Anterior talofibular ligament (ATFL) repair of the ankle is a common surgical procedure. Ultrasound (US)-guided anchor placement for ATFL repair can be performed anatomically and accurately. However, to our knowledge, no study has investigated ankle kinematics after US-guided ATFL repair.US-guided ATFL repair with and without inferior extensor retinaculum (IER) augmentation will restore ankle kinematics.Controlled laboratory study; Level of evidence, 4.A 6 degrees of freedom robotic testing system was used to apply multidirectional loads to fresh-frozen cadaveric ankles (N = 9). The following ankle states were evaluated: ATFL intact, ATFL deficient, combined ATFL repair and IER augmentation, and isolated US-guided ATFL repair. Three loading conditions (internal-external rotation torque, anterior-posterior load, and inversion-eversion torque) were applied at 4 ankle positions: 30° of plantarflexion, 15° of plantarflexion, 0° of plantarflexion, and 15° of dorsiflexion. The resulting kinematics were recorded and compared using a 1-way repeated-measures analysis of variance with the Benjamini-Hochberg test.Anterior translation in response to an internal rotation torque significantly increased in the ATFL-deficient state compared with the ATFL-intact state at 30° and 15° of plantarflexion (P = .022 and .03, respectively). After the combined US-guided ATFL repair and augmentation, anterior translation was reduced significantly compared with the ATFL-deficient state at 30° and 15° of plantarflexion (P = .0012 and .005, respectively). Anterior translation was not significantly different for the isolated ATFL-repair state compared with the ATFL-deficient or ATFL-intact states at 30° and 15° of plantarflexion.Combined US-guided ATFL repair with augmentation of the IER reduced lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair did not reduce laxity due to ATFL deficiency, nor did it increase instability compared with the intact ankle.US-guided ATFL repair with IER augmentation is a minimally-invasive technique to reduce lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair may be a viable option if accompanied by a period of immobilization.
From 1965 to 1973, 23 cases of calcium deposits were treated, 5 of these had bilateral involvement, making in all 28 shoulders.This disease was twice in female than in male. The average age was 45.8 years. Most common occupation was housewife which accounted for 47.8%.There was some correlation between the configuraton and density of the deposit and the course of the clinical syndrome. The disease, regardless of the stage of the stage of the symptom, is better first treated by conservative measures, and failure to it justifies surgical excision of the calcific deposit.
Since 1959, cervical osteochondrosis and idiopatic cervico-omo-brachialgia have been examined in our clinic. Those invlod 256 cases of idiopatic cervico-omo-brachialgia, 116 cases of cervial osteochondrosis. In the previous paper, upon the cervical osteochondrosis, the myelopathy and radiculopathy were comparatively studied. In this paper the author wishes to make a comparison with the radiculopathy, the myelopathy and idipatic cervico-omo-brachialgia. Both of the radiculopathy and the idiopatic cervico-omo-brachialgia, manifest the nuchal and shoulder pains.The symptome of the myelopathy are specialized as sensory disturbance and numbness sensetion with various manifestation in cervical X-ray finding. On the other hand, idiopatic cervico-omo-brachialgia has only pain and tenderness localized in cervical and shoulder region and there are some changes in X-ray.The follow-up studies were upon the idiopatic cervico-omo-brachialgia, the radiculopathy and the myelopathy. The symptome became better in 58% of the idiopatic cervico-omo-brachialgia, and 68% of the radiculopathy, but it was unchanged or became worse in 60% of the myelopathy.
A female achondroplastic dwarf was referred because of intermittent claudication, complained for 4 months, with numbness and dull sensation in her legs. She had slight bowel and rectum disturbance.This 45 year-old female was 112cm in tall, weighed 40kg, and had short arms and legs, hyperlordosis of the lumbar spine, and moderate kyphosis at the thoraco-lumbar level.Sensation was diminished over the L1 to L5 and S1 dermatomes.Lumbar puncture was unsuccessful and myelogram by cisternal puncture was done which revealed total block between the L1 and L2 level.Operation: Total laminectomy at L1 through L5 was carried out.The laminae were thick and pedicles were all short and thick. The dura and nerveroots were compressed extremely. After the laminectomy the widening of the canal was done including foraminotomy. There was no evidence of a ruptured disc. The dura was not opened. Post operative course was very good and four months later she can walk well without complaints in her legs.
130 cases of whiplash injury were followed up directly or by mail from 4 years up to 13 years (average 8. 2 years).These cases were divided into 2 groups, which is, 75 cases with mild symptoms (improved less than 6 months after injury) and 55 cases with persistent symptoms (more than 6 months).Comparative study of 2 groups regarding age, sex, occupation, clinical pictures, x-ray findings and other factors were described.Of them, ten cases (7.7%) have being treated for 6.2 years in average.The factors which kept their symptoms remained for such a long time were discussed.
The tension and compression fatigue test was carried out with butt-brazed joint specimens prepared by brazing with several silver filler metals and by using Monel alloy and nickel silver alloy being Ni-Cu ones as the base alloys to study the effect of kinds of filler metal, base alloy and the joint clearance on the fatigue strength. Four kinds of filler metal having different compositions were used for brazing. An electro-hydraulic servo tester was used for the tension test and the fatigue test. The follwing results were obtained from these tests: Jointed aera decreased owing to blow holes generated by the flux evaporation for the brazed joint with low melting point filler metal, resulting in the decrease of tensile strength. On the other hand, high tensile strength was obtained for the specimens brazed by high melting point filler metal. When a base metal of higher elastic modulus and higher strength was used, the tensile strength was higher than that of a filler metal. The brazed joint specimen prepared by using a filler metal of higher melting point and a base metal of higher elastic modulus showed the higher fatigue strength. Since the defects in the filler metal affected greatly on the fatigue characteristics, the effect of joint clearance did not sppear so clearly. 11 refs., 14 figs., 5 tabs.
We studied the characteristic findings of lumbar canal stenosis associated with the entire spinal canal stenosis. They are as follows; 1) They have generally severe symptoms. 2) They tend to have various neurological deficits. 3) They show many intervertebral lesions in myelogram. 4) They tend to have urinary-fecal disturbance. 5) They sometimes complicate with cervical or thoracic lesions. 6) Their recovery are poor. In this report, we made the radiological standard for the entire spinal canal stenosis; C5≤14mm, T11≤13mm, and L4≤17mm in sagittal diameter. Filmfocus distance was 1.5m at C5, 1m at T11 and L4. According to the standard, 51% of lumbar canal stenosis were regarded as the entire spinal canal stenosis.
Vascular tests for thoracic outlet syndrome are considered to be one of the important diagnostic aid in order to determine the localization and the severity of neurovascular lesion at the thoracic outlet region. However, the mechanism and significance of vascular tests are still unclear.This is to report our clinical and autopsial study to try to clarify the exact meanings of each vascular test.Materials are 72 cases in 48 patients with thoracic outlet syndrome (46 cases in 39 patients recieved first rib resection) and 21 cases of exploration in autopsy.Positive Adson's test, although the incidence is quite low, may suggest severe lesion at the scalen triangle. Eden's test indicate lesions at the costo-clavicular space. In this positive the clavicle moves most to the posteromedial direction among the various positions. Abduction-external rotation test and Wright's test show neurovascular compression mainly at the costo-clavicular region and partly at the scalen triangle. These positions make the neurovascular bundle tracted foward the lateral. Compression at the subcoracoideal region is not the main cause in Wright's test.
