Takeshi Egi

Temporary scapho-trapezoidal joint fixation for Kienböck's disease in a 12-year-old girl : A case report

Temporary scapho-trapezoidal joint fixation with Kirschner wires was performed for stage IIIB Kienböcks disease in a 12-year-old girl. Preoperative evaluation with radiographs and magnetic resonance imaging confirmed the diagnosis. After 4 months of fixation, wrist range of motion was improved and pain was decreased. Postoperative magnetic resonance imaging revealed revascularization and fracture healing. Temporary scapho-trapezoidal fixation may be useful in the treatment of selected cases of Kienböcks disease in children.

Repair of long intercalated rib defects in dogs using recombinant human bone morphogenetic protein‐2 delivered by a synthetic polymer and beta‐tricalcium phosphate

Long intercalated defects in canine ribs can be repaired successfully using porous beta-tricalcium phosphate (beta-TCP) cylinders, infused with a biodegradable polymer (poly D,L-lactic acid-polyethylene block copolymer) containing recombinant human bone morphogenetic protein-2 (rhBMP-2). We previously reported the successful regeneration of bony rib and periosteum defects using beta-TCP cylinders containing 400 microg of rhBMP-2. To reduce the amount of rhBMP-2 and decrease the time required for defect repair, we utilized a biodegradable polymer carrier, in combination with rhBMP-2 and the porous beta-TCP cylinders. An 8 cm long section of rib bone was removed and replaced with an implant comprised of the porous beta-TCP cylinders and the polymer containing 80 microg of rhBMP-2. Six weeks after surgical placement of the beta-TCP cylinder/polymer/BMP-2 implants, new rib bone with an anatomical configuration and mechanical strength similar to the original bone was regenerated at the defect site. The stiffness of the regenerated ribs at 3, 6, and 12 weeks after implantation of the composite implant was significantly higher than that of ribs regenerated by implantation of rhBMP-2/beta-TCP implants. Thus, addition of the synthetic polymer to the drug delivery system for BMP potentiated the bone-regenerating ability of the implant and enabled the formation of mechanically competent rib bone. This new method appears to be applicable to the repair of intercalated long bone defects often encountered in clinical practice.

Regenerative repair of long intercalated rib defects using porous cylinders of beta-tricalcium phosphate: an experimental study in a canine model.

Background: In maxillofacial, spinal, and orthopedic surgery, bony ribs have been used as a source of donor bone. The resultant defects are not usually repaired, despite the pain or cosmetic morbidity experienced by the patient. The authors evaluated the efficacy of an osteoconductive &bgr;-tricalcium phosphate and the contribution of the periosteum in rib bone regeneration. Methods: Two 8-cm-long intercalated rib defects were generated in each of 30 beagle dogs. In the first group (n = 15), one defect was implanted with 16 small, short, porous &bgr;-tricalcium phosphate cylinders that were connected with a titanium wire, and the other defect was left untreated. In the remaining 15 dogs, the periosteum was devitalized by ethanol, and then the same surgical procedures were performed. Each group was subdivided into three groups (n = 5), and the animals were euthanized at 3, 6, and 12 weeks. Bone regeneration was assessed radiologically, histologically, and mechanically. Results: In the defect implanted with &bgr;-tricalcium phosphate on intact periosteum, newly formed bone was present on and in the &bgr;-tricalcium phosphate cylinders and bridged both ends of the resected ribs at 12 weeks, with replacement of &bgr;-tricalcium phosphate by new bone. Mechanical testing of these ribs revealed that they had 70 percent of the strength of normal ribs when compared in a bending stress test at 12 weeks after surgery. No regenerative bone bridging the rib defects was seen in the ethanol-devitalized or untreated groups. Conclusions: Porous &bgr;-tricalcium phosphate cylinders placed in tandem on the intact periosteum might be useful for the repair of rib bone donated at surgery, presenting a new and unique method for regenerating rib defects.

