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Naoyuki Kuga
2012 Volume 61 Issue 1 Pages
1-4
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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The basic principles of minimally invasive plate osteosynthesis (MIPO) using locking compression plates (LCP) are indirect reduction and elastic fixation of the fracture, which are opposite to direct reduction and rigid fixation with conventional compressive plating. A longer implant with few locking screws at the far ends similar to interlocking nailing is preferable for flexible fixation, which contributes to secondary bone healing.
The procedure of indirect reduction for mildly comminuted articular fractures in the distal femur consists of the following steps: percutaneous screw fixation of the articular fragments, anatomical setting of the LCP on the lateral condyle, closed reduction with percutaneous handling of the plate along the femoral shaft, and re-alignment of the bone with a compression reduction screw in the middle of the plate.
Deformed femurs, the shape of which differs extremely from that of the LCP, require reforming the plate for the reconstruction of the anatomical alignment. Bone grafting in massive bone defects is necessary to reduce the risk of nonunion, malunion, and implant failures.
MIPO is more difficult but more effective than intramedullary nailing for osteoporotic, periprosthetic, and comminuted fractures in the distal femur. It is essential for all LCP users to understanding the biomechanics of elastic fixation and be experienced in the indirect reduction technique.
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Koichiro Sakimura, Shinichi Nakahara, Kohei Kawaguchi, Masao Eto
2012 Volume 61 Issue 1 Pages
5-8
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We reviewed the outcome of temporary fixation in high-energy tibia fractures with local soft tissue damage followed by conversion to internal fixation. The fifteen cases consisted of 14 men and one woman, whose mean age was 53.2 years. The region of the 15 fractures were: three proximal tibia, four tibia diaphysis, and seven distal tibia. There were five open fractures and one compartment syndrome.
The average timing of the conversion to internal fixation was 10.2 days from the time of external fixation. Removal of external fixation and definitive fixation was performed in all patients. Implants used for fracture fixation were intramedullary nail for three fractures, and locking plate for thirteen fractures. All patients achieved bone union without wound complications. We conclude that the initial treatment of high-energy tibia fractures with external fixation, followed by planed conversion to internal fixation is a safe and effective option.
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Shinji Yoshino, Yasuomi Kawasoe, Kouji Sameshima, Natsuko Tomimura, Yo ...
2012 Volume 61 Issue 1 Pages
9-12
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We performed radiographic evaluation of total hip arthroplasty (THA) in 39 hips; we examined the complications associated with the procedure and the precautions to be taken while performing THA through a direct anterior approach (DAA). The average patient age was 68.0 years. All patients had coxarthrosis, and the Crowe classification was group I for 27 hips, group II for 10 hips, and group III for 2 hips. The BiCONTACT system was used in all patients. The average duration of operation was 127 minutes, with the average intraoperative bleeding amount being 397 mL and the average postoperative bleeding amount being 829 mL. Complications included transient femoral nerve palsy in 1 patient and femoral perforation in 1 patient; and No patients showed hip dislocation and deep infection. Radiographic evaluation revealed the following findings: average cup abduction angle of 44°, average cup anteversion angle of 22°, and placement rate of 76.9% within Lewinnek safe zone. In 10 hips (25.6%), the femoral stems were inserted in flexed position. DAA is an easy technique for preparation of acetabulum and enables good cup placement. However, the technique for manipulating the femur needs to be mastered. DAA-THA is a useful method if its drawback is sufficiently understood.
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Naoya Kozono, Hiroshi Nomura, Junichi Arima, Soichiro Nakano, Takayuki ...
2012 Volume 61 Issue 1 Pages
13-16
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that is characterized by progressive ossification of the spine associated with morbid bony proliferation in other body parts. Herein, we report a case of surgical treatment by resection of the osteophyte in the hip joint caused by DISH. The patient was a 79-year-old woman, Who had suffered left coxalgia for five years. She had painful hip joint on the left side, particularly in the sitting position. Radiographic examination revealed prominent ossification in the hip joint on the left side. We performed resection of the osteophyte, with which she gained pain relief of the hip joint in the sitting position with full range of motion of the hip. We recommend resection of the osteophyte of DISH in hips as an effective surgical treatment.
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Umito Kuwashima, Yasuharu Nakashima, Takuaki Yamamoto, Taro Mawatari, ...
2012 Volume 61 Issue 1 Pages
17-20
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Pubic/ischial stress fracture is a rare of complication periacetabular osteotomy. The purpose of this study was to analyze the incidence of stress fractures in the pubic/ischial bone after transposition osteotomy of the acetabulum (TOA). We examined 251 hips of 229 patients (male 23 hips, female 206 hips; mean age 42.8 years) with whom it was possible to conduct follow-up observations of one year minimum after TOA. For the fractured group, we diagnosed pubic/ischial fractures was radiograghs and investigated the facter and the onset time of the fracture. The fractured group consisted of nine (3.6%) out of the 251 hips examined, and fractures occurred within 1.6 months after TOA. A statistically significant difference was observed in age (p=0.014), body mass index (p=0.003), and rotation angle of osteotomy (postoperative center-edge (CE) angle subtracted preoperative CE angle) (p=0.0045) according to multivariate studies. Stress fracture was found in cases with large rotation angle, the odds were 1.2 to 1 degree. All cases had bony union by conservative method.
