to the cranial side. After complete removal of this mass, his symptoms and signs disappeared remarkably.
Hematoma of the ligamentum flavum is a comparatively rare disorder, it maybe possible to diagnose it preoperatively by its characteristic intensity in MRI, especially in T1WI.
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—A Report of Two Cases—
Tetsuji Inoue, Tatsuro Yamauchi, Saburo Nakashima, Kazuaki Fukuda, Mak ...
2011 Volume 60 Issue 3 Pages
457-461
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report here two cases of ligamentum flavum hematoma in the lumbar spine who presented with radicular symptoms and cauda equine claudication. The first case was a 71-year-old man who complained of left gluteal region pain after falling on the ground. Five months later, the patient suffered gait disturbance, and MRI demonstrated spinal canal stenosis at L4-L5, caused by a left posterolateral mass lesion continuous with the ligamentum flavum. The second case was a 56-year-old man who complained of low back pain and bilateral gluteal region pain after lifting a desk. MRI showed spinal canal stenosis at L3-L4, caused by a posterior mass lesion continuous with ligamentum flavum. Two months later, he had obvious intermittent claudication with bilateral gluteal region pain after low back extension. Second MRI revealed that the mass lesion had expanded and changed signals. In both instances, surgical treatment was performed with partial laminectomy and excision of the degenerative ligamentum flavum containing hematoma, resulting in excellent pain relief. Histological findings confirmed the diagnosis of old hematoma with granulomatous change in the degenerative ligamentum flavum.
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Yugo Takano, Seiich Kawamura, Ryuma Aso, George Huang, Masayuki Kawagu ...
2011 Volume 60 Issue 3 Pages
462-466
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Spinal metastasis of patients with advanced stage lung cancer is an important reason for palliative therapy. Because their incidence is high, they often cause severe symptoms and worsen quality of life. Neurological improvement of at least 1 Frankel grade was seen in four out of six cases (71 %). Improvement of the capacity was noted in four (64%), and improvement of pain and performance was seen in all six. Surgical treatment for symptomatic metastatic spinal tumor in lung cancer can improve quality of life. Surgery should be considered even if preoperative performance status is poor.
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—A Report of 2 Cases—
Takahiro Yasuhara, Hiroshi Tada, Takashi Matsusaki, Takeshi Nishijima, ...
2011 Volume 60 Issue 3 Pages
467-472
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We rarely experience development of malignant lymphoma during rheumatoid arthritis (RA) treatment. We report two cases of malignant lymphoma in patients treated with methotrexate (MTX) and human monoclonal antibody for rheumatoid arthritis. A 55-year-old woman with active RA had been treated with MTX and infliximab therapy. She developed soft tumor in her left arm and skin ulcer on both hands two months after the initiation of infliximab therapy. An open biopsy showed malignant lymphoma. Spontaneous remission of malignant lymphoma was obtained after cessation of infliximab therapy. A 71-year-old woman with active RA had been treated with MTX. She noticed stomatitis in the oral cavity six years after the initiation of MTX therapy. Gingival biopsy in the right maxilla showed malignant lymphoma. After chemotherapy and radiation, complete remission was achieved.
RA patients have an overall two-fold increased risk of malignant lymphoma compared with the general population. RA itself and drugs for RA are considered to be risk factors for the development of malignant lymphoma. We suspect that MTX and human monoclonal antibody are associated with the development of malignant lymphoma in our RA patients.
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Osei Tsuji, Misao Urakado, Eiichi Koyanagi, Michio Shinohara, Masayosh ...
2011 Volume 60 Issue 3 Pages
473-476
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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As bone metabolism markers play an important bole in evaluating the effects of osteoporosis treatment, we conducted a comparative study of TRACP-5b (Tartrate-resistant Acid Phosphatase 5b) a new biochemical marker of bone turnover and serum NTX(N-telopeptides of type I collagen) in 23 primary osteoporosis patients who required bisphosphonate treatment in order to estimate the efficiency and problem of TRACP-5b.TRCP-5b levels were checked in nine patients and serum NTX in 14 patients before treatment and three months after treatment. There was higher rate of decrease in MSC(Minimum Significant Change) in the TRACP-5b group (88.9%) than the NTX group (35.7%). TRACP-5b maybe more useful than serum NTX for deciding treatment. The pre-treatment readings of three patients (33.3%) and month 3 post-treatment readings of seven patients (77.8%) were under the cutoff point for risk of fracture. This maybe due to the cutoff point itself, or because TRACP-5b is an enzyme and therefore unstable, and its activity may decrease during treatment.
