Hironobu Kotani

Posterior interosseous nerve paralysis with multiple constrictions

We report four cases of posterior interosseous nerve paralysis with multiple constrictions. At surgery the constrictions were found between the arcade of Frohse and a point of bifurcation of the supinator motor branch. External neurolysis with epineurotomy using the microscope was performed in all cases, and full recovery was obtained.

New procedure on making a thumb—One-stage reconstruction with free neurovascular flap and iliac bone graft

A new method for reconstruction of an amputated thumb with a free neurovascular flap and an iliac bone graft in one stage is described. The method consists of fbur operative steps: (1) preparation of the recipient hand, (2) elevation of a free dorsalis pedis flap, (3) iliac bone graft, and (4) transfer of the flap with microvascular anastornoses. Four successful results with this operation are presented. The method, which reconstructs the thumb in a single operation, is suitable for patients who refuse other reconstructive methods which sacrifice uninjured digits or toes.

CONGENITAL LAMINAR DEFECT OF THE UPPER LUMBAR SPINE ASSOCIATED WITH PARS DEFECT : A REPORT OF ELEVEN CASES

Lumbar spondylolysis generally is considered to be a fatigue fracture of the pars interarticularis, and no unequivocal case of congenital spondylolysis has been reported. The authors describe 11 cases of unilateral spondylolysis (possibly congenital laminar defect associated with pars defect) of the upper lumbar spine. They have roentgenographic characteristics distinct from conventional spondylolysis of the lumbar spine, including hypoplasia of the spinal accessory process, rotation of the spinous process contralaterally to the spondylolysis, and prominent ipsilateral lamina. The anomaly found in these 11 patients probably is congenital, and its clinical significance is not known.

Unusual course of the extensor pollicis longus tendon associated with tenosynovitis, presenting as de Quervain disease--a case report.

Pigmented villonodular synovitis (PVNS), a benign, predominantly monolateral, proliferative process of the synovial membrane (Rydholm 1998), was first described by Jaffe in 1941 (Jaffe 1958). Although it has been reported in most joints (Pantazopoulos et al. 1975, Dorwart et al. 1984), few cases have been found in the wrist. The tenosynovial form, with tendon-sheath involvement, is seen oftener in the wrist, but primary intra-articular involvement is rare, as shown by the few cases reported in the literature (Moynagh 1968, Schajowicz and Blumenfeld 1968, Patel and Zinberg 1984, Duriez et al 1986, Valer et al 1997). In our cases, the diagnosis was considerably delayed. This is often the case with PVNS (Rollo and Wapner 1993), since pain at first is usually mild and radiographs and laboratory tests are usually normal. Early diagnosis and treatment of PVNS to minimize joint destruction may be of value. Attention should also paid to the lack of relationship between the clinical symptoms and bone lesions, since the patient with the worst bone lesions recovered better than the one with less severe bone lesions. Dorwart R H, Genant H K, Johnston W H, Morris J M. Pigmented villonodular synovitis of synovial joints: Clinical, pathologic, and radiologic features. Am J Roentgenol 1984; 143 (4): 877-85. Duriez F, Orcel P, Prier A, Kaplan G. La synovite villonodulaire du poignet. Rev Rhum 1986; 53 (11): 655-6. Jaffe H L.Tumors and tumorous conditions of the bones and joint. Lea and Febiger, Philadelphia 1958: 540-65. Moynagh P D. Pigmented villonodular synovitis of the wrist joint. Proc Roy Soc Med 1968; 6: 30-2. Pantazopoulos T H, Stavrou Z, Stamos C, Kehyaas G, Hartolfilakidis-Garofalidis G. Bone lesions in pigmented villonodular synovitis. Acta Orthop Scand 1975; 46 (4): 579-92. Patel M R, Zinberg E M. Pigmented villonodular synovitis of the wrist invading bone. Report of a case. J Hand Surg 1984; 9 (6): 854-8. Rollo V J, Wapner K L. Pigmented villonodular synovitis of the subtalar joint: A case report. Foot Ankle 1993; 14 (8): 471-5. Rydholm U. Pigmented villonodular synovitis. Acta Orthop Scand 1998; 69 (2): 203-10. Schajowicz F, Blumenfeld I. Pigmented villonodular synovitis of the wrist and penetration into bone. J Bone Joint Surg (Br) 1968; 50 (2): 312-3. Valer A, Ramirez G, Massons J, Lopez C. Synovite villonodulaire hemopigmentée du poignet. À propos d’un cas. Rev Chir Orthop 1997; 38 (3): 355-8.

Evaluation of cervical cord function using spinal evoked potentials from surface electrode.

Spinal evoked potentials from cervical skin surface (surface spinal evoked potentials) were measured to evaluate spinal cord function as a convenient method that precludes inserting electrodes into the epidural space, and results were compared with those of the former epidural recording method. Surface spinal evoked potentials were obtained from cervical skin surface over the C3, C5, and C7 spinous processes after median nerve stimulation in 18 normal subjects and 37 patients with a cervical lesion. In normal subjects, surface spinal evoked potentials consisted of three negative waves (N1, N2, N3). Abnormal N2 (80%) and abnormal N3 (100%) were observed in cervical myelopathy, and abnormal N2 was observed only in radiculopathy; this allows for differentiation between myelopathy and radiculopathy. Comparing preoperative and postoperative surface spinal evoked potentials, it was seen that improvement of clinical symptoms was proportional to that of surface spinal evoked potentials.

Evaluation of cervical cord function in cervical spondylotic myelopathy and/or radiculopathy using both segmental conductive spinal-evoked potentials (SEP)

To evaluate the function of the cervical cord and to diagnose the level and severity of cervical cord lesions in myelopathy, both segmental and conductive spinal evoked potentials (SEP) were measured in 73 patients with cervical spondylotic myelopathy and/or radiculopathy. In normal subjects, segmental SEPs consisted of two waves (R and N waves). Ascending conductive SEPs also consisted of two waves (first and second waves). The function of the cervical cord, including roots, grey matter, and white matter, can be measured by the combined method using both segmental and conductive SEPs, and this allows differentiation among radiculopathy and various types of myelopathy.

Total Knee Arthroplasty Using Bisurface-Type Joint (KU Knee) Designed to Increase the Range of Flexion

A new type of artificial joint, the KU knee, was developed at Kyoto university in 1989 for the purpose of increasing the postoperative range of flexion. The individual knee functions, supporting function and moving function, are allotted to different parts of the artificial knee joint. The accessory joint in the mid-posterior portion of the femoral and tibial component is designed to facilitate the flexion of the knee. Total knee replacements using the KU knee were performed in 218 joints from September 1990 to June 1995. The average preoperative range of flexion was 123.5°, which significantly improved to 131.7° postoperatively. The group of maximum flexion between 135° and 145° comprises the greater part in the groups. The patients who cannot flex the knee more than 135° preoperatively might attain a greater range of flexion after surgery using the KU knee. Thirty-seven joints, i.e., 17% of the knees operated on, obtained full range of flexion 1 month after surgery.