It is essential to be aware of pubic/ischial stress fractures after TOA.
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Yusuke Kubo, Yasuo Noguchi, Shunichi Rikimaru, Shunsuke Hotokezaka, Ta ...
2012 Volume 61 Issue 1 Pages
21-25
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We analyzed the destination at discharge and ambulatory ability at the time of discharge from rehabilitation hospitals of 115 hip fracture patients, who underwent surgical treatment at our hospital, in relation with pre-injury level of activities of daily living (ADL) and dementia, by using feedback data of regional liaison pathway sheets sent from rehabilitation hospitals. Seventy-three percent of the patients who lived at home were discharged back home. Patients who were discharged back to nursing homes had lower ambulatory ability at discharge than those who returned home. An apparent relationship between pre-injury level of ADL and ambulatory ability at discharge was found, and 40% of patient who could walk by themselves before hip fracture regained outdoor ambulatory ability. Patients with dementia showed lower recovery rate of ambulatory ability than those without. We conclude that ambulatory ability at discharge from rehabilitation hospital is influenced by the discharge destination, i.e., own home or nursing home, and that ambulatory ability at the time of discharge is related to the pre-injury level of ambulatory ability and dementia.
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Akira Hashimoto, Itaru Furuichi, Masakazu Murata, Noboru Moriguchi, Ma ...
2012 Volume 61 Issue 1 Pages
26-28
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Generally, the number of proximal femoral fracture increases with aging, and new surgical treatments are hoped for to improve activites of daily living (ADL) and quality of life (QOL) although treatment by surgery is often accompanied by the risk of perioperative period complications. Forty-six hips of 45 patients who underwent surgery for proximal femoral fracture from January 2009 to January 2011 were enrolled in this study. There were six men and 39 women whose mean age was 94 years.
We investigated complications and gait ability, etc. before and after operation, and examined the effectiveness of treatment by surgery. Femoral trochanteric and subtrochanteric fractures were found in 35 hips, neck fracture in 11 hips, and conservative treatment was performed only in two hips. At hospitalization, severe complications were seen in seven patients. Three patients died within ten days after operation, the causes of which were intraoperative massive bleeding, gastrointestinal bleeding, and pneumonia. Other postoperative complications were admitted in 11 patients, chiefly heart failure, pneumonia, and cerebrovascular disease. Nineteen out of 37 patients who were able to walk before femoral fracture could walk again after operation.
Treatment by surgery is preferred to QOL under strict perioperative management for early ambulation, although it has a high risk of complications. For this reason, adequate informed consent is required.
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Shigeru Mochida, Shinji Tanishima, Satoru Fukata, Hiroyuki Ishii, Yasu ...
2012 Volume 61 Issue 1 Pages
29-31
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Femoral neck stress fracture is rare. We report a case of femoral neck stress fracture in an adult female. A 47-year-old female who works as a caregiver causelessly felt a sudden onset of pain in her left hip joint. She gradually could not walk, so she visited another hospital. Radiographs showed no abnormal findings. Due to continuous hip pain, she visited our hospital after a month. She had pain on motion and tenderness in her hip joint. Radiographs on her left hip joint showed wide spacing, but magnetic resonance(MR) images showed low signal intensity lesion in T1-weighted and high signal intensity lesion in T2-weighted images on the femoral neck. She was diagnosed with stress fracture of the left femoral neck and hospitalized. We performed osteosynthesis under general anesthesia. She was permitted partial weight-bearing after six weeks and full weight-bearing after eight weeks. Six months later, she was able to return to normal life. Femoral neck stress fracture can develop from muscles fatigue around the hip joint. In this case, squatting at work caused the femoral neck stress fracture.
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Ryutaro Shimada, Masahiro Nakamura, Hideki Kawamura, Ryoki Nojiri, Mas ...
2012 Volume 61 Issue 1 Pages
32-35
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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To reduce workload related to providing guidance to patients in preventing dislocations at our hospital, we are actively carrying out prosthetic replacement of the femoral head by the direct anterior approach (DAA) for femoral neck fractures to achieve early postoperative walking ability. To investigate the effectiveness of this method, we studied29cases (5males, 24females) who had undergone this surgery in the one year from October2009. Age at surgery was77.9±8.4years (range59to92). According to Garden's classification of fracture type, there were nine cases of stage3, 19cases of stage4, and one unknown. Compared to total hip arthroplasty (THA) for osteoarthritis of the hip, this method is slightly difficult to carry out and is accompanied by more intraoperative complications. So though it is an excellent expansion method with little invasion, it should be performed after having carefully considered preoperative activities of daily living (ADL) and previous diseases.
