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Katsunori Yazawa, Eiichi Nakamura, Yasunari Oniki, Hiroaki Nishioka, N ...
2012 Volume 61 Issue 2 Pages
167-172
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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A 48-year-old woman complained of lateral knee pain for five years. Conservative cure was not effective. Physical examination revealed genu valgum and tenderness of the lateral joint space of both knees. In plain radiographs, right femorotibial angle (FTA) was 156 degrees, and intra-joint space was lost in standing AP projection. After supracondylar femoral varus osteotomy was performed on the right knee, hemocallotasis was started at 1 mm/day. Four month after surgery, pain disappeared and there was no limitation in range of motion (ROM). Radiographs showed FTA as 180 degrees, and good ossification where we performed osteotomy. Nonunion or delayed union is reported in 10 to 20% of supracondylar femoral varus osteotomies performed using plate fixation for genu valgum. This procedure is effective for femur union, initiation of loading, and conservation of ROM.
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Masato Tomita, Noriaki Miyata, Yoshihiro Nozaki, Kenji Kumagai, Tomayo ...
2012 Volume 61 Issue 2 Pages
173-175
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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In the diagnosis of musculoskeletal tumors, we perform cytological examination with histopathological diagnosis, because cytological diagnosis provides results sooner than histopathological diagnosis after biopsy and surgery. In this study, we examined the accuracy of cytological diagnosis for musculoskeletal tumors.
We studied 199 surgical musculoskeletal tumor specimens (January 2009-December 2010) diagnosed both histopathologically, and the accuracy of cytological diagnosis for musculoskeletal tumors. In 160 cases, the results of cytological diagnosis agreed with those of histopathologcal diagnoses (accuracy: 80.4%). In 39 cases, cytological diagnoses did not. Of these cases, 24 were liposarcoma.
The accuracy of cytological diagnosis of musculoskeletal tumors was found to be acceptable (80.4%). In the case of liposarcoma, the accuracy of cytological diagnosis is very low (22.6%). These findings suggest that it was difficult to diagnose liposarcoma with just cytology.
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Kohei Kamito, Masato Tomita, Yoshihiro Nozaki, Noriaki Miyata, Tomayos ...
2012 Volume 61 Issue 2 Pages
176-178
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We experienced a case of sacral osteosarcoma, who was relieved from severe pain by irradiation, and improved her Activities of Daily Living (ADL) considerably. The patient was a 85-year-old woman who experieuced pain in the sacral area in July X. Because the pain increased gradually, she visited a nearby hospital. She was suspected of sacral bone tumor on X-ray, and was referred to our outpatient clinic in October X. She was diagnosed with osteosarcoma with open biopsy. Because she and her family did not want aggressive treatment, palliative radiotherapy for the pain (50 Gy) and opioid treatment were started. Pain gradually improved after the start of radiotherapy, and improved ADL, and she was able to walk by herself again. After radiotherapy, she was transferred to a hospice and ADL has not decreased. Primary sacral bone sarcoma is very rare and its prognosis is very poor. Chemotherapy, heavy ion radiotherapy, surgery, and radiation are choices of treatment for osteosarcoma of the sacrum. In case radical radiotherapy is difficult, palliative radiation treatment is useful and effective.
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Hiroo Yasuda, Koichiro Yokoyama, Atsushi Shimizu, Tatsuya Mori
2012 Volume 61 Issue 2 Pages
179-185
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case in which the reconstruction material used for metastatic femoral shaft tumor broke. The case was a 52-year-old man with renal metastasis to the diaphysis of the right femur. The first bone tumor resection and reconstruction of the diaphysis was performed using the Huckstep intramedullary nail. Approximately five months after the surgery, he experienced right thigh pain during walking, and breakage of the nail was confirmed in the proximal part of the bone cement filling. Hence, construction was performed again using artificial diaphysis (JMM, K-MAX). He was able to walk soon after surgery and was discharged two weeks postoperatively.
The Huckstep intramedullary nail is useful for reconstruction after resection of malignant tumors of long bones, but breakage may have occurred in the present patient possibly due to excessive weight-bearing.
The patient is young but works in construction which involves heavy work, and the breakage may have originated in the screw hole. There are some concerns regarding the use of artificial diaphysis for rapidly growing tumors, as it takes approximately three weeks to make one according to the individual specifications of the patient.The artificial diaphysis is however considered to be effective because it is rigid and can be easily used.
