Absorbable FIXSORB SCREWS are made from poly-L-lactic acid. We used these screws for internal fixation when performing Transposition Osteotomy of the Acetabulum (TOA) in 8 hips instead of using Kirschner wires or screws which are made of titanium. At an average follow-up of fourteen weeks, there were no displacements of the osteotomized fragment or foreign body reaction in all our patients. Although the period of postoperative follow-up is short, we believe that these absorbable screws seem to be a useful internal fixation device for TOA.
A retrospective study was performed on 8 hips in 6 consecutive patients with avascular necrosis of the femoral head.Avascular necrosis of the femoral head was induced by alcohol abuse in 1 hip, trauma in 3 hips, and steroid intake in 4 hips.Each patient was treated by Sugioka's transtrochanteric rotational osteotomy of the femoral head. In 5 of the 8 hips, varus osteotomy of the femur was simultaneously performed at the time of transtrochanteric rotational osteotomy. With an average follow-up of 1 year after Sugioka's transtrochanteric rotational osteotomy, seven hips showed good or excellent results. The remaining one patient had postoperative hip pain, although collapse of the affected area was not demonstrated on the recent radiographs.
Maffucci's syndrome is a congenital, non-hereditary mesodermal dysplasia manifested by multiple enchondromas and hemangiomas. It is associated with diverse secondary musculoskeletal deformities. A high proportion of the enchondromas undergo malignant degeneration.We report one case of Maffucci's syndrome in a 17-year-old girl.
Tibial tubercle transfer is often used for the treatment of patella maltracking. Because the periosteum of both sides of the tibia is stripped off along the tibial tubercle and then the bilateral cortices are transferred, this procedure may disturb the blood supply to the tibial tubercle. However, the blood supply to the tibial tubercle has not yet been clearly elucidated. The purpose of this study is to investigate the effect of surgical dissection on blood flow to the tibial tubercle in an animal model using a hydrogen washout technique. Eleven knees of nine mongrel dogs weighing from 7.0 to 19.1 kg were utilized. The blood flow was measured using a hydrogen washout technique. Before performing the surgical procedures, the control blood flow rate of the tibial tubercle averaged 19.6 ml/min per 100 g of tissue. The blood flow rate did not significantly decrease after transecting the periosteum on the lateral side of the tibia alone (P > 0.05). After completing the tibial tubercle osteotomy, the blood flow rate averaged 11.5 ml/min per 100 g of tissue, which is a 25.3% decrease as compared with the value after transecting the periosteum on the lateral side of the tibia alone (P < 0.05). The blood flow rate significantly decreased to 3.4 ml/min per 100 g of tissue after the distal periosteal transection and osteotomy of the distal cortex of the tibial tubercle (P < 0.05). The addition of a medial periosteal transection caused a complete arrest of the blood flow in 10 out of 11 knees, or a 91.2% decrease as compared with the value after a distal periosteal transection and osteotomy of the distal cortex of the tibial tubercle (P < 0.05).
Dewar-Harris's procedure is often performed for paralysis of the trapezius caused by accessory nerve injury in order to restore shoulder function. This is a method in which the scapula is fixed on the second and third thoracic vertebrae using the fascia lata to obtain stability of the scapula and forces necessary to rotate it. We used the Leeds-keio artificial ligament instead of the fascia lata in three patients with trapezius paralysis. Abduction functional brace was used for four weeks postoperatively. All patients achieved good functional recovery of the shoulder.
We reported the treatment for radial head fractures (Morrey classification; type 2) by reduction and fixation using intramedullary pinning from the distal of the radius (Métaizeau method). From May 2003, we treated three cases (one female and two males) by the Métaizeau method. Their mean age was 42.3 (range: 33 to 54) years. According to Morrey classification, all fractures were type 2.After operation, triangle bandage fixation was performed for three or four weeks. Soon flexural extension exercise was carried for pain self-control, and the Kirschner wire extracted early when bone union was achieved.Bone union was achieved in all patients, and the average range of motion was flex/ 131.6°: , extension/-6.6°: , pronation/ 80.0°: , spination/ 78.3°: . The average JOA score was 93 points.The Métaizeau method is originally carried out for radius neck fractures, but it is considered a simple and minimally invasive good method for type 2 patients who are generally adaptive to operations.
Tibial tubercle transfer is often performed for patella maltracking. In this procedure, the periosteum of both sides of the tibia is stripped off along the tibial tubercle and then the bilateral cortices are transected. It is however likely to disturb blood supply to the tibial tubercle. We have, therefore, devised a new procedure in which the periosteum of the medial side of the proximal tibia is left intact when tibial tubercle transfer is performed. The purpose of this study is to investigate the blood supply to the tibial tubercle in an animal model using a hydrogen washout technique.10 mongrel dogs weighing 10.0 to 19.1kg were used. Blood flow was measured using a hydrogen washout technique.Before the surgical procedure, the control blood flow rate of the tibial tubercle averaged 19.2ml/minute per 100g of tissue. The blood flow rate did not significantly decrease after dissection of the periosteum on the lateral side of the tibia alone (p> 0.05). After the tibial tubercle osteotomy, the blood flow rate averaged 11.2ml/minute per 100g of tissue, which is a 26% decrease as compared with the value after dissection of the periosteum on the lateral side of the tibia alone (p<0.05). The blood flow rate significantly decreased to 3.4ml/minute per 100g of tissue after distal periosteal dissection (p<0.05). The addition of medial periosteal dissection caused a complete arrest of the blood flow in 11 out of 12 knees, which is a 99% decrease as compared with the value after distal periosteal dissection (p<0.05).
The Bernese periacetabular osteotomy described by Ganz et al restores the position and acetabular coverage of the dysplastic hip to nearly normal, but it has several disadvantages due to the asphericity of the osteotomy surfaces. Because this osteotomy is a series of straight cuts, incongruity at the site of the osteotomy and anterior displacement of the hip joint may occur in patients who need an extensive acetabular reorientation. We designed a curved periacetabluar osteotomy to improve these drawbacks.The direct anterior approach described by Murphy et al is used with the patient supine. The triple osteotomy is done with a specially curved osteotome, designed to approximately correspond to the circumferential curvature of the acetabulum. Except for the use of the osteotome, an incomplete cut of the ischium and a complete cut of the pubis are performed in the similr manner as those of the Bernese periacetabular osteotomy. The first step in osteotomy of the ilium is to score the inner table of the pelvis with a power drill. A C-shaped osteotomy line is started proximal to the anteroinferior iliac spine and ended in the distal part of the quadriilateral surface. The actual osteotomy along the scored line is done with the osteotome being directed proximally in the supraacetabular portion, posteriorly in the proximal part of the quadrilateral surface, and distally in the distal part of the quadrilateral surface. Then, the acetabular fragment can be redirected and is fixed with two or three screws. The posterior column of the acetabulum is kept intact. The results of the first 24 hips in 24 patients were prospectively studied with a minimum of 6-month follow-up. All hips had residual hip dysplasias. At operation, the osteotomized acetabular fragment was rotated without difficulty and was medialized as necessary. The averge lateral center-edge angle was 6 degrees preoperatively, compared with 29 degrees postoperatively. The average anterior center-edge angle was 8 degrees preoperatively, compared with 26 degrees postoperatively. Bone union and relief of pain were obtained in all hips.
