Goro Awaya

Torn acetabular labrum in young patients. Arthroscopic diagnosis and management

Arthroscopy of the hip revealed a torn acetabular labrum in seven young patients. Three of them had had an acute onset of symptoms during sporting activities. On examination all seven patients had pain on passive flexion and medial rotation of the joint. All but one of the tears were located on the posterosuperior portion of the labrum, and, in the acute cases, vascular dilatation around the tear was observed. In these cases, repeated arthroscopy several months later showed that the vascular changes had disappeared, but the tear was still present. The aetiology, diagnosis and treatment of the torn acetabular labrum are discussed.

Arthroscopic diagnosis of ruptured acetabular labrum.

We performed arthroscopy in nine hips in 8 patients with hip pain of unknown origin. Of them, 5 patients had a rupture in the posterior or posterosuperior labrum, not seen by arthrography. On physical examination the patients complained of pain on both passive flexion and internal rotation of the hip, and when the thigh was pushed backwards at 90 degrees of flexion.

Arthroscopic surgery for synovial chondromatosis of the hip

We report a case in which arthroscopic surgery was successfully performed for synovial chondromatosis of the hip, and report an experience with diagnostic arthroscopy of this joint

Malignant fibrous histiocytoma of bone. A review of 13 cases and an ultrastructural study

Observations on 13 patients with primary malignant fibrous histiocytoma of bone were reported. Included were nine male and four female patients, ranging in age from 6 to 81 years (mean, 44.8 years). Pain was the most common complaint. The interval from the first symptom to the initial treatment varied from 2 months to 20 years. Seven tumors arose in the knee region. Roentgenologically, most of the lesions presented with an osteolytic and destructive appearance. Histologically, highly variable morphologic features existed. The storiform‐pleomorphic pattern was found in every tumor, although it was not necessarily pathognomonic for malignant fibrous histiocytoma of bone. Surgery, radical or incomplete, was the primary treatment for all but one patient. Lymph node metastasis was present in three. Five patients died of the disease from 3 to 79 months after the diagnosis (mean, 28 months), all exhibiting metastasis to the lung. Gauchers body‐like structure demonstrated in the electron microscopic study shows the histiocytic quality of malignant fibrous histiocytoma of bone.

Examination by ultrasound of Legg-Calvé-Perthes disease.

Eleven patients with Legg-Calvé-Perthes disease (LCP) were examined ultrasonographically for their femoral head deformity. The outline of the cartilaginous femoral head was well demonstrated, and the image obtained corresponded to that observed by arthrography. Using ultrasonography, a simple method was developed to determine the rate of deformity due to LCP. Ultrasonography does not have the hazards of x-ray and is useful for the diagnosis of LCP.

Diagnosis by ultrasound of congenital dislocation of the hip joint.

Two hundred thirty-four hips of 117 babies from one day to 18 months of age were examined ultrasonographically for congenital dislocation of the hip joint. Ten hips in eight babies were dislocated or subluxated and there were 11 hip dysplasias in seven babies. In the normal hip, the adaptation between the acetabulum and the femoral head is well demonstrated, and there is no apparent interposition of the limbus between the acetabular roof and the cartilaginous head. In the dislocated hip, the protrusion of the acetabular rim is not so clear as that of the normal hip, and the limbus is seen to be interpositioned between the acetabular roof and the cartilaginous head. In severe cases, the acetabular rim is hidden under the shade of the femoral head. Ultrasonography is an effective method of determining the incidence of dislocation and of diagnosing hip subluxation as well as dysplasia and does not have the hazards of x-ray examination.

Stress fracture of the vertebral arch in osteopetrosis.

Stress fracture of the fourth vertebral arch occurred in a 21-year-old woman with a benign osteopetrosis. The fracture healed in three months after application of a body cast. It seems likely that the osteopetrotic bone resists force, in parallel with the cortical layer, but is fragile to forces at right angles to the plane of the cortical layer.