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Ryuta Iwanaga, Keiichi Muramatsu, Toshihiko Taguchi, Koichiro Ihara
2012 Volume 61 Issue 2 Pages
186-191
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Reconstruction of massive bone defect after resection of malignant tumor by irradiated bone graft is reported. But because irradiated bone graft is dead-bone, it poses are many problems such as fracture, infection, and non-union. To resolve these problems, we combined use of the free vascularized bone graft (VBG) and irradiated bone graft (IRBG). We reviewed 10 patients with a, mean age of 28 years old. The locations were one proximal humerus, one shaft of ulna, two acetabular, one distal femur, and five shaft of tibia. One case developed necrosis by venous thrombus, but the other nine cases survived. Two cases developed nonunion, but the other eight cases achieved union. Oncological outcome was nine none eridence of disease (NED) and one dead of disease (DOD). Muskloskeltal tumor society (MTS) score was 84.5% on average (67-100). Three patients with weight-bearing joint reconstruction using IRBG showed osteoarthritic change in the long-term. Combined use of VBG and IRBG provides good functional assessment by compensating each other. If irradiated osteochondral grafts are used for weight-bearing joints, osteoarthritic changes cannot be avoided but clinical outcome is excellent.
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Yoshihiro Nozaki, Masato Tomita, Noriaki Miyata, Kenji Kumagai, Kohei ...
2012 Volume 61 Issue 2 Pages
192-196
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Glomus tumor is usually benign, but some rare cases show malignant features such as relapse and metastasis. We experienced one case with repeated relapse and metastasis for about 25 years.
The subject was a 64-year-old male whose left kidney lesion was assumed to start at age 38. Metastatic lesions of the left buttock and in both lungs were found simultaneously at 53 and treated surgically. At 64, the tumor on his left buttock recurred. Embolization was performed on feeding vessels before surgery, and radiation therapy (50 Gy/25 fr) of the residual tumor after surgery. It is uncertain if the lesion occurring at 38 was malignant, but the present recurring lesion was malignant according to Folpe's criteria.
Malignant glomus tumor is very rare, and standard diagnosis and treatment have yet to be established. Pathological findings, location, and size are thus important for deciding appropriate therapy. The tumor in this case is assumed to have gradually become malignant, and requires continuous careful observation over a long time.
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Kenzo Hashimoto, Kiyoshi Oka, Toshitake Yakushiji, Hiro Sato, Hiroshi ...
2012 Volume 61 Issue 2 Pages
197-200
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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This report describes differrented magnetic resonance imaging (MRI) findings of two cases of desmoplastic fibroblastoma. Case 1 was a 25-year-old male referred to our clinic for a mass on his right arm. The mass was iso-intensity on T1-weighted images and mixed low and high intensity on T2-weighted images. T1-weighted images after Gd showed inhomogeneous enhancement. Case 2 was a 34-year-old man with a mass in the deltoid muscle. The mass was iso-and low-intensity on T1-weighted images, and low intensity on T2-weighted images. T1-weighted images after Gd showed inhomogeneous enhancement and the rim area was more enhanced. Previous reports indicate that on MR imaging, low density areas represent areas of low cellularity with abundant collagen content, and high density areas represent areas of high cellulality. Our findings suggest that desmoplastic fibroblastoma shows various patterns of cellularity and myxoid matrix on T2-weighted images.
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Chieko Noguchi, Akihiko Yonekura, Chikara Miyamoto, Kenichi Kidera, Ko ...
2012 Volume 61 Issue 2 Pages
201-203
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We compared the clinical results of using biological and non-biological agents in treatments for patients with rheumatoid arthritis after total knee arthroplasty (TKA). The study followed 50 knees in 39 patients who underwent TKA from January 2007 to December 2010. The Patients were divided into two groups according to the baseline use of the biological agents. The biological agent group (bio group) consisted of 13 knees in 10 patients, and the non-biological group (control group) consisted of 37 knees in 28 patients. There were no significant differences in the patient background except for the period of observation. The period of use of biological agents before surgery ranged from one to three years.
No significant differences in postoperative bleeding, inflammation, infection, and complications were seen, nor in the range of motion. The improvement in the Japanese Orthopaedics Association (JOA) knee functional score postoperatively was better in the bio group than the control group.
Our findings suggest that the use of biological agents may affect clinical results after TKA in rheumatoid arthritis patients.
