Koji Fujii

Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results.

The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60–88 years) and the mean follow-up period was 24 months (range, 12–53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were ‘excellent’ in 64% of fractures and ‘good’ in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7°, ulnar variance was 4.0 mm, and palmar tilt was −2.7° respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the nondominant hand injured.

Surgical treatment of lumbar disc herniation in elderly patients

Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%). The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.

Validity of arthroscopic measurement of glenoid bone loss using the bare spot

Purpose Our aim was to test the validity of using the bare spot method to quantify glenoid bone loss arthroscopically in patients with shoulder instability. Methods Twenty-seven patients with no evidence of instability (18 males, nine females; mean age 59.1 years) were evaluated arthroscopically to assess whether the bare spot is consistently located at the center of the inferior glenoid. Another 40 patients with glenohumeral anterior instability who underwent shoulder arthroscopy (30 males, ten females; mean age 25.9 years) were evaluated for glenoid bone loss with preoperative three-dimensional computed tomography (3D-CT) and arthroscopic examination. In patients without instability, the distances from the bare spot of the inferior glenoid to the anterior (Da) and posterior (Dp) glenoid rim were measured arthroscopically. In patients with instability, we compared the percentage glenoid bone loss calculated using CT versus arthroscopic measurements. Results Among patients without instability, the bare spot could not be identified in three of 27 patients. Da (9.5±1.2 mm) was smaller than Dp (10.1±1.5 mm), but it was not significantly different. However, only 55% of glenoids showed less than 1 mm of difference between Da and Dp, and 18% showed more than 2 mm difference in length. The bare spot could not be identified in five of 40 patients with instability. Pearson’s correlation coefficient showed significant (P<0.001) and strong (R2=0.63) correlation in percentage glenoid bone loss between the 3D-CT and arthroscopy method measurements. However, in ten shoulders (29%), the difference in percentage glenoid bone loss between 3D-CT and arthroscopic measurements was greater than 5%. Conclusion The bare spot was not consistently located at the center of the inferior glenoid, and the arthroscopic measurement of glenoid bone loss using the bare spot as a landmark was inaccurate in some patients with anterior glenohumeral instability. Level of evidence Level II, prospective comparative study.

Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report.

Study design:A case report and a review of literature.Objectives:To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst.Setting:General Orthopedics, Japan.Methods:A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion.Results:The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst.Conclusions:Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.

Diagnostic Value of the Supine Napoleon Test for Subscapularis Tendon Lesions.

PURPOSE The purpose of this study was to compare the diagnostic value of the supine Napoleon test (a variation of the belly-press test that reduces compensatory motion) with other clinical tests for subscapularis tendon (SSC) tears. METHODS One hundred thirty consecutive patients who were scheduled for arthroscopic rotator cuff repair were evaluated preoperatively with the lift-off test, Napoleon test, bear-hug test, and supine Napoleon test. The supine Napoleon test was performed by placing the patients hand on their belly while they lay supine with an examiner holding their hand and shoulder to prevent compensatory motion. The patient was asked to move their elbow upward and the test was considered positive if they were unable to do so. During surgery, SSC lesions were classified with the Lafosse classification system. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios (LR+, LR-) were calculated for each test. The ability to detect partial SSC tears was compared among the clinical tests. RESULTS Fifty-two of 130 patients (40%) had SSC tears confirmed arthroscopically. For diagnosis of these tears, the supine Napoleon test was the most sensitive (84%), followed by the bear-hug test (74%), and the bear-hug test was the most specific (97%), followed by the supine Napoleon test (96%). The LR+ was greatest for the bear-hug test (28.4) and next greatest for the supine Napoleon test (21.9). The LR- was lowest for the supine Napoleon test (0.16) and the bear-hug test was second (0.27). The sensitivity of the supine Napoleon test (65%) was highest for detecting partial tears. CONCLUSIONS In comparison with other clinical tests for SSC tears, the supine Napoleon test had the greatest diagnostic value for full-thickness SSC tears and was most able to detect partial tears. LEVEL OF EVIDENCE Level III, diagnostic nonrandomized study.

Clinical evaluation of aged patients who underwent surgery for femoral neck fractures — Comparative study of clinical results according to age

The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80–84 years old), group B (85–89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.

Development of secondary ossification centres of the acromion in Japanese youth: a computed tomographic study

Purpose. To determine the age range when the secondary ossification centres of the acromion appear and fuse in Japanese youth using computed tomography (CT). Methods. CT scans of 85 shoulders in 35 male and 14 female consecutive patients aged 6 to 20 (mean, 16) years were reviewed. No patient had pain or tenderness at the acromion. Appearance and fusion of the secondary ossification centres of the acromion were determined twice by an orthopaedist. A secondary ossification centre was considered to have appeared when a low-density line was noted at the juxta-epiphyseal area and to have fused when the line had disappeared. Intra-observer reliability was determined. Results. The intra-observer reliability was 0.93. The secondary ossification centres of the acromion had appeared at around 10 years of age and had fused at around 15 years of age, with one exception. Conclusion. In these Japanese subjects, the secondary ossification centres of the acromion had appeared at around 10 years of age and had fused at 15 to 16 years.

Arthroscopic Removal of a Wire Fragment from the Posterior Septum of the Knee following Tension Band Wiring of a Patellar Fracture

Tension band wiring with cerclage wiring is most widely used for treating displaced patellar fractures. Although wire breakage is not uncommon, migration of a fragment of the broken wire is rare, especially migration into the knee joint. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar fracture with tension band wiring and cerclage wiring. Although it was difficult to determine whether the wire fragment was located within or outside the knee joint from the preoperative plain radiographs or three-dimensional computed tomography (3D CT), we found it arthroscopically through the posterior transseptal portal with assistance of intraoperative fluoroscopy. Surgeons who treat such cases should bear in mind the possibility that wire could be embedded in the posterior septum of the knee joint.