Hiromichi Tanaka

A Stay Wire Technique for Fresh Subcutaneous Achilles Tendon Rupture

For the treatment of freshly ruptured Achilles tendon, we devised a stay wire technique that temporarily placed a 0.55-mm soft wire alongside the repaired part of the tendon. This provided reinforcement and better protection for the sutured area, and in consequence allowed early joint mobilization. Ten men and 10 women, ranging from 31 to 64 years of age (43.1 years old being the average), underwent this treatment. After the operation, a short leg cast was applied for 2 days. Ankle joint motion exercise was started on the third day. Weight bearing walking was permitted with half body weight load from the second week, two-thirds of body weight from the third week, and no limit from the fourth week. The wire was removed 4 weeks after the operation. Follow-up observation was continued for 8 to 64 weeks, with 34.8 weeks being the average period of time. In all cases, by the eighth week, the range of motion of the operated ankle recovered to nearly that of the uninjured side. After 6 months, all patients could return to the preinjury level of activities. We experienced no serious complications such as rerupture or deep infection.

Atypical Osteomyelitis of the Knee -A Case Report-

The diagnosis of chronic osteomyelitis expanded out of bone is important in order to avoid confusion with a neoplasm. We report an unusual case of chronic osteomyelitis of the femur. A 27-year-old man complaining of motion pain in his right knee, especially in the medial femoral condyle, came to our hospital. He had occasional episodes of pain in the knee after Japanese fencing activities since 1989. Examination of the knee was unremarkable except for slight tenderness and swelling over the vastus medialis. Radiographs showed a clearly defined hemispherical defect with a sclerotic margin in the superior part of the medial femoral condyle of the right knee. MRI and angiograms revealed a tumor-like lesion beyond this sclerotic area which was more suggestive of chronic inflammation. Surgical removal of the lesion showed a granulomatous tissues. Histological examination of scleroitic lesion showed a chronic inflammatory pattern suggesting a diagnosis of primary chronic osteomyelitis originated from subperiosteal bone of the femur.