Masateru Ijichi

Symphalangism (two phalanges) in the digits of the Japanese foot

We report here an investigation into the number of phalanges of the 2nd to 5th toes in a Japanese population. The number of phalanges in each of these toes is normally three, distal, middle and proximal. However, occasionally only two phalanges are observed. In this condition, known as symphalangism, the middle and distal phalanges are fused (synarthrosis of the distal interphalangeal joint). The incidence of symphalangism in the 488 feet was found to be 72.5% in the 5th toe, 11.9% in the 4th toe, 0.8% in the 3rd toe, and 0.0% in the 2nd toe. No left-to-right or sex differences were observed. The reported overall incidence of symphalangism in the 5th toe of the foot in the Japanese population (74.7%) is significantly higher than that in the European population (40.2%). In the present sample, the incidence of symphalangism of the 4th toe (11.9%) was significantly higher than that in Japanese population samples previously studied (4.2%).

Computed tomography in calcification of ligamenta flava of the cervical spine.

A case with cervical myelopathy caused by massive calcifications of ligamenta flava is presented. The round radiopaque nodules were found on conventional cervical radiography. Following examination by computed tomography, the nodules were diagnosed as calcified ligamenta flava in the cervical spine. The findings were confirmed at surgery and by histological investigations.

Report of 10 cases with Myeloma

Patients of myelomas often first visit orthopaedic surgeons complaining of bone pain.We report 10 cases of myelomas that were diagnosed in our hospital in the last 5 years. Patients included 6 males and 4 females with a mean age of 64.8 years. The initial clinical symptoms were lumbago in 4 cases, thigh pain in 2 cases, rib pain in 2 cases, neck pain in 1 case, and sacral pain in 1 case. X-ray findings included osteolytic changes in 6 cases, pathological fractures in 2 cases. However 2 cases only showed bone atrophy. Blood biochemistry revealed, 9 cases with abnormal values. Five cases underwent operative therapy to maintain their quality of life.

Humeral Shaft Fractures after Shoulder Fusion

The arthrodesis is very effective for the functional reconstruction of the paralytic shoulder joints. But humeral shaft fractures are the most embarrassing complications. We experienced two such cases. These cases are presented. We thought that it would be better for these patients to make contracture with preserving some passive movement than to fuse completely their paralytic shoulder joints.

Peripheral Nerve Injuries in the Hand

Although the repairments of the peripheral nerve have been developed in cases recently, there are some controversies over the timing of the secondary repairment. We have experienced 14 cases (18 nerves) of secondary repairment of divided peripheral nerve injuries. There are 5 nerves of the ulnar nerve, 3 of the median nerve, 2 of the radial nerve and 8 of the digital nerve. All cases were sutured with epineural suture microscopically, and these postoperative results were evaluated by using Heighets criterion and the static two-point discrimination method. No significant differences were observed between the timing before and after 3 month from the initial injuries. However, neuromas and relative big scars at the nerve stumps were observed in the cases which repair was performed after 3 months. We suggest that the large gap should be avoided, so the timing of secondary repairment is better within 3 months after injuries.

Osteoarthrotic Changes Seen on X-ray Flms of Other Departmens (Part III)

Four roentogenographic changes with aging, osteoporosis, subchondral sclerosis, vertebral disc or joint narrowing and bony spur formation are observed in the acromioclavicular, sacroiliac, hip joint, cervical and lumbar spine.The total number of areas is 3514. In the cervical spine, vertebral disc narrowing and bony spur formation are observed most remarkably at the levels of C-5 and C-6, and in the sixth decades.Changes in the lumbar spine, especially osteoporosis and bony spur formation are clearly seen in the seventh decades and at the levels of L-3 and L-4, L-4 and L-5.Concerning bony spur formation, there is no particular difference between men and women but in the case of osteoporosis, there is a significant difference. In women osteoporosis is most developmental between the sixth and seventh decades, but in men it develops slowly and gradually from the fourth decades.The correlations between bony spur formation and vertebral disc narrowing, osteoporosis and suhchondral sclerosis are outstanding.

Complications after Durotomy-Report of Two Cases-

Complications after durotomy, liquorrhea and meningitis are possible. We had two cases of suspecting purulent meningitis after resection of the spinal cord tumors.The two patients with complications after durotomy, which was done for the removal of the intradural neurinoma of the cervical spinal cord in the first patient and for the removal of the extradural neurinoma of the lumbar spinal root in the second patient, were presented and discussed.Of the complications after durotomy, liquorrhea is the one to be most careful of.These patients recovered and returned to their daily activities.

Aging on X-ray film of bone

The authors have been tried to study aging changes on X-ray films which were collected randomly from some clinics except for the orthopaedic clinic in our university hospital. Four items, that is, spur formation, narrowing, subchondral sclerosis and osteoporosis, in each bone were checked always by two doctors of the authors and numerical expression, which was classified as follows, no changes; O, some changes; 1, and prominent changes; 2, of each item was summed up in each bone. In each decade, these summed-up numbers were divided by numbers of patients in each bone.Of these data, correlations between these numerical data and ages in lumbar spines were reported and discussed in this paper.Of total 1274 films on the acromio-clavicular joints, the sacro-iliac joints, the lumbar spines and the hip joints, 226 films of lumber spines were studied and analyzed. Prominent aging changes were detected in lower lumbar spines of both sexes after the fifth decade. On the other hand, osteoporotic changes were remarkable after the sixth decade of female.These methods studying for aging are concluded as useful maneuvers.