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Takashi Imagama, Hiroshi Tanaka, Atsunori Tokushige, Ryo Date, Toshihi ...
2012 Volume 61 Issue 2 Pages
204-207
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Patients who discontinued infliximab (IFX) for rheumatoid arthritis after achieving clinical remission were assessed for clinical progress and features. Of 93 patients treated with IFX, six patients with informed consent were enrolled as the subjects of the present study, in whom remission had been maintained for over at least six months according to the DAS28 criteria and who had discontinued IFX therapy and been followed up for more than one year Three patients had biologic-free remission maintained for move than one year of whom two patients had long-term remission for more than three years. Both had Steinbrocker stage II and their duration of illness was relatively short. Both patients attained remission after the first dose of IFX onwards. It was only in these two patients that Boolean remission criteria were fulfilled for more than six months prior to the discontinuation of IFX. These results suggested that factors coutributing to long-term maintenance of biologics-free remission include excellent responders to IFX who are in the early stage of disease without advanced bone destruction and who fulfill the Boolean criteria for remission, which tends to be more stricter than the DAS criteria.
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Noboru Moriguchi, Itaru Furuichi, Masakazu Murata, Tomonori Taura, Mas ...
2012 Volume 61 Issue 2 Pages
208-212
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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The aim of this study was to review the results of total knee arthroplasty (TKA) for rheumatoid arthritis using GENESIS II manufactured by Smith & Nephew. The subjects were 73 patients and 61 joints who underwent TKA at our hospital between June 2006 and December 2010. They consisted of eight males and 53 females, 31 right joints, and 42 left joints. The mean age at surgery was 68.7 and mean observation period was 16.5 months after surgery. The breakdown of artificial joint types used were; 69 PS type, four CR type, 19 PS cement type, 41 PS cementless type, nine PS hybrid type, and four CR cement type. As a result of using GENESIS II, the mean JOA score was 85.8 points postoperatively versus 42.8 points preoperatively, Barthel Index was 88 points at discharge versus 68.2 points preoperatively. The mean angle of the implant was 97.3 degrees for angle α, 88.2 degrees for angle β, 4.7 degrees for angle γ, and 85.2 degrees for angle δ. The mean femorotibial angle (FTA) was 175.9 degrees preoperatively and 174 degrees postoperatively. Postoperative complications delayed wound healing in three joints, two joints developed peroneal nerve palsy, and one joint was infected. Although short-term results were good, long-term postoperative follow-up is required.
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Hirofumi Bekki, Osamu Kawano, Keiichiro Shiba, Nokitaka Setsu, Yoshina ...
2012 Volume 61 Issue 2 Pages
213-217
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a rare case where the fractured vertebral body disappeared and severe kyphosis developed due to bone absorption, without basic diseases such as inflammatory or malignancy.
A 72-year-old male complained of low back pain with slight trigger, who was diagnosed with L2 vertebral compression fracture. The cause was unclear despite detailed examinations. The patient was treated by posterior spine fusion due to developing kyphosis, followed by anteroposterior procedures after one year because stabilization of the spine failed first.
The fractured vertebral body disappeared with impaired bone healing due to repeated external force to it.
It seems that anterior spine fusion is essential to restore sagittal alignment in patients with bone resorption and severe kyphosis.
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Kazumasa Maeda, Hiroaki Konishi, Tsuyoshi Okudaira, Shoichi Kuba, Hiro ...
2012 Volume 61 Issue 2 Pages
218-222
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report two cases of pyogenic spondylitis in the young. Case 1 was a 16-year-old man who He felt back pain and developed fever about two weeks ago. After consulting the department of internal medicine in our hospital, he was introduced to our department. We diagnosed pyogenic spondylitis, and administered meropenem (MEPM) intravenously. He improved and was discharged in about two weeks. Changes appeared to progress on follow-up magnetic resonance imaging (MRI) a month later, so biopsy was performed because of definitive diagnosis. Cultures were negative, and the abscess had disappeared. Case 2 was a 15-year-old man who felt low back pain, nausea, and developed fever. He visited a nearby hospital, and was diagnosed with pyogenic spondylitis. Cefazolin (CEZ) was started but was ineffective. Symptoms however alleviated with amikacin (AMK). Both cases had cousulted physicians first. Rest and antibiotics provided improvement.