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Naotoshi Ninomiya, Koshi Furusho, Koichi Hara
2012 Volume 61 Issue 1 Pages
36-40
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report eight cases of femoral subtrochanteric fractures which we experienced. Case 1 was a 20-year-old male carpenter with right femoral subtrochanteric fracture. Osteosynthesis with nailing system was performed with good reduction. Twenty-nine weeks after the operation, bone union was achieved. Case 2 was a 53-year-old male with right femoral subtrochanteric fracture. Osteosynthesis with nailing system was performed with poor reduction. Two years and three months after the operation, bone union was achieved. Case 3 was a 60-year-old female with left femoral subtrochanteric fracture. Osteosynthesis with locking plate system was performed with good reduction. Twenty-seven weeks after the operation, bone union was achieved. Femoral trochanteric fracture increases biodynamic stress, and nonunion results from poor reduction. We found that treatment of subtrochanteric fracture is harder than that of trochanteric fracture.
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Tomohiro Isa, Hideki Asato, Mika Takaesu, Tomoyuki Ohshiro, Hisashi Se ...
2012 Volume 61 Issue 1 Pages
41-44
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of delayed union of the scaphoid succesfully treated with low-intensity pulsed ultrasound (LIPUS). A 16-year-old girl who played volleyball sprained her wrist while playing. She was diagnosed with wrist sprain and was treated with a cast for one week three months ago. She continued playing volleyball, but she visited us because of pain starting two weeks ago. In spite of normal plain radiographs, an occult scaphoid fracture was revealed on magnetic resonance imaging (MRI). Conservative therapy (cast and splint) for eight weeks could not decrease her wrist pain. But further conservative therapy (thumb spica splint) with LIPUS for eight more weeks did improved the signal intensity on MRI, and enabled her to resume playing volleyball. One year and eleven months after the injury, MRI showed almost normal signal intensity and she has had no pain playing volleyball with normal wrist motion.
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Hirotaka Okubo, Chojo Futenma, Hirota Kohama, Kenji Horikiri, Masaki K ...
2012 Volume 61 Issue 1 Pages
45-49
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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The congruity of the distal radioulnar joint (DRUJ) could change after radial osteotomy for Kienböck's disease, because the osteotomy is performed proximal to the DRUJ. We report two cases of Kienböck's disease with ulna zero variance, treated by a devised radial osteotomy. The osteotomy (very distal radial wedge oseotomy) was a 15° lateral closing wedge. The vertex of the wedge was located at the intersection 2 mm radial to the sigmoid notch and 2 mm proximal to the radiolunate joint.
The patients were a 68-year-old and 27-year-old male. Both suffered from stage III-B Kienböck disease by Lichtman classification. At the final follow-up (29 and 18 months postoperatively), their grip strength was 34 and 36.5 kg (4 and 26.5 kg preoperatively) and wrist range of motion was 130° and 110° (95° and 90° preoperatively), respectively. The clinical results were good by Nakamura's scoring system. No evidence of osteoarthritis of DRUJ was observed in postoperative radiographs.
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Shiro Yoshida, Kenji Yoshida, Kensuke Sakai, Michihiro Katouda, Kenji ...
2012 Volume 61 Issue 1 Pages
50-54
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Diagnosis of predynamic scapholunate instablility is difficult even when dynamic X-ray and MRI are used. We report here the use of arthroscopy for detection of a complete tear of the scapholunate ligament in the patient who was a 44 years old male after forced dorsiflexion in his left wrist. The clinical presentation was severe dorsal pain of the wrist, limited wrist motion and diminished grip strength. Debridement and insertion of percutaneous interosseous Kirschner wires into the scapholunate and lunotriquetral joints were performed under wrist arthroscopy. The patient's wrist was kept in a cast for 4 weeks and the interosseous Kirschner wires were removed after eight weeks. After 5 months, the patient had returned to his previous level of activity with normal wrist motion and full strength. The clinical presentation, diagnosis and pathological results of this case are discussed.
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Kiyoshi Sada, Keizo Furukawa, Shiro Kajiyama, Toshiyuki Sakimura, Hiro ...
2012 Volume 61 Issue 1 Pages
55-58
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of subcutaneous distal biceps tendon rupture. We operated this case at the subacute stage but gained excellent clinical results. A 42-year-old man caught his son who was stumbling on the stairs with his right arm. He had pain in his right elbow and visited an orthopaedics. Magnetic resonance imaging (MRI) revealed distal biceps tendon rupture so he was introduced to our hospital. He hesitated about operation but decided to undergo surgical treatment after 30 days. We approached the antecubital fossa and found the edge of the biceps tendon adhering to the soft tissue. The tendon had shortened with degeneration so we performed tendon lengthening by milking the tendon and cutting one part tendon. We then performed double-incision and sewed the tendon at radial tuberosity with flexion 90 degrees of the elbow. After operation, we instructed him to keep his elbow fixed by cast and to undergo rehabilitation. After one year, he got full range of motion at his right elbow and was able to work at his rice shop without restriction. Though he suffered shortening of the tendon in subacute operation, excellent results were obtained by tendon lengthening and double-incision.
