Hiroshi Hagihara

The Device of the Operation that Used Wiring Together for Intertrochanteric Fractures and Subtrochanteric Femoral Fractures

【目的】大腿骨転子部及び転子下骨折に対する内固定法の発展によりその成績は飛躍的に向上したが，まれにカットアウト等の合併症が出現する．その原因は主に整復不良，ラグスクリュー挿入位置不良である．我々は閉鎖的整復不良な症例に対しては積極的に観血的整復を行っている．整復位を鋼線締結で保持しCHSあるいはγネイルで内固定することで術後内反変形やカットアウトを防ぐことができた症例を報告し，その適応について考察する．【対象と方法】鋼線締結を併用しCHSあるいはγネイルを行った大腿骨転子部及び転子下骨折の10例である．平均年齢は76.7歳だった．骨折型をAO分類で分類した．【結果】全例でカットアウト等の合併症なく骨癒合した．荷重までの期間は平均23.5日だった．【結語】閉鎖的整復不良な症例に対しては内固定材の固定力を過信することなく観血的整復を行い，正確な整復位での内固定を目指すことで良好な成績が期待できる．

Application of Hemicallotasis for Tibia Vara Deformity with Metaphysical Dysplasia

We treated two cases of tibia vara deformity with metaphyseal dysplasia using hemicallotasis technique. One was a 16-year-old boy with 12 degrees of bilateral tibia vara. Another was a 17-year-old boy with 17 degrees of tibia vara in the right side, and 18 degrees of tibia vara in the left side. After osteotomy, hemicortical elongation was gradually performed until the aimed angular correction was gained. Height was increased by 1.5cm. There were no problems in both cases and we concluded that the Orthofix technique is useful for the treatment of tibia vara deformity and shortening.

Results of Tension Band Wiring for Fractures of Patella

We reviewed 28 cases of tension band wiring for the fracture of the patella, in which subcutaneous wiring was used in 21 cases. There were 11 males and 17 females with an average age of 58 years old (20-80). They were classified into 17 transverse, 6 three-parts, 4 comminuted, and 1 vertical fracture. The evaluation of the treatment, before the removal of the wire, was performed based on Watanabes score. All patients showed satisfactory results, with 22 evaluated as excellent, 5 as good, and 1 as fair.

A Simple Method of Arthroscopic Meniscal Repair

We report a simple method for repairing damage to the meniscus by utilizing eye-holed Kirschner wire and a single suture strand. The repair involves the following: Step 1, the peripheral meniscal tear suitable for repair is identified arthroscopically. Step 2, a 1.8mm diameter eye-holed Kirschner wire is inserted into the joint and passed through the meniscus across the tear and then panetrates through to the skin. Step 3, an open incision is made around the wire and the neurovascular structurues are retracted. A free nylon suture is then passed through the eye-hole of the wire. Step 4, The wire is pulled back into the joint and repushed out through the meniscus about 5mm from the original stitch. Step 5: The nyron suture is removed from the wire and tied over the retinaculum. The same procedure may be need to repeated according to the width of the meniscal tear.

Lateral Discoid Meniscal Lesion as a Cause of lateral Osteoarthrosis of the Knee

Pathological findings of plain X-rays and arthrography were investigated to realize the causes of lateral asteoarthrosis of the knee.The number of lateral osteoarthrosis cases was 22 knees of 18 patients.14 cases were women. 12 cases were on the right side, 2 cases on the left and 4 cases on both sides.10 of 17 lateral menisci were found to be of the discoid type.In 9 knees which were classfied in the advanced stage (Stages III, and IV), 5 knees had seriously torn lateral discoid meniscus.Torn lateral discoid meniscus was supposed to be one of the important causes of lateral osteoarthrosis of the knee.