We report a case of congential contractual arachnodactyly (CCA) with extentional limitation of the knee joint. CCA is characterized by multiple contractures, arachnodactyly, dolichostenomelia, scoliosis, abnormality of the external ears, and autosomal dominant transmission.A 15-year-old female had been suffering from extentional limitation of the left knee (20 degrees) since age 8. When she was 12, physical examination showed scoliosis of 20 degrees, but scoliosis continued to remain at 20 degrees. She experienced no pain while resting, walking, and in the full flexion position of the left knee. Plain radiograph, MRI and arthroscopy did not indicate abnormal changes of the left knee, but plain radiograph showed elongation of the proximal phalanges. She also had extentional limitation of the fingers in each hand. She was diagnosed with CCA because of multiple contractures, arachnodactyly, dolichostenomelia, and scoliosis.
We report two cases of stress fracture of the ribs related to sports activities.The first case involved fracture of the first rib caused by repeated stress from Japanese styled archery (kyudou). This is the first time such a case has been reported.The second case, a typical stress fracture of the lower ribs and spinous process of the seventh cervical vertebra was caused by a golf swing.
Patellar tendon is a very useful autogenous material for anterior cruciate ligament reconstruction, but this surgery is not easy. Double-skin incision and a bone plug cutter are used to examine the problems in the use of the patellar tendon for endoscopic anterior cruciate ligament reconstruction.The double-skin incision presented little saphenous nerve injury in front of the knee and satisfied the patients in cosmetic appearance. The use of the bone plug cutter facilitated achievement of the bone-tendon-bone from the patellar tendon and made it easy to insent the bone-tendonbone into the drilled holes of the femur and tibia for the endoscopic anterior cruciate ligament reconstruction.
Twenty-six cases (fifty-two hips) of congenital dislocation of the bilateral hips were reviewed. All cases were followed above five years old, and evaluated according to Severin's assessment. The results showed that the bilateral cases were later than the unilateral cases for the begining of the treatment and worse in the evaluation. In comparison with right hip and left hip, left hip was worse than right side in the evaluation.
As previously reported, MRI is found to be useful in the evaluation of meniscal and cruciate ligament injuries. But at our institute, however, due to frequent in consistencies between MRI and arthroscopic findings, we investigated problem knees by MRI and compared the findings with those using arthroscopy subsequently performed. 28 cases with medial and lateral meniscus, and 31 cases with anterior and posterior crucial ligament were examined. The field strength of MRI was 1.0 Tesla, and images were meared by the T2 weighted gradient echo method. Sensitivity for medial meniscus, lateral meniscus, anterior cruciate ligament, and posterior cruciate ligament was 60, 38, 33, and 20 percent respectively, specificity was 78, 90, 91, and 89 percent respectively, and accuracy was 75, 75, 74, and 77 percent respectively. These values are lower compared with other reports. Diagnoses of meniscal and cruciate ligament injuries from magnetic resonance imaging of the knee at our institute are not confidential. For improvement, the scanning and imaging methods, must be changed and a new sophisticated MRI scanner is desirable.
The curvature of the human femoral condyle can be represented by the Archimedean spiral. The center of the Archimedean spiral was found to be situated in the attachment of P. C. L., M. C. L. and L. C. L. of the femoral condyle.
We investigated the natural history of dislocation of the patella with conservative treatment. This study group was composed of nine women (twelve knees) and four men (four knees) with a median age of 11.8 years (range 4 to 16.3) at the time of primary dislocation of the patella.The treatment for the first episode of dislocation was plaster cast in nine cases and elastic bandage in two cases. Five cases were not treated. In twelve cases, there was at least one recurrent dislocation, and in seven of these twelve cases, dislocation recurred frequently. All cases of recurrent dislocation eventually underwent operation.
Forty patients with lumbar canal stenosis who underwent laminectomy (with or without posterolateral fusion) at our hospital from April, 1973 to March, 1984 were reviewed. Thirty-two patients were clinically examined personally, and eight patients by questionnaire. Their follow-up period ranged from 5 to 124 months with an average of 43 months.The results were as follows:1) Over-all clinical results were excellent in 5 (12.5%), good in 18 (45.0%), fair in 10 (25.0%) and poor in 7 (17.5%).2) Preoperative intermittent claudicatios was relieved very well, while backache and sciatica were moderately, and numbness and weakness poorly.3) Poor results appeared to he correlated with their follow-up period and post oprative narrowing of transverse diameter in laminectomy area.4) postoperative instability or slipping did not appeared to be a direct factor of poor results.5) There was no difference between fusion and nonfusion groups in the final clinical results.
A fracture of the clavicle is a common injury around the shoulder girdle. A figure of-eight bandage is the generally accepted treatment for such lesions during childhood. However, the choice of treatment for this injury in adults is still controversial. It is the purpose of this paper to study ten cases of nonunion of the clavicle occuring at our hospital from 1977 to the present time. We investigated them with special regard to factors predisposing them to pseudoarthrosis and the surgical treatment employed. Wesuggest that the chief reasons for development of nonunion would be insufficient reduction and/or inadequate fixation in non-operative treatment and insufficient fixation in operative treatment. Two patients required operative treatment with plate fixation, iliac bone on-lay graft and cancellous bone graft. Their results were classified as excellent.
