Masamitsu Tsuchiya

A Technique for Reconstruction of the Medical Patellofemoral Ligament

Additional medial patellofemoral ligament reconstruction was performed successfully on six consecutive patients with recurrent dislocation of the patella because of residual patellar instability after medial transfer of the tibial tubercle. A technique for medial patellofemoral ligament reconstruction is described, and complications and postoperative management are discussed. The reconstruction was performed using a double strand hamstring tendon graft in five patients and iliotibial allograft in one. Good stabilization of the patella was achieved in all six patients, resulting in improved confidence in higher levels of activity. The satisfactory outcome of additional medial patellofemoral ligament reconstruction suggests the possibility that the procedure may be part of the optional procedure in proximal realignment for recurrent dislocation of the patella.

Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging

We studied magnetic resonance images of rotator cuff tears to determine whether it was possible to establish preoperatively the feasibility or infeasibility of primary repair. The study comprised 27 shoulders in 26 patients who underwent magnetic resonance imaging before surgery because of complete tears of the rotator cuff and who were treated with primary repair or by the patch graft technique because primary repair was not feasible. The length and width of each tear, the thickness of the supraspinatus muscle at the superior margin of the glenoid, and the presence or absence of a high signal intensity in the infraspinatus muscle were statistically analyzed. Primary repair was often not feasible when both the length and width of the tear exceeded 40 mm on a preoperative magnetic resonance image, when the supraspinatus muscle was thin at the superior margin of the glenoid, and when a high signal intensity was observed in the infraspinatus muscle.

A vascularised iliac musculo-periosteal free flap transfer: a case report.

Abstract A patient with a severely comminuted fracture of the tibia was successfully treated using a vascularised musculo-periosteal free-flap. Bone union was demonstrably accelerated and the patient was permitted full weight-bearing within 6 months of the operation.

Talar head fracture in a professional baseball player: A case report

Fractures of the talus are uncommon, representing less than 1% of all fractures [1,2]. Since Anderson coined these fractures as aviators astragalus [3], it is known that they usually occur due to highenergy trauma and present a high risk of complications including osteonecrosis, arthrosis of the surrounding joints, and malunion [4]. Fractures of the talar head are rarer and account for 3e10% of all talar injuries [1,5,6]. In athletic activities, fractures of the lateral process of the talus in snowboarding have been well described in the literature [7,8], however, fractures of the talar head are more rare and only few case reports have been published [9e14]. Despite the good outcomes without complications including osteonecrosis in these case reports, the follow-up time reported for these patients is relatively short, precluding final conclusions from being drawn on the management of talar head fractures in athletes. To our knowledge, there are no published reports of a talar head fracture in a professional athlete that was treated surgically. We present the case of a 30-year-old professional baseball player who was treated with open reduction and internal fixation for an isolated talar head fracture with a 5.4-year follow-up.

III–2 LIPUS Treatment for Periprosthetic Fractures Following Bipolar Hip Arthroplasty: Report of Two Cases

Objective: Periprosthetic fractures following total and bipolar hip arthroplasty have increased in recent years. As such fractures often occur in the elderly, this causes difficulties for surgical treatment. We report successful treatment with LIPUS in 2 elderly patients with periprosthetic fracture following bipolar hip arthroplasty. Case 1: An 84-year-old female who could walk with a walker after treatment with bipolar hip arthroplasty. Six years after surgery, she fell and sustained a periprosthetic fracture (Vancouver B1). She was treated by open reduction and fixation with plate, cable (Synthes LCP), and band (Smith&Nephew CCG). A week after the second operation, LIPUS treatment began. Six weeks later, partial weight-bearing was permitted, and 8 weeks later full weight-bearing was permitted. Six months after the operation, bone union was completed, and she could again walk with a walker. Case 2: An 88-year-old female who could walk with a walker after treatment with bipolar hip arthroplasty. Six months after surgery, she fell and sustained a periprosthetic fracture (Vancouver B1). She was treated by open reduction and fixation with plate, cable (Synthes LCP), and band (Smith&Nephew CCG). A week after the second operation, LIPUS treatment started. Eight weeks later full weight-bearing was permitted. Ten months after the operation, bone union was completed, and she could again walk with a walker. Discussion: Bone union was obtained with LIPUS, and the patients could maintain their activities of daily living.