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Yoichi Kishikawa
2011 Volume 60 Issue 3 Pages
477-479
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Patients on bisphosphonate (BP) treatment show significantly lower undercaboxylated osteocalcin (ucOC) value than those not treated with any drugs (P<0.05) in drug-based comparisons. With regard to association between ucOC and N-telopeptide (NTx), correlation was seen amongst patients on BP (P<0.001) and patients on raloxifene (RLX) (P<0.007).
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Takuya Akamine, Dai Takata, Tetsuo Fukunaga
2011 Volume 60 Issue 3 Pages
480-482
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We investigated the effects of physical exercise of NIFS Chokin Project (average 2.5 months) on body constituents and bone mineral density (BMD) of 13 middle and old-aged women (average 67.5 ± 3.3 years old). Several findings were obtained as follows. (1) For whole body DEXA results after exercise, total lean mass, legs BMD, legs lean mass significantly increased (p < 0.05) and total fat mass, total fat % significantly decreased (p < 0.01) when respectively compared with those before exercise. (2) For left femur DEXA results after exercise, BMD in the Ward's triangle area significantly increased (p < 0.01) when compared with that before exercise.
Middle and old-aged women in the control group (non-loading exercise, average 65.3 ± 5.7 years old) did not show such significant changes. These results suggest that healthy exercise of NIFS Chokin Project had good effects on the bone of middle and old-aged women.
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Makoto Shiraki, Yasuo Noguchi, Yusuke Kubo, Masahiro Izumi, Satoshi Na ...
2011 Volume 60 Issue 3 Pages
483-487
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Saga Prefectural Hospital Koseikan started regional liaison path (RLP) for the treatment of hip fractures from April 2006. The aim of this study was to investigate its effects on hospital stay for hip fracture. 451 hip fracture patients who underwent operation in our hospital between April 2006 and March 2009 were enrolled. The patients were divided into the following two groups: RLP group (226 patients treated with RLP) and non-RLP group (225 patients treated without RLP). As a result, length of hospital stay of the RLP group was 26.5 days, dominantly shorter than that of the non-RLP group with 31.7 days. To compare the differences between the operation methods, the patients were divided into two groups by operation method (open reduction and internal fixation or femoral head prosthetic replacement). Still the length of hospital stay of the RLP group was dominantly shorter than that of the non-RLP group. The shorter time needed for arrangement of admission to another rehabilitation hospital was considered one of the reasons for this.
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Koji Sameshima, Yoshihisa Kawauchi, Shinji Yoshino, Natsuko Tomimura, ...
2011 Volume 60 Issue 3 Pages
488-490
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Our hospital is located in the northern part of Kagoshima City and is the first hospital using liaison-clinical pathway for hip fractures in the city since 2007. On the other hand, in the southern part of the city, Kagoshima Red Cross Hospital, an administrative hospital, has been using liaison-clinical pathway since 2008. Recently, the two hospitals attempted to merge the two pathways.
From April to October 2010, we studied 33 patients (5 males and 28 females) who had been operated or treated for hip fracture at our hospital.
Fifty-six percent of the patients used the liaison-clinical pathway between April to July and 100% between August to October, indicating increased use compared to before the merge (18.2%). Since the merged liaison-clinical pathway has just started, we need to review its usefulness to patient outcome by variance analysis in future.
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Masahiro Izumi, Yasuo Noguchi, Shunichi Rikimaru, Shunsuke Hotokezaka, ...