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Takuro Yara, Tetsuro Nakamura, Kenichi Kawaguchi, Kuniyoshi Tsuchiya
2012 Volume 61 Issue 2 Pages
223-224
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Sixty-four patients (31 males and 33 females, average 68.4 years) who had undergone posterior lumbar spinal fusion between April 2009 and December 2010 were screened for deep venous thrombosis (DVT) in the lower extremities with ultrasonography. Prevalence after lumbar spinal fusion was retrospectively reviewed. Prevention of DVT was performed according to the guidelines of our hospital and the rate of DVT occurrence, site, and type were obtained. Body mass index (BMI), operation time, blood loss at surgery, and presence of paralysis were evaluated. Three patients (4.7%) had DVT. One patient had mixed-type DVT (proximal side was old), and two patients had distal-type DVT. There was no symptomatic pulmonary embolism. BMI was 19.3 kg/m
2 in the DVT positive group and 23.3 kg/m
2) in the DVT negative group. Operation time was 256 min and 245 min, blood loss was 306 ml and 331 ml respectively. One patient in the DVT(+) group had slight weakness of the lower extremities before surgery. The rate of DVT occurrence in our series was not substantially different from other reports.
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Toshiyuki Dokai, Toru Okano, Haruhisa Kanaya, Makoto Enokida, Ryota Te ...
2012 Volume 61 Issue 2 Pages
225-228
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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A 10-year-old girl was referred to our hospital with high fever and pain in the left hip. Staphylococcus aureus was detected from joint fluid. On the first day, we performed operation under arthroscopy. Irrigation and drainage followed by intravenous antibiotics reduced her symptoms. However, on the 21st day after surgery, she complained of pain in the left hip again and had tenderness of the pubis. T2-weighted magnetic resonance imaging (MRI) showed high intensity changes at the pubis and ilium. Her symptoms diminished after reoperation. In cases with intensity changes at the pelvic bone on MRI, septic arthritis of the hip might be caused by osteomyelitis of the pelvic bone.
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Ken Miyaoka, Yasuharu Nakashima, Takayuki Hoshina, Shuichi Matsuda, Hi ...
2012 Volume 61 Issue 2 Pages
229-233
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report three cases of osteomyelitis and arthritis as a complication of bacille Calmette-Guerin (BCG) vaccination. Case 1 was a 1-year 7-month-old baby girl who experienced right knee swelling and pain 13 months after BCG vaccination at four months. As there was a radiolucent area between the epiphysial line of the distal femur on X-ray, we performed biopsy this point. Tokyo strain of BCG was identified by culture of acid-fast bacillus and multiplex polymerase chain reaction (PCR). As this case had resistance against chemotherapy, we performed curettage. Case 2 was a 10-month-old baby boy who developed right knee arthritis six months after BCG vaccination. BCG was identified by PCR after two curettages, and he has been healing gradually. Case 3 was a 1-year 6-month-old baby boy who experienced right ankle swelling and pain 13 months after BCG vaccination. As right talus osteomyelitis was suspected, we performed curettage. BCG osteomyelitis was diagnosed by culture of acid-fast bacillus and PCR, which healed by postoperative surgery. BCG osteomyelitis and arthritis are rare clinical states occurring after BCG vaccination, and we should be given differential diagnosis. Culture of acid-fast bacillus and PCR proved decisive in diagnosis.
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Hironori Tanoue, Hiro Sato, Toshitake Yakushiji, Kiyoshi Oka, Yuya Ima ...
2012 Volume 61 Issue 2 Pages
234-238
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of osteomyelitis of the clavicle following radiation therapy for postoperative breast cancer. A 72-year-old woman had undergone right radical mastectomy followed by radiation therapy for breast cancer about 28 years ago. The radiographs of her right clavicle showed osteonecrosis and pseudoarthrosis. From around June 2010, she initially noticed a skin ulcer which eventually developed into osteomyelitis of the right clavicle. Then intermittent bleeding from the wound led to emergency hospital admission. After emergency surgical hemostasis and debridement under general anesthesia, wound treatment was continued for two months. Since the wound was edematous, there was necrotic tissue at the base, has poor granulation tissue, so V.A.C.® (vacuum assisted closure) therapy system (KCI Co.) was applied. VAC therapy promoted the formation of healthy granulation tissue. Finally, the soft tissue defect was reconstructed with pedicled omental flap and meshed skin graft. VAC therapy is useful in the treatment of osteomyelitis with skin defect following radiation therapy for postoperative breast cancer.
