Takanobu Matsunaga

The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand

The authors have developed a new skeletal traction system for comminuted intraarticular fractures and fracture-dislocations in the hand. The system consists of two or three Kirschner wires and rubber bands, and is easy to assemble. It is more compact and comfortable than the banjo splint, and equally effective, and it allows early motion of the affected digits. A description of the technique is followed by the clinical results of seven cases of severe articular injuries in the hand. At the time of follow-up, the average range of the affected PIP joint motion was about 80° The final active motion of the injured DIP joint ranged from 0 to 40° in flexion and that of the affected thumb (trapezia1 fracture) was not limited. The average follow-up period was 13.1 months.

Arthroscopic restoration of depressed tibial plateau fractures using bone and hydroxyapatite grafts

Depressed tibial plateau fractures in 13 patients were treated under arthroscopic control. In 3 patients, bone autograft was used; in the remaining 10, hydroxyapatite (HAP) grafts were used. The depression of the articular surface was managed by elevation of the subchondral plate through a small window. Assisted by fluoroscopy, we corrected and performed the grafting under arthroscopic control. Follow-up periods averaged 5 years 6 months for the autograft and 18 months for the HAP grafts. At the conclusion of the follow-up period, x-ray radiographs and computed tomography (CT) scan showed no evidence of arthrosis and knee motion was normal. There were no significant differences between the two groups. The interporous spaces showed new bone formation on closed biopsy 6 months postoperatively.

Use of arthroscopy and interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures

Tibial plateau fractures in 17 patients were managed arthroscopically, using interporous hydroxypatite (HA) as a bone graft substitute. Soft-tissue repair and intra-articular lavages were carried out arthroscopically, and depression of the articular surface was done by elevation of the subchondral plate by the bone compactor through a small window under image intensification and filling with HA through the tibial outer rim. Follow-up periods averaged 2 years and 6 months. According to roentgenograms and computed tomograms no development of arthrosis could be found. All of the patients have been followed to fracture union and have returned to their previous activity levels.

Treatment of osteomyelitis by antibiotic impregnated porous hydroxyapatite block

A novel drug delivery system was developed for osteomyelitis using porous hydroxyapatite blocks (HA-b) that were impregnated with antibiotics by a centrifuge method. For the experimental study, a 10 mm3 HA-b was placed in a container, mixed with an antibiotic solution and centrifuged at 1500 rpm for 15 min for the purpose of impregnating antibiotics into the pores. The slow release activity of antibiotic (Arbekacin sulfate [1-N-(S)-4 amino-2-hydroxybutyryl dibekacin]) from the HA-b was tested. An evaluation was made of the slow-releasing capabilities of the ABK from HA-b which was still maintained at 0.5 microgram/ml within 21 exchanges of PBS after 42 days. Consequently, seven patients with osteomyelitis, including one with tuberculosis and two with infected hip arthroplasty, have been treated. On a follow-up study, all of the foci had completely healed by the end of the follow-up period without complications. This new method is simple and can be performed safety as a one-stage operation.

Carpal tunnel syndrome caused by aberrant lumbrical muscles associated with cystic degeneration of the tenosynovium: A case report

A 7-year-old boy who suffered from carpal tunnel syndrome caused by aberrant lumbrical muscles associated with cystic degeneration of the tenosynovium of the left hand is described. Judging from the literature studied, this seems to have a very rare origin. Symptoms subsided, and no recurrence has been noticed after operative removal of these structures.

Ankle arthroplasty by excision of the talar body: subtotal talectomy.

We carried out the ankle arthroplasty by excision of the talar body (subtotal talectomy) on 10 ankles of nine patients with talar body tumor, paralytic talipes equinovarus, talipes varus due to spinal injury, or comminuted fracture of the talar body. Talar body excision was initiated by lateral incision and subsequent osteotomy of the fibula. The fibula was everted, leaving the lateral ligament (calcaneofibular ligament) intact. After the talus was exposed, the talar body was excised, leaving about 1.5 cm of head unresected. Subsequently, the fibula was shortened slightly, and the tibia was pulled down to the level of the calcaneus to form a joint, instead of arthrodesis being performed. After surgery, the joint formed by the tibia and calcaneus was mobile in seven of the 10 feet and immobile (arthrodesis) in the remaining three feet. The average follow-up period was 6 years. Although postoperative x-ray revealed slight osteoarthritic changes of Choparts joint and the tibiocalcaneal joint, none of the patients showed ankle pain that impaired activities of daily living. Subtotal talectomy allows correction of talipes equinus without Achilles tendon lengthening.

A study of the arterial supply of the human acetabulum using a corrosion casting method.

This anatomical study concerns the arterial supply of the human acetabulum. The purpose is to contribute to prevention of postoperative necrosis of the acetabular bone fragment after rotational acetabular osteotomy (RAO). The arterial supply of the acetabulum was determined using a corrosion casting method. The acetabular branch of the obturator artery supplies the acetabulum through the acetabular notch. The pubic branches supply the pelvic surface of the acetabulum. Deep branches of the superior gluteal artery supply the superior region and the inferior gluteal artery supplies the postero‐inferior region. From these results, we recognized that the important artery for achieving successful RAO is the acetabular branch of the obturator artery that supplies the acetabulum through the acetabular notch. Clin. Anat. 10:77–81, 1997

Silver-stained nucleolar organizer proteins in chondrosarcoma

SummarySilver-stained nucleolar proteins (AgNORs) were counted in primary chondrosarcomas of three histologic grades and in metastatic chondrosarcomatous lesions in the lung. The AgNOR numbers of neoplastic cells in primary tumors increased stepwise from grade 1 (4.42+1.11) through grade 2 (4.94+1.31) to grade 3 (6.97 + 1.10). There was a significant difference in AgNOR numbers between grade 3 and both grades 1 and 2 (p< 0.001). Furthermore, the mean number of AgNORs in metastatic lesions (9.75 ±0.83) was significantly higher than that in primary sites (p< 0.001). The number of AgNORs therefore reflects the grade of the chondrosarcoma. The results in the present study indicate that silver colloid staining is a useful technique for determining the histologic grade and evaluating the proliferative activity of chondrosarcomas.

HLA-DR, DRw52.53, and DQ homozygosity in patients with neural tube defects

SummaryStudies of the possible relationship between malformations of the neuraxis and the human major histocompatibility complex have been contributive to the search for a human equivalent of the murine T/t complex. We conducted a population and family study in 34 Japanese couples together with their children with neural tube defects. HLA-DR homozygosity among the affected children was significantly increased as compared with that in controls. HLA-DR and DQ maternal-paternal sharing was also significantly higher than the controls. Significantly higher frequencies of A11 (father), B35 (mother) and A11 (affected children) were observed. These data support the hypothesis that a T/t-like complex in or near the HLA complex might be etiologically related to neural tube defects.

Congenital Deformities of the Carposcaphoid and Styloid Processes of the Radius in Mother and Son

Congenital dysplasia of the radiocarpal and talocrural joints is extremely rare except in certain severe congenital disorders. We report on 2 cases of a congenital deformity involving a hyperplastic carpal scaphoid and a hypoplastic styloid process of the radius resulting in limitation of wrist extension in both wrists in a female and her son. The son also had an abnormal accessory bone on the distal end of the medial malleolus in both ankles. This is the first case report of such deformities in these anatomical regions.