Tatsuhiko Henmi

Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results.

The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60–88 years) and the mean follow-up period was 24 months (range, 12–53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were ‘excellent’ in 64% of fractures and ‘good’ in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7°, ulnar variance was 4.0 mm, and palmar tilt was −2.7° respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the nondominant hand injured.

Surgical treatment of lumbar disc herniation in elderly patients

Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%). The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.

Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture.

This report reviews a case of radial nerve palsy associated with a supracondylar fracture of the right humerus. The patient was a four-year-old boy. Radiographs of the injury showed simple extension and a slightly angulated fracture. Complete radial nerve palsy was observed at the first consultation. After three months of conservative treatment without any obvious improvement, an operative exploration of the right radial nerve was conducted. Intraoperatively, the nerve was found to be transected, with both ends of the ruptured nerve buried in scar tissue at the fracture site. Five months after the nerve suture operation, the palsy was cured completely. This case shows that even a minimal displacement fracture can be associated with severe nerve injury that requires surgical treatment.

Foramen magnum schwannoma with an unusual clinical presentation: case report

This case report illustrates a patient with a unilateral localized epidural schwannoma at C1 – 2 level, showing contralateral spinal cord symptoms and signs. The clinical presentation was compared with the neuroradiological examinations showing an epidural cord tumor at the right C1 – C2 level. However, the neurological examination revealed contralateral hemiparesis and ipsilateral hemihypoalgesia, indicating a contralateral Brown – Sequard syndrome. We presumed with this slow growing tumor, contralateral cord involvement may result from counter pressure on the spinal cord, which may be generated by cord deviation and by frequent neck rotation.

Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report.

Study design:A case report and a review of literature.Objectives:To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst.Setting:General Orthopedics, Japan.Methods:A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion.Results:The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst.Conclusions:Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Morphometric Changes of the Lumbar Intervertebral Foramen after Percutaneous Endoscopic Foraminoplasty under Local Anesthesia

Background Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal. Methods In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery‐related complications were reviewed. Results There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4‐L5, one case at L3‐L4, and one case at L5‐S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm2 before surgery to 88.4 mm2 after surgery (p < 0.05 by paired t test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ˜ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED. Conclusion Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.

Salmonella osteomyelitis of the distal radius in a healthy young adult patient: Report of a rare case and literature review

Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.

Clinical evaluation of aged patients who underwent surgery for femoral neck fractures — Comparative study of clinical results according to age

The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80–84 years old), group B (85–89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.

Magnetic resonance imaging and diffusion-weighted imaging findings in posterior spinal cord infarction: Case report

Acute spinal cord ischemia (SCI) accounts for 5%e8% of all acute myelopathies [1]. In the SCI, posterior spinal artery (PSA) syndrome is much less common than in anterior spinal artery (ASA) syndrome [2], with PSA accounting for 3% of all acute SCIs and ASA syndrome accounting for 67% [3]. In 1994, Kaneki et al. provided a case report review of 27 cases of PSA syndrome in the literature [2]. Essentially, all 27 cases were diagnosed from neurological findings and the exclusion of other pathological conditions by neuroimaging. Even MRI cannot easily detect acute ischemic lesions in PSA syndrome due to their small size and changes in the signal that occur over the disease course. Diffusion-weighted imaging (DWI) is a well-established diagnostic method for acute cerebral ischemic injury [4] and is a potential tool for the detection of SCI. Among cases of SCI detected by DWI, ASA infarction was more involved than PSA infarction [5e7]. On the other hand, the proportion of PSA infarction among cases of SCI detected by DWI may be high than that among cases diagnosed by clinical sign, although there are only three reports on PSA infarction detected by DWI [5,8,9]. Here, we report clinical and imaging findings in a case of PSA infarction, including time-dependent changes of the apparent diffusion coefficient (ADC) abnormality, and propose that time