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Shintaro Hara, Junji Ide, Hiroshi Mizuta
2012 Volume 61 Issue 1 Pages
59-62
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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A 56-year-old right-handed male farmer experienced right shoulder pain after heavy labor including digging bamboo shoots for two months. He sustained right shoulder pain for four months. Physical examination revealed limitation of flexion on the right shoulder at 110 degrees with pain. He showed positive impingement signs and belly press tests. There was no abnormality in plain radiographs, but detachment of the subscapularis tendon was suspected on magnetic resonance imaging system (MRI), and confirmed in arthroscopic examination. In addition, complex bucket-handle tear and detachment of the superior labrum were found. Partial thickness tear of the long head of the biceps tendon at the bicipital groove was also confirmed. Tenodesis of the long head of the biceps tendon to rotator interval was performed. Detachment of the subscapularis tendon was repaired using a suture anchor. Six months after surgery, he had no pain and limitation of range of motion on the right shoulder.
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Yasuhiro Mizuki, Mikihito Tamai, Yoshiteru Shida, Masuo Hanada, Naoyuk ...
2012 Volume 61 Issue 1 Pages
63-66
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Some patients with calcifying tendinitis of the shoulder are found with inferior subluxation. We report a case treated for calcifying tendinitis with progressing inferior subluxation regardless of conservative treatment. The patient was a 58-year-old female working as a hair dresser. She had right shoulder pain since September 2009, and was diagnosed with calcifying tendinitis. Regardless of conservative treatments, calcification grew and she subluxated her shoulder inferiorly. So she visited our hospital in April 2010. We found a marked decrease in range of motion (particularly elevation and rotation) and huge calcification with inferior subluxation on X-ray. We treated her conservatively and her symptoms improved. But calcification continued to grow and inferior subluxation progressed. We removed calcification arthroscopically in May 2010. Her subluxation improved after surgery and she returned to her previous job two months later. Inferior subluxation progressing though conservative treatments provided pain relief in this case. Huge calcification of the shoulder may possibly cause large inferior subluxation.
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Katsuhiko Murakami, Katsutoshi Sunami
2012 Volume 61 Issue 1 Pages
67-70
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Clavicle fracture is a common injury in all age groups. Injuries can be classified into groups. Three different areas of fracture were identified: the diaphysis and the medial and lateral ends. Type 1 was the fifth of the bone lying medial to a vertical line drawn upwards from the centre of the first rib. Fractures were also divided into subgroupa A and B depending on displacement of the major fragments. Type-1A and type-1B fractures were further subdivided into extra- or intra-articular. These fracrures are uncommon and involve the medial end of the clavicle and are rarely caused by direct violence. If the costo-clavicular ligament remains intact, there is little or no displacement of the fractured bone. A 74-year-old woman fell down, who was diagnosed fracture of the medial end of the clavicle. Operative treatment was done using the locking plate. Clinical outcome was good. The locking plate is considered an effective materials for clavicular fractures.
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Kunihide Muraoka, Hidetoshi Onoue, Kazuo Kimura, Ryota Iwamoto, Yoshih ...
2012 Volume 61 Issue 1 Pages
71-75
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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From January 2009 to June 2010, we have performed plate fixation in five children (four boys and one girl) for fractures in the distal third of the forearm, and obtained good results. The mean age at operation was 11 years, ranging nine to 14 years and the mean follow-up period was nine months, ranging two to 21. Volar approach and AO small or mini DCP was used for the operation. After operation short arm cast or splint immobilization was applied for two to five weeks. All cases achieved radiographic union and there were no complications and clinical symptoms. In conclusion, we recommend plate fixation for fractures in the distal third of the forearm in children above ten years old with complete fractures or green stick fractures which re-dislocate in spite of conservative treatment.
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Toru Asakura, Naohito Oshima, Kunichika Shin, Kenjiro Ooe, Koumei Mats ...
2012 Volume 61 Issue 1 Pages
76-80
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report the clinical results of treatment for distal radius fractures using a VariAx locking plate system. All 28 cases were women and their mean age at the time of surgery was 72.1 years. According to the AO classification, seven fractures were A2, 17 were A3, three were C1, and one was C2. The mean follow-up period was 6.7 months. Radiographic fracture parameters were measured three times in preoperative X-rays, postoperative ones, and final ones. Volar tilt (VT) changed −11.0 degrees, 9.0 degrees, 7.1 degrees. Radial inclination (RI) changed 17.8 degrees, 24.4 degrees, 23.5 degrees. Ulnar variance (UV) changed 2.28mm, 0.41mm, 1.31mm. Correctional loss were 1.9 degrees (VT), 0.9 degrees (RI), 0.9mm (UV). The average final volar flexion was 56.4 degrees, dorsiflexion 72.8 degrees, pronation 87.5 degrees, and supination 86.7 degrees.