2011 Volume 60 Issue 3 Pages
491-494
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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The purpose of this study was to investigate the usefulness of electric clinical pathway (ECP), which supports the standardization of medical processes, to prevent thrombotic events in hip fracture patients. Our ECP for hip fracture, which includes the seventh-day postoperative measurement of the serum D-dimer level and antithrombotic drug therapy for two weeks postoperatively, was started to use in March 2009. This study includes 53 patients continuously using ECP (ECP group), and 53 patients not using ECP (control group) who were treated before February 2009. The rates of D-dimer level check and antithrombotic drug administration were analyzed. In addition, the D-dimer levels of both groups were compared. Computed tomography of the lungs and lower extremities was performed on in cases with D-dimer level> 20 microgram per ml, in order to confirm whether they had thrombosis events such as pulmonary embolism (PE) or deep venous thrombosis (DVT). In the ECP group, the D-dimer level was found to be 96.2% and the rate of use of antithrombotic drugs was 81.1%. In contrast, these percentages were 88.7% and 26.4% in the control group. Five cases showed PE in the control group and none in the ECP group. These results suggest that ECP promotes medical standardization and improves the quality of treatment.
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Yasuo Noguchi, Shunichi Rikimaru, Shunsuke Hotokezaka, Takao Mae, Kosu ...
2011 Volume 60 Issue 3 Pages
495-501
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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In this study, we analyzed length of stay (LOS) in our acute stage hospital and other hospitals for continuing rehabilitation and final discharge destination (home, nursing institution, death, or the third hospital) of 341 hip fracture patients who received operative treatment from April 2007 to March 2010. The average LOS in our hospital and other rehabilitation hospitals were 28.4 and 79.9 days, respectively. The average LOS of patients with regional liaison pathway (RLP) was shorter than that of patients without the RLP. One hundred and ninety two out of 243 patients (79.0%) who lived at home before hip fracture were eventually able to return home. The RLP was not correlated with the percentage of patients who returned home.
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Takeshi Kojima, Teruyuki Kashiwagi, Shoji Hanado, Yoshihide Yano, Etsu ...
2011 Volume 60 Issue 3 Pages
502-508
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We compared the clinical results of trochanteric fractures treated with Gamma 3 nails with CCD angles of 120° and 125°. Twenty cases that were treated by a single surgeon from January 2010 to August 2010. They consisted of three males and 17 females with average age or 83.3 years old. Their medical reports were reviewed for number of days to operation, operating time, Tip-Apex Distance (TAD), position of lag screw and the amount slid by the lag screw (after 1 week or after 2 weeks). As a result, there was no significant difference in the four parameters. Regarding the lag screw position in the femoral head, in eight cases treated with 120° Gamma 3 nails, the lag screw was positioned at the center or inferiorly in the AP view; and in two cases treated with 120° Gamma 3 nails, the lag screw was positioned posteriorly in the ML view. With Gamma 3 nail of 125° CCD angle, in eight cases the lag screw was positioned at the center or inferiorly in the AP view, and in two cases, the lag screw was positioned posteriorly in the ML view. Gamma 3 nails of 120° CCD angle enables the lag screw to be placed more easily into the inferior part of the femoral head than the 125° CCD angle, and they do not have any negative impact on lag screw sliding. These results suggest that Gamma 3 nails with 120° CCD angle can sene as an efficient method for treating trochanteric fractures.
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Takafumi Tajima, Fumio Fukuda, Yasuhito Motojima, Gentaro Hanaishi, Te ...
2011 Volume 60 Issue 3 Pages
509-513
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We reviewed the results of surgically treating displaced femoral neck fractures in patients under 70 years old. Between 2005 and 2010, eight patients (two males, six females, average age 53 years old) were treated at our hospital, and we reviewed bone union and late segmental collapse. We investigated age, BMI, standby days, reduction of post operation, AP and lateral GAI, and position of implant. Six patients (75%) gained bone union, and two out of six (33%) had LSC. Significant differences were seen in bone union, reduction, and lateral GAI. Cases with under-reduced and low lateral GAI could not gain bone union. In LSC, there was significant difference in standby days. Long standby cases with long standby cases (average 4.5 days) are prone to LSC.
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Go Takayama, Yasutaka Kugimoto, Yukiko Uemichi
2011 Volume 60 Issue 3 Pages
514-518
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We investigated the clinical results of cementless bipolar hemiarthroplasty with tapered-wedge designed stem using a prospectively collected database of 13 hips with femoral neck fracture or osteonecrosispatients for one year. The same posterolateral approach and prosthesis (Accolade TMZF Stryker®) were used in all cases.