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Satoshi Kido, Shinji Fukuoka, Kiyoyuki Torigoe
2012 Volume 61 Issue 2 Pages
239-244
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of congenital clubfoot associated with calcaneonavicular coalition.
The patient was a 5-year-old boy. Diagnosis of the right congenital clubfoot was made at birth and treated by cast correction for three months from the fifth day after his birth. He was able to get up at two years and one month, stand up at two years and five months, and walk at three years and six months. We operated on his right foot at five years. Despite calcaneocuboid fusion, we found cartilaginous coalition in the region between the anterial process of the calcaneus and navicular, and we excised the coalition. One year after operation, he was able to go up the stairs and on slopes. Preoperative magnetic resonance image (MRI) scan and ultrasonography showed the coalition.
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Ayako Kurogi, Masao Noguchi, Seiji Tsuji, Hirofumi Dokawa, Kazuhisa Ku ...
2012 Volume 61 Issue 2 Pages
245-248
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Pediatric forearm fractures are usually treated conservatively. However, there is a high incidence of redisplacement and residual angulation of both-bone diaphyseal forearm fractures. We reviewed the clinical results of 19 patients with both-bone diaphyseal forearm fractures treated under general anesthesia from 2000 to 2010. They consistad of 14 male and five female patients with a mean age of 8.6 years (range; 2 to 14 years). The right forearm was injured in 10 children and the left forearm in nine. The average follow-up period was 6.5 months (range; 3 to 16 months). Sixteen patients were treated by percutaneous pin fixation, one by plate fixation, and two by only manual reduction. The average period until bone union was 10.3 weeks (range; 3 to 26 weeks). There were no cases with arm length discrepancies or deformities due to peuetration through the physis. Although clinical results by the Grace & Eversmann's rating system were excellent in all cases, a 14-year-old boy treated with intramedurally fixation had delayed bone union and two cases suffered refracture.
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Michihiro Katouda, Kensuke Sakai, Kenji Yoshida, Shiro Yoshida, Kenji ...
2012 Volume 61 Issue 2 Pages
249-254
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Pediatric femoral neck fracture is a relatively rare type of fracture. Herein we report our experience with 10 cases of pediatric femoral neck fracture over the past 10 years with respect to treatment method and clinical evaluations, along with a review of literature. Delbet-Colonna classification was type II (n=2), III (n=5), or IV (n=3). In three patients, healing was achieved with conservative therapy. Among the seven patients who underwent open reduction, coxa vara was observed in two patients and femoral head necrosis in three patients. Outcomes were assessed using Ratliff's criteria as good (n=7) or fair (n=3), with none assessed as poor. Although various studies have been conducted on the prevention of the complications of the pediatric femoral neck fracture, specifically femoral head necrosis, pseudarthrosis and early closure of the epiphyseal lines, but consensus has not been reached. Considering the anatomical characteristics of the femoral neck in children and the causes of pediatric femoral neck fracture, the occurrence of femoral head necrosis following this type of fracture is considered inevitable to some extent, and prevention of coxa vara and early closure of the epiphyseal lines using accurate reduction and internal fixation are important.
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Ryodai Kawabata, Naoya Kawabata, Hironori Kakoi, Kosei Ijiri, Setsuro ...
2012 Volume 61 Issue 2 Pages
255-260
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We recently encountered a 16-year-old male patient with osteochondral lesion of the left talus. He suffered from ankle pain when he plays soccer since sprainig it before. Consevative therapy was provided but in vain. So we performed fixation of the osteochondral lesion using cortical bone peg. Six months after operation, he resumed soccer. But two months later, multiple bone bruise occurred in his left foot and training had to be restricted. We recommeded cuanging his kicking foot. After several months, fatigue fracture of the right tibia and bone bruise of the left calcaneus appeared. This case shows that rehabilitation must be reconsideved for advance athletes.
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Sanshiro Inoue, Kosei Miyazaki, Naoshi Kikuchi, Takashi Inokuchi, Tomo ...
2012 Volume 61 Issue 2 Pages
261-264
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We investigated 12 patients suffering traumatic skin and soft tissue defects around the foot and ankle. The twelve patients included eight males and four females ranging in age from 2 to 78 years old. No patient had injured their soles. All patients finally healed without flap surgery. Five patients were treated with open wet dressing therapy alone. Four patients were treated with both open wet dressing therapy and skin graft. We consider open wet dressing therapy as the first line therapy. Second line therapy includes surgical treatment and it is important to consult the dermatology or plastic surgery departments.