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Yohei Takahashi, Shinjiro Moriwaki, Yasuhiro Ochi, Yoshihiko Kunishi, ...
2012 Volume 61 Issue 1 Pages
81-85
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We applied F-wave to evaluate the presence of neuropathy at the proximal segment of nerves. Here we report the relativity of the injury of the cervical spinal cord or nerves and F-wave of upper extremity. We studied 10 persons with no symptoms and 26 patients with cervical radiculopathy or myelopathy who were diagnosed at our hospital from 2009 to 2011. We derived F-wave from median nerve and ulnar nerve, and counted the number of negative peaks, measured and calculated the density. Compared with these parameters of the control group, abnormal results were seen in the F-wave derived from the median nerve of 10 patients whose culprit lesions were C5/6 level. Moreover, this suggested that the number of anterior horn cells influences the number of F-wave negative peaks, and that conduction disturbance affects the duration of F-waves.
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Ko Sugata, Hiroshi Kuroki, Hideaki Hamanaka, Naoki Inomata, Hiroshi Ma ...
2012 Volume 61 Issue 1 Pages
86-88
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Cervical angina is defined as anterior chest pain that resembles true cardiac angina but originates from cervical spondylosis first reported by Phillips, et al. in 1927. This chest pain is similar to that of ischemic cardiac disease, therefore differential diagnosis is important. Various mechanisms suggest that the pain is caused by some stimuli to the anterior or posterior spinal nerve root, arthralgia of intervertebral disk or facet facet joint, and the involvement of the sympathetic nerve, but the obvious cause is unclear. We experienced a 65-year-old male case who had anterior chest pain when he walked. At first we suspected cardiac angina but it was not detected in echocardiography, cardiac catheterization, and stress myocardial scintigraphy. We found compression of the C7 nerve root in the foramen by computed tomography (CT) myelography and magnetic resonance imaging system (MRI), and C7 celective nerve root block was effective. We diagnosed cervical angina caused by C7 nerve root disorder, and the pain was improved by cervical foraminotomy and laminoplasty.
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Yuya Imamura, Toru Fujimoto, Akira Sei, Takuya Taniwaki, Tatsuya Okada ...
2012 Volume 61 Issue 1 Pages
89-93
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We present a case of spontaneous regression of a herniated cervical disc. A 48-year-old woman visited our hospital because of severe pain in her neck and numbness of both hands without cause. On physical examination, there was no muscles weakness, and deep tendon reflexes were normal. Magnetic resonance (MR) imaging revealed a central extruded disc at the C3-4 level. The patient's pain decreased after three weeks with a soft cervical collar. Follow-up MR imaging revealed partial spontaneous regression after two months, and complete spontaneous regression after seven months of extruded herniation. Spontaneous regression of the herniated lumbar disc had been well established, however; reports of spontaneous regression of the herniated cervical disc is rare in such a huge central herniation. The findings of this case suggest that spontaneous regression of the herniated cervical disc may be obtained in cases showing mild symptoms in a short term.
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—A Case Report—
Naoto Nema, Taketsugu Gaja, Satoshi Kuroshima, Shinji Miyoshi, Ayana Y ...
2012 Volume 61 Issue 1 Pages
94-97
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case who was treated by cervical laminoplasty, thoracic posterior decompression, and fusion with instrumentation. A 67-year-old woman had limped for four years, but she could walk independently. After rear end crash of her car 2 years ago, she could not walk steadily because of spasiticity. She could not go up and down the stairs without using a handrail from four months ago and visited a doctor. Magnetic resonance imaging (MRI) showed compression-like ossification of posterior longitudinal ligament (OPLL) at the cervical and thoracic spine and she was refered to our hospital. At first examination, she complained of numbness of her legs and dullness below her chest. Both her legs were spastic and weak. MRI showed compression of the spinal cord by hypertrophy of the posterior longitudinal ligament from C5 to Th8 and hypertrophy of the yellow ligament at Th4/5, Th5/6. CT showed no apparent ossification of the ligament. We performed laminoplasty from C4 to C7 and posterior decompression and fusion from Th1 to Th8. Two months after operation, she could walk independently. The pathological diagnosis of the yellow ligament was fibrous tissue and partial cartilaginous tissue.
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Atsuko Saruwatari, Kei Yamada, Kimiaki Sato, Mamoru Mitsukawa, Hiroki ...