We studied probable factors influencing clinical results including age, sex, BMI, operative time, operative blood loss, etc. We examined their preoperative bone quality (according to Dorr's classification), canal flare index (Noble's classification), postoperative alignment of the inserted femoral prosthesis and adequacy of intramedullary fill from X-ray exams. Furthermore, we followed these cases and monitored their fitting pattern of the stem according to Engh's classification.
The mean operative time was 46 minutes and the mean blood loss were 214 grams. Only one case needed blood transfusion. On postoperative radiographs, eight stems were inserted at the medial position in their femoral canals, three were at the valgus, and two were at the varus. There were no intra- or postoperative accidents. All cases acquired stable bone ingrown fixation.
This short study suggests that tapered-wedge designed stem maybe useful for accomplishing maximum initial fixation and minimal invasion.
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Seiichiro Shimauchi, Itaru Furuichi, Masakazu Murata, Noboru Moriguchi ...
2011 Volume 60 Issue 3 Pages
519-521
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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At our hospital, we operate on patients with femoral neck fracture on the day of hospitalization under anesthesia. In this study, we examined the usefulness of performing the operation to this within 24 hours after hospitalization for this fracture. Patients operated within 24 hours were grouped into the early operation group, and those operated 24 hours after were grouped into the standby operation group. There was no significant difference between the two groups. However, the numder of days hospitalized was shorter with the early operation group.
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Seiko Takai, Tomoki Takahashi, Manabu Taguchi, Yoichi Hayashida, Shuic ...
2011 Volume 60 Issue 3 Pages
522-526
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We calculated the inter-observer variation in Garden's classification for femoral neck fracture. Forty radiographs were evaluated using Garden's classification by five orthopedic surgeons. The agreement rate between observers and Kappa statistics were assessed.
The agreement rate was 37.5%, and Kappa value was 0.51. When the fracture was classified into two stages; non-displaced (Stage I, II) or displaced (Stage III, IV), the agreement rate was 80.0%, and Kappa value was 0.80. Eight cases did not agree in the two stages. Seven of eight were cases of complete fracture with valgus position or with slight displacement.
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Shinichiro Hirano, Nobuhiro Urakawa, Shinjiro Tomita, Masakazu Kan
2011 Volume 60 Issue 3 Pages
527-530
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Pneumarthrosis is very rare condition. We report a case of pneumarthrosis of the knee joint after trauma. A 31-year-old man ran into the car while riding a motorcycle and tipped over on the left. He was transported by ambulance to our hospital with left knee injury. When he was brought to our hospital, his vital signs were normal, and his left knee had a 7 mm puncture wound, swelling, palpable wave. He could walk but in pain. There was gas in the knee cavity on simple radiography on the first visit, and the gas and bloody synovial fluid were collected by arthrocentesis. We suspected septic arthritis, and administered oral antibiotics for five days. The synovial fluid culture were negative. Thirteen days after the injury, pneumarthrosis disappeared, but pain of knee persisted. Twenty-three days after the injury, there was femoral bone contusion on MRI. Only 10 weeks after the injury did, the pain heal by non-steroidal analgesic drugs.
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Kazuma Yamashiro, Tetsuo Nakano, Ryuya Ochi, Naoya Murakami, Daisuke I ...
2011 Volume 60 Issue 3 Pages
531-535
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Injuries in the vicinity of the knee joint are often seen in daily medical care. Occult fractures are fractures which do not show up on roentgenograms in the first examination, but in follow-up examinations. In this study, we investigated 60 cases of occult fractures around the knee joint treated at our department which did not appear in initial roentgenograms. Their ages ranged from 15 to 96 years old, with a mean age of 71.5 years old. They consisted of eight men and 52 females. Fifty-nine cases were diagnosed by MRI. All samples were treated by conservative management. At week 8 from the first examination, symptoms were found to have disappeared in 82.1%. Fractures tend to occur easily in elderly women. More than 75% are caused by moderate external force, suggesting relation with osteoporosis.
When elderly women fall, if swelling of the knee joint and hemarthrosis are seen, fractures should be suspected even if they do not appear on X-ray, and MRI should be useful for such diagnosis.
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—A Case Report—
Tomohisa Inoue, Takashi Shimauchi, Osamu Nakagawara, Shinichi Motomats ...