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Ryosuke Yamaguchi, Osamu Jono, Akihiko Hamasaki, Akio Sakamoto, Toshih ...
2012 Volume 61 Issue 2 Pages
265-269
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Ninety-six elderly patients who had received surgical treatment for femoral trochanteric fracture were divided into two groups; early operation group who were operated within the day after admission and delayed operation group. Background, surgical treatment, pre- and post-operative complication, length of hospital stay, and outcome were compared between both groups, and causes of delayed operation were investigated.
Eighty percent of all patients received early operation. The average pre-operative waiting day was 1.6. There was no significant difference in mortality and complication associated with operation between both groups. In the delayed operation group, pre- and post-operative infections of the respiratory tract or urinary tract were significantly higher than the early operation group. The delayed operation group needed longer hospital stay and less patients were discharged home. The most frequent cause of delayed operation was antithrombotic drug.
Early operation for elderly patients with femoral trochanteric fracture could improve in complication, length of hospital stay, and outcome. Therefore, this approach is expected to spread in general through the improvement of facilities and strategies for patients using antithrombotic drugs.
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Shinya Kawahara, Yasuharu Nakashima, Masanori Fujii, Takuaki Yamamoto, ...
2012 Volume 61 Issue 2 Pages
270-273
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Acetabular retroversion is observed in hips after various pediatric hip diseases including Legg-Calvé-Perthes disease (LCPD). We retrospectively investigated the version and morphological features of acetabulum using pelvic radiographs of 85 hips from 71 patients after LCPD. The diagnosis of acetabular retroversion was made based on the presence of a positive cross-over sign on antero-posterior pelvic radiographs. The correlation between the presence of acetabular retroversion and prominence of the ischial spine (PRIS), modified Stulberg classes, and onset age of LCPD were examined. The prevalence of acetabular retroversion was 45.9% (39 of 85 hips), which was nearly ten times higher than the rate found in normal hips. The prevalence of PRIS was 69.2% and 17.4% in the positive and negative cross-over sign groups respectively, indicating a significant correlation between the cross-over sign and PRIS. The onset age of the positive cross-over sign group was significantly older than that of the negative cross-over sign group. Acetabular retroversion did not have any correlation with the severity of the femoral head deformity. In conclusion, high prevalence of acetabular retroversion after LCPD was demonstrated in the patients studied. Further follow-up is needed to clarify the pathological significance of acetabular retroversion after LCPD.
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Takumi Tomihara, Takeyuki Miyazato, Takafumi Noguchi, Shunsuke Nakamur ...
2012 Volume 61 Issue 2 Pages
274-276
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of bilateral trigger hallux in a classical ballet dancer. A 15-year-old girl who started classical ballet at the age of six had suffered bilateral halluces and sharp pain at the posteromedial aspect of both ankle joints with triggering at age 15. Triggering of hallucis occurred at the ankle plantar and dorsal flexion at the right side, but only at the ankle plantar flexion at the left side. We injected steroid hormone in both tendon sheaths of the flexor hallucis longus. Triggering and pain disappeared at left side, but triggering remained at the right side. We performed operation of release of the tendon sheath of the flexor hallucis longus. After the operation, triggering and pain improved. She resumed ballet lessons four months later without triggering and pain.
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Shiro Yoshida, Yoshizo Kimura, Kimiaki Sato, Yasuo Sugita, Nobuko Suef ...
2012 Volume 61 Issue 2 Pages
277-279
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Vascular abnormalities associated with neurofibromatosis type 1 (NF-1) occur frequently, but arteriovenous fistulae (AVF) rarely. This report describes a case of epidural AVF with scoliosis associated with NF-1 and resulting in death. A 74-year-old man with a medical history of NF-1 was admitted because of vomiting. The vital signs indicated shock with blood pressure of 54/30mmHg and heart rate of 120/min. Death followed 2 hours later. Histopathological findings showed a ruptured epidural AVF with neurofibroma. This was a very rare case of epidural AVF occurring in relatively rare association with NF-1, for which the in-hospital mortality rate is comparatively low. Our experience indicates that it is very important to screen patients with NF-1 for vascular abnormalities.