2012 Volume 61 Issue 1 Pages
98-104
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Brain-evoked muscle-action potential (BrE-MsEP) is generally used for spinal monitoring during surgery. However, the success rate obtaining the Br(E)-MsEP is low, and alarm criteria have yet to been established. It is difficult to obtain Br(E)-MsEP in patients with muscle weakness during spinal surgery. Here we report our findings on the different meanings of wave changes under the same alarm criteria during spinal surgery considering the incidence of neurofunctional deficit. Fifty patients who sustained neurological symptoms due to compressive myelopathy were categorized as Group C and thirty-six patients with scoliosis without neurological symptoms were categorized as Group S. In Group C, the Br(E)-MsEP was recorded in 276 out of 373 muscles, and in Group S Br(E)-MsEP was recorded in 275 out of 278 muscles. In Group C, only nine patients showed more than 50% amplitude decrease, and one had postoperative motor deficit. In Group C, 19 patients showed disappearance in the wave, and four of these sustained motor loss after surgery. In Group S, 17 patients showed more than 50% decrease in amplitude, and none showed any motor deficit after surgery. Moreover no patient in Group S showed wave loss. These results suggested that wave changes such as 50% decrease in Br(E)-MsEP and loss in Br(E)-MsEP have different meanings according to spinal cord pathology. In patients with sustained myelopathy, a more than 50% decrease in amplitude is concluded to be a safe criterion for preventing spinal cord dysfunction.
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Koichiro Toyoda, Eiichi Shiigi, Ryuutaro Kuriyama, Takenori Fujisawa, ...
2012 Volume 61 Issue 1 Pages
105-108
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We studied the usefulness of Walking Impairment Questionnaire (WIQ) for the evaluation of intermittent claudication in lumbar spinal stenosis. The subjects consisted of 18 males and 12 females whose average age was 71. Of the 30 subjects, we operated on 12. WIQ, AWD, RDQ, and JOABPEQ scores improved significantly after treatment. As for the correlation between these scores and evaluative parameters, significant correlation was seen between pain score and VAS numbness of the lower limb only; distance score and JOA, RDQ, JOABPEQ lumbar dysfunction, AWD, PF, RP, RE of SF-36; speed score and AWD, PF, RP, RE of SF-36; and climbing score and PF, RP, GH, SF, RE of SF-36. The WIQ was found to be useful for evaluating intermittent claudication in lumbar spinal stenosis.
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Kimiaki Sato, Kensei Nagata, Mamoru Mitsukawa, Kei Yamada, Takuya Wata ...
2012 Volume 61 Issue 1 Pages
109-111
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Spinal microendoscopic surgery is becoming increasingly popular for treating lumbar disorders. However, there is a steep learning curve for performing this procedure effectively and safely, mainly due to the very limited working space within the tubular retractor. Here we report the clinical outcomes from employing microendoscopic surgery using the 18 mm tubular retractor of the METRx™ microdiscectomy (MD) system. This system offers variable tubular retractor lengths and increased available working space within the tubular retractor. Between December 2003 and March 2011, 101 patients with lumbar disorders were treated using this technique by the same surgeon. These patients included 62 males and 39 females, with a mean age at operation of 39.3 (16-80) years. The lumbar disorder was disc herniation in 88 cases, spinal stenosis in ten, and cystic lesion in the other three. The mid-term results at a mean of 17.7 months after surgery show statistically significant improvement in the visual analog scale (VAS), and in the Roland-Morris Disability Questionnaire (RDQ) score. The METRx™ MD system offered a choice of retractor lengths that could be matched to the patient's characteristics. These results indicate that this technique using the tubular retractor of the MD system is effective for treating lumbar disorders.
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Minoru Kashihara, Takamitsu Tokioka
2012 Volume 61 Issue 1 Pages
112-116
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of lumbar canal stenosis and facet cyst of the lumbar spine after posterolateral lumbar spinal fusion. A 74-year-old woman suffered bilateral lower extremity pain four months after posterolateral fusion with the pedicle screw from L3 to L5. Magnetic resonance imaging (MRI) revealed canal stenosis of L2/3 and intraspinal cyst around the left facet at L2/3. Conservative therapy was not effective and laminectomy of L3 and resection of the cyst was performed. Histologically the cyst was diagnosed as synovial cyst by the synovial lining cells. Facet cyst after lumbar surgery is rare. We believe that excessive stress at L2/3 by pedicle screw fixation from L3 to L5 and injury against the facet joint capsule at L2/3 during the initial surgery produced an accelerated development of cyst formation.