2011 Volume 60 Issue 3 Pages
536-539
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We present a case with avulsion of the tibial tubercle. Classification of the fracture was type 3 according to Watson-Jones. At arthroscopy, there was fracture site anterior to ACL attachment, although the tonus of AM bundle was poor, the whole tonus of ACL was good enough. We performed open reduction and internal fixation using cortical screws, following good postoperative course. We attribute the mechanism of injury to strong quadriceps contraction with the knee flexed and the foot fixed.
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Keita Nagira, Ryoji Otuki, Yasutsugu Yamashita, Hideki Nagashima, Ryot ...
2011 Volume 60 Issue 3 Pages
540-543
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Coronal fractures of the femoral condyles, known as Hoffa fractures, are rare fractures. Conservative management of Hoffa fractures often yields poor outcomes.
We report three patients with Hoffa fractures of the medial femoral condyle who were treated with open reduction and internal fixation with screws by medial parapatellar approach. Postoperatively, all patients began immediate unrestricted range of motion. Initial weight bearing was limited. The age of the three patients ranged from 48 to 54 years (average 50.7 years), and they consisted of one man and two women. Follow-up averaged 16 months (range 6 to 28). Although two cases required arthroscopically assisted manipulation, at final follow-up, average range of motion of the three injuried knee joints was 1.7° to 141°, and all paitients healed without complications.
We recommend open reduction and internal fixation with screws and immediate unrestricted range of motion to avoid the risk of joint ankylosis, malunion, and possible secondary osteoarthritis.
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Koichiro Sakimura, Shinichi Nakahara, Kohei Kawaguchi, Masao Eto
2011 Volume 60 Issue 3 Pages
544-547
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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High-energy distal femur fractures present challenges in treatment because of complex fracture patterns or local soft tissue damage. We reviewed the clinical outcome of minimally invasive plate osteosynthesis (MIPO) technique using a locking plate. The six cases consisted of four men and two women, whose mean age was 49.5 years. Fracture type by AO/OTA classification was one A3, one C2, four C3. Intraarticular fractures were reconstructed directly through a lateral parapatellar incision, while supracondylar fractures were indirectly reduced using external fixator. Three cases (two open injuries and one crush injury) were treated using staged management. Good alignment was maintained in all cases, but delayed union occurred in one case. There ware two excellent results, three satisfactory results, one unsatisfactory result, and no failures according to Neer criteria.
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Shuhei Murase, Tanefumi Nakagawa, Hiroshi Maruyama, Kunihiko Suzuki, F ...
2011 Volume 60 Issue 3 Pages
548-551
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Patellar tendon rupture is a rare complication of total knee arthroplasty (TKA), many different reconstruction techniques of patellar tendon rupture have been described with variable and often discouraging results. We describe a technique for repair using the teros artificial ligament.
An 82-year-old woman suffered a patella tendon rupture after TKA. She underwent extensor mechanism reconstruction by teros artificial ligament. Then knee was followed up for four months. Knee extension power and improved function were obtained. There were no graft complications. Use of the teros artificial ligament is a reliable treatment option for the repair of patellar tendon rupture following TKA.
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Azusa Tanaka, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Hiroa ...
2011 Volume 60 Issue 3 Pages
552-556
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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[Objective] The purpose of this study is to investigate the availability of the measurement of D-dimer as a screening method for venous thromboembolism (VTE) before and after total knee arthroplasty (TKA).
[Material and Methods]A total of 128 knees with osteoarthritis underwent TKA. There were 19 men and 97 women with a mean age of 77 years old. All patients were measured for D-dimer preoperatively and postoperative days 3 and 7. We performed multidetector-CT (MD-CT) examination to determine the diagnosis for VTE preoperatively and on day 7 after surgery.
[Results]At preoperation (n128), the averaged D-dimer value was 1.5±1.5μg/ml. The incidence of VTE was 10% (13 knees). There were no significant difference in the D-dimer between the VTE (+) and VTE (-) groups. On the other hand, postoperatively (n99) the averaged D-dimer value was 6.7μg/ml on day 3 and 13.6μg/ml on day 7. The incidence of VTE was 24% (23 knees). The D-dimer values on days 3 and 7 postoperatively were significantly different between the VTE (+) and VTE (-) groups.
[Conclusions]Our findings demonstrated that D-dimer value cannot be measured for the preoperative screening of TKA, suggesting the need to establish cut-off value for D-dimer in individual institutions for postoperative screening.
