Takuya Goto

Emergency Operation for Spinal Diseases

There are few reports on the prognosis of emergency operations for spinal diseases. We investigated the prognosis of emergency operations. Twenty-nine out of 632 patients with spinal diseases, who were operated during the fifteen years between 1998 and 2003, were treated by emergency operations. These patients were followed up for an average of one and a half years. Operations were performed for the following diseases; nine lumbar disc herniations, four spinal epidural hematomas, three spinal tumors, three spinal fractures, two osteoporotic vertebral fractures, one cervical disc herniation, one lumbar canal stenosis, and five pyogenic spondylitis with sepsis. When operations were performed 24 hours from paralysis, the dysuria or sepsis occured. Nineteen patients showed paralysis, 13 of which improved. Lumbar disc degenerative diseases and spinal epidural hematomas tended to improved better than the spinal fractures. Fifteen patients showed dysuria, 9 of which improve. Four out of five pyogenic spondylitis improved, and the remaining one with secondary pyogenic spondylitis after posterior spinal fusion with instrumentation needed further closed suction irrigation. Emergency operation was effective for paralysis, dysuria, and severe inflammation. The indication should be considered depending on disease.

Examination of Emergency Orthopaedic Patients at a Major Regional Hospital

We report the realities of our emergency medical treatment, and define problems associated with being a regional hospital. The method of presentation, cause of injury, and the principal complaint were collected and examined. Targeted patients included 5, 992 in total examined mainly by the orthopaedics department. They accounted for 11.9% of 50, 273 patients cases who were sent to our hospital for emergencies.According to our data, 12% of 5, 992 patients required admission to hospital. This number comprises 65% of the total yearly orthopaedics inpatients. We also found 33% of the patients come from the suburbs of Kurume city, reflecting the role of the hospital works well as the major regional hospital.However these are times when the second or the third emergency patients are not treated adequately. This implies, the first (the most urgent) patients are treated urgently white less urgent patients are not treated as well. We suggest adjustment to our medical systems. In the near future we have to examine our hospitals function as well as the needs of the community.After doing this, we may have to adjust our medical care systems.

Results of Treatment for Fracture of Extremities and Trunk with Hemopneumothrax.

We report on the usefulness and safety of thoracodrainage for patients with traumatic hemopneumothorax who had fractures of the extremities and trunk. Traffic accident was the most common cause of hemopneumothorax. 20 in 47 patients (42.6%) had multiple bone fractures, and so orthopedic operations were conducted on 23 patients (48.9%). A thoracic drain was inserted for 42 patients (89.3%) including 1 patient who underwent thoracodrainage in both lungs. The outcome of all the patients was satisfactory.

A Case of Epiphyseal Separation of the Proximal Humerus in a New-born Infant with Difficulties for Diagnosis and Treatment

A case of epiphyseal separation of the proximal humerus was reported. The lesion occurred by a birth trauma at pelvic presentation. As the proximal humerus did not appear on X-ray, the diagnosis was established by clinical findings. The new-born was treated by skin traction at abduction of 70 degrees in an incubator, aligning the humeral shaft to the scapular glenoid with difficulties. On the 12th day, callus developed on the lateral aspect of the proximal humerus, and the skin traction was discontinued on the 15th day. The patient was discharged from the hospital without fixation of his arm on the 19th day.Remodelling of the callus was recognized in 2 months, and the humerus showed its normal shape on X-ray and no restriction of ROM of the shoulder was noticed in 6 months.