A comparative study of the modified Sauvé–Kapandji procedure for rheumatoid wrist with and without stabilization of the proximal ulnar stump

We compared the clinical and radiological results of the modified Sauvé–Kapandji procedure for 41 of 86 operated rheumatoid wrists with (n = 22) and without (n = 19) stabilization of the proximal ulnar stump with a slip of half the extensor carpi ulnaris tendon. Gender, age, and follow-up period were similar in the two groups. We found no difference clinically or on radiographs between the two groups other than better early postoperative pain relief in those stabilized. Stabilization of the proximal ulnar stump may not be necessary in the modified Sauvé–Kapandji procedure for rheumatoid wrists.

Clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture: Use of one-stage skin closure

Abstract Y-V or Z-plasties are a useful one-stage technique for skin closure after aponeurotomy. However, we know no details about postoperative improvement, particularly at each joint. The purpose of this study was to evaluate the clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytrens contracture. We retrospectively reviewed the postoperative results of 23 patients (25 hands, 29 fingers). The preoperative severity of the contracture evaluated by the Meyerding classification was grade I in 11 fingers, II in two fingers, and III in 16 fingers. In total, 26 metacarpophalangeal (MP) joints and 27 proximal interphalangeal (PIP) joints were treated. In each finger we assessed clinical outcomes according to the percentage improvement in extension and a modified version of Tubianas classification. Primary wound closure was possible in all cases. The mean contracture values were improved from 46.5° preoperatively to 4.2° postoperatively for the MP joint and from 43.9° to 22.4° for the PIP joint. The mean percentage improvement in extension for the MP joint was 92% and for the PIP joint 56%. The rate for the PIP joint of the little finger was 40% and for the other fingers 78%. In total, 83% of the fingers had satisfactory results. For Dupuytrens contracture, primary skin closure with Y-V and Z-plasties gives satisfactory results, more so with involvement of the MP than the PIP joint and less so with involvement of the little finger.

Modified Sauvé-Kapandji procedure for rheumatoid wrists: A long-term study with a minimum follow-up of 5 years

Abstract Objectives. We performed a modified Sauvé-Kapandji procedure for treating disorders of distal radioulnar joint in patients with rheumatoid arthritis (RA). This procedure involves resecting the distal part of the ulna, rotating the resected portion by 90° and fixating it with the distal part of the radius for shelf plasty. The purpose of this study was to examine the clinical and radiographic outcomes of this procedure with more than 5 years’ follow-up. Methods. We studied 32 wrists of 27 RA patients with the mean follow-up of 93.1 months after operation. Pain, grip strength and range of motion of the wrist were examined clinically, while two indices for evaluation of ulnar and palmar translation of the carpus, carpal translation index and palmar carpal subluxation ratio were calculated on radiographs. Results. The wrist pain reduced in all cases. Range of motion increased significantly regarding pronation and supination but decreased significantly regarding flexion. Change in grip power was not significant. No significant differences were recognized between radiographic indices, suggesting carpal alignment was maintained well throughout the follow-up period. Conclusions. We think this procedure could be applied for distal radioulnar joint disorders in RA patients with promising clinical as well as radiographic outcomes over a long period.

Outcome of the Sauvé–Kapandji procedure for distal radioulnar joint disorder with rheumatoid arthritis or osteoarthritis: Results of one-year follow-up

Abstract Objectives: We performed the Sauvé–Kapandji procedure for treating disorders of the distal radioulnar joint (DRUJ) in patients with rheumatoid arthritis (RA) or osteoarthritis (OA). This study aimed to compare and clarify the results of the SK procedure between RA and OA patients. We report the one-year follow-up results of patients who underwent the SK procedure to correct the DRUJ disorder caused by RA or OA. Methods: The study included 22 wrists of 19 patients with RA and 10 wrists of nine patients with OA. Pain, grip strength and range of motion of the wrist were examined clinically. For the evaluation of the stability of the carpus, ulnar stump and bone union, parameters were measured using radiographs. Shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) was used for functional evaluation. Results: Wrist pain reduced in all cases, and bone union was achieved in all wrists. The QuickDASH score significantly improved in both patients with RA and OA. In patients with RA, the range of motion increased significantly with regard to supination but decreased significantly with regard to palmar flexion. Carpal alignment and ulnar stump stability were maintained well at one-year follow-up. Conclusion: The Sauvé–Kapandji procedure for treating disorders of the distal radioulnar joint DRUJ showed good results clinically and radiographically, irrespective of RA or OA.