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Tomomitsu Hashiguchi, Keisuke Matsuo, Yoichi Kawano, Mitsuru Saeki, Te ...
2011 Volume 60 Issue 3 Pages
557-560
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Patients with celebral palsy frequently develop dislocated or subluxated hip in youth secondary to muscle imbalance, coxa valga, or femoral anteversion. The dislocated or subluxated hip developsinto secondary osteoarthritis of the hip and causes severe painand difficulty in sitting, walking, and ADL. We performed three THA procedures on two patients to relieve pain and improve ADL. Two patients were restored to the functional level at which they had became disabled by the painful hip. Both patients are very satisfied with the results.
We conclude that THA can serve as an effective treatment for the osteoarthritis of the hip in middle and advanced aged celebral palsy.
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Katsuhiko Kiyota, Nobutake Nakane, Takako Ishii, Koji Kubota, Tomoki T ...
2011 Volume 60 Issue 3 Pages
561-565
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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From April 2008 through April 2010, 185 patients (38 males and 147 females, and mean 65.0 years) undergoing primary total hip arthroplasty (THA) had blood taken for measurement of D-dimer on postoperative day 6, and color doppler ultrasounds of the lower extremities were taken on postoperative days 2 and 7. They were managed with intermittent pneumatic compression devices immediately after operation and low molecular weight heparin after removal of the epidural catheter.
Twenty- two deep venous thrombosis (DVT) (prevalence, 11.9%) were identified, however, no symptomatic pulmonary embolism (PE) was seen.
D-dimer of 10μg/ml was significantly effective as the cutoff for DVT detection. Five patients who were diagnosed as DVT on postoperative day 7 had D-dimer abave 10μg/ml. The results of the present study agreed with data reported previously.
Prevention and careful inspection for DVT and PE through varions tests are important.
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Kohei Kamito, Makoto Osaki, Akira Hozumi, Hisataka Goto, Tatsuya Fukus ...
2011 Volume 60 Issue 3 Pages
566-568
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We carried out revision THA by reconstruction on a case with huge posterior wall defect using allograft, buttress plate, and KT plate.
A 46-year-old man sustained right hip joint posterior fracture dislocation and left multiple leg fracture by dashboard-injury.
He was operated for right posterior wall osteosynthesis and the left below-knee amputation. The same year, he was operated for right THA.
After that, two times greater THA was carried out over a period of nine years after injury, due to loosening and damage of KT plate, etc.
Ten years after injury, he was introduced our hospital, and we performed the third THA. We detected a postacetabular bone defect, and fixed it by block allograft using screw and buttress plate, and reconstructed the acetabulum in the KT plate.
KT plate fixation is considered useful in acetabular bone defect cases but in the case of huge wall defect, this technique which uses screw and plate provides more stability and is useful.
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Yoshihisa Anraku, Kimiaki Nishida, Katsuhiko Kunitake, Yasujiro Tutsum ...
2011 Volume 60 Issue 3 Pages
569-574
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of THA revision for severe thigh pain after endoprosthesis. A 67-year-old woman, who had underwent hip endoprosthesis 17 years ago, complained of thigh pain. There was no radiolucent zone or osteolysis. However, radiograph showed stress shielding (cortical hypertrophy around the midstem, and cortical porosis in trochanteric region and below the tip of the component). In arthrography, the contrast agent did not enter into the gap between the implants and bone, and local anesthetic did not improve pain. Laboratory findings including leukocytes and C-reactive protein did not elevate significantly. Conservative therapy was not effective and THA revision was performed, which alleviated thigh pain. At revision surgery, there was no failure of polyethylene liner or metallosis. The acetabular cartilage showed a normal appearance. All bacterial and viral cultures were negative, and there was no malignancy. But infiltration of macrophages was observed in the histological sections of the granulation tissue around the implant. Although it is difficult to determine the cause of pain, stress-shielding or wear debris maybe associated with the thigh pain of this patient.
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Akira Hashimoto, Itaru Furuichi, Masakazu Murata, Noboru Moriguchi, Ma ...