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Shunichi Rikimaru, Yasuo Noguchi
2012 Volume 61 Issue 1 Pages
117-119
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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In surgical treatments for the vertebral fracture of the thoracic or lumbar spine with osteoporosis, there are risks of large invasiveness of the procedure and pullout and/or loosening of pedicle screws after using the rigid system. As a new attempt, we started the combined use of vertebroplasty and stabilization with the semi-rigid system in 2006. Nine patients (eight females and one male) with a mean age of 71.7 years (range 62 to78 years) were chosen. This method was applied to four cases of thoracolumbar and five cases of lumbar spine. Follow-up averaged 18.8 months (range 7 to 44 months). Low back pain and numbness were observed preoperatively in all patients, and seven patients had lower extremity paralysis. Degree of independent living scale of old Japanese with handicap was C2 in two cases, C1 in two, B2 in three, and A1 in two. Complication of depression was seen in six cases, chronic rheumatoid arthritis in two, and diabetes mellitus and kidney dialysis in one each. During postoperative follow-up, loss of correction in all cases of vertebroplasty was observed but there was no pullout and/or loosening of the pedicle screws. All patients had complete pain relief and two more levels of improvement in degree of independent living scale. Seven patients became capable of walking, and all were satisfied with the clinical results after surgery,
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Kazuya Yokota, Shuichi Matsuda, Ken Okazaki, Yasutaka Tashiro, Yukihid ...
2012 Volume 61 Issue 1 Pages
120-123
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Total knee arthroplasty (TKA) provides good stability for a long period, however, there are concerns that deep knee flexion and malalignment of component may influence loosening or the radiolucent line between the component and bone. We analyzed postoperative alignment (hip-knee-ankle angle), body mass index (BMI), and range of motion (ROM) as influencing factors for postoperative radiolucent line or loosening. We reviewed 89 knees (10 men, 79 women) in 69 patients (8 men, 61 women) who received TKA for osteoarthritis. The mean age was 67.2 years old (range 47-84). The mean follow-up period was 6.8 years (range 5.0-10.3). We detected radiolucent line in 12 femoral components (13.5%) and in four tibial components (3.5%), and found that one case had loosened due to deep infection. No significant correlation was seen between the abovementioned clinical factors and radiolucent line.
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Makoto Shiraki, Shuya Ide, Joji Morinaga, Motoki Sonohata, Masaaki Maw ...
2012 Volume 61 Issue 1 Pages
124-127
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We use different guides for determining femoral rotational alignment in total knee arthroplasty (TKA) according to the technique applied. The purpose of this study was to evaluate the accuracy of the external rotation guide. Fifty knees of 25 patients were enrolled. TKA was performed with the measured resection technique for one side and gap control technique for the opposite side. The patients were classified into two groups; measured group and gap group. Condylar twist angle (CTA) was measured before and after TKA in each group. In the measured group, there was more discrepancy between the planned CTA preoperatively and measured CTA postoperatively than those of the gap group. The result demonstrated that the 3 degree external rotation guide has poorer accuracy than the JDK-mini guide.
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Hisato Tanaka, Takaki Kasahara, Nanae Akiyama
2012 Volume 61 Issue 1 Pages
128-133
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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The disadvantages of intramedullary osteosynthesis include implant cut-outs occurring due to failure of telescoping caused by the adherence of bone fragments to the nail. On the other hand, compression hip screw (CHS) fixation is able to join bones directly as there is no interference, enabling good bone union in various types of fractures. In this study, CHS fixation was performed by inserting the lag screw at the position of the surgical incision so that the bone fragment can be guided into the bone marrow. The tip of the nail was positioned within20mm from the tip-apex distance (TAD). Loading was allowed three weeks later. In case l, the femoral neck cortex penetrated into the bone marrow, so the use of the intramedullary nail posed the risk of interference with the bone fragment. For this reason, 145° CHS was used to guide the bone fragment into the bone marrow. As the bone fragment was able to move and compress the bone marrow, this increased bone density, leading to good bone union. Rotation fixation force was also good. Case2was a patient who also suffered greater trochanteric fracture in addition to femoral trochanteric fracture. The bone fragment was guided with an intramedullary nail into the bone marrow with strong bone cortex, so there was no need to use the CHS with collar.
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Hidehiko Matsushita, Noburo Hashimoto, Tetsuya Fukumoto, Satoshi Maeda ...
2012 Volume 61 Issue 1 Pages
134-137
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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In this study, we reserched dislocation type, reduced position, and length of sliding of the short femoral nail and evaluated the relation between reduced position and length of sliding in 81 cases after more than a month since surgery using the short femoral nail was performed from December 2006 to April 2011. We classified the dislocation type in X-rays into nine types according to three types of front images and three types of lateral images. As a result, the greatest length of sliding was found in a case using the extra-medullary type in the lateral image after reduction. The length of sliding was relative to the reduced position in the lateral image and was independent from it in the front image. So we concluded that it is important to obtain the exact reduction position in the lateral image as reported by many authors.
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Seiichiro Shimauchi, Itaru Furuichi, Masakazu Murata, Noboru Moriguchi ...
2012 Volume 61 Issue 1 Pages
138-140
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We usualy operate on the femoral neck fracture at our hospital as soon as possible under anesthetic regardless of whether the patients are taking the anticoagulants and antiplatelet drugs. This time, we examined the feasibility of surgery for femoral neck fracture without stopping these drugs. sixty-seven patients treated with anticoagulants and antiplatelet drugs underwent surgery at our hospital within 48 hour after their visit between May 2007 and March 2011. We investigated the operation time, amount of blood loss, amount of change of Hb value, amount of transfusion, serious complication after operation, and mortality before leaving hospital.