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Yasutaka Kugimoto, Go Takayama, Yukiko Uemichi
2012 Volume 61 Issue 2 Pages
280-282
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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A 73-year-old female who had been on alendronate therapy for three years developed a nontraumatic fracture of the left femoral diaphysis. She had been experiencing pain in her left thigh for nine months before the fracture. X-ray and magnetic resonance imaging (MRI) T2 image showed bony upheaval and high signal intensity in the lateral diaphyseal region. Nine months later, she had severe right fracture and underwent operation with intramedullary nail. But one year later, she developed a left one. Femoral pain must be treated in atypical stress fractures associated with severely suppressed bone turnover (SSBT) by prolonged bisphosphonate therapy.
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Takayuki Akiyama, Toshihiro Ohdera, Shusaku Matsuda
2012 Volume 61 Issue 2 Pages
283-286
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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There are several reports that open wedge high tibial osteotomy with plate is associated with change in the posterior tibial slope and patellar height. We radiologically evaluated 65 knees with open wedge osteotomy using hemicallotasis between 2006 and 2008. Clinically JOA score significantly improved from average 63.0 points to 88.5 points. In X-ray examination, the average preoperative femoro-tibial angle 181.5° was corrected to 168°. However, there were no significant changes in the posterior tibial slope and patellar height after surgery. Their results suggest that open wedge osteotomy using hemicallotasis has several merits in knee function rather than osteotomy with plate.
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Naotoshi Ninomiya, Koshi Furusho
2012 Volume 61 Issue 2 Pages
287-290
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Recently, early rehabilitation is carried out in many hospitals for osteosynthesis in patient with trochanteric femoral fracture. We report two cases with nonunion. Two patients with trochanteric femoral fracture were treated at our hospital between July 2008 and June 2010. We considered fracture type, tip-apex distance (TAD), and rehabilitation. Both cases had instable type fracture. Post-operatively TAD was 21.6 mm and 30.7 mm respectively, over the recommended index. The timing of full-weight-bearing was six days and four weeks after operation. Both had good positioning of reduction, but both resulted in poor nonunion because of poor instrument positioning.
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Hideo Kinjyo, Hideki Asato, Yusei Funakoshi, Mika Takaesu, Fuminori Ka ...
2012 Volume 61 Issue 2 Pages
291-297
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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We report a case of anterior shoulder instability who underwent arthroscopic repair for Bankart lesion, rotator cuff tear, and large Hill-Sachs lesion. The patient was a 81-year-old right-handed female with right shoulder pain. She had dislocation of the right shoulder with intercuspation three years ago. At that time, a large part of the humeral head had collapsed in radiographs but surgical treatment was not performed. One week before visiting our clinic, she felt right shoulder pain when she leaned against the wall with the right hand. Anterior shoulder dislocation was observed in radiographs. Humeral head and glenoid cavity showed intercuspation. In magnetic resonance imaging (MRI), there were Bankart lesion, rotator cuff tear, and large collapse of the humeral head. We reduced the right shoulder under general anesthesia, but it dislocated again easily. We repaired the Bankart lesion arthroscopically, and the collapsed humeral head with an iliac bone graft (1.5×1.0×1.0cm), and tixed it using the rotator cuff and suture anchor. Right shoulder pain improved remarkably after the surgery. She has no re-dislocation since surgery, and JOA score was 85 points at six months after surgry.
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Ryo Tanesue, Masafumi Gotoh, Yasuhiro Mitsui, Isao Shirachi, Takahiro ...
2012 Volume 61 Issue 2 Pages
298-301
Published: March 25, 2012
Released on J-STAGE: June 26, 2012
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Calcifying tendonitis usually localizes the supuraspinatus tendon. We report a case of extensive calcifying tendonitis in which calcium deposition occurred in the subscapularis, the supuraspinatus, and infraspinatus tendons. A 51-year-old woman had been suffering right shoulder pain for two years. She was diagnosed with chronic calcifying tendonitis and underwent conservative treatments. Because of persistent shoulder pain, she was referred to our hospital, and underwent arthroscopic surgery for removal of the deposition. First, arthroscopic inspection of the glenohumeral joint and subacromial bursa were performed, but they failed to confirm the appearance of the deposition on the surface of the tendon, suggesting that the deposition was hidden in the tendon. Consequently, the tendon insertion was detached from the subscapuraris to the infraspinatus tendons on the basis of the findings of preoperative 3D-CT. Following complete removal of the deposition, the detached cuff was repaired by suture bridge technique. Six months after the operation, the shoulder pain subsided with no recurrence of calcium deposition. To our knowledge, such cases have not been reported so far.
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