2011 Volume 60 Issue 3 Pages
575-579
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of using delta-lock stem for breaking LCP curved broad plate (LCP) after osteosynthesis of the periprosthetic fracture after total hip arthroplasty. The patient was an 80-year-old female. She underwent right total hip arthroplasty (THA) and revision THA at 71. She fell down at home and sustained periprosthetic fracture after THA, Vancouver classification type C. We used LCP together with cable wire system. While practicing walking at postoperatively week 12, she substained breaking of the LCP without any reason. We performed rerevision THA with delta-lock stem. Given that this case involved bone fracture of the cement circumference, transverse fracture, bone insufficiency of an elderly person, conditions which make it difficult to achieve bone union. In addition, weight-bearing in delayed union and a slight gap in the bone fracture department may have caused breakage of the LCP. Informed consent on complications such as breakage of the LCP is required when bone union is difficult to achieve.
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Atsunori Tokushige, Ryo Date, Akihito Sakka, Toshihiko Taguchi
2011 Volume 60 Issue 3 Pages
580-583
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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This study evaluated the clinical and radiographic results of revision total hip arthroplasty using the interlocking stem.
Nineteen hips underwent revision total hip arthroplasty using the interlocking stem from November 1997 to August 2010. Eight hips had aseptic loosening of total hip arthroplasty (THA), six hips had infection of the THA, three hips had fracture of the femur, and two hips had broken implant. According to the Paprosky classification, seven hips were type III b, and nine hips were type IV . According to the Vancouver classification, two hips were type B2, and one hip was type B3. Mean duration of follow-up was 3.7 years. Five components ware radiographically seen to be loose at the time of final follow-up. No patients showed bone ongrowth. Cases with loosening also had massive bone loss and/or infection.
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Motoyuki Tanaka, Yoshiharu Horikawa, Junichi Kamizono, Hironori Kakoi, ...
2011 Volume 60 Issue 3 Pages
584-589
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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Treatment for patients with idiopathic osteonecrosis of the femoral head (ION) is decided according to disease type, stage, age, occupation, and background of the original disease. We report four young cases who underwent transtrochanteric anterior rotational osteotomy (ARO) of the femoral head after artificial bone-graft for idiopathic osteonecrosis (ION). Between December 2005 and September 2006, two teenage female patients, one female patient in her 20's, and one male in his 30's with extensive necrosis were studied. All four cases had stage 3, type C necrosis caused by steroid. In the last examination, two patients showed no progress of collapse and one patient showed 5 mm collapse. One patient sustained fracture of the femoral neck seven months after removal of the fixed screw, and underwent total hip arthroplasty (THA) for this.
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Yasunao Miyai, Kazuya Takeuchi, Kazuhiro Sakai
2011 Volume 60 Issue 3 Pages
590-591
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of acetabular fracture. The case was a 28-year-old female admitted into hospital for anorexia. Four days after admission, she complained of stomach pain and was unable to walk. Fifteen days after admission, abdominal X-rays showed acetabular fracture. We performed ORIF two days later. She was suspected with traumatic acetabular fracture associated with osteoporosis. Traumatic acetabular fracture cases are discussed in this report, referring to available literature.
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—A Case Report—
Kiyoshi Sada, Takashi Miyamoto, Tomohiko Asahara, Tatsuya Fukushima, K ...
2011 Volume 60 Issue 3 Pages
592-597
Published: September 25, 2011
Released on J-STAGE: December 09, 2011
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We report a case of Fournier's gangrene with untreated diabetes. A 42-year-old woman with pubic region pain visited our gynecology department. She was given antibiotics but her symptoms did not improve. She was suspected with necrotizing fasciitis and was transferred to the orthopedic department. Her body temperature was 38.8°C and complete blood count showed severe inflammation of WBC16500/μl, CRP26.4 mg/dl. X-rays revealed gas in the left inguinal region and MRI revealed inflammation. With the diagnosed of necrosis fasciitis, emergency debridement was carried out. We debrided all the necrotic tissues under the skin. and after Two days later, we performed a second debridement and started negative pressure wound therapy due to skin loss. Gradually the skin and soft tissue healed with granulation and we closed the wound by skin graft. She had no recurrence of infection. Fournier's gangrene is a fatal disease if diagnosed late. MRI is useful for early diagnosis for revealing infected region. Excellent clinical results were achieved by aggressive debridement and control of diabetes.
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