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Yuichiro Sakamoto, Shunji Matsunaga, Yuhei Yahiro, Yoshiharu Horikawa, ...
2012 Volume 61 Issue 1 Pages
141-143
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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The number of hip fracture continues to increase, despite the development of drugs for osteoporosis. We studied the yearly change of hip fractures in oldest-old female patients treated at our hospital with particular reference to bilateral fractures. We reviewed hip fracture in females between 2004 and 2010 by an electronic health record system, focusing on the incidence of bilateral fractures and the relationship between incidence and taking of osteoporosis drug. The ratio of the oldest-old patients with total hip fracture did not change significantly. However, the ratio of bilateral hip fractures in oldest-old females decreased from 17.5% in 2004 to 9.2% in 2010. In this period, the usage rate of bisphosphonate and Selective Estrogen Receptor Modulator (SERM) in oldest-old females was low. Decrease in bilateral hip fractures in oldest-old females may involve factors other than osteoporosis drugs.
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Satoshi Miyake, Hidetoshi Onoue, Kazuo Kimura, Atsuhiko Nakamura, Ryot ...
2012 Volume 61 Issue 1 Pages
144-147
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We performed minimally invasive plate osteosynthesis using a narrow LCP (locking plate) on one case of femoral shaft fracture and one case of tibial shaft fracture. Both were 12-year-old boys. Three months after surgery, we experienced destructive failure of the plate. However excellent bone union was achieved by ischial weight-bearing knee-ankle-foot orthosis and low intensity pulsed ultrasonography.
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—A Case Report—
Kazuhiko Yoshikawa, Hiroo Matsuse, Takashi Inoue, Toyoaki Yamanouchi
2012 Volume 61 Issue 1 Pages
148-152
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of diaphysis fracture of the femur with nail breakage due to a fall, after osteosynthesis using ITST which showed satisfactory progress over a long term. The case was a 80-year-old woman who fell and fractured her left trochanteric femur. We carried out osteosynthesis using ITST, and confirmed synostosis of the bone three months after the operation. About five years later, she fell from a chair and was transported to our hospital by ambulance. We took X-ray and diagnosed left diaphysis fracture of the femur with nail breakage at the lag screw hole part. Until now, we have experienced a few cases of nail breakage at the lag screw hole part due to pseudoarthrosis, but a case of nail breakage after synostosis of the fracture never had been confirmed and satisfactory progress had been seen for a long-term as in this case. Nail breakage at the locking screw hole is very rare taking into consideration reports on nail breakage so far. For this reason we conducted a study on this case.
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Takuya Ikuta, Hiroshi Sakamoto, Kazumitsu Uto
2012 Volume 61 Issue 1 Pages
153-156
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Nine cases with distal tibial fracture were treated surgically using anterior locking plate. They were classified into A2 (1 case), A3 (2 cases), C1 (1 case), C2 (1 case), C3 (4 cases) according to AO classification. Four cases were treated after primary external fixation. All cases except one achieved good bone union. One case needed re-operation because of breakage of the proximal screws.
This method is useful for distal tibial fractures with comminuted anterior wall, and after temporally external fixation.
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Ryota Iwamoto, Hidetoshi Onoue, Kazuo Kimura, Kunihide Muraoka, Yoshih ...
2012 Volume 61 Issue 1 Pages
157-160
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We often experience difficulty in the treatment of bone defects and nonunion occurring after trauma. This time, we report two cases treated with external fixator and free vascularized bone graft. Case 1 was a 51-year-old man who was injured when he fell down the stairs. Open fracture of the left tibia was diagnosed and bone loss of two-thirds of the entire circumference of the tibia was found. Case 2 was a 32-year-old man who was hit by an iron bar dropping onto his left lower leg. Open left proximal diaphyseal tibial fracture was found. We treated the two fractures using Ilizarov external fixation and free bone graft but bone union was not obtained. However, bone union was achieved with vascularized iliac bone graft.
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Yujiro Oyama, Yasunari Oniki, Eiichi Nakamura, Hiroaki Nishioka, Nobuk ...
2012 Volume 61 Issue 1 Pages
161-165
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of complete discoid medial menisci in the bilateral knees. A 13-year-old boy complained of pain in his right knee without any history of injury for a year. Physical examination revealed medial joint-line tenderness and click of the McMurray maneuver. Radiograph views showed no specific abnormalities. T2-weighted magnetic resonance imaging (MRI) of both knees revealed bilateral medial discoid menisci with high intensity area in the form of horizontal tears. Arthroscopic surgery was performed in his right knee and the same tears as MRI were seen. He achieved complete recovery after three months and returned to previous sports